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J Neurol Surg A Cent Eur Neurosurg 2020; 81(03): 213-219
DOI: 10.1055/s-0039-1696680
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Quantitative Analysis of Superb Microvascular Imaging versus Color-Coded Doppler Sonography for Preoperative Evaluation of Vascularization of Schwannomas

Christopher Kloth
1   Department of Diagnostic and Interventional Radiology, Universitaet Ulm Medizinische Fakultaet, Ulm, Baden-Württemberg, Germany
,
Alexandra Eissler
2   Department of Internal Medicine I, Universitaet Ulm Medizinische Fakultaet, Ulm, Baden-Württemberg, Germany
,
Julian Schmidberger
2   Department of Internal Medicine I, Universitaet Ulm Medizinische Fakultaet, Ulm, Baden-Württemberg, Germany
,
Tillmann Gräter
1   Department of Diagnostic and Interventional Radiology, Universitaet Ulm Medizinische Fakultaet, Ulm, Baden-Württemberg, Germany
,
Angelika Scheuerle
3   Department of Neuropathology, Universitaet Ulm Medizinische Fakultaet, Ulm, Baden-Württemberg, Germany
,
Wolfgang Kratzer
2   Department of Internal Medicine I, Universitaet Ulm Medizinische Fakultaet, Ulm, Baden-Württemberg, Germany
,
Maria Teresa Pedro
4   Department of Neurosurgery, University of Ulm, Guenzburg, Germany
› Author Affiliations
Further Information

Publication History

27 January 2019

30 April 2019

Publication Date:
27 November 2019 (online)

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Abstract

Purpose Comparison of vascularization of schwannomas, benign peripheral nerve sheath tumors, using color-coded Doppler sonography (CCDS) and the Toshiba monochrome Superb Microvascular Imaging (mSMI) (Minato, Tokyo, Japan) technique.

Methods In a retrospective single-center analysis, 16 patients were identified with histologically confirmed schwannomas. Between March and June 2018, all of them underwent ultrasonography using mSMI and CCDS before surgery. Schwannoma vascularization was quantitatively measured using ImageJ, an open platform for scientific image analysis. As the diagnostic gold standard, magnetic resonance imaging was mandatory.

Results The mSMI and CCDS vascularization showed a moderate agreement between the techniques (κ = 0.5556; p = 0.0066). The quantitative visual assessment of the vascularization revealed no difference (25.3 ± 8.2 vs. 18.2 ± 3.8; p = 0.0532). Significant differences were found for the quantitative assessment of CCDS with ImageJ (26.8 ± 8.8 vs. 19.3 ± 2.8; p = 0.0368). However, in a subanalysis of highly vascularized schwannomas, mSMI revealed significant differences to slightly vascularized schwannomas (32.0 ± 8.2 vs. 21.3 ± 6.1; p = 0.0065) but not between moderately and slightly vascularized types (p = not significant).

Conclusion The mSMI mode is qualitatively superior to conventional CCDS; however, quantitative analysis of the vascularization of schwannomas revealed no significant quantitative advantage for mSMI. Nevertheless, the mean ImageJ values showed a positive trend toward a better representation of the vascularization degree of schwannomas with mSMI.

Keywords

schwannoma - neurosonography - monochrome Superb Microvascular Imaging - benign peripheral nerve sheath tumor

Ethical Statement

The study was approved by the local ethics committee and was conducted in accordance with the Declaration of Helsinki (Ref. no. 115/18). Informed consent was obtained from all patients before inclusion in the study.


 

