Objective image analysis of real-time three-dimensional intraoperative ultrasound for intrinsic brain tumour surgery.

Content Provider	Europe PMC
Author	Camp, Sophie J. Apostolopoulos, Vasileios Raptopoulos, Vasileios Mehta, Amrish O’Neill, Kevin Awad, Mohammed Vaqas, Babar Peterson, David Roncaroli, Federico Nandi, Dipankar
Abstract	Background There is growing evidence that maximal surgical resection of primary intrinsic brain tumours is beneficial, both by improving progression free and overall survival and also by facilitating postoperative chemotherapy and radiotherapy. Hence, there has been an increase in the popularity of real-time intraoperative imaging in brain tumour surgery. The complex theatre arrangements, prohibitive cost and prolonged theatre time of intraoperative MRI have restricted its application. By comparison, intraoperative three-dimensional ultrasound (i3DUS) is user friendly, cost-effective and portable and adds little to surgical time. However, operator-dependent image quality and image interpretation remain limiting factors to the wider application of this technique. The aim of this study was to explore objective i3DUS image analysis and its potential therapeutic role in brain tumour surgery. Methods A prospective, observational study was undertaken (approved by the local Research and Ethics Committee prior to recruitment). Biopsies were taken from the solid, necrotic, periphery and brain/tumour interface of intrinsic primary brain tumours. Digital i3DUS images were analysed to extract quantitative parameters from these regions of interest (ROI) in the i3DUS images. These were then correlated with the histology of the relevant specimens. The histopathologist was blinded to the imaging findings. Results Ninety-seven patients (62 males; mean 54 years) with varying gliomas (84 high grade) were included. Two hundred and ninety regions of interest were analysed. Mean pixel brightness (MPB) and standard deviation (SD) were correlated with histological features. Close correlations were noted between MPB and cellularity, and SD and intrinsic cellular diversity. Conclusions MPB and SD are objective measures reflecting the sensitivity of i3DUS in detecting the presence and extent of intrinsic brain tumours. They indirectly suggest heterogeneity, cellularity and invasiveness, providing information of the nature of the tumour, and also reflect the sensitivity of intraoperative US to detect the presence of residual intrinsic brain tumours. Development of this paradigm will enhance i3DUS use as an adjunct in brain tumour surgery. Optimizing its intraoperative application will impact surgical resection and, hence, patient outcome.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC5311721&blobtype=pdf
Volume Number	5
DOI	10.1186/s40349-017-0084-0
PubMed Central reference number	PMC5311721
PubMed reference number	28228966
Journal	Journal of Therapeutic Ultrasound [J Ther Ultrasound]
e-ISSN	20505736
Language	English
Publisher	BioMed Central
Publisher Date	2017-02-16
Publisher Place	London
Access Restriction	Open
Rights License	Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. © The Author(s). 2017
Subject Keyword	Brain tumours Intraoperative ultrasound Image analysis
Content Type	Text
Resource Type	Article
Subject	Radiology, Nuclear Medicine and Imaging