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Prada F, Vitale V, Del Bene M, Boffano C, Sconfienza LM, Pinzi V, Mauri G, Solbiati L, Sakas G, Kolev V, D'Incerti L, DiMeco F. Contrast-enhanced MR Imaging versus Contrast-enhanced US: A Comparison in Glioblastoma Surgery by Using Intraoperative Fusion Imaging. Radiology 2017; 285:242-249. [PMID: 28562204 DOI: 10.1148/radiol.2017161206] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Purpose To compare contrast material enhancement of glioblastoma multiforme (GBM) with intraoperative contrast-enhanced ultrasonography (US) versus that with preoperative gadolinium-enhanced T1-weighted magnetic resonance (MR) imaging by using real-time fusion imaging. Materials and Methods Ten patients with GBM were retrospectively identified by using routinely collected, anonymized data. Navigated contrast-enhanced US was performed after intravenous administration of contrast material before tumor resection. All patients underwent tumor excision with navigated intraoperative US guidance with use of fusion imaging between real-time intraoperative US and preoperative MR imaging. With use of fusion imaging, glioblastoma contrast enhancement at contrast-enhanced US (regarding location, morphologic features, margins, dimensions, and pattern) was compared with that at gadolinium-enhanced T1-weighted MR imaging. Results Fusion imaging for virtual navigation enabled matching of real-time contrast-enhanced US scans to corresponding coplanar preoperative gadolinium-enhanced T1-weighted MR images in all cases, with a positional discrepancy of less than 2 mm. Contrast enhancement of gadolinium-enhanced T1-weighted MR imaging and contrast-enhanced US was superimposable in all cases with regard to location, margins, dimensions, and morphologic features. The qualitative analysis of contrast enhancement pattern demonstrated a similar distribution in contrast-enhanced US and gadolinium-enhanced T1-weighted MR imaging in nine patients: Seven lesions showed peripheral inhomogeneous ring enhancement, and two lesions showed a prevalent nodular pattern. In one patient, the contrast enhancement pattern differed between the two modalities: Contrast-enhanced US showed enhancement of the entire bulk of the tumor, whereas gadolinium-enhanced T1-weighted MR imaging demonstrated peripheral contrast enhancement. Conclusion Glioblastoma contrast enhancement with contrast-enhanced US is superimposable on that provided with preoperative gadolinium-enhanced T1-weighted MR imaging regarding location, margins, morphologic features, and dimensions, with a similar enhancement pattern in most cases. Thus, contrast-enhanced US is of potential use in the surgical management of GBM. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Francesco Prada
- From the Department of Neurosurgery (F.P., M.D.B., F.D.), Department of Neuroradiology (C.B., L.D.), and Radiotherapy Unit (V.P.), Fondazione IRCCS Istituto Neurologico "C. Besta," Via Celoria n.11, 20133 Milan, Italy; Department of Imaging and Radiation Therapy, Azienda Socio-sanitaria Territoriale di Lecco, Lecco, Italy (V.V.); Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy (L.M.S.); Department of Biomedical Sciences for Health, University of Milan, Milan, Italy (L.M.S.); Department of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy (G.M.); Department of Radiology, Humanitas Research Hospital, Rozzano, Italy (L.S.); Department of Research and Development, MedCom, Darmstadt, Germany (G.S., V.K.); and Department of Neurologic Surgery, Johns Hopkins Medical School, Baltimore, Md (F.D.)
| | - Valerio Vitale
- From the Department of Neurosurgery (F.P., M.D.B., F.D.), Department of Neuroradiology (C.B., L.D.), and Radiotherapy Unit (V.P.), Fondazione IRCCS Istituto Neurologico "C. Besta," Via Celoria n.11, 20133 Milan, Italy; Department of Imaging and Radiation Therapy, Azienda Socio-sanitaria Territoriale di Lecco, Lecco, Italy (V.V.); Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy (L.M.S.); Department of Biomedical Sciences for Health, University of Milan, Milan, Italy (L.M.S.); Department of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy (G.M.); Department of Radiology, Humanitas Research Hospital, Rozzano, Italy (L.S.); Department of Research and Development, MedCom, Darmstadt, Germany (G.S., V.K.); and Department of Neurologic Surgery, Johns Hopkins Medical School, Baltimore, Md (F.D.)
