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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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