Coburger Jan, Scheuerle Angelika, Thal Dietmar Rudolf, Engelke Jens, Hlavac Michal, Wirtz Christian R, König Ralph
Department of Neurosurgery, University of Ulm, Ludwig Heilmeyerstr. 2, 89312, Günzburg, Germany,
Acta Neurochir (Wien). 2015 Feb;157(2):195-206. doi: 10.1007/s00701-014-2314-3. Epub 2015 Jan 6.
INTRODUCTION: In low-grade glioma (LGG) surgery, intraoperative differentiation between tumor and most likely tumor-free brain tissue can be challenging. Intraoperative ultrasound can facilitate tumor resection. The aim of this study is to evaluate the accuracy of linear array ultrasound in comparison to conventional intraoperative ultrasound (cioUS) and intraoperative high-field MRI (iMRI). METHODS: We prospectively enrolled 13 patients harboring a LGG of WHO Grade II. After assumed near total removal, a resection control was performed using navigated cioUS, navigated lioUS, and iMRI. We harvested 30 navigated biopsies from the resection cavity and compared the histopathological findings with the respective imaging results. Spearman's rho was calculated to test for significant correlations. Sensitivity and specificity as well as receiver operating characteristics (ROC) were calculated to assess test performance of each imaging modality. RESULTS: Imaging results of lioUS correlated significantly (p < 0.009) with iMRI. Both iMRI and lioUS correlated significantly with final histopathological diagnosis (p < 0.006, p < 0.014). cioUS did not correlate with other imaging findings or with final diagnosis. The highest sensitivity for residual tumor detection was found in iMRI (83 %), followed by lioUS (79 %). The sensitivity of cioUS was only 21 %. Specificity was highest in cioUS (100 %), whereas iMRI and lioUS both achieved 67 %. ROC curves showed fair results for iMRI and lioUS and a poor result for cioUS. CONCLUSIONS: Intraoperative resection control in LGGs using lioUS reaches a degree of accuracy close to iMRI. Test results of lioUS are superior to cioUS. cioUS often fails to discriminate solid tumors from "normal" brain tissue during resection control. Only in lesions <10 cc cioUS does show good accuracy.
引言：在低级别胶质瘤（LGG）手术中，术区分肿瘤组织与最可能无肿瘤的脑组织具有挑战性。术中超声有助于肿瘤切除。本研究旨在评估线阵超声与传统术中超声（cioUS）及术中高场强磁共振成像（iMRI）相比的准确性。 方法：我们前瞻性纳入了13例世界卫生组织二级LGG患者。在假定几乎完全切除后，使用导航cioUS、导航线阵超声（lioUS）和iMRI进行切除控制。我们从切除腔获取了30份导航活检标本，并将组织病理学结果与相应的影像学结果进行比较。计算Spearman秩相关系数以检验显著相关性。计算敏感性、特异性以及受试者工作特征曲线（ROC）以评估每种成像方式的检测性能。 结果：lioUS的成像结果与iMRI显著相关（p < 0.009）。iMRI和lioUS均与最终组织病理学诊断显著相关（p < 0.006，p < 0.014）。cioUS与其他影像学结果或最终诊断均无相关性。iMRI检测残留肿瘤的敏感性最高（83%），其次是lioUS（79%）。cioUS的敏感性仅为21%。cioUS的特异性最高（100%），而iMRI和lioUS均为67%。ROC曲线显示iMRI和lioUS结果较好，cioUS结果较差。 结论：使用lioUS进行LGG术中切除控制的准确性接近iMRI。lioUS的检测结果优于cioUS。在切除控制过程中，cioUS常常无法区分实体肿瘤与“正常”脑组织。仅在病变体积<10 cc时，cioUS才显示出良好的准确性。
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