• World Neurosurg · Sep 2024

    Intraoperative comparison between strain elastography and pre-operative MRI features in high-grade gliomas using fusion imaging: a pilot study.

    • Antonio Giulio Gennari, Fabio Martino Doniselli, Justin Coley, Marina Grisoli, Emilio Quaia, Remi Souchon, Francesco Prada, and Francesco DiMeco.
    • Department of Neuropediatrics, University Children's Hospital, Zurich, Switzerland; Center for MR Research, University Children's Hospital, Zurich, Switzerland.
    • World Neurosurg. 2024 Sep 10.

    ObjectiveTo compare the elastographic patterns of high-grade gliomas (HGGs) solid portions and those of adjacent healthy brain parenchyma, on intraoperative ultrasound, with magnetic resonance image (MRI) characteristics.MethodsClinical records and images of HGGs patients, operated between June and December 2018, were retrospectively reviewed. Fusion images were used to compare preoperative gadolinium-enhanced T1-weighted MRI/fluid-attenuated inversion recovery images (Gd-T1 MRI/FLAIR) to intraoperative strain elastography (SE). FLAIR/Gd-T1 MRI images were used to define enhancement patterns (absent/whole lesion/peripheral) and lesions' characteristics (primary and secondary pattern, further subdivided in solid/necrotic/cystic/infiltrating). HGGs SE patterns were categorized as homogeneous/inhomogeneous, while lesions' primary and secondary patterns as stiff/intermediate/elastic. The SE motive of neighboring healthy brain parenchyma was defined similarly.ResultsEighteen patients (M:F, 11:7; mean age: 53 years) harboring 14 glioblastomas (77.8%) and 4 anaplastic astrocytomas (22.2%) were compared. Glioblastomas typically enhanced peripherally and had a primary necrotic pattern (78.6% and 64.3%, respectively), while anaplastic astrocytomas did not enhance and were solid (75% both) at T1-Gd MRI and FLAIR images. At SE anaplastic astrocytomas had a homogeneous stiff primary pattern, whereas the majority of glioblastomas primary patterns were heterogeneous (85.7%) and intermediate (78.6%).ConclusionsThree major SE patterns defined HGGs and adjacent healthy brain parenchyma. SE patterns varied according to HGG histotypes and Gd-T1 MRI/FLAIR characteristics.Copyright © 2024 Elsevier Inc. All rights reserved.

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