ITVT-05. Intraoperative Ultrasound Guidance Improves Resection In Gliomas – Results From A Single Centre Propensity Matched Comparative Cohort Analysis Of 2D Vs Navigated 3D Ultrasound In 500 Gliomas

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi228-vi229
Author(s):  
Aliasgar Moiyadi ◽  
Prakash Shetty ◽  
Vikas Singh
Keyword(s):  
Cohort Analysis ◽  
Univariate Analysis ◽  
Intraoperative Ultrasound ◽  
Positive Likelihood Ratio ◽  
3D Ultrasound ◽  
Prior Treatment ◽  
Control Mode ◽  
Glioma Surgery ◽  
Resection Control ◽  
Tumor Residue

Abstract INTRODUCTION Intraoperative ultrasound (iUS) is a promising tool for glioma surgery. Navigated 3-D (n3D) iUS has many benefits over standard 2-D iUS. METHODS This was a retrospective comparative cohort study using propensity score matching (PSM). 500 consecutive histologically confirmed gliomas were divided into 2 cohorts – 2DiUS - Cohort A; and n3DiUS -Cohort B. PSM was used to account for known confounders (250 in each group; 1:1 matching). Gross total resection rates (based on iUS findings as well as postoperative MR) and perioperative morbidity were analyzed across the groups as were factors influencing these outcomes (using univariate as well as multivariate regression models). RESULTS Overall, the majority of the patients were adults (94%), males (71%) with hemispheric tumors (96%). 35% had tumors close to eloquent regions and 23% had received some prior treatment. The majority were high-grade gliomas (85%). 2D iUS was employed mainly for localization (80%) whereas n3D was used predominantly for resection control (84%) [p < 0.001]. GTR rate was higher in the n3D cohort (55.2% vs 38.4% in 2D; p = 0.001). The odds of having a complete resection in the n3D cohort was twice that of the 2D. Prior treatment, hemispheric location, and use of fluorescence were also significantly associated with higher GTR rates on univariate analysis. On multivariate analysis, all of these remained significant. There was no difference in the morbidity rates in the two cohorts. N3D iUS had a higher specificity and positive likelihood ratio in detecting tumor residue. CONCLUSION For hemispheric gliomas undergoing resective surgery, the use of navigated 3D ultrasound improves GTR rates, with no added morbidity. It is more likely to be used for resection control mode than is 2DUS and this is probably because n3DUS is more specific and likely to pick up tumor residues contributing to its better accuracy.

389 Advanced Intraoperative Navigated Ultrasound in Brain Tumor Surgery Lessons Learnt from a Personal Experience of 300 Cases

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 293-293
Author(s):  
Aliasgar V Moiyadi
Keyword(s):  
Brain Tumor ◽  
Malignant Gliomas ◽  
Tumor Resection ◽  
3D Ultrasound ◽  
Small Subset ◽  
Neurosurgical Procedures ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Resection Control ◽  
Tumor Residue

Abstract INTRODUCTION Navigated 3D-ultrasound (nUS) is a powerful and multi-purpose adjunct during tumor resections. We review our cumulative results in a dedicated neuro-oncology service spanning a six year period, highlighting its role in glioma surgery. METHODS Since 2011 we have been used a navigated 3D ultrasound system for intraoperative image guidance during brain tumor surgery in 300 cases. A prospectively updated database was queried to retrieve demographic, clinico-radiological and pathological details. Specifically, we evaluated the utility of the IOUS in different setups and assessed its predictive accuracy and impact on extent of resection (EOR) as well as survival in gliomas. RESULTS >300 (204 males/96 females) brain tumors were operated [197 high grade gliomas, 28 LGG, 24 Meningiomas, and 51 other tumors]. Radical resection/debulking was intended in 270 (90%). In 30 (10%), only frameless biopsy was performed. The US was intended for resection control in 219 (73%) tumors, most of them being intrinsic gliomas. Intermediate scans prompted further resection in 101 cases (46%). A final resection control scan was performed in 176 cases (confirming complete excision in 99, and residual tumor which could not be further resected in 77). The nUS was a very useful tool in tumor surgery, providing a good diagnostic accuracy (85-90%) in predicting tumor residue. It also helped us improve the EOR in malignant gliomas as well as non-enhancing gliomas. In the subset of resectable tumors, the gross total resection rate was 88%. Further, in a small subset of malignant gliomas, we demonstrated that it helps extend tumor resection beyond the contrast enhancement zone. In GBMs, in a multivariate model, use of the nUS was an independent predictor of survival. CONCLUSION Considering the ease of use, widespread accessibility and low-cost nature, IOUS can be a potentially useful adjunct during a range of neurosurgical procedures, especially tumor resections.