| | - Massimiliano Del Bene
- From the Department of Neurosurgery (F.P., M.D.B., F.D.), Department of Neuroradiology (C.B., L.D.), and Radiotherapy Unit (V.P.), Fondazione IRCCS Istituto Neurologico "C. Besta," Via Celoria n.11, 20133 Milan, Italy; Department of Imaging and Radiation Therapy, Azienda Socio-sanitaria Territoriale di Lecco, Lecco, Italy (V.V.); Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy (L.M.S.); Department of Biomedical Sciences for Health, University of Milan, Milan, Italy (L.M.S.); Department of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy (G.M.); Department of Radiology, Humanitas Research Hospital, Rozzano, Italy (L.S.); Department of Research and Development, MedCom, Darmstadt, Germany (G.S., V.K.); and Department of Neurologic Surgery, Johns Hopkins Medical School, Baltimore, Md (F.D.)
| | - Carlo Boffano
- From the Department of Neurosurgery (F.P., M.D.B., F.D.), Department of Neuroradiology (C.B., L.D.), and Radiotherapy Unit (V.P.), Fondazione IRCCS Istituto Neurologico "C. Besta," Via Celoria n.11, 20133 Milan, Italy; Department of Imaging and Radiation Therapy, Azienda Socio-sanitaria Territoriale di Lecco, Lecco, Italy (V.V.); Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy (L.M.S.); Department of Biomedical Sciences for Health, University of Milan, Milan, Italy (L.M.S.); Department of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy (G.M.); Department of Radiology, Humanitas Research Hospital, Rozzano, Italy (L.S.); Department of Research and Development, MedCom, Darmstadt, Germany (G.S., V.K.); and Department of Neurologic Surgery, Johns Hopkins Medical School, Baltimore, Md (F.D.)
| | - Luca Maria Sconfienza
- From the Department of Neurosurgery (F.P., M.D.B., F.D.), Department of Neuroradiology (C.B., L.D.), and Radiotherapy Unit (V.P.), Fondazione IRCCS Istituto Neurologico "C. Besta," Via Celoria n.11, 20133 Milan, Italy; Department of Imaging and Radiation Therapy, Azienda Socio-sanitaria Territoriale di Lecco, Lecco, Italy (V.V.); Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy (L.M.S.); Department of Biomedical Sciences for Health, University of Milan, Milan, Italy (L.M.S.); Department of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy (G.M.); Department of Radiology, Humanitas Research Hospital, Rozzano, Italy (L.S.); Department of Research and Development, MedCom, Darmstadt, Germany (G.S., V.K.); and Department of Neurologic Surgery, Johns Hopkins Medical School, Baltimore, Md (F.D.)
| | - Valentina Pinzi
- From the Department of Neurosurgery (F.P., M.D.B., F.D.), Department of Neuroradiology (C.B., L.D.), and Radiotherapy Unit (V.P.), Fondazione IRCCS Istituto Neurologico "C. Besta," Via Celoria n.11, 20133 Milan, Italy; Department of Imaging and Radiation Therapy, Azienda Socio-sanitaria Territoriale di Lecco, Lecco, Italy (V.V.); Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy (L.M.S.); Department of Biomedical Sciences for Health, University of Milan, Milan, Italy (L.M.S.); Department of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy (G.M.); Department of Radiology, Humanitas Research Hospital, Rozzano, Italy (L.S.); Department of Research and Development, MedCom, Darmstadt, Germany (G.S., V.K.); and Department of Neurologic Surgery, Johns Hopkins Medical School, Baltimore, Md (F.D.)
| | - Giovanni Mauri
- From the Department of Neurosurgery (F.P., M.D.B., F.D.), Department of Neuroradiology (C.B., L.D.), and Radiotherapy Unit (V.P.), Fondazione IRCCS Istituto Neurologico "C. Besta," Via Celoria n.11, 20133 Milan, Italy; Department of Imaging and Radiation Therapy, Azienda Socio-sanitaria Territoriale di Lecco, Lecco, Italy (V.V.); Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy (L.M.S.); Department of Biomedical Sciences for Health, University of Milan, Milan, Italy (L.M.S.); Department of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy (G.M.); Department of Radiology, Humanitas Research Hospital, Rozzano, Italy (L.S.); Department of Research and Development, MedCom, Darmstadt, Germany (G.S., V.K.); and Department of Neurologic Surgery, Johns Hopkins Medical School, Baltimore, Md (F.D.)
