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© 2005 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 24:985-992 • 0278-4297

Technical Advance

Vibrography During Tumor Neurosurgery

Martin Scholz, MD, PhD, Volker Noack, Ioannis Pechlivanis, MD, Martin Engelhardt, MD, Britta Fricke, MD, Ulf Linstedt, MD, PhD, Bernhard Brendel, Dipl Ing, Kirsten Schmieder, MD, PhD, Helmut Ermert, PhD and Albrecht Harders, MD, PhD

Department of Neurosurgery (M.S., V.N., I.P., M.E., K.S., A.H.), Institute of High Frequency Engineering (B.B., H.E.), Department of Neuroanatomy (B.F.), and Department of Anesthesiology and Surgical Intensive Care Medicine (U.L.), Ruhr University Bochum, Bochum, Germany.

Address correspondence to Martin Scholz, MD, PhD, Department of Neurosurgery, Ruhr University Bochum, Knappschaftskrankenhaus, In der Schornau 23–25, 44892 Bochum, Germany. E-mail: martin.scholz{at}ruhr-uni-bochum.de

Objective. The aim of this study was to determine whether elastography, a sonographically based real-time strain imaging method for registering the elastic properties of tissue, can be used in brain tumor surgery. Methods. A modification of classic elastography called vibrography was applied in these measurements with static compression replaced by low-frequency axial vibration. Twenty patients were examined with this technique during brain tumor surgery. A conventional sonographic system with a custom-designed radio frequency (RF) interface was used. The RF data were digitized with a 50-MHz, 12-bit peripheral component interconnect analog/digital converter for real-time or offline processing. Sonographic RF data were acquired with a 6.5-MHz endocavity curved array. A special applicator equipped with a stepping motor moved the ultrasonic probe and produced a low-frequency mechanical vibration of approximately 5 to 10 Hz with a vibration amplitude of 0.3 mm. Results. Detection of tumors was possible in 18 of 20 cases. Brain tissue was normally color coded orange or red. Three major groups of tumors with different elastic properties relative to brain tissue could be differentiated. In 3 cases, the stiffness of the tumor was identical to that of brain tissue, but the tumors were surrounded by a thin yellow border. Six tumors displayed higher strain than brain, whereas 7 tumors exhibited lower strain than the surrounding cerebrum. Two patients could not be assigned clearly to either of these groups. Conclusions. These findings indicate that vibrography is a feasible imaging method for brain tumor surgery and may have numerous potential applications in neurosurgery if further improvements are made.

Key Words: elastography • neuronavigation • real-time strain imaging • vibrography

Abbreviations: CT, computed tomography • ICP, intracranial pressure • MRI, magnetic resonance imaging • RF, radio frequency • WHO, World Health Organization

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Copyright © 2005 by the American Institute of Ultrasound in Medicine.