Abstract
BackgroundImage contrast between normal tissue and brain tumours may sometimes appear to be low in intraoperative ultrasound. Ultrasound imaging of strain is an image modality that has been recently explored for intraoperative imaging of the brain. This study aims to investigate differences in image contrast between ultrasound brightness mode (B-mode) images and ultrasound strain magnitude images of brain tumours.MethodsUltrasound radiofrequency (RF) data was acquired during surgery in 15 patients with glial tumours. The data were subsequently processed to provide strain magnitude images. The contrast in the B-mode images and the strain images was determined in assumed normal brain tissue and tumour tissue at selected regions of interest (ROI). Three measurements of contrast were done in the ultrasound data for each patient. The B-mode and strain contrasts measurements were compared using the paired samples t- test.ResultsThe statistical analysis of a total of 45 measurements shows that the contrasts in the strain magnitude images are significantly higher than in the conventional ultrasound B-mode images (P < 0.0001).ConclusionsThe results indicate that ultrasound strain imaging provides better discrimination between normal brain tissue and glial tumour tissue than conventional ultrasound B-mode imaging. Ultrasound imaging of tissue strain therefore holds the potential of becoming a valuable adjunct to conventional intraoperative ultrasound imaging in brain tumour surgery.
Highlights
Image contrast between normal tissue and brain tumours may sometimes appear to be low in intraoperative ultrasound
Quantitative assessments of ultrasound strain images of brain tumours have been performed in one study, which used the natural pulsation of the brain parenchyma to generate strain images
For each glial tumour (15 cases) three analyses of contrast were done on ultrasound strain magnitude and Bmode images, giving a total of 45 measurements for each modality
Summary
Image contrast between normal tissue and brain tumours may sometimes appear to be low in intraoperative ultrasound. Even today when an operating microscope is used, the surgeon may palpate the tissue using the surgical instruments in order to find areas of the brain with differences in tissue hardness This manual inspection of tissue hardness may aid to identify remaining tumour tissue that may be difficult to detect with direct visualisation using the operating microscope. Previous studies have demonstrated strain images (elastograms) generated by the internal displacements in the brain parenchyma caused by arterial pulsation, or generated by the use of either a mechanical shaker device or manual palpation to induce tissue displacements [1,2,3]. Quantitative assessments of ultrasound strain images of brain tumours have been performed in one study, which used the natural pulsation of the brain parenchyma to generate strain images. Quantitative comparisons between ultrasound strain images and conventional brightness mode images have not been published so far
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