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  • Residual Tumor Identification with Intra-operative Contrast-enhanced Ultrasound During Glioblastoma Resection

    Final Number:

    Francesco Prada MD; Massimiliano Del Bene; Riccardo Fornaro; Ignazio G. Vetrano MD; Alberto Martegani; Luca Aiani; Luca Maria Sconfienza; Giovanni Mauri; Luigi Solbiati; Bianca Pollo MD; Francesco DiMeco MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Our purpose was to assess contrast-enhanced ultrasound (CEUS) capability to identify residual tumor mass during glioblastoma (GBM) surgery, in order to increase the extent of resection.

    Methods: We 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 were localized within the surgical field with navigated ultrasound and 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 hystopathological analysis. In 1 case only CEUS partially failed to demonstrate residual tumor because the residual hyperehoic area was devascularized prior to ultrasound contrast agent injection. In all cases CEUS enhanced B-mode findings.

    Conclusions: As already shown in other neoplastic lesions in other organs CEUS is extremely specific in the identification of residual tumor. CEUS distinction between tumor and artifacts/normal brain on B-mode is based on its capability 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 surgical resection.

    Patient Care: UCA can play a decisive role in the process of maximizing surgical resection as they precisely identify and locate neoplastic tissue, both prior and after resection, allowing for safe removal.

    Learning Objectives: To understand CEUS role in identifying residual tumor mass in GBMs’ surgery, thus enhancing tumor resection


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