scholarly journals Application of Multiparametric Intraoperative Ultrasound in Glioma Surgery

2021 ◽  
Vol 2021 ◽  
pp. 1-18
Author(s):  
Ji Shi ◽  
Ye Zhang ◽  
Bing Yao ◽  
Peixin Sun ◽  
Yuanyuan Hao ◽  
...  
Keyword(s):  
Real Time ◽  
Low Cost ◽  
Three Dimensional ◽  
Intraoperative Ultrasound ◽  
Ultrasound Elastography ◽  
Primary Malignancy ◽  
Glioma Surgery ◽  
Attractive Option ◽  
Ultrasound Technology ◽  
Shape Descriptions

Gliomas are the most invasive and fatal primary malignancy of the central nervous system that have poor prognosis, with maximal safe resection representing the gold standard for surgical treatment. To achieve gross total resection (GTR), neurosurgery relies heavily on generating continuous, real-time, intraoperative glioma descriptions based on image guidance. Given the limitations of currently available equipment, developing a real-time image-guided resection technique that provides reliable functional and anatomical information during intraoperative settings is imperative. Nowadays, the application of intraoperative ultrasound (IOUS) has been shown to improve resection rates and maximize brain function preservation. IOUS, which presents an attractive option due to its low cost, minimal operational flow interruptions, and lack of radiation exposure, is able to provide real-time localization and accurate tumor size and shape descriptions while helping distinguish residual tumors and addressing brain shift. Moreover, the application of new advancements in ultrasound technology, such as contrast-enhanced ultrasound, three-dimensional ultrasound, navigable ultrasound, ultrasound elastography, and functional ultrasound, could help to achieve GTR during glioma surgery. The current review describes current advancements in ultrasound technology and evaluates the role and limitation of IOUS in glioma surgery.

MO558ROLE OF ANEMIA ON PROGRESSION AND CLINICAL OUTCOMES OF CKD: A PATIENT-LEVEL, RETROSPECTIVE, COHORT ANALYSIS OF A CKD OUTPATIENTS POPULATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Sara Fernandes ◽  
Beatriz Donato ◽  
Adriana Paixão Fernandes ◽  
Luís Falcão ◽  
Mário Raimundo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Cohort Analysis ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Multivariate Logistic Regression ◽  
Ckd Progression ◽  
Patient Level

