Yin Lu, Cheng Linggang, Wang Fumin, Zhu Xueli, Hua Yue, He Wen
Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Ultrasound, Peking University First Hospital, Beijing, China.
Quant Imaging Med Surg. 2021 Jun;11(6):2733-2743. doi: 10.21037/qims-20-1368.
To evaluate the value of intraoperative B-mode ultrasound and shear wave elastography (SWE) in differentiating low-grade and high-grade gliomas.
A total of 172 patients with glioma were examined by B-mode ultrasound to obtain a tumor sonogram. Intraoperative SWE was performed on 52 patients to obtain Young's modulus values of peritumor tissue and tumor tissue, and the differences in conventional B-mode signs and Young's modulus values of gliomas of different grades were then compared. The diagnostic performance of SWE in glioma grading was assessed by receiver operating characteristic (ROC) curve analysis, and the intra- and interobserver reliability of SWE was analyzed by the intraclass correlation coefficient (ICC).
For B-mode ultrasound, patient age, cystic degeneration, and peritumor edema were independent risk factors for high-grade glioma (P<0.05, OR >1). For SWE, Young's modulus values of peritumor tissue, low-grade glioma, and high-grade glioma tissues were 8.20 (7.50, 9.70) kPa, 19.65 (15.30, 24.75) kPa, and 9.55 (8.50, 13.80) kPa, respectively. The area under the ROC curve for the diagnosis of high-grade glioma by SWE was 0.859 (95% CI: 0.758-0.961, P<0.05), and the optimal cutoff value was 12.1 kPa, with 89.3% sensitivity and 75.0% specificity. The intra- and interobserver reliability of SWE in grading gliomas was excellent, with ICCs ranging from 0.921 to 0.965.
High-grade glioma is associated with significantly more severe necrotic cystic degeneration and peritumoral edema on B-mode ultrasound and lower stiffness on SWE. Further, SWE exhibits excellent intra- and interobserver reliability. Intraoperative B-mode ultrasound combined with SWE helps differentiate different grades of gliomas.
评估术中B超和剪切波弹性成像（SWE）在鉴别低级别和高级别胶质瘤中的价值。
对172例胶质瘤患者进行B超检查以获取肿瘤超声图像。对52例患者进行术中SWE检查以获取瘤周组织和肿瘤组织的杨氏模量值，然后比较不同级别胶质瘤的传统B超征象和杨氏模量值的差异。通过受试者操作特征（ROC）曲线分析评估SWE在胶质瘤分级中的诊断性能，并通过组内相关系数（ICC）分析SWE的观察者内和观察者间可靠性。
对于B超，患者年龄、囊性变和瘤周水肿是高级别胶质瘤的独立危险因素（P<0.05，OR>1）。对于SWE，瘤周组织、低级别胶质瘤组织和高级别胶质瘤组织的杨氏模量值分别为8.20（7.50，9.70）kPa、19.65（15.30，24.75）kPa和9.55（8.50，13.80）kPa。SWE诊断高级别胶质瘤的ROC曲线下面积为0.859（95%CI：0.758-0.961，P<0.05），最佳截断值为12.1 kPa，敏感性为89.3%，特异性为75.0%。SWE在胶质瘤分级中的观察者内和观察者间可靠性良好，ICC范围为0.921至0.965。
高级别胶质瘤在B超上与更严重的坏死性囊性变和瘤周水肿相关，在SWE上硬度较低。此外，SWE表现出良好的观察者内和观察者间可靠性。术中B超联合SWE有助于鉴别不同级别的胶质瘤。
