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Ultraschall Med 2016; 37(06): 584-590
DOI: 10.1055/s-0034-1399152
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

In Vivo Measurement of Brain Tumor Elasticity Using Intraoperative Shear Wave Elastography

In-vivo-Messung der Elastizität von Hirntumoren mittels intraoperativer Scherwellen-Elastografie
D. Chauvet   *
1   Neurosurgery Department, Pitié-Salpêtrière Hospital, 47–83 boulevard de l’Hôpital, Paris, France
,
M. Imbault   *
2   Langevin Institute, ESPCI ParisTech, PSL Research University, Paris, France
,
L. Capelle
1   Neurosurgery Department, Pitié-Salpêtrière Hospital, 47–83 boulevard de l’Hôpital, Paris, France
,
C. Demene
2   Langevin Institute, ESPCI ParisTech, PSL Research University, Paris, France
,
M. Mossad
2   Langevin Institute, ESPCI ParisTech, PSL Research University, Paris, France
,
C. Karachi
1   Neurosurgery Department, Pitié-Salpêtrière Hospital, 47–83 boulevard de l’Hôpital, Paris, France
,
A.-L. Boch
1   Neurosurgery Department, Pitié-Salpêtrière Hospital, 47–83 boulevard de l’Hôpital, Paris, France
,
J.-L. Gennisson
2   Langevin Institute, ESPCI ParisTech, PSL Research University, Paris, France
,
M. Tanter
2   Langevin Institute, ESPCI ParisTech, PSL Research University, Paris, France
› Author Affiliations
Further Information

Publication History

29 September 2014

23 January 2015

Publication Date:
15 April 2015 (online)

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Abstract

Purpose: Objective Shear wave elastography (SWE) enabled living tissue assessment of stiffness. This is routinely used for breast, thyroid and liver diseases, but there is currently no data for the brain. We aim to characterize elasticity of normal brain parenchyma and brain tumors using SWE.

Materials and Methods: Patients with scheduled brain tumor removal were included in this study. In addition to standard ultrasonography, intraoperative SWE using an ultrafast ultrasonic device was used to measure the elasticity of each tumor and its surrounding normal brain. Data were collected by an investigator blinded to the diagnosis. Descriptive statistics, box plot analysis as well as intraoperator and interoperator reproducibility analysis were also performed.

Results: 63 patients were included and classified into four main types of tumor: meningiomas, low-grade gliomas, high-grade gliomas and metastasis. Young’s Modulus measured by SWE has given new insight to differentiate brain tumors: 33.1 ± 5.9 kPa, 23.7 ± 4.9 kPa, 11.4 ± 3.6 kPa and 16.7 ± 2.5 kPa, respectively, for the four subgroups. Normal brain tissue has been characterized by a reproducible mean stiffness of 7.3 ± 2.1 kPa. Moreover, low-grade glioma stiffness is different from high-grade glioma stiffness (p = 0.01) and normal brain stiffness is very different from low-grade gliomas stiffness (p < 0.01).

Conclusion: This study demonstrates that there are significant differences in elasticity among the most common types of brain tumors. With intraoperative SWE, neurosurgeons may have innovative information to predict diagnosis and guide their resection.

Zusammenfassung

Ziel: Die Scherwellen-Elastografie (SWE) ermöglicht die Einschätzung der Steifigkeit von lebendem Gewebe. Sie wird routinemäßig bei Brust-, Schilddrüsen- und Lebererkrankungen angewandt, am Gehirn ist die Datenlage derzeit hingegen schlecht. Unser Ziel ist die Charakterisierung der Elastizität von normalem Hirnparenchym und von Hirntumoren mittels SWE.

Material und Methoden: Patienten mit geplanter Entfernung des Hirntumors wurden in die Studie eingeschlossen. Zusätzlich zum Routine-Ultraschall wurde die intraoperative SWE mittels UltraFAST-Ausstattung durchgeführt, um die Elastizität jedes Tumors und des umgebenden normalen Gewebes zu bestimmen. Vergleichende statistische Verfahren, Box-Plot-Analysen sowie die Auswertung der Intra- und Inter-Operator-Reproduzierbarkeit wurden ebenfalls durchgeführt.

Ergebnis: 63 Patienten wurden in die vier Haupttumortypen unterteilt: Meningeome, niedriggradige Gliome, hochgradige Gliome und Metastasen. Der mittels SWE gemessene Elastizitätskoeffizient lag für diese 4 Tumorgruppen bei 33,1 ± 5,9 kPa, 23,7 ± 4,9 kPa, 11,4 ± 3,6 kPa und 16,7 ± 2,5 kPa. Das normale Hirngewebe wurde durch eine reproduzierbare mittlere Steifigkeit von 7,3 ± 2,1 kPa charakterisiert. Darüber zeigt sich ein Unterschied in der Steifigkeit von niedriggradigen und hochgradigen Gliomen (p = 0,01), ebenso unterscheidet sich die Steifigkeit von normalem Hirngewebe sehr stark von der niedriggradiger Gliome (p < 0,01).

Schlussfolgerung: Es bestehen signifikante Unterschiede in der Elastizität der häufigsten Arten von Hirntumoren. Die intraoperative SWE kann dem Neurochirurgen neuartige Informationen für die Diagnosestellung und Unterstützung der Resektion bieten.

Key words

brain - ultrasound - surgery

* These authors contributed equally to this work (as co-first authors).


 

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