Applications Of Intraoperative Conventional Ultrasonography And Contrast-enhanced Ultrasonography In The Diagnosis Of Glioma Grades

ObjectiveTo evaluate conventional intraoperative ultrasonograply in localization diagnosis and the qualitative diagnosis of grading cerebral glioma and explore the clinical applications of combinated intraoperative ultrasonograpy and contrast-enhanced ultrasonography (CEUS) exminations in real-time guidance and pathological grade analysis.MethodsCases selection:A total of64patients who were doubted cerebral gliomas by computed tomography(CT) or magneticresonance(MR) test in our hospital from February2006to June2011were involved in this study.31cases of them were also provided CEUS examination. The subjects signed informed consent before examinations.Inspection equipment and contrast agents:Acuson Sequoia512ultrasound diagnostic apparatus with contrast pulse sequence imaging techniques (contrast The pulse sequencing CPS), conventional ultrasound probes is4C1(5-10Mhz) and9L4(frequency2-5Mhz), the CEUS use probe4C1, the center frequency is1.5MHz; angiography mechanical index is between0.18to0.21was used in this study. The ultrasound contrast agents "SonoVue" purchased from a commercial company named Bracco (Italian) were mixed with5ml of physiological saline before exmination. Research methods:Probe was injected a little of physiological saline and then wrapped in a laparoscopic sleeve to keep sterile after removal of the craniectormy,placed the probe lightly on the surface of brain during the operation with coronal, sagittal and horizontal slice multislice scanning. Ultrasound in the preoperative can complete display the characteristics of the tumor lesions and the relationship with the surrounding tissue and blood vessels, Intraoperative ultrasoundcan monitoring of lesion resection in the operative, residuals of tumor or hematoma were identified before the operation ending. When did SEUS exmination, firstly injected1.5-2. Oml SonoVue by jugular vein injection, and then rinsed5ml physiological saline to elminate the agents. While imaging was completed, started the acoustic analysis software and analyzed the levels of lension, according to the pathological diagnosis and the characteristics of the ultrasound image.Experiment I:64cases of glioma patients by preoperative diagnosis, recorded the lesion location, size, internal echo, boundary, shape, and its relations with the surrounding tissue, blood supply of internal and external by intraoperative conventional ultrasonography exmination. The data was stored in the hard drive. Comparative analyzed of the sonographic features of different pathological grades of glioma patients after the completion of surgery.Experiment II:31cases of above glioma patients were also provided gray-scale ultrasound imaging exmination and the data was also stored in the hard drive. Accessed the characteristics of CEUS exmiantion, included maximum intensity (IMAX), time to peak (TTP), rising time (RT), and mean transit time (mTT) by Sonolive CPA offline analysis software (TomTec company). Then, comparative analyzed the characteristics between hight and low-grade gliomas with pathological diagnosis.ResultsLesions were indentified hight-grade33cases and low-grade31cases in the64cases of glioma patients by intraoperative ultrasonograpy. The located proporation of the lensions in the whole patients was100%. The areas of gliomas showed hyperecho or slightly hyperecho, compared with the normal brain tissue or the surrounding edemas in the ultrasonograpy images.There were different ultrasonic appearances in ize, internal echo, boundary, shape, and its relations with the surrounding tissue, blood supply of internal and external between high and low grade gliomas.Experiment II:15high and16low grade of31CEUS exmiantion patients were confirmed by pathological diagnosis. The CEUS results showed increased tumor tissue echo, clear boundaries, accurate lension size, real-time display of the tumor location. There were significant differences of IMAX and TTP between high-and low-grade gliomas, but no significant differences of RT and mTT (P>0.05).Conclusion1、Intraoperative ultrasonography locate the gliomas accuratly and reliably, which can guide the surgeon to correct lesions drift after the skull and select the best surgical approach based on preoperative MRI data. Ultrasound navigation can helps the surgeon to achieve maximum removal of the tumor but preserve the neurological function according to the relationship between the structure of lesion surrounding and the blood vessels. This enhance the tumor totally be removed and the surgical safety.2、The sonographic features of different grades of glioma can help the surgeon to choose the best pathological materials, which improve the accuracy of the pathological examination. The integrated image data and pathological diagnosis results provideds a complete understanding to intraoperative condition of glioma. It helps the neurosurgeon to determine surgical resection, intraoperative removal of the program of choice.3、Intraoperative CEUS makes the glioma tumor tissue echo enhanced. This provides clear tumor boundaries so that the neurosurgeon can remove the glioma accurately, and also helps to observate tumor microvascular perfusion and evaluate of the grade of glioma by quantitative detection of the CEUS characterictics, accurate to the application of ultrasoundaspects determine the pathological grade of glioma. CEUS has great potential to provide valuable information for the diagnosis of glioma grade.