Abstract Background and Aims Anemia is a well-know complication of Chronic Kidney Disease (CKD) and it seems to contribute for deterioration of kidney function. Experimental data suggest that anemia produces hypoxia of tubular cells which leads to tubulointerstitial damage resulting on CKD progression. Other mechanism described is that red blood cells have antioxidant properties that prevent the damage of tubulointerstitial cells and glomerulosclerosis from oxidative stress. There aren’t many observational studies that evaluated the association between anemia and progression of CKD. Therefore, our aim was to evaluate the association of anemia and CKD progression and its association outcomes in an outpatient ND-CKD population. Method We conduct a retrospective, patient-level, cohort analysis of all adult ND-CKD patients evaluated in an outpatient nephrology clinic over a 6 years period. The follow up time was at least 12 months. Anemia was defined according to the WHO definition (hemoglobin [hb] < 13.0 g/dL in men and 12.0 g/dL in women). Progression of CKD was defined by one of the following criteria: decline in eGFR (CKD-EPI) superior to 5 ml/min/1.73 m2/year; duplication of serum creatinine or the need renal replacement therapy. Demographics and clinical data were also accessed. Results Out of 3008 patients referred to the nephrology clinic, 49.9% had anemia (mean age 71.9±15.9 years; 50.4% male; 92% white; mean follow-up time of 2.3±1.2 years). The mean Hb was 11.8 ±1.9 g/dL. Important cardiovascular comorbidities in patients with anemia were arterial hypertension (86.7%), obesity (65.5%), Diabetes Mellitus (DM) (52%) and dyslipidemia (46%). In univariate analysis, mortality was associated with anemia (36.9 vs 13.0%, p<0.001), obesity (30.1 vs 21.8%, p<0.001) and DM (30.1 vs 21.1%, p<0.001). Of the patients with anemia, 738 met the criteria for CKD progression. In univariate analysis, CKD progression was associated with anemia (49.6 vs 43.9%, p=0.002), male gender (49.5 vs 43.6% p= 0.001); DM (49.6 vs 44.8 % p=0.009) and hypertension (47.9 vs 42.3% p=0.0018). In multivariate logistic regression analysis, anemia emerged was an independent predictor of CKD progression (OR 1.435, CI 95% 1.21-1.71, p<0,001). Comparing hb values intervals (hb ≤10g/dl; hb10-12 g/dL; hb ≥12 g/dL), in the multivariate logistic regression analysis, hb ≤10g/dl was not associated with CKD progression and hb value between 10-12 g/dL was associated (OR 1,486, CI 95% 1.23-1.80, p<0,001), when compared with the group with hb ≥12g/dL. In multivariate logistic regression analysis, the independent predictors of mortality were: older age (OR per 1 year increase: 1.048, 95% CI 95% 1.04-1.06, p<0.001); arterial hypertension (OR 0.699 CI 95% 0.51-0.96, p=0.0029); obesity (OR 0.741, CI 95% 0.60-0.91, p=0.004) and hb value (OR per 1 g/dL decrease: 1.301, CI 95% 1.23-1.38, p<0.001). Cardiovascular events were correlated with Hb levels between 10-12 g/dL (univariate analysis: OR 2.021, CI 95% 1.27-3.22, P=0.003), but not with the group with hb≤10 g/dL (univariate analysis: OR 1.837, CI 95% 0.96-3.51, P=0.066), having the group with hb ≥12g/dL was reference. Anemia was strongly associated with hospitalizations (multivariate logistic regression analysis: OR per 1 g/dL of Hb decrease: 1.256 CI 95% 1.12-1.32 p<0.001), and this strong association was also observed on the groups with hb hb≤10 g/dL (multivariate logistic regression analysis: OR 3.591 CI 95% 32.67-4.84 p<0.001) and between 10-12 g/dL (multivariate logistic regression analysis: OR 1.678 CI 95% 1.40-2.02, p<0.001) Conclusion Our study suggests that anemia, at first consultation, increases the risk for rapid CKD progression and global mortality. This study could guide us on the development of futures studies in order to prove if anemia correction can slow the progression of CKD.

scholarly journals Patient and tumor factors contributing to distant metastasis in well-differentiated thyroid cancer: a retrospective cohort study

2020 ◽  
Vol 49 (1) ◽  
Author(s):  
Usman Khan ◽  
Ayham Al Afif ◽  
Abdullah Aldaihani ◽  
Colin MacKay ◽  
Matthew H. Rigby ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Distant Metastasis ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Univariate Analysis ◽  
Cox Proportional Hazards Model ◽  
Resection Margins ◽  
Substantial Impact ◽  
Well Differentiated ◽  
Over Time

