Predicting meningioma consistency and brain-meningioma interface with intraoperative strain ultrasound elastography: a novel application to guide surgical strategy
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- Giuseppe Maria Della Pepa
- Institute of Neurosurgery and
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- Grazia Menna
- Institute of Neurosurgery and
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- Vito Stifano
- Institute of Neurosurgery and
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- Angelo Maria Pezzullo
- Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
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- Anna Maria Auricchio
- Institute of Neurosurgery and
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- Alessandro Rapisarda
- Institute of Neurosurgery and
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- Valerio Maria Caccavella
- Institute of Neurosurgery and
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- Giuseppe La Rocca
- Institute of Neurosurgery and
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- Giovanni Sabatino
- Institute of Neurosurgery and
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- Enrico Marchese
- Institute of Neurosurgery and
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- Alessandro Olivi
- Institute of Neurosurgery and
抄録
<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Providing new tools to improve surgical planning is considered a main goal in meningioma treatment. In this context, two factors are crucial in determining operating strategy: meningioma-brain interface and meningioma consistency. The use of intraoperative ultrasound (ioUS) elastosonography, a real-time imaging technique, has been introduced in general surgery to evaluate similar features in other pathological settings such as thyroid and prostate cancer. The aim of the present study was to evaluate ioUS elastosonography in the intraoperative prediction of key intracranial meningioma features and to evaluate its application in guiding surgical strategy.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>An institutional series of 36 meningiomas studied with ioUS elastosonography is reported. Elastographic data, intraoperative surgical findings, and corresponding preoperative MRI features were classified, applying a score from 0 to 2 to both meningioma consistency and meningioma-brain interface. Statistical analysis was performed to determine the degree of agreement between meningioma elastosonographic features and surgical findings, and whether intraoperative elastosonography was a better predictor than preoperative MRI in assessing meningioma consistency and slip-brain interface, using intraoperative findings as the gold standard.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A significantly high degree of reliability and agreement between ioUS elastographic scores and surgical finding scores was reported (intraclass correlation coefficient = 0.848, F = 12.147, p < 0.001). When analyzing both consistency and brain-tumor interface, ioUS elastography proved to have a rather elevated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive (LR+) and negative likelihood ratio (LR−). This consideration was true especially for meningiomas with a hard consistency (sensitivity = 0.92, specificity = 0.96, PPV = 0.92, NPV = 0.96, LR+ = 22.00, LR− = 0.09) and for those presenting with an adherent slip-brain interface (sensitivity = 0.76, specificity = 0.95, PPV = 0.93, NPV = 0.82, LR+ = 14.3, LR− = 0.25). Furthermore, predictions derived from ioUS elastography were found to be more accurate than MRI-derived predictions, as demonstrated by McNemar’s test results in both consistency (p < 0.001) and interface (p < 0.001).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>While external validation of the data is needed to transform ioUS elastography into a fully deployable clinical tool, this experience confirmed that it may be integrated into meningioma surgical planning, especially because of its rapidity and cost-effectiveness.</jats:p></jats:sec>
収録刊行物
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- Neurosurgical Focus
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Neurosurgical Focus 50 (1), E15-, 2021-01
Journal of Neurosurgery Publishing Group (JNSPG)