Prada Francesco, Perin Alessandro, Martegani Alberto, Aiani Luca, Solbiati Luigi, Lamperti Massimo, Casali Cecilia, Legnani Federico, Mattei Luca, Saladino Andrea, Saini Marco, DiMeco Francesco
*Department of Neurosurgery, and ¶ICU, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy; ‡Department of Radiology, Ospedale Valduce, Como, Italy; §Department of Radiology, Ospedale di Circolo, Busto Arsizio, Italy; ‖Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, Maryland.
Neurosurgery. 2014 May;74(5):542-52; discussion 552. doi: 10.1227/NEU.0000000000000301.
Contrast-enhanced ultrasound (CEUS) is a dynamic and continuous modality that offers a real-time, direct view of vascularization patterns and tissue resistance for many organs. Thanks to newer ultrasound contrast agents, CEUS has become a well-established, live-imaging technique in many contexts, but it has never been used extensively for brain imaging. The use of intraoperative CEUS (iCEUS) imaging in neurosurgery is limited.
To provide the first dynamic and continuous iCEUS evaluation of a variety of brain lesions.
We evaluated 71 patients undergoing iCEUS imaging in an off-label setting while being operated on for different brain lesions; iCEUS imaging was obtained before resecting each lesion, after intravenous injection of ultrasound contrast agent. A semiquantitative, offline interobserver analysis was performed to visualize each brain lesion and to characterize its perfusion features, correlated with histopathology.
In all cases, the brain lesion was visualized intraoperatively with iCEUS. The afferent and efferent blood vessels were identified, allowing evaluation of the time and features of the arterial and venous phases and facilitating the surgical strategy. iCEUS also proved to be useful in highlighting the lesion compared with standard B-mode imaging and showing its perfusion patterns. No adverse effects were observed.
Our study is the first large-scale implementation of iCEUS in neurosurgery as a dynamic and continuous real-time imaging tool for brain surgery and provides the first iCEUS characterization of different brain neoplasms. The ability of CEUS to highlight and characterize brain tumor will possibly provide the neurosurgeon with important information anytime during a surgical procedure.
超声造影（CEUS）是一种动态且连续的检查方式，能实时、直接地观察多个器官的血管化模式和组织阻力。得益于新型超声造影剂，CEUS在许多情况下已成为一种成熟的实时成像技术，但从未广泛应用于脑成像。术中超声造影（iCEUS）成像在神经外科手术中的应用有限。
首次对多种脑病变进行动态、连续的iCEUS评估。
我们对71例在非适应证情况下接受iCEUS成像的患者进行了评估，这些患者因不同脑病变接受手术；在静脉注射超声造影剂后，于切除每个病变前获取iCEUS图像。进行了半定量的离线观察者间分析，以观察每个脑病变并描述其灌注特征，并与组织病理学相关联。
在所有病例中，术中通过iCEUS均能观察到脑病变。识别出了传入和传出血管，从而能够评估动脉期和静脉期的时间及特征，并有助于制定手术策略。与标准B模式成像相比，iCEUS在突出病变及其灌注模式方面也被证明是有用的。未观察到不良反应。
我们的研究是神经外科中首次大规模应用iCEUS作为脑外科手术的动态、连续实时成像工具，并首次对不同脑肿瘤进行了iCEUS特征描述。CEUS突出和描述脑肿瘤的能力可能会在手术过程中的任何时候为神经外科医生提供重要信息。
