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The diagnostic properties of intraoperative ultrasound in glioma surgery and factors associated with gross total tumor resection.

Artikel i vetenskaplig tidskrift
Författare Bodil Karoline Ravn Munkvold
Asgeir Store Jakola
Ingerid Reinertsen
Lisa Millgård Sagberg
Geirmund Unsgård
Ole Solheim
Publicerad i World neurosurgery
Volym 115
Sidor e129-36
ISSN 1878-8769
Publiceringsår 2018
Publicerad vid Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap
Sidor e129-36
Språk en
Länkar dx.doi.org/10.1016/j.wneu.2018.03.2...
www.ncbi.nlm.nih.gov/entrez/query.f...
Ämneskategorier Neurokirurgi

Sammanfattning

In glioma operations, we sought to analyze sensitivity, specificity and predictive values of intraoperative 3D ultrasound (US) for detecting residual tumor compared to early postoperative MR imaging. Factors possibly associated with radiological complete resection were also explored.144 operations for diffuse supratentorial gliomas were included prospectively in an unselected, population-based single institution series. Operating surgeons filled out a questionnaire immediately after surgery, stating if residual tumor was seen with US at the end of resection and rated US image quality (good, medium, poor). Extent of surgical resection was estimated from pre- and postoperative MRI images.Overall specificity was 85% for "no tumor remnant" seen in US images at the end of resection as compared to postoperative MRI findings. Sensitivity was 46%, but tumor remnants seen on MRI were usually small (median 1.05 ml) in operations with false negative US findings. Specificity was highest in low-grade glioma operations (94%), and lowest in patients who had previously undergone radiotherapy (50%). Smaller tumor volume and superficial location were factors significantly associated with gross total resection in a multivariable logistic regression analysis, while good ultrasound image quality did not reach statistical significance (p = 0.061).The specificity of intraoperative US is rather good, but sensitivity for detecting the last milliliter is low compared to postoperative MRI. Tumor volume and tumor depth are the predictors of achieving gross total resection, while ultrasound image quality was not.

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