| | - Luigi Solbiati
- From the Department of Neurosurgery (F.P., M.D.B., F.D.), Department of Neuroradiology (C.B., L.D.), and Radiotherapy Unit (V.P.), Fondazione IRCCS Istituto Neurologico "C. Besta," Via Celoria n.11, 20133 Milan, Italy; Department of Imaging and Radiation Therapy, Azienda Socio-sanitaria Territoriale di Lecco, Lecco, Italy (V.V.); Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy (L.M.S.); Department of Biomedical Sciences for Health, University of Milan, Milan, Italy (L.M.S.); Department of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy (G.M.); Department of Radiology, Humanitas Research Hospital, Rozzano, Italy (L.S.); Department of Research and Development, MedCom, Darmstadt, Germany (G.S., V.K.); and Department of Neurologic Surgery, Johns Hopkins Medical School, Baltimore, Md (F.D.)
| | - Georgios Sakas
- From the Department of Neurosurgery (F.P., M.D.B., F.D.), Department of Neuroradiology (C.B., L.D.), and Radiotherapy Unit (V.P.), Fondazione IRCCS Istituto Neurologico "C. Besta," Via Celoria n.11, 20133 Milan, Italy; Department of Imaging and Radiation Therapy, Azienda Socio-sanitaria Territoriale di Lecco, Lecco, Italy (V.V.); Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy (L.M.S.); Department of Biomedical Sciences for Health, University of Milan, Milan, Italy (L.M.S.); Department of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy (G.M.); Department of Radiology, Humanitas Research Hospital, Rozzano, Italy (L.S.); Department of Research and Development, MedCom, Darmstadt, Germany (G.S., V.K.); and Department of Neurologic Surgery, Johns Hopkins Medical School, Baltimore, Md (F.D.)
| | - Velizar Kolev
- From the Department of Neurosurgery (F.P., M.D.B., F.D.), Department of Neuroradiology (C.B., L.D.), and Radiotherapy Unit (V.P.), Fondazione IRCCS Istituto Neurologico "C. Besta," Via Celoria n.11, 20133 Milan, Italy; Department of Imaging and Radiation Therapy, Azienda Socio-sanitaria Territoriale di Lecco, Lecco, Italy (V.V.); Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy (L.M.S.); Department of Biomedical Sciences for Health, University of Milan, Milan, Italy (L.M.S.); Department of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy (G.M.); Department of Radiology, Humanitas Research Hospital, Rozzano, Italy (L.S.); Department of Research and Development, MedCom, Darmstadt, Germany (G.S., V.K.); and Department of Neurologic Surgery, Johns Hopkins Medical School, Baltimore, Md (F.D.)
| | - Ludovico D'Incerti
- From the Department of Neurosurgery (F.P., M.D.B., F.D.), Department of Neuroradiology (C.B., L.D.), and Radiotherapy Unit (V.P.), Fondazione IRCCS Istituto Neurologico "C. Besta," Via Celoria n.11, 20133 Milan, Italy; Department of Imaging and Radiation Therapy, Azienda Socio-sanitaria Territoriale di Lecco, Lecco, Italy (V.V.); Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy (L.M.S.); Department of Biomedical Sciences for Health, University of Milan, Milan, Italy (L.M.S.); Department of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy (G.M.); Department of Radiology, Humanitas Research Hospital, Rozzano, Italy (L.S.); Department of Research and Development, MedCom, Darmstadt, Germany (G.S., V.K.); and Department of Neurologic Surgery, Johns Hopkins Medical School, Baltimore, Md (F.D.)
| | - Francesco DiMeco
- From the Department of Neurosurgery (F.P., M.D.B., F.D.), Department of Neuroradiology (C.B., L.D.), and Radiotherapy Unit (V.P.), Fondazione IRCCS Istituto Neurologico "C. Besta," Via Celoria n.11, 20133 Milan, Italy; Department of Imaging and Radiation Therapy, Azienda Socio-sanitaria Territoriale di Lecco, Lecco, Italy (V.V.); Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy (L.M.S.); Department of Biomedical Sciences for Health, University of Milan, Milan, Italy (L.M.S.); Department of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy (G.M.); Department of Radiology, Humanitas Research Hospital, Rozzano, Italy (L.S.); Department of Research and Development, MedCom, Darmstadt, Germany (G.S., V.K.); and Department of Neurologic Surgery, Johns Hopkins Medical School, Baltimore, Md (F.D.)
