Gross pathology of brain mass lesions by intraoperative ultrasonography: a comparative study

IF 0.7 Q4 CLINICAL NEUROLOGY
Wael Abd Elrahman Ali Elmesallamy
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Abstract

The purpose of this study was to evaluate the ability of intraoperative ultrasound (IOUS) to differentiate the gross pathological features of brain mass lesions in comparison with preoperative imaging and confirmable histopathological results. A total of 365 patients were operated on for brain mass lesions removal from May 2017 to May 2022 under the guidance of intraoperative ultrasound with transducers 2.5–8 megahertz (MHZ). Ultrasound gross pathological findings were compared to the preoperative imaging and the confirmable histopathological results. Intraoperative ultrasound defined either internal or external gross pathological features of all brain mass lesions. The IOUS showed spontaneous enhancements of the brain abscess walls, which were equivalent to contrasted CT and MRI. Significantly large diameters were noted in the IOUS measurement of abscesses in comparison with CT and MRI (P = 0.001). The walls of the brain abscesses were significantly well defined in IOUS imaging in comparison with CT (P = 0.001) and equivalent to MRI. IOUS showed equivalent significance to CT and MRI in characterizing intra-parenchymal hematomas. Significantly large diameters were noted in the IOUS measurement of hematomas in comparison with CT and MRI (P = 0.001). IOUS showed significant definition of brain tumors in comparison with CT and MRI regarding tumor edge definition, tumor contours, necrosis, and cystic components (cystic definition, cystic multiplicity, cystic trabeculations, and cystic wall thickness) (P = 0.001). IOUS was equivalent to CT and MRI regarding intra-tumoral hematomas and brain edema. IOUS was equivalent to CT regarding calcification detection. The significant criteria for high-grade brain tumors versus low grade by IOUS were: P = 0.001 (necrosis, brain edema, rare calcifications, presence of cystic components, thick cystic walls, large diameter, hypo-echogenicity, and heterogeneity); P = 0.002 (cystic trabeculations); P = 0.005 (multiple cysts); and P = 0.03 (irregular contour). IOUS can characterize brain tumors and suspect specific and significant criteria for many types with great overlap. Intraoperative ultrasound has the ability to differentiate the gross pathological features of brain mass lesions in comparison with preoperative imaging and confirmable histopathological results.
通过术中超声波检查脑肿块病变的大体病理:一项比较研究
本研究旨在评估术中超声(IOUS)与术前成像和可确认的组织病理学结果相比,对脑肿块病变大体病理特征的分辨能力。2017年5月至2022年5月期间,共有365名患者在2.5-8兆赫(MHZ)换能器的术中超声引导下进行了脑肿块病灶切除手术。超声大体病理结果与术前成像和可确认的组织病理学结果进行了比较。术中超声确定了所有脑肿块病变的内部或外部大体病理特征。IOUS 显示脑脓肿壁自发增强,与对比 CT 和 MRI 相当。与 CT 和 MRI 相比,IOUS 测量的脓肿直径明显增大(P = 0.001)。与 CT 相比(P = 0.001),IOUS 成像对脑脓肿壁的清晰度有明显提高,与核磁共振成像相当。IOUS 在定性脑实质内血肿方面的意义与 CT 和 MRI 相当。与 CT 和 MRI 相比,IOUS 测量的血肿直径明显较大(P = 0.001)。与 CT 和 MRI 相比,IOUS 在肿瘤边缘定义、肿瘤轮廓、坏死和囊性成分(囊性定义、囊性多度、囊性小梁和囊壁厚度)方面显示出脑肿瘤的显著定义(P = 0.001)。在瘤内血肿和脑水肿方面,IOUS与CT和MRI相当。在钙化检测方面,IOUS与CT相当。IOUS 检测高级别脑肿瘤与低级别脑肿瘤的重要标准是P=0.001(坏死、脑水肿、罕见钙化、存在囊性成分、囊壁厚、直径大、低回声和异质性);P=0.002(囊性小梁);P=0.005(多个囊肿);P=0.03(轮廓不规则)。IOUS 可以描述脑肿瘤的特征,并对许多类型的脑肿瘤提出具体而重要的怀疑标准,而且这些标准具有很大的重叠性。与术前成像和可确认的组织病理学结果相比,术中超声能够区分脑肿块病变的大体病理特征。
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