The Value Of Intraoperative Ultrasound And Contrast-Enhanced Ultrasound In Glioma Surgery

Objective: To explore the value of intraoperative ultrasound(IOUS) andcontrast-enhanced ultrasound(CEUS)in glioma surgery.Materials and Methods: In2011October-2012October in general hospital of NingxiaMedical University Department of Neurosurgery diagnosis for62patients of brainglioma,were confirmed by pathology after operation,grading standard reference WHO2000central nervous system tumors,28cases of low grade gliomas,34cases of high-gradegliomas,aged7to70years old,mean age(44.76±13.46)years old.Instrument and Equipment: Intraoperative detction using Aloka prosound10colordoppler ultrasonic diagnostic apparatus,with an imaging technique of contrast pulsesequence(CPS),intraoperative ultrasound probe for UST9133,the frequency of3-6MHz.Contrast-enhanced ultrasond:using Bracco company’s SonoVue(injection with sixsulfur fluoride powder59mg/branch).Methods:(1) Understanding the patient history before operation,check the CT,MRIimage date of a preliminary understanding of masses.(2) The ultrasound probe preparation,thesurgeon craniotomy during intraoperative ultrasound probe coated with coupling agenttogether with a wire sleeve aseptic laparoscopic sleeve is fixed on the operation tablebackup.(3) Ultrasound operation:1) Before tumor resection: Removal of bone flap afteroperation,probe by the physician will be ready with a small amount of normal saline ascoupling agent into the epidural or placed directly in the dural surface ultrasound,ultrasounddoctors on-site guidance and regulation of ultrasonic instrument makes clear imagedisplay,associated operation of interest,target image.By multislice scanning,observed lesions size,shape,boundary,internal echo,blood flow distribution,peripheral edema zone and adjacentrelation,measure the distance of the brain surface depth,then starting the contrast-enhancedultrasound,using Bracco’s SonoVue(the main component of six sulfur fluoride,59mg drypowder with5ml saline injection configured to six of sulfur hexafluoride microbubblessuspension,via the great saphenous vein to bolus injection2.4ml,contrast condition of MI0.09-0.18,the real-time observation of the tumor and peritumoral blood flow perfusion andenhanced features,once again clear border of tumor,measuring the size of tumors,the accuratelocalization of tumor,avoid the important blood vessels and functional areas,to provide thebest operation approach for patients.2) After tumor resection.Tumor residualjudgment:Resection of the lesion after thorough hemostasis and remove the residual cavityhemostatic materials,irrigation with saline residual cavity of2-3times after the instillation ofsaline,the ultrasonic probe is placed in the physiological saline of aneurysm and surroundingbrain surface to scan,observation of residual cavity irregular echogenic mass or ring strongecho determine residual tumor,measuring the residual range again,contrast-enhancedultrasound,tumor residual and measuring range.Such as ultrasound examination no residue,therandom sampling of3sent to pathology,if ultrasonic determine resection of residual linefurther operation and residue were sent for pathological examination.All patients withpathological diagnosis as the standard,a retrospective analysis of different pathological gradesof glioma in ultrasound images,blood flow distribution,contrast enhancdecharacteristics,summarized ultrasound and contrast-enhanced ultrasound intraoperativeresidual application value judgment of tumor.Experiment1:62cases of glioma patients were checked by two-dimensional ultrasoundand color doppler flow imaging,observing the tumor echo and blood flow distribution,clearingtumor range,measuring the tumor size and the deph of the tumor from the brainsurface,providing the best surgical approach that can avoid important vascular and functionalareas,judging the residue of the tumor after operation. Experiment2:44cases of glioma patients in the intraoperative ultrasound contrastobserved the size,boundary and angiographic lesion enhancement characteristics.Located thetumor accurately,judged the peritumoral edema zone by the different enhancement aroundthe tumor.Experiment3:31cases of cerebral gliomas were examined by conventional ultrasoundand contrast-enhanced ultrasound before and after the removal of the tumor, observing thetumor residual cavity and comparing with the preoperative tumor echo and imagingcharacteristics to judge the residual tumor after operation.Results:Experiment1: Intraoperative ultrasound can accurately locate tumors by100%andcorrect the deviation of the neural navigation. For glioma residual judgment, the positivepredictive value was71.42%,the quantity of high and low grade gliomas blood flow havestatistical difference (Z=3.060, p=0.002).Experiment2: In44cases of gliomas grade Ⅰin3cases,18cases in grade II,16casesin grade III,7cases in grade Ⅳ, contrast enhanced ultrasound can accurately locate tumors,defined tumor border and judge peritumoral edema further more, observe the tumorenhancement mode in real time, the difference of enhancement of time to peak and clearancetime was statistically significant between high and low grade gliomas(p<0.05).Experiment3: In31cases of cerebral gliomas, the tumor resection rates of routineoperation and contrast-enhanced ultrasound guided operation were respectively45.16%and74.19%(χ2=5.429, p<0.05). The sensitivity of judging residual tumor by contrast-enhancedultrasound is85.71%, and the specificity is90.32%, however, the sensitivity of conventionalultrasound is61.91%and specificity is83.87%.Conclusion: Intraoperative ultrasound and contrast enhanced ultrasound has excellentclinical application value in glioma surgery.