Intraoperative Cerebral Glioma Characterization with Contrast Enhanced Ultrasound

Figure 4

Intraoperative control of a right frontal GBM, using fusion imaging between intraoperative US (a1) and preoperative MRI (a2) linked via a navigated US probe with a virtual navigation system: (a1) shows a hyperechoic superficial lesion, with ill-defined borders and microcystic areas and in (a2) the corresponding MRI imaging is displayed. In panel (b) the B-mode imaging is enhanced with a contrast agent, showing a superficial nodular enhancement with a deeper ring enhancement delimitating a nonperfused necrotic central area. Medullary draining veins are also visible, draining towards the ependymal zone. In panel (c) the postresection control with CEUS shows the absence of the nodular ring enhancement, without contrast enhancement along the wall of the surgical cavity.