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Prada F, Del Bene M, Casali C, Saladino A, Legnani FG, Perin A, Moiraghi A, Richetta C, Rampini A, Mattei L, Vetrano IG, Fornaro R, Saini M, Martegani A, DiMeco F. Intraoperative Navigated Angiosonography for Skull Base Tumor Surgery. World Neurosurg 2015; 84:1699-707. [PMID: 26193670 DOI: 10.1016/j.wneu.2015.07.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/04/2015] [Accepted: 07/07/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND One of the main challenges during skull base tumor surgery is identifying the relationships between the lesion and the principal intracranial vessels. To this end, neuronavigation systems based on preoperative imaging lack accuracy because of brain shift and brain deformation. Intraoperative navigated B-mode ultrasonography is useful in defining the extent of brain tumor. Doppler imaging adds information regarding flow entity in neighboring vessels. Second-generation ultrasound contrast agents improve the signal-to-noise ratio of B-mode imaging and permit the study of the vessel's course, blood flow, and perfusion characteristics of focal lesions. We report our experience using intraoperative navigated contrast-enhanced ultrasound to perform a navigated angiosonography (N-ASG) for the visualization of vessels in a series of 18 skull base tumors. METHODS We performed N-ASG in a series of 18 skull base tumors (10 meningiomas, 3 craniopharyngiomas, 2 giant pituitary adenomas, 1 posterior fossa epidermoid, 2 dermoid cysts). N-ASG was obtained after craniotomy before resecting each lesion and during tumor removal, after intravenous injection of ultrasound contrast agent. RESULTS In all 18 cases, major vessels and their branches were simultaneously identified (both high and low flow) using N-ASG, which allowed to visualize the whole length of each vessels. N-ASG was also useful in highlighting the lesion, compared with standard B-mode imaging, and showing its perfusion patterns. CONCLUSIONS N-ASG can be applied to skull base tumor surgery, providing helpful information about the relationship between principal intracranial vessels and tumors. This technique could be of assistance in approaching the tumor and avoiding vascular damages.
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Affiliation(s)
- Francesco Prada
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.
| | - Massimiliano Del Bene
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Cecilia Casali
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Andrea Saladino
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | | | - Alessandro Perin
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Alessandro Moiraghi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Carla Richetta
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Angela Rampini
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Luca Mattei
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | | | - Riccardo Fornaro
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Marco Saini
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | | | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, Maryland, USA
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11
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Prada F, Del Bene M, Mattei L, Casali C, Filippini A, Legnani F, Mangraviti A, Saladino A, Perin A, Richetta C, Vetrano I, Moiraghi A, Saini M, DiMeco F. Fusion imaging for intra-operative ultrasound-based navigation in neurosurgery. J Ultrasound 2014; 17:243-51. [PMID: 25177400 DOI: 10.1007/s40477-014-0111-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 06/02/2014] [Indexed: 12/19/2022] Open
Abstract
The major shortcoming of image-guided navigation systems is the use of presurgically acquired image data, which does not account for intra-operative changes such as brain shift, tissue deformation and tissue removal occurring during the surgical procedure. Intra-operative ultrasound (iUS) is becoming widely used in neurosurgery but they lack orientation and panoramic view. In this article, we describe our procedure for US-based real-time neuro-navigation during surgery. We used fusion imaging between preoperative magnetic resonance imaging (MRI) and iUS for brain lesion removal in 67 patients so far. Surgical planning is based on preoperative MRI only. iUS images obtained during surgery are fused with the preoperative MRI. Surgery is performed under intra-operative US control. Relying on US imaging, it is possible to recalibrate navigated MRI imaging, adjusting distortion due to brain shift and tissue resection, continuously updating the two modalities. Ultrasound imaging provides excellent visualization of targets, their margins and surrounding structures. The use of navigated MRI is helpful in better understanding cerebral ultrasound images, providing orientation and panoramic view. Intraoperative US-guided neuro-navigation adjustments are very accurate and helpful in the event of brain shift. The use of this integrated system allows for a true real-time feedback during surgery.
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Affiliation(s)
- Francesco Prada
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy
| | - Massimiliano Del Bene
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Università degli Studi di Milano, Milan, Italy
| | - Luca Mattei
- Università degli Studi di Milano, Milan, Italy
| | - Cecilia Casali
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy
| | - Assunta Filippini
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Università degli Studi di Milano, Milan, Italy
| | - Federico Legnani
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy
| | | | - Andrea Saladino
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy
| | - Alessandro Perin
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy
| | - Carla Richetta
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Università degli Studi di Milano, Milan, Italy
| | - Ignazio Vetrano
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Università degli Studi di Milano, Milan, Italy
| | - Alessandro Moiraghi
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Università degli Studi di Milano, Milan, Italy
| | - Marco Saini
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Department of Neurosurgery, Johns Hopkins University, Baltimore, USA
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