  • References

  • 1 Desai KI. The surgical management of symptomatic benign peripheral nerve sheath tumors of the neck and extremities: an experience of 442 cases. Neurosurgery 2017; 81 (04) 568-580
    CrossrefPubMedGoogle Scholar
  • 2 Ho M, Lutz AM. Tumors of peripheral nerves [in German]. Radiologe 2017; 57 (03) 204-212
    CrossrefPubMedGoogle Scholar
  • 3 Montano N, D'Alessandris QG, D'Ercole M. , et al. Tumors of the peripheral nervous system: analysis of prognostic factors in a series with long-term follow-up and review of the literature. J Neurosurg 2016; 125 (02) 363-371
    PubMedGoogle Scholar
  • 4 Abreu E, Aubert S, Wavreille G, Gheno R, Canella C, Cotten A. Peripheral tumor and tumor-like neurogenic lesions. Eur J Radiol 2013; 82 (01) 38-50
    CrossrefPubMedGoogle Scholar
  • 5 Kopf H, Loizides A, Mostbeck G. , et al. Diagnostic sonography of peripheral nerves: indications, examination techniques and pathological findings [in German]. Ultraschall Med 2011; 32: 242-266
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Bendix N, Wolf C, Gruber H, Bodner G. Sonographisches Bildessay: Periphere Nerventumoren. Ultraschall Med 2005; 26 (04) 318-324 ; quiz 264–266.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Karaman İ, Öner M, Kafadar IH, Güney A, Argun M. Surgical excision of peripheral nerve schwannomas: analysis of 11 patients. Acta Orthop Traumatol Turc 2015; 49 (02) 139-143
    CrossrefPubMedGoogle Scholar
  • 8 Gosk J, Gutkowska O, Mazurek P, Koszewicz M, Ziółkowski P. Peripheral nerve tumours: 30-year experience in the surgical treatment. Neurosurg Rev 2015; 38 (03) 511-520 ; discussion 521
    CrossrefPubMedGoogle Scholar
  • 9 Karsy M, Guan J, Ravindra VM, Stilwill S, Mahan MA. Diagnostic quality of magnetic resonance imaging interpretation for peripheral nerve sheath tumors: can malignancy be determined?. J Neurol Surg A Cent Eur Neurosurg 2016; 77 (06) 495-504
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Yu YH, Wu JT, Ye J, Chen MX. Radiological findings of malignant peripheral nerve sheath tumor: reports of six cases and review of literature. World J Surg Oncol 2016; 14: 142
    CrossrefPubMedGoogle Scholar
  • 11 León Cejas L, Binaghi D, Socolovsky M. , et al. Intraneural perineuriomas: diagnostic value of magnetic resonance neurography. J Peripher Nerv Syst 2018; 23 (01) 23-28
    CrossrefPubMedGoogle Scholar
  • 12 Chhabra A, Madhuranthakam AJ, Andreisek G. Magnetic resonance neurography: current perspectives and literature review. Eur Radiol 2018; 28 (02) 698-707
    CrossrefPubMedGoogle Scholar
  • 13 Matsumine A, Kusuzaki K, Nakamura T. , et al. Differentiation between neurofibromas and malignant peripheral nerve sheath tumors in neurofibromatosis 1 evaluated by MRI. J Cancer Res Clin Oncol 2009; 135 (07) 891-900
    CrossrefPubMedGoogle Scholar
  • 14 Madi S, Pandey V, Mannava K, Acharya K. A benign ancient schwannoma of the tibia nerve. BMJ Case Rep 2016; 2016: bcr2016215620
    PubMedGoogle Scholar
  • 15 Crist J, Hodge JR, Frick M. , et al. Magnetic resonance imaging appearance of schwannomas from head to toe: a pictorial review. J Clin Imaging Sci 2017; 7: 38
    CrossrefPubMedGoogle Scholar
  • 16 Koenig RW, Pedro MT, Heinen CP. , et al. High-resolution ultrasonography in evaluating peripheral nerve entrapment and trauma. Neurosurg Focus 2009; 26 (02) E13
    PubMedGoogle Scholar
  • 17 Koenig RW, Schmidt TE, Heinen CP. , et al. Intraoperative high-resolution ultrasound: a new technique in the management of peripheral nerve disorders. J Neurosurg 2011; 114 (02) 514-521
    CrossrefPubMedGoogle Scholar
  • 18 Jacobson JA, Wilson TJ, Yang LJ-S. Sonography of common peripheral nerve disorders with clinical correlation. J Ultrasound Med 2016; 35 (04) 683-693
    CrossrefPubMedGoogle Scholar
  • 19 Pedro MT, Antoniadis G, Scheuerle A, Pham M, Wirtz CR, Koenig RW. Intraoperative high-resolution ultrasound and contrast-enhanced ultrasound of peripheral nerve tumors and tumorlike lesions. Neurosurg Focus 2015; 39 (03) E5
    PubMedGoogle Scholar
