Using Real-Time Fusion Imaging Constructed from Contrast-Enhanced Ultrasonography and Magnetic Resonance Imaging for High-Grade Glioma in Neurosurgery

OBJECTIVE: To compare the observation of high-grade glioma (HGG) based on intraoperative multiplane ultrasonography (US) images and preoperative reconstructive coplanar T1-weighted enhanced magnetic resonance imaging (MRI) using volume navigation (V Nav) fusion image technology. METHODS: We retrospectively evaluated intraoperative data obtained from 16 patients diagnosed with HGG (grade III and IV). Overall, 18 nodules observed in 15 patients were examined. HGG images from US and contrast-enhanced US (CEUS) were compared with those from preoperative reconstructive coplanar enhanced T1-weighted MRI using automatic V Nav fusion image technology. RESULTS: All HGG tumors were detected. Images of 13 of 18 tumors (72.2%) with obscure margins using B-mode US were improved with clear tumor boundaries using CEUS imaging. The relative difference in tumor area between CEUS and enhanced MRI modalities in 14 mainly solid component lesions was considered statistically significant (P value < 0.05). There was a perfect correlation of the enhanced area between coplanar CEUS and enhanced MRI. CONCLUSIONS: The V Nav fusion image system combining intraoperative real-time US imaging with reconstructive preoperative coplanar MRI is valuable for imageguided HGG resection. It is suitable for neurosurgeons who lack the expertise in US technology to discern the brain structure and allows better recognition of tumor and edema tissues comparedwith reconstructive preoperative coplanar-enhanced MRI in real time and in multiplane from different angles. In addition, CEUS combined with B-mode US could improve tumor detection and resection control in neurosurgery, even in single US-guided operations.