The Clinical Application Of Intraoperative Real-Time Ultrasonic Elastography In Intracranial Space Occupying Lesions

Objective To investigate the relationship between the ultrasonicelastosonography characteristics of different intracranial space occupying lesionswith pathologic features. To evaluate the clinical value of intraoperative real-timeultrasonic elastosonography in the diagnosis of benign and malignant glioma.Method Ninty-five patients who were diagnosed as intracranial spaceoccupying lesions by CT or MRI were examined by Hitachi HI VISION Preiruscolor doppler ultrasound diagnostic instrument. We used the high frequencyprobes that O54J (frequency7MHz~13MHz) and C532(frequency4MHz~9MHz) in the operation. The probe was insulated by sterile gum and gel,and placed lightly on the dura or direct contact with the surface of the brainthrough open craniotomy during the operation. We observed the location, size,shape, imaging characters and measured table distance from the brain. Then weopen elastography, elasticity imaging region of interest adjusted to the appropriate size, generally1-3times the size of the lesion, the probe subtlevibrated on lesion surface to ultrasound diagnostic instrument screen displayedthe pressure and pressure release frequency comprehensive index to reach2-3advisable. We simultaneouly observed the tumor size, location, elastosonographycharacteristics and measured strain rate values..Results (1) Lesions were indentified and located with100%accuracy byintraoperative ultrasonography, especially for a small or deep-located lesion canprovide accurate advice for the neurosurgeon.(2) The ultrasonic elastographicappearance of the tumor differed from the pathology character, there are40casesof low-grade gliomas, part of which are expressed even green signal;36cases ofhigh-grade gliomas whose elastography is mainly blue;10cases of cavernoushemangioma, whose elastography are reticulate cyan signal;3cases ofmeningiomas, whose elastography wink alternately with blue and green signal；2cases of pituitary tumor, whose elastography mostly display in green；1cases ofintracranial parasites, whose elastography mostly display in blue；1cases ofMelanom, whose elastography mostly display five-color alternate with colorsignal.(3) The diagnosis of benign and malignant glioma to use the ultrasonicelastosonography score that the accuracy rate was87.5%, the sensitivity was89.4%and specificity was84.6%.(4) We constructed the ROC curves todetermine the elastic strain rate ratiocritical value for the diagnosis benign andmalignant glioma was4.015, thus accuracy was96.9%, sensitivity was94.7%and specificity was92.8%.Conclusions (1) The ultrasonic elastosonography characteristics ofdifferent intracranial space occupying lesions consistent with pathologic features.Ultrasonic elastosonography could reflect the hardness of the lesion, show theborder of the lesion and surrounding normal tissue more clearly.(2) Using real-time ultrasonic elastography technique in intracranial space occupying lesionsurgery, help neurosurgeon to preliminary judge the nature of tumor beforesurgery, to improve the efficiency of surgical resection, to further reducepostoperative complications and recurrence rates have a certain guidingsignificance.(3) It is a new means for preoperative diagnosis glioma that the useof ultrasonic elastosonography score and the elastic strain rate ratio to identifybenign and malignant gliomas.