  • 20 Ayaz E, Ayaz M, Önal C, Yıkılmaz A. Seeing the unseen: evaluating testicular vascularity in neonates by using the Superb Microvascular Imaging ultrasound technique. J Ultrasound Med 2019; 38 (07) 1847-1854
    CrossrefPubMedGoogle Scholar
  • 21 Goeral K, Hojreh A, Kasprian G. , et al. Microvessel ultrasound of neonatal brain parenchyma: feasibility, reproducibility, and normal imaging features by Superb Microvascular Imaging (SMI). Eur Radiol 2019; 29 (04) 2127-2136
    CrossrefPubMedGoogle Scholar
  • 22 Hata J. Medical review: Seeing the unseen: new techniques in vascular imaging. Toshiba Medical Systems. 2014 : Available at: https://pdfs.semanticscholar.org/cd4b/b692fc285cc65791de0034c0229fc3411daa.pdf . Accessed October 10, 2019
    PubMedGoogle Scholar
  • 23 Machado P, Segal S, Lyshchik A, Forsberg F. A novel microvascular flow technique: initial results in thyroids. Ultrasound Q 2016; 32 (01) 67-74
    CrossrefPubMedGoogle Scholar
  • 24 Ohno Y, Fujimoto T, Shibata Y. A new era in diagnostic ultrasound, Superb Microvascular Imaging: preliminary results in pediatric hepato-gastrointestinal disorders. Eur J Pediatr Surg 2017; 27 (01) 20-25
    PubMedGoogle Scholar
  • 25 Ma Y, Li G, Li J, Ren WD. The diagnostic value of Superb Microvascular Imaging (SMI) in detecting blood flow signals of breast lesions: a preliminary study comparing SMI to color Doppler flow imaging. Medicine (Baltimore) 2015; 94 (36) e1502
    PubMedGoogle Scholar
  • 26 Chen J, Chen L, Wu L. , et al. Value of Superb Microvascular Imaging ultrasonography in the diagnosis of carpal tunnel syndrome: compared with color Doppler and power Doppler. Medicine (Baltimore) 2017; 96 (21) e6862
    PubMedGoogle Scholar
  • 27 Karaca L, Oral A, Kantarci M. , et al. Comparison of the Superb Microvascular Imaging technique and the color Doppler techniques for evaluating children's testicular blood flow. Eur Rev Med Pharmacol Sci 2016; 20 (10) 1947-1953
    PubMedGoogle Scholar
  • 28 Rasband WS. . ImageJ. U.S. National Institutes of Health. Bethesda, MD: NIH; 1997–2015. https://imagej.nih.gov/ij/
    PubMed
  • 29 Rasband WS. . ImageJ. U.S. National Institutes of Health. Bethesda, MD: NIH; 1997–2106. http://imagej.nih.gov/ij/
    PubMed
  • 30 Böhringer HJ, Lankenau E, Stellmacher F, Reusche E, Hüttmann G, Giese A. Imaging of human brain tumor tissue by near-infrared laser coherence tomography. Acta Neurochir (Wien) 2009; 151 (05) 507-517 ; discussion 517
    CrossrefPubMedGoogle Scholar
  • 31 Henry FP, Wang Y, Rodriguez CL. , et al. In vivo optical microscopy of peripheral nerve myelination with polarization sensitive-optical coherence tomography. J Biomed Opt 2015; 20 (04) 046002
    CrossrefPubMedGoogle Scholar
  • 32 He MN, Lv K, Jiang YX, Jiang TA. Application of Superb Microvascular Imaging in focal liver lesions. World J Gastroenterol 2017; 23 (43) 7765-7775
    CrossrefPubMedGoogle Scholar
  • 33 Mao Y, Mu J, Zhao J, Zhao L, Xin X. The value of Superb Microvascular Imaging in differentiating benign renal mass from malignant renal tumor: a retrospective study. Br J Radiol 2018; 91 (1082): 20170601
    PubMedGoogle Scholar
  • 34 Park AY, Seo BK, Woo OH. , et al. The utility of ultrasound superb microvascular imaging for evaluation of breast tumour vascularity: comparison with colour and power Doppler imaging regarding diagnostic performance. Clin Radiol 2018; 73 (03) 304-311
    CrossrefPubMedGoogle Scholar
  • 35 Durmaz MS, Sivri M. Comparison of Superb Micro-Vascular Imaging (SMI) and conventional Doppler imaging techniques for evaluating testicular blood flow. J Med Ultrason (2001) 2018; 45 (03) 443-452
    CrossrefPubMedGoogle Scholar
  • 36 Abràmoff MD, Magalhães PJ, Ram SJ. Image processing with ImageJ. Biophoton Int 2004; 11: 36-42
    PubMedGoogle Scholar
  • 37 Zink F, Kratzer W, Schmidt S. , et al. Comparison of two high-end ultrasound systems for contrast-enhanced ultrasound quantification of mural microvascularity in Crohn's DIsease. Ultraschall Med 2016; 37 (01) 74-81
    Article in Thieme ConnectPubMedGoogle Scholar