title: Intraoperative cerebral glioma characterization with contrast enhanced ultrasound.
abstract: BACKGROUND
  Contrast enhanced ultrasound (CEUS) is a dynamic and continuous modality providing real-time view of vascularization and flow distribution patterns of different organs and tumors. Nevertheless its intraoperative use for brain tumors visualization has been performed few times, and a thorough characterization of cerebral glioma had never been performed before.
  
  
  OBJECTIVE
  To perform the first characterization of cerebral glioma using CEUS and to possibly achieve an intraoperative differentiation of different gliomas.
  
  
  METHODS
  We performed CEUS in an off-label setting in 69 patients undergoing surgery for cerebral glioma. An intraoperative qualitative analysis was performed comparing iCEUS with B-mode imaging. A postprocedural semiquantitative analysis was then performed for each case, according to EFSUMB criteria. Results were related to histopathology.
  
  
  RESULTS
  We observed different CE patterns: LGG show a mild, dotted CE with diffuse appearance and slower, delayed arterial and venous phase. HGG have a high CE with a more nodular, nonhomogeneous appearance and fast perfusion patterns.
  
  
  CONCLUSIONS
  Our study characterizes for the first time human brain glioma with CEUS, providing further insight regarding these tumors' biology. CEUS is a fast, safe, dynamic, real-time, and economic tool that might be helpful during surgery in differentiating malignant and benign gliomas and refining surgical strategy.
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", 20133 Milan, Italy.
authors.forename: Francesco
authors.identifier: 0000-0003-0653-9317
authors.initials: F
authors.lastname: Prada
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", 20133 Milan, Italy ; Università degli Studi di Milano, 20122 Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Mattei
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", 20133 Milan, Italy.
authors.forename: Massimiliano
authors.identifier: 0000-0002-6672-9721
authors.initials: M
authors.lastname: Del Bene
authors.affiliation: Department of Radiology, Ospedale Valduce, 22100 Como, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Aiani
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", 20133 Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Saini
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", 20133 Milan, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Casali
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", 20133 Milan, Italy ; Università degli Studi di Milano, 20122 Milan, Italy.
authors.forename: Assunta
authors.initials: A
authors.lastname: Filippini
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", 20133 Milan, Italy.
authors.forename: Federico Giuseppe
authors.initials: FG
authors.lastname: Legnani
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", 20133 Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Perin
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", 20133 Milan, Italy.
authors.forename: Andrea
authors.identifier: 0000-0002-6439-6556
authors.initials: A
authors.lastname: Saladino
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", 20133 Milan, Italy ; Università degli Studi di Milano, 20122 Milan, Italy.
authors.forename: Ignazio Gaspare
authors.initials: IG
authors.lastname: Vetrano
authors.affiliation: Department of Radiology, Ospedale di Circolo, 21052 Busto Arsizio, Italy.
authors.forename: Luigi
authors.identifier: 0000-0002-3109-1449
authors.initials: L
authors.lastname: Solbiati
authors.affiliation: Department of Radiology, Ospedale Valduce, 22100 Como, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Martegani
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", 20133 Milan, Italy ; Department of Neurosurgery, Johns Hopkins Medical School, Baltimore, MD 21218, USA.
authors.forename: Francesco
authors.identifier: 0000-0001-6213-5793
authors.initials: F
authors.lastname: DiMeco
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002648:Child; D003287:Contrast Media / Q000627:therapeutic use*; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging* / Q000473:pathology; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D003287:Contrast Media