Use of intraoperative ultrasound for localizing tumors and determining the extent of resection: a comparative study with magnetic resonance imaging

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✓ A prospective study of 70 patients with intraparenchymal brain lesions (36 gliomas and 34 metastases) was performed to evaluate the efficacy of intraoperative ultrasound (IOUS) in localizing and defining the borders of tumors and in assessing the extent of their resection. Eighteen of the 36 glioma patients had no previous therapy. All of these 18 tumors were well localized by IOUS; margins were well defined in 15 and moderately defined in three. The extent of resection was well defined on IOUS in all 18 patients, as confirmed by measurements taken on postoperative magnetic resonance (MR) images (p = 0.90). The remaining 18 patients with gliomas had undergone previous surgery and/or radiation therapy; five had recurrent tumors and 13 had radiation-induced changes. The extent of resection of the recurrent tumors was well defined in all but one patient, as confirmed by postoperative MR imaging. The extent of resection was poorly defined in all 13 patients whose pathology showed radiation effects. All 34 metastatic lesions were well localized and had well-defined margins. In addition, IOUS accurately determined the extent of resection in all cases; the results were confirmed with postoperative MR imaging.

In conclusion, IOUS is not only helpful in localizing and defining the margins of gliomas and metastatic brain lesions, it also accurately determines the extent of resection, as confirmed by postoperative MR imaging. This assessment does not apply, however, when the lesion is due primarily to radiation effect.

Article Information

Address reprint requests to: Raymond Sawaya, M.D., Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe, Box 64, Houston, Texas 77030.

© AANS, except where prohibited by US copyright law.

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Figures

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    Magnetic resonance image (left) and intraoperative ultrasound image (right) of juvenile pilocytic astrocytoma (T) showing the cyst (C), tumor margins (B), falx (F), edema (E), and anterior horns of the lateral ventricles (V).

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    Intraoperative ultrasound images of left occipital metastatic melanoma (T) in coronal (left) and axial (right) views showing the well-defined margins of tumor (B), falx (F), and edema (E).

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    Intraoperative ultrasound image of radiation-induced changes (RC) showing the poorly defined margins of the lesion.

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    Scatterplot showing preoperative tumor volumes on magnetic resonance imaging versus preexcision intraoperative ultrasound volumes for all tumors grouped together.

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    Graph comparing pre- and postoperative mean tumor volumes revealed by intraoperative ultrasound and magnetic resonance imaging. HGG = high-grade gliomas; LGG = low-grade gliomas; METS = brain metastases.

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    Graph showing postoperative tumor volumes on magnetic resonance imaging versus postexcision volumes on intraoperative ultrasound in patients with residual tumors.

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