1Institute of Neurosurgery and.
2Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy.
Neurosurg Focus. 2021 Jan;50(1):E15. doi: 10.3171/2020.10.FOCUS20797.
Providing new tools to improve surgical planning is considered a main goal in meningioma treatment. In this context, two factors are crucial in determining operating strategy: meningioma-brain interface and meningioma consistency. The use of intraoperative ultrasound (ioUS) elastosonography, a real-time imaging technique, has been introduced in general surgery to evaluate similar features in other pathological settings such as thyroid and prostate cancer. The aim of the present study was to evaluate ioUS elastosonography in the intraoperative prediction of key intracranial meningioma features and to evaluate its application in guiding surgical strategy.
An institutional series of 36 meningiomas studied with ioUS elastosonography is reported. Elastographic data, intraoperative surgical findings, and corresponding preoperative MRI features were classified, applying a score from 0 to 2 to both meningioma consistency and meningioma-brain interface. Statistical analysis was performed to determine the degree of agreement between meningioma elastosonographic features and surgical findings, and whether intraoperative elastosonography was a better predictor than preoperative MRI in assessing meningioma consistency and slip-brain interface, using intraoperative findings as the gold standard.
A significantly high degree of reliability and agreement between ioUS elastographic scores and surgical finding scores was reported (intraclass correlation coefficient = 0.848, F = 12.147, p < 0.001). When analyzing both consistency and brain-tumor interface, ioUS elastography proved to have a rather elevated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive (LR+) and negative likelihood ratio (LR-). This consideration was true especially for meningiomas with a hard consistency (sensitivity = 0.92, specificity = 0.96, PPV = 0.92, NPV = 0.96, LR+ = 22.00, LR- = 0.09) and for those presenting with an adherent slip-brain interface (sensitivity = 0.76, specificity = 0.95, PPV = 0.93, NPV = 0.82, LR+ = 14.3, LR- = 0.25). Furthermore, predictions derived from ioUS elastography were found to be more accurate than MRI-derived predictions, as demonstrated by McNemar's test results in both consistency (p < 0.001) and interface (p < 0.001).
While external validation of the data is needed to transform ioUS elastography into a fully deployable clinical tool, this experience confirmed that it may be integrated into meningioma surgical planning, especially because of its rapidity and cost-effectiveness.
提供新的工具来改善手术计划被认为是脑膜瘤治疗的主要目标。在这种情况下，有两个因素在确定手术策略时至关重要：脑膜瘤-脑界面和脑膜瘤一致性。术中超声（ioUS）弹性成像是一种实时成像技术，已被引入普通外科，用于评估甲状腺和前列腺癌等其他病理情况下的类似特征。本研究的目的是评估 ioUS 弹性成像术在术中预测颅内脑膜瘤关键特征中的应用，并评估其在指导手术策略中的应用。
报告了一项机构系列 36 例脑膜瘤的研究，该系列脑膜瘤采用 ioUS 弹性成像术进行研究。对弹性数据、术中手术发现以及相应的术前 MRI 特征进行分类，对脑膜瘤一致性和脑膜瘤-脑界面分别应用 0 至 2 分的评分。应用术中发现作为金标准，进行统计学分析以确定脑膜瘤弹性特征与手术发现之间的一致性程度，以及术中弹性成像术在评估脑膜瘤一致性和滑离脑界面方面是否优于术前 MRI。
报告了 ioUS 弹性评分与手术发现评分之间具有显著高的可靠性和一致性（组内相关系数=0.848，F=12.147，p<0.001）。当分析一致性和脑-肿瘤界面时，ioUS 弹性成像术表现出相当高的灵敏度、特异性、阳性预测值（PPV）、阴性预测值（NPV）、阳性（LR+）和阴性似然比（LR-）。对于质地坚硬的脑膜瘤（灵敏度=0.92，特异性=0.96，PPV=0.92，NPV=0.96，LR+=22.00，LR-=0.09）和与脑附着的脑膜瘤（灵敏度=0.76，特异性=0.95，PPV=0.93，NPV=0.82，LR+=14.3，LR-=0.25），这种考虑更为准确。进一步的，与术前 MRI 预测相比，McNemar 检验结果显示，ioUS 弹性成像术的预测更为准确（一致性 p<0.001，界面 p<0.001）。
虽然需要对数据进行外部验证才能将 ioUS 弹性成像术转化为一种完全可部署的临床工具，但这一经验证实，它可以整合到脑膜瘤手术计划中，尤其是因为它的快速性和成本效益。
