Renner C, Lindner D, Schneider J P, Meixensberger J
Department of Neurosurgery, University of Leipzig, Leipzig, Germany.
Neurol Res. 2005 Jun;27(4):351-7. doi: 10.1179/016164105X40039.
The purpose of our study was to evaluate intra-operative ultrasound (IOUS) as a tool of resection control after brain tumor surgery. In addition, we looked for tumor species suitable for ultrasound representation.
Using a Siemens Omnia Sonoline Ultrasound, 36 tumors were examined, high-grade gliomas (62%), metastases (22%) and others (16%). We focused on tumor imaging by ultrasound with regard to its reliability of tumor expansion and margins. Evaluation of the images was carried out by correlating the ultrasound-based intra-operative measured tumor volume before and after resection with a pre- and post-operative (within 48 hours) measured volume by MRI. The IOUS measurements were performed by the neurosurgeon and the MRI measurements by the neuroradiologist. Thus, the measurement procedures were blinded. Corresponding to a deviation of the ultrasound volume by 10, 20 and > 20% from the MRI volume, the correlation was ranked good, moderate and poor. For assessing the agreement between these two methods of imaging, the statistical analysis was conducted using a method described by Bland and Altman.
High-grade gliomas mostly showed a moderate or poor correlation in comparing IOUS- and MRI-tumor volumetry resulting in incomplete resection. Metastases resulted in a good to moderate correlation with a satisfactory extent of resection. The other tumors had poor images with larger tumor residues. The MRI measured volumes tended to be larger on average; the deviation grew with tumor size .
The reliability of IOUS depends on tumor type. It is beneficial to use IOUS for the resection of metastases and a few high-grade gliomas. Concerning the volumetric accuracy, the value of IOUS is worse than its value of navigation and resection control.
本研究旨在评估术中超声（IOUS）作为脑肿瘤手术后切除控制工具的效果。此外，我们还寻找适合超声显示的肿瘤类型。
使用西门子Omnia Sonoline超声仪对36例肿瘤进行检查，其中高级别胶质瘤占62%，转移瘤占22%，其他肿瘤占16%。我们重点关注超声对肿瘤的成像，包括肿瘤扩展和边界的可靠性。通过将术中超声测量的切除前后肿瘤体积与术前和术后（48小时内）MRI测量的体积进行关联，对图像进行评估。IOUS测量由神经外科医生进行，MRI测量由神经放射科医生进行。因此，测量过程是盲法的。根据超声体积与MRI体积相差10%、20%和>20%，相关性分别评为良好、中等和较差。为了评估这两种成像方法之间的一致性，使用Bland和Altman描述的方法进行统计分析。
在比较IOUS和MRI肿瘤体积测量时，高级别胶质瘤大多显示中等或较差的相关性，导致切除不完全。转移瘤的相关性良好至中等，切除范围令人满意。其他肿瘤的图像较差，有较大的肿瘤残留。MRI测量的体积平均倾向于更大；偏差随肿瘤大小增加。
IOUS的可靠性取决于肿瘤类型。使用IOUS切除转移瘤和一些高级别胶质瘤是有益的。关于体积准确性，IOUS的价值低于其导航和切除控制的价值。
