title: Intraoperative contrast-enhanced ultrasound in traumatic brain surgery.
abstract: OBJECTIVE
  The objective was to assess intraoperative contrast-enhanced ultrasound (CEUS) in traumatic brain surgery.
  
  
  METHODS
  We prospectively performed intraoperative conventional ultrasound (IOUS) and CEUS in 32 patients who underwent emergency surgery for the treatment of traumatic brain injury (TBI). Sonographic appearance including echogenicity, border, and size of the traumatic lesion and adjacent brain tissue on CEUS were compared with those on IOUS using surgical results as the gold standard. The differences in the size and contrast enhancement parameters of the lesions between IOUS and CEUS were analyzed with a paired t test.
  
  
  RESULTS
  The accuracy of CEUS in assessing TBI was 100%, whereas IOUS was 51%. The absolute peak intensity (API) varied depending on the severity of brain injury. Lower API was observed in severely damaged brain tissue, whereas high API was seen in normal brain tissue or the brain tissue with mild injury. The border of the trauma lesion was more clearly defined on CEUS when compared to IOUS. The size of the lesions measured on CEUS was significantly larger than that on IOUS (P<.01). Importantly, small vessels supplying blood to the tissue in traumatic lesions, as an indication of possible brain vitality, were optimized on CEUS during the surgery. Based on the parameter of time intensity curve and appearances of the lesions on CEUS, the severity of lesions was reclassified and surgical intervention was redesigned in 21 (21/32, 66%) cases.
  
  
  CONCLUSIONS
  Intraoperative CEUS improves accuracy in classification of traumatic brain injury, which helps neurosurgeons to effectively remove hematoma, preserve normal brain tissue, and prevent damaging the vessels during surgical intervention.
authors.affiliation: Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. Electronic address: 168hewen@sina.com.
authors.forename: Wen
authors.initials: W
authors.lastname: He
authors.forename: Li-Shu
authors.initials: LS
authors.lastname: Wang
authors.forename: Hui-Zhan
authors.initials: HZ
authors.lastname: Li
authors.forename: Ling-Gang
authors.initials: LG
authors.lastname: Cheng
authors.forename: Man
authors.initials: M
authors.lastname: Zhang
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wladyka
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000145:classification / Q000000981:diagnostic imaging* / Q000601:surgery*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D018084:Ultrasonography, Interventional / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: Contrast-enhance ultrasound; Intraoperative ultrasound; Traumatic brain injury