Wu Dong-Fang, He Wen, Lin Song, Zee Chi-Shing, Han Bo
Department of Ultrasound, Beijing Tian tan Hospital, Capital Medical University, 6 Tiantan Xi Li, Dong Cheng District, Beijing, 100050, China.
Department of Ultrasound, Beijing Tian tan Hospital, Capital Medical University, 6 Tiantan Xi Li, Dong Cheng District, Beijing, 100050, China.
Clin Neurol Neurosurg. 2018 Dec;175:84-90. doi: 10.1016/j.clineuro.2018.10.009. Epub 2018 Oct 16.
The aim of study is to evaluate the general performance and efficiency of the using real time intraoperative ultrasound system with Volume Navigation system technology in glioma. Compare glioma intraoperative ultrasound and contrast agent ultrasound images to obtained preoperative MRI with fusion image in a real-time.
Fifteen patients had been performed fusion imaging involved intraoperative real-time ultrasound and contrast agent ultrasound with preoperative MR imaging including preoperative gadolinium-enhanced MRI from March 2017 to December 2017. The number of tumor was counted online fusion imaging in real time ultrasound with and without preoperative MR. We analyzed ultrasound coplanar MR modalities in real time including tumor location, margin (obscure or defined). In addition, intraoperative ultrasound enhancement pattern was analyzed compare it to preoperative reconstruction gadolinium-enhanced T1-weighted MRI. Two radiologists who made planning ultrasound assessment for the focus lesion based on a 4 scoring system according to the degree of confidence.
Thirteen of fifteen patients whose automatically registration successful intraoperative neurosurgery accepted preoperative MR examination. Seven of fifteen fine-tuning registration phase were performed and satisfactory with fusion image substantially. Intraoperatively, 73.3% (11/15) glioma nodules were definite on conventional B-mode US by a radiologist who doesn't know the MR result before fusion US with MRI. However, 100% tumors were detected on fusion B-mode ultrasound imaging with MRI. Two radiologists evaluated the score between fusion B-mode ultrasound and CEUS with coplanar MRI and had a result that score was upgraded in 69.2% (9/13) and 84.6% (11/13) patients. Inter-observer agreement was significant (kappa value = 1.0, p < 0.001) in B-mode ultrasound fusion image with MRI. Inter-observer agreement was moderate (kappa value = 0. 0.618, p < 0.001) in CEUS fusion image with MRI.
Fusion imaging is very useful to detect poor sonographic visibility tumor on fusion B-mode US imaging with MR images. Fusion image may demonstrate multiplane images including same standard and nonstandard MRI and US images to help localize tumor. The additional real time fusion CEUS mode image with MR is a safe method for neurosurgery and the use of CEUS should be considered when fusion B-mode ultrasound imaging alone is not satisfactory for margin.
本研究旨在评估采用容积导航系统技术的实时术中超声系统在胶质瘤中的总体性能和效率。将胶质瘤术中超声和造影剂超声图像与术前MRI实时融合成像进行比较。
2017年3月至2017年12月，15例患者接受了术中实时超声和造影剂超声与术前MR成像的融合成像，包括术前钆增强MRI。在有和没有术前MR的情况下，在实时超声中对肿瘤数量进行在线融合成像计数。我们实时分析了超声共面MR模式，包括肿瘤位置、边缘（模糊或清晰）。此外，分析术中超声增强模式并将其与术前重建的钆增强T1加权MRI进行比较。两名放射科医生根据置信度的4分制对焦点病变进行超声评估规划。
15例术中神经外科自动配准成功的患者中有13例接受了术前MR检查。15例中有7例进行了微调配准阶段，融合图像基本满意。术中，一位在超声与MRI融合前不知道MR结果的放射科医生通过传统B模式超声确定了73.3%（11/15）的胶质瘤结节。然而，在与MRI融合的B模式超声成像中检测到了100%的肿瘤。两名放射科医生评估了融合B模式超声和CEUS与共面MRI之间的评分，结果显示69.2%（9/13）和84.6%（11/13）的患者评分有所提高。在B模式超声与MRI融合图像中，观察者间一致性显著（kappa值 = 1.0，p < 0.001）。在CEUS与MRI融合图像中，观察者间一致性为中等（kappa值 = 0.618，p < 0.001）。
融合成像对于在与MR图像融合的B模式超声成像中检测超声可见性差的肿瘤非常有用。融合图像可以显示包括标准和非标准MRI及US图像的多平面图像，以帮助定位肿瘤。与MR的额外实时融合CEUS模式图像是神经外科手术的一种安全方法，当单独的融合B模式超声成像对边缘不满意时，应考虑使用CEUS。
