title: Navigated high frequency ultrasound: description of technique and clinical comparison with conventional intracranial ultrasound.
abstract: OBJECTIVE
  Conventional curved or sector array ultrasound (cioUS) is the most commonly used intraoperative imaging modality worldwide. Although highly beneficial in various clinical applications, at present the impact of linear array intraoperative ultrasound (lioUS) has not been assessed for intracranial use. We provide a technical description to integrate an independent lioUS probe into a commercially available neuronavigation system and evaluate the use of navigated lioUS as a resection control in glioblastoma surgery.
  
  
  METHODS
  We performed a prospective study assessing residual tumor detection after complete microsurgical resection using either cioUS or lioUS in 15 consecutive patients. We compared the imaging findings of both ultrasound modalities in 44 sites surrounding the resection cavity. The respective findings were correlated with the histopathologic findings of tissue specimen obtained from those sites.
  
  
  RESULTS
  Use of cioUS leaded to an additional resection in 9 patients, whereas lioUS detected residual tumor during all surgeries. A further resection was performed at 33 of 44 intraoperative sites (75%) based on results of lioUS alone. Resected tissue was solid tumor in 66% and infiltration zone in 34%. No false-positive or false-negative findings were seen using lioUS. There was no case of a tumor detection in cioUS combined with a negative finding in lioUS. The difference of imaging results between cioUS and lioUS was significant (sign test, P<0.001).
  
  
  CONCLUSIONS
  lioUS can be used as a safe and precise tool for intracranial image-guided resection control of glioblastomas. It can be integrated in a commercially available navigation system and shows a significant higher detection rate of residual tumor compared with conventional cioUS.
authors.affiliation: Department of Neurosurgery, University of Ulm, Günzburg, Germany. Electronic address: jan.coburger@uni-ulm.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Coburger
authors.affiliation: Department of Neurosurgery, University of Ulm, Günzburg, Germany.
authors.forename: Ralph W
authors.initials: RW
authors.lastname: König
authors.affiliation: Section of Neuropathology, University of Ulm, Günzburg, Germany.
authors.forename: Angelika
authors.initials: A
authors.lastname: Scheuerle
authors.affiliation: Department of Neurosurgery, University of Ulm, Günzburg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Engelke
authors.affiliation: Department of Neurosurgery, University of Ulm, Günzburg, Germany.
authors.forename: Michal
authors.initials: M
authors.lastname: Hlavac
authors.affiliation: Section of Neuropathology, University of Ulm, Günzburg, Germany.
authors.forename: Dietmar R
authors.initials: DR
authors.lastname: Thal
authors.affiliation: Department of Neurosurgery, University of Ulm, Günzburg, Germany.
authors.forename: Christian Rainer
authors.initials: CR
authors.lastname: Wirtz
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D064847:Multimodal Imaging; D018365:Neoplasm, Residual / Q000000981:diagnostic imaging; D038361:Neuronavigation / Q000295:instrumentation / Q000379:methods*; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: Cerebral tumor; Extent of resection; Glioma; High frequency ultrasound imaging; Ultrasound; cioUS; iMRI; lioUS