title: Sensitivity and specificity of linear array intraoperative ultrasound in glioblastoma surgery: a comparative study with high field intraoperative MRI and conventional sector array ultrasound.
abstract: BACKGROUND
  Linear array intraoperative ultrasound (lioUS) is an emerging technology for intracranial use. We evaluated sensitivity and specificity of lioUS to detect residual tumor in patients harboring a glioblastoma.
  
  
  METHODS
  After near total resection in 20 patients, residual tumor detection using lioUS, conventional intraoperative ultrasound (cioUS), and gadopentetic-diethylenetriamine penta-acetic acid (Gd-DTPA)-enhanced intraoperative MRI (iMRI) were compared. Sensitivity and specificity were calculated based on 68 navigated biopsies. Receiver operator characteristic (ROC) curves and correlation with histopathological findings of each imaging modality were calculated. Additionally, results were evaluated in the subgroup of recurrent disease (23 biopsies in 8 patients).
  
  
  RESULTS
  Sensitivity of lioUS (76 %) was significantly higher compared with iMRI (55 %) and cioUS (24 %). Specificity of lioUS (58 %) was significantly lower than in cioUS (96 %), while there was no significant difference to iMRI (74 %). All imaging modalities correlated significantly with histopathological findings. In the subgroup of recurrent disease, sensitivity and specificity decreased in all modalities. However, cioUS showed significant lower values than iMRI and lioUS. In ROC curves, lioUS showed a higher area und the curve (AUC) in comparison with iMRI and cioUS. We found similar results in the subgroup of recurrent disease.
  
  
  CONCLUSIONS
  Tumor detection using a lioUS is significantly superior to cioUS. Overall test performance in lioUS is comparable with results of iMRI. While, the latter has a higher specificity and a significantly lower sensitivity in comparison with lioUS.
authors: Department of Neurosurgery, University of Ulm, Ludwig Heilmeyerstr. 2, 89312, Günzburg, Germany, jan.coburger@uni-ulm.de.
authors: Jan
authors: J
authors: Coburger
authors: Angelika
authors: A
authors: Scheuerle
authors: Thomas
authors: T
authors: Kapapa
authors: Jens
authors: J
authors: Engelke
authors: Dietmar Rudolf
authors: DR
authors: Thal
authors: Christian R
authors: CR
authors: Wirtz
authors: Ralph
authors: R
authors: König
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D019786:Gadolinium DTPA; D005909:Glioblastoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009364:Neoplasm Recurrence, Local; D038361:Neuronavigation; D019635:Neurosurgical Procedures / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D025321:Surgery, Computer-Assisted / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D019786:Gadolinium DTPA