title: Intraoperative contrast-enhanced ultrasound for brain tumor surgery.
abstract: BACKGROUND
  Contrast-enhanced ultrasound (CEUS) is a dynamic and continuous modality that offers a real-time, direct view of vascularization patterns and tissue resistance for many organs. Thanks to newer ultrasound contrast agents, CEUS has become a well-established, live-imaging technique in many contexts, but it has never been used extensively for brain imaging. The use of intraoperative CEUS (iCEUS) imaging in neurosurgery is limited.
  
  
  OBJECTIVE
  To provide the first dynamic and continuous iCEUS evaluation of a variety of brain lesions.
  
  
  METHODS
  We evaluated 71 patients undergoing iCEUS imaging in an off-label setting while being operated on for different brain lesions; iCEUS imaging was obtained before resecting each lesion, after intravenous injection of ultrasound contrast agent. A semiquantitative, offline interobserver analysis was performed to visualize each brain lesion and to characterize its perfusion features, correlated with histopathology.
  
  
  RESULTS
  In all cases, the brain lesion was visualized intraoperatively with iCEUS. The afferent and efferent blood vessels were identified, allowing evaluation of the time and features of the arterial and venous phases and facilitating the surgical strategy. iCEUS also proved to be useful in highlighting the lesion compared with standard B-mode imaging and showing its perfusion patterns. No adverse effects were observed.
  
  
  CONCLUSIONS
  Our study is the first large-scale implementation of iCEUS in neurosurgery as a dynamic and continuous real-time imaging tool for brain surgery and provides the first iCEUS characterization of different brain neoplasms. The ability of CEUS to highlight and characterize brain tumor will possibly provide the neurosurgeon with important information anytime during a surgical procedure.
authors.affiliation: *Department of Neurosurgery, and ¶ICU, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy; ‡Department of Radiology, Ospedale Valduce, Como, Italy; §Department of Radiology, Ospedale di Circolo, Busto Arsizio, Italy; ‖Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, Maryland.
authors.forename: Francesco
authors.initials: F
authors.lastname: Prada
authors.forename: Alessandro
authors.initials: A
authors.lastname: Perin
authors.forename: Alberto
authors.initials: A
authors.lastname: Martegani
authors.forename: Luca
authors.initials: L
authors.lastname: Aiani
authors.forename: Luigi
authors.initials: L
authors.lastname: Solbiati
authors.forename: Massimo
authors.initials: M
authors.lastname: Lamperti
authors.forename: Cecilia
authors.initials: C
authors.lastname: Casali
authors.forename: Federico
authors.initials: F
authors.lastname: Legnani
authors.forename: Luca
authors.initials: L
authors.lastname: Mattei
authors.forename: Andrea
authors.initials: A
authors.lastname: Saladino
authors.forename: Marco
authors.initials: M
authors.lastname: Saini
authors.forename: Francesco
authors.initials: F
authors.lastname: DiMeco
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D001927:Brain Diseases / Q000175:diagnosis; D001932:Brain Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D002648:Child; D003287:Contrast Media; D003937:Diagnosis, Differential; D004806:Ependymoma / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005910:Glioma / Q000175:diagnosis / Q000601:surgery; D018325:Hemangioblastoma / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008579:Meningioma / Q000175:diagnosis / Q000601:surgery; D045423:Microbubbles; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D060787:Neoplasm Grading; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging; D015588:Observer Variation; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000601:surgery; D013459:Sulfur Hexafluoride; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D003287:Contrast Media; D013459:Sulfur Hexafluoride