Abstract Background Distant metastasis in thyroid cancer significantly reduces survival in patients with well-differentiated thyroid carcinoma (WDTC). There is limited information available to clinicians regarding pathological features that confer a higher risk of distant metastasis (DM). This study aimed to identify patient and tumor factors that were associated with the development of DM over time in patients with WDTC. Methods A retrospective cohort analysis of patients with WDTC (n = 584) at our institution was performed between 2007 and 2017. A total of 39 patients with DM and 529 patients with no DM (NDM) were included. Patient demographics, tumor characteristics and patient survival were compared between the DM and NDM groups using a univariate analysis. Multivariate Cox-proportional hazards model was used to evaluate the risk of developing distant metastasis over time. Kaplan-Meier analysis was used to compare survival between the DM and NDM groups. Results Distant metastasis had a substantial impact on disease-specific survival (DSS) at 5 and 10-years in the DM group; 71.0% (SE 8.4%) and 46.9% (SE 11.6%) respectively, compared to 100% survival in the NDM group (p < 0.001). The DM group had significantly higher proportions of males, lymphovascular invasion (LVI), nodal metastasis (NM), large tumor size (TS), extrathyroidal extension (ETE), positive resection margins, multifocality, follicular thyroid cancer (FTC), tall cell variant of papillary thyroid cancer (PTC), and Hurthle cell carcinoma (HCC), when compared to the NDM group (p < 0.05). A TS ≥ 2 cm (Hazard Ratio (HR) 1.370), NM (HR 3.806) and FTC (HR 7.068) were associated with a significantly increased hazard of developing distant metastasis in patients with WDTC. Conclusions TS ≥ 2 cm, NM and FTC are associated with a significantly increased propensity for developing DM in our cohort of WDTC patients. Graphical abstract

Letter to the Editor Regarding “The Diagnostic Properties of Intraoperative Ultrasound in Glioma Surgery and Factors Associated with Gross Total Tumor Resection”

2019 ◽  
Vol 125 ◽  
pp. 553-554
Author(s):  
Francesco Prada ◽  
Ignazio G. Vetrano ◽  
Massimiliano DelBene ◽  
Giovanni Mauri ◽  
Luca M. Sconfienza ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Intraoperative Ultrasound ◽  
Glioma Surgery ◽  
Factors Associated ◽  
Letter To The Editor ◽  
Diagnostic Properties

scholarly journals Navigated Intraoperative 2-Dimensional Ultrasound in High-Grade Glioma Surgery: Impact on Extent of Resection and Patient Outcome

2019 ◽  
Author(s):  
Alessandro Moiraghi ◽  
Francesco Prada ◽  
Alberto Delaidelli ◽  
Ramona Guatta ◽  
Adrien May ◽  
...  
Keyword(s):  
Real Time ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Intraoperative Ultrasound ◽  
High Grade Glioma ◽  
Extent Of Resection ◽  
High Grade ◽  
Glioma Surgery ◽  
Supratentorial Gliomas ◽  
The Impact

Abstract BACKGROUND Maximizing extent of resection (EOR) and reducing residual tumor volume (RTV) while preserving neurological functions is the main goal in the surgical treatment of gliomas. Navigated intraoperative ultrasound (N-ioUS) combining the advantages of ultrasound and conventional neuronavigation (NN) allows for overcoming the limitations of the latter. OBJECTIVE To evaluate the impact of real-time NN combining ioUS and preoperative magnetic resonance imaging (MRI) on maximizing EOR in glioma surgery compared to standard NN. METHODS We retrospectively reviewed a series of 60 cases operated on for supratentorial gliomas: 31 operated under the guidance of N-ioUS and 29 resected with standard NN. Age, location of the tumor, pre- and postoperative Karnofsky Performance Status (KPS), EOR, RTV, and, if any, postoperative complications were evaluated. RESULTS The rate of gross total resection (GTR) in NN group was 44.8% vs 61.2% in N-ioUS group. The rate of RTV > 1 cm3 for glioblastomas was significantly lower for the N-ioUS group (P < .01). In 13/31 (42%), RTV was detected at the end of surgery with N-ioUS. In 8 of 13 cases, (25.8% of the cohort) surgeons continued with the operation until complete resection. Specificity was greater in N-ioUS (42% vs 31%) and negative predictive value (73% vs 54%). At discharge, the difference between pre- and postoperative KPS was significantly higher for the N-ioUS (P < .01). CONCLUSION The use of an N-ioUS-based real-time has been beneficial for resection in noneloquent high-grade glioma in terms of both EOR and neurological outcome, compared to standard NN. N-ioUS has proven usefulness in detecting RTV > 1 cm3.

scholarly journals Diagnostic ability of intraoperative ultrasound for identifying tumor residual in glioma surgery operation

Oncotarget ◽  
2017 ◽  
Vol 8 (42) ◽  
pp. 73105-73114 ◽  
Author(s):  
Guangying Zhang ◽  
Zhanzhan Li ◽  
Daolin Si ◽