Wang Lu, Liu Jinsong, Jiang Yong, Liang Ying, Fang Mengru, Ma Weichao, Li Jiami, Li Xiangyu, Ren Tianjian, Lu Man
Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
Department of Cerebral Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
Quant Imaging Med Surg. 2025 May 1;15(5):4146-4155. doi: 10.21037/qims-24-2271. Epub 2025 Apr 22.
New ultrasound (US) techniques, such as contrast-enhanced ultrasound (CEUS) and shear wave elastography (SWE), are being used to identify artifacts, guide the interventions and evaluate the extent of resection, as it is difficult for gray-scale ultrasound to distinguish the artifacts in intraoperative ultrasound (IOUS). However, to date, no comparative study has been conducted on the role of several new US technologies in guiding brain tumor resection. Thus, this study sought to compare the roles of various new US technologies in guiding brain tumor resection to find a convenient and useful guiding technology for brain tumor resection.
From July 2022 to July 2023, 64 brain tumor patients (33 men and 31 women), with ages ranging from 26 to 78 years (53.2±11.6 years), were included in the study. Before surgery, a planned resection (pRS) was determined for all of the included patients by a multidisciplinary neuro-oncology team. All patients underwent microsurgical resection of the lesion. After the craniotomy and before the dural opening, ultrasonic techniques, including B-mode, micro-flow imaging (MFI), CEUS, and SWE, were used to evaluate the features of the brain tumor and its surrounding structure. Then, those ultrasonic techniques were applied to each patient to confirm the microsurgical margin achieving the pRS at the end of the resection. Next, 3 days after surgery, a magnetic resonance imaging (MRI) scan was performed on each patient as the reference standard. The agreement between B-mode, color Doppler flow imaging (CDFI), MFI, CEUS, SWE, and MRI was measured by Fleiss' kappa agreement.
In the evaluation of the surgical resection edges, all the included US technologies showed substantial agreement compared to the MRI results. The Kappa values were 0.717, 0.751, 0.714, and 0.892 for B-mode, MFI, SWE, and CEUS, respectively. CEUS and MRI showed the best diagnostic consistency. CEUS had the highest sensitivity, specificity, positive predictive value, and negative predictive value under the receiver operating characteristic (ROC) curve analysis (77.78%, 100%, 100%, and 86.05%, respectively), followed by MFI. B-mode and SWE showed similar accuracy in detecting tumor residue.
US is a convenient and cost-effective method for guiding the procedure and evaluating the extent of resection in neurosurgery. CEUS has the highest diagnostic accuracy for residual lesions among the new US technologies. Thus, MFI can be recommended as a technique for guiding and evaluating residues in neurosurgery in addition to CEUS.
新的超声（US）技术，如超声造影（CEUS）和剪切波弹性成像（SWE），正被用于识别伪像、指导干预措施以及评估切除范围，因为灰阶超声难以区分术中超声（IOUS）中的伪像。然而，迄今为止，尚未对几种新的超声技术在指导脑肿瘤切除中的作用进行比较研究。因此，本研究旨在比较各种新的超声技术在指导脑肿瘤切除中的作用，以找到一种方便且有用的脑肿瘤切除指导技术。
2022年7月至2023年7月，64例脑肿瘤患者（33例男性和31例女性）纳入研究，年龄范围为26至78岁（53.2±11.6岁）。术前，多学科神经肿瘤团队为所有纳入患者确定计划切除范围（pRS）。所有患者均接受病变的显微手术切除。开颅后、硬脑膜打开前，使用包括B模式、微血流成像（MFI）、CEUS和SWE在内的超声技术评估脑肿瘤及其周围结构的特征。然后，将这些超声技术应用于每位患者，以确认在切除结束时达到pRS的显微手术切缘。接下来，术后3天，对每位患者进行磁共振成像（MRI）扫描作为参考标准。通过Fleiss卡帕一致性检验测量B模式、彩色多普勒血流成像（CDFI）、MFI、CEUS、SWE与MRI之间的一致性。
在手术切除边缘的评估中，与MRI结果相比，所有纳入的超声技术均显示出高度一致性。B模式、MFI、SWE和CEUS的卡帕值分别为0.717、0.751、0.714和0.892。CEUS与MRI显示出最佳的诊断一致性。在接受者操作特征（ROC）曲线分析中，CEUS具有最高的敏感性、特异性、阳性预测值和阴性预测值（分别为77.78%、100%、100%和86.05%），其次是MFI。B模式和SWE在检测肿瘤残留方面显示出相似的准确性。
超声是神经外科手术中指导手术过程和评估切除范围的一种方便且经济有效的方法。在新的超声技术中，CEUS对残留病变的诊断准确性最高。因此，除CEUS外，MFI可推荐作为神经外科手术中指导和评估残留病变的一种技术。
