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BioMed Research International
Volume 2014, Article ID 484261, 9 pages
Clinical Study

Intraoperative Cerebral Glioma Characterization with Contrast Enhanced Ultrasound

1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico “C. Besta”, 20133 Milan, Italy
2Università degli Studi di Milano, 20122 Milan, Italy
3Department of Radiology, Ospedale Valduce, 22100 Como, Italy
4Department of Radiology, Ospedale di Circolo, 21052 Busto Arsizio, Italy
5Department of Neurosurgery, Johns Hopkins Medical School, Baltimore, MD 21218, USA

Received 13 February 2014; Accepted 1 May 2014; Published 12 June 2014

Academic Editor: Gustavo Pradilla

Copyright © 2014 Francesco Prada et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Contrast enhanced ultrasound (CEUS) is a dynamic and continuous modality providing real-time view of vascularization and flow distribution patterns of different organs and tumors. Nevertheless its intraoperative use for brain tumors visualization has been performed few times, and a thorough characterization of cerebral glioma had never been performed before. Aim. To perform the first characterization of cerebral glioma using CEUS and to possibly achieve an intraoperative differentiation of different gliomas. Methods. We performed CEUS in an off-label setting in 69 patients undergoing surgery for cerebral glioma. An intraoperative qualitative analysis was performed comparing iCEUS with B-mode imaging. A postprocedural semiquantitative analysis was then performed for each case, according to EFSUMB criteria. Results were related to histopathology. Results. We observed different CE patterns: LGG show a mild, dotted CE with diffuse appearance and slower, delayed arterial and venous phase. HGG have a high CE with a more nodular, nonhomogeneous appearance and fast perfusion patterns. Conclusion. Our study characterizes for the first time human brain glioma with CEUS, providing further insight regarding these tumors’ biology. CEUS is a fast, safe, dynamic, real-time, and economic tool that might be helpful during surgery in differentiating malignant and benign gliomas and refining surgical strategy.