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Study On Intraoperative Ultrasonography In Resection Of Cerebral Gliomas And The Relationship Between Contrast-enhanced Ultrasound And Microvessel Density

Posted on:2010-09-11Degree:DoctorType:Dissertation
Country:ChinaCandidate:J WangFull Text:PDF
GTID:1114360275973005Subject:Medical imaging and nuclear medicine
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Objective To observe the scope of the lesion and the relationship with thesurrounding structures,real-time monitoring of resection by using intraoperativeultrasonography and contrast-enhanced ultrasound in patients with cerebral glioma to locatethe lesion;to analyze quantitatively the correlation between the contrast-enhancedultrasound parameters and tumor microvessel density (MVD) of different pathologic gradesof cerebral gliomas,and to follow-up patients regularly postoperative survival time.Theapplication value of intraoperative ultrasonography and contrast-enhanced ultrasound in realtimeguidance and pathological grade analysis was investigated.Methods (1) 113 patients who were doubted cerebral gliomas by computedtomography (CT) or magnetic resonance (MR) were involved in the study.The ultrasonicprobe was sterilized and placed lightly on the surface of the brain during the operation.Thelocation,extent,characteristics and adjacent tissue of the lesion were observed.Residuals oftumor or hematoma were identified before the operation ending.Combination of pathologicaldiagnosis compared with ultrasound echo characteristic of different pathologic grades ofcerebral gliomas after operation.(2) 33 cases were examined by contrast-enhancedultrasound after the lower segment of great saphenous vein injection of 2.4ml SonoVue,realtimeobservation of tumor blood perfusion and enhance characteristics.The results were recorded and compared with baseline ultrasound.Imaging is completed,start the acousticanalysis software,according to lesion size determine the sense of interest areas,automaticallydraw the time-intensity curves,analysis of curve patterns.The microvessels were counted byimmunostaining with anti-CD34,and the differences of these parameters in cerebral gliomaswere compared and the correlation between contrast-enhanced ultrasound time of maximum(Tmax) and tumor MVD was analyzed.(3) The patients of cerebral gliomas who hadundergone intraoperative ultrasound-guided were regularly followed-up postoperativesurvival time using the telephone or out-patient or in hospital way,following-up time 3months to 50 months.In addition,randomly selected 30 patients of high grade cerebralgliomas that without intraoperative ultrasound-guided,follow-up their survival time andstatistical analysis the differences in the survival time.Results (1) Lesions were indentified and located with 100% accuracy byintraoperative ultrasonography,enable the neurosurgeon to procure appropriate treatmentadvice.Total removal of the lesion was achieved in 80 cases (71%) and subtotal removal in33 cases (29%).All lesions showed hyperecho compared with normal brain tissue,differentpathologic grades of cerebral gliomas present different ultrasonic appearances.(2) Aftercontrast-enhanced ultrasound,the tumor tissue echo significantly increased,the bordershowed more clear,can real-time display of the tumor location,blood vessels and bloodperfusion characteristics,the lesions in blood classification have statistic significance(P<0.05)before and after contrast-enhanced ultrasound.The mean of Tmax in the low and high gradecerebral gliomas was (40.9±6.2) s and (29.8±7.5) s,The mean of MVD in the group of thelow and high grade cerebral gliomas was 46.1±5.5 and 63.5±6.6,Tmax with differentiationswas found to have statistic significance,and the MVD in the low and high grade cerebralgliomas was statistically significant.Tmax was negative correlation with MVD (r=-0.79P<0.05 ).(3) 92 cases of patients in 113 cases with complete follow-up data,follow-up ratewas 81.4 percent,following-up time 3 months to 50 months.Total removal of the lesion was63 cases(69%) and subtotal removal in 29 cases(31%).49 cases appear partial recurrence,recurrence rate 53.3%,45 patients death due to tumor recurrence.Patients with total tumorresection experienced a longer survival time than those patients who had subtotal resection.Survival rate in patients with low grade gliomas was significantly higher than that in patientswith high grade glioma.28 patients died in 30 cases of control group in follow-up process, the survival time of 3~24 months,The postoperative 6 months,1 year and 2 year survivalrates for these patients were 83.3%,43.3% and 13.3%;and research group after 6 months,1year and 2 year survival rates of 94.0%,62.0% and 38.0%,1 year and 2 year survival rateshave statistic significance(P<0.05).Conclusion (1) Intraoperative ultrasonography can be helpful to the reliable andaccurate location of the lesions,real-time monitoring of resection and residuals detection oftumor or hematoma.Therefore it can be used to protect neurological function and reducecomplications in cerebral gliomas operation.The intraoperative ultrasonic imaging correlatedto pathologic grades of cerebral gliomas,so intraoperative ultrasonography is valuable ingrading cerebral gliomas.(2) Intraoperative contrast-enhanced ultrasound can enhance theimaging of cerebral gliomas significantly and make the border display more clearly.Thistechniche can accurately show the tumor position,determine the extent of surgical resection,and observe microvascular perfusion in real-time.According to Tmax and MVD negativecorrelation,contrast-enhanced ultrasound parameters can indirectly reflect the information ofMVD in cerebral gliomas,which is help to grade cerebral gliomas,guide surgical resectionand postoperative treatment.(3) Cerebral gliomas operation with intraoperativeultrasonography guidance is helpful for operator to understand the relationship between thelesion and essential surrounding structure,increase the safety of surgery and reduce theresidual tumor.It is of great value in improving total resection rate of the tumor and thesurvival time of patients.
Keywords/Search Tags:Intraoperative ultrasonography, Contrast-enhanced ultrasound, Cerebral glioma, Microvessel density, Survival time
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