改进超声技术在脑胶质瘤术中应用

Application of technologically improved high-resolution ultrasound in brain glioma resections

目的改进术中超声技术,评价超声在脑胶质瘤术中判断残余肿瘤价值。方法选择高频(12 MHz)专用术中探头,采用残腔腔内与残腔表面扫查结合的检查方法,在37例拟行肿瘤根治术脑胶质瘤患者常规显微手术结束时行超声检查。将超声影像与病理组织学检查结果对比,评价超声判断胶质瘤残余肿瘤的能力和价值。结果通过改进扫查方法,可获得高质量术中影像,降低了病理基础不确定的超声征象的出现率,避免了其对诊断的干扰。本组脑胶质瘤术中超声诊断残余肿瘤敏感性、特异性及准确性分别为65．71%(23/35)、98．34%(178/181)和93．06%(201/216)。假阴性诊断中的91．67%(11/12)发生于高分级胶质瘤,以胶质母细胞瘤明显。结论通过改进检查技术,获得高质量术中实时影像,超声可作为脑胶质瘤手术术中判断残余肿瘤安全可靠的影像手段。

Objective To evaluate the intra-operative high-resolution ultrasound with some technological improvements as a tool of detecting residual glioma. Methods With 12 MHz high frequency sonoprobe, using technologically improved high-resolution ultrasound, 37 gliomas were examined at the end of conventional microneurosurgery, Gross total resection was achieved in all patients, The biopsy specimens were matched with every positive sonographic site as well as with every negative resection cavity in 5 sites. Results With the benefits of intraoperative probe and new technique, the appearance of the sonographic signs, matched with inhomogeneous histopathologic results, had been reduced. Sensitivity, specificity and accuracy of improved ultrasound in detecting residual tumor were 65.71% （23/35）, 98.34% （178/181） and 93.06% （201/216）, respectively. 91.67%（11/12） of the ultrasonic pseudo-negative cases occurred in high-grade glioma, especially glioblastoma. Conclusion With proper technological adjustments and then high imaging quality, intra-operative ultrasound could be used as a reliable real-time imaging measure with great security for detecting residual glioma.