title: Identification of residual tumor with intraoperative contrast-enhanced ultrasound during glioblastoma resection.
abstract: OBJECTIVE
  The purpose of this study was to assess the capability of contrast-enhanced ultrasound (CEUS) to identify residual tumor mass during glioblastoma multiforme (GBM) surgery, to increase the extent of resection.
  
  
  METHODS
  The authors prospectively evaluated 10 patients who underwent surgery for GBM removal with navigated ultrasound guidance. Navigated B-mode and CEUS were performed prior to resection, during resection, and after complete tumor resection. Areas suspected for residual tumors on B-mode and CEUS studies were localized within the surgical field with navigated ultrasound and samples were sent separately for histopathological analysis to confirm tumor presence.
  
  
  RESULTS
  In all cases tumor remnants were visualized as hyperechoic areas on B-mode, highlighted as CEUS-positive areas, and confirmed as tumoral areas on histopathological analysis. In 1 case only, CEUS partially failed to demonstrate residual tumor because the residual hyperechoic area was devascularized prior to ultrasound contrast agent injection. In all cases CEUS enhanced B-mode findings.
  
  
  CONCLUSIONS
  As has already been shown in other neoplastic lesions in other organs, CEUS is extremely specific in the identification of residual tumor. The ability of CEUS to distinguish between tumor and artifacts or normal brain on B-mode is based on its capacity to show the vascularization degree and not the echogenicity of the tissues. Therefore, CEUS can play a decisive role in the process of maximizing GBM resection.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Francesco
authors.initials: F
authors.lastname: Prada
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Massimiliano Del
authors.initials: MD
authors.lastname: Bene
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Fornaro
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Ignazio G
authors.initials: IG
authors.lastname: Vetrano
authors.affiliation: Department of Radiology, Ospedale Valduce, Como;
authors.forename: Alberto
authors.initials: A
authors.lastname: Martegani
authors.affiliation: Department of Radiology, Ospedale Valduce, Como;
authors.forename: Luca
authors.initials: L
authors.lastname: Aiani
authors.affiliation: Department of Radiology, IRCCS Policlinico San Donato, Milan;
authors.forename: Luca Maria
authors.initials: LM
authors.lastname: Sconfienza
authors.affiliation: Department of Radiology, IRCCS Policlinico San Donato, Milan;
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mauri
authors.affiliation: Department of Radiology, Humanitas Research Hospital, Rozzano, Italy; and.
authors.forename: Luigi
authors.initials: L
authors.lastname: Solbiati
authors.affiliation: Neuropathology, Fondazione IRCCS Istituto Neurologico C. Besta, Milan;
authors.forename: Bianca
authors.initials: B
authors.lastname: Pollo
authors.affiliation: Departments of 1 Neurosurgery and.|Department of Neurosurgery, Johns Hopkins Medical School, Baltimore, Maryland.
authors.forename: Francesco
authors.initials: F
authors.lastname: DiMeco
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D003287:Contrast Media; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D018365:Neoplasm, Residual / Q000000981:diagnostic imaging* / Q000601:surgery; D011446:Prospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: 5-ALA = 5-aminolevulinic acid; CEUS = contrast-enhanced ultrasound; EOR = extent of resection; GBM = glioblastoma multiforme; UCA = ultrasound contrast agent; contrast-enhanced ultrasound; extent of resection; glioblastoma; iCT, iMRI, iUS = intraoperative CT, MRI, US; intraoperative imaging; intraoperative ultrasound; residual tumor