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© 2009 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 28:191-203 • 0278-4297

Technical Advance

An Intraoperative Brain Shift Monitor Using Shear Mode Transcranial Ultrasound

Preliminary Results

P. Jason White, PhD, Stephen Whalen, BS, Sai Chun Tang, PhD, Greg T. Clement, PhD, Ferenc Jolesz, MD and Alexandra J. Golby, MD

Departments of Radiology (P.J.W., S.C.T., G.T.C., F.J.) and Neurosurgery (S.W., A.J.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts USA.

Address correspondence to P. Jason White, PhD, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Ave, EBRC 521, Boston, MA 02115 USA. E-mail: white{at}bwh.harvard.edu

Objective. Various methods of intraoperative structural monitoring during neurosurgery are used to localize lesions after brain shift and to guide surgically introduced probes such as biopsy needles or stimulation electrodes. With its high temporal resolution, portability, and nonionizing mode of radiation, ultrasound has potential advantages over other existing imaging modalities for intraoperative monitoring, yet ultrasound is rarely used during neurosurgery largely because of the craniotomy requirement to achieve sufficiently useful signals. Methods. Prompted by results from recent studies on transcranial ultrasound, a prototype device that aims to use the shear mode of transcranial ultrasound transmission for intraoperative monitoring was designed, constructed, and tested with 10 human participants. Magnetic resonance images were then obtained with the device spatially registered to the magnetic resonance imaging (MRI) reference coordinates. Peaks in both the ultrasound and MRI signals were identified and analyzed for both spatial localization and signal-to-noise ratio (SNR). Results. The first results aimed toward validating the prototype device with MRI showed an excellent correlation (n = 38; R2 = 0.9962) between the structural localization abilities of the two modalities. In addition, the overall SNR of the ultrasound backscatter signals (n = 38; SNR = 25.4 ± 5.2 dB, mean ± SD) was statistically equivalent to that of the MRI data (n = 38; SNR = 22.5 ± 4.8 dB). Conclusions. A statistically significant correlation of localized intracranial structures between intraoperative transcranial ultrasound monitoring and MRI data was achieved with 10 human participants. We have shown and validated a prototype device incorporating transcranial shear mode ultrasound for clinical monitoring applications.

Key Words: brain shift • monitor • neurosurgery • transcranial • ultrasound

Abbreviations: FOV, field of view • FSPGR, fast spoiled gradient echo • ICSF, insular cortex/sylvian fissure • ITUM, intraoperative transcranial ultrasound monitor • MRI, magnetic resonance imaging • SE, spin echo • SNR, signal-to-noise ratio • TE, echo time • 3D, 3-dimensional • TR, repetition time

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Copyright © 2009 by the American Institute of Ultrasound in Medicine.