Abstract
Objective
The objective was to assess intraoperative contrast-enhanced ultrasound (CEUS) in
traumatic brain surgery.
Methods
We prospectively performed intraoperative conventional ultrasound (IOUS) and CEUS
in 32 patients who underwent emergency surgery for the treatment of traumatic brain
injury (TBI). Sonographic appearance including echogenicity, border, and size of the
traumatic lesion and adjacent brain tissue on CEUS were compared with those on IOUS
using surgical results as the gold standard. The differences in the size and contrast
enhancement parameters of the lesions between IOUS and CEUS were analyzed with a paired
t test.
Results
The accuracy of CEUS in assessing TBI was 100%, whereas IOUS was 51%. The absolute
peak intensity (API) varied depending on the severity of brain injury. Lower API was
observed in severely damaged brain tissue, whereas high API was seen in normal brain
tissue or the brain tissue with mild injury. The border of the trauma lesion was more
clearly defined on CEUS when compared to IOUS. The size of the lesions measured on
CEUS was significantly larger than that on IOUS (P<.01). Importantly, small vessels supplying blood to the tissue in traumatic lesions,
as an indication of possible brain vitality, were optimized on CEUS during the surgery.
Based on the parameter of time intensity curve and appearances of the lesions on CEUS,
the severity of lesions was reclassified and surgical intervention was redesigned
in 21 (21/32, 66%) cases.
Conclusion
Intraoperative CEUS improves accuracy in classification of traumatic brain injury,
which helps neurosurgeons to effectively remove hematoma, preserve normal brain tissue,
and prevent damaging the vessels during surgical intervention.
Keywords
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Article info
Publication history
Published online: September 12, 2013
Accepted:
August 1,
2013
Received:
July 23,
2013
Footnotes
☆This study was supported by Capital Medical Development Grant (2005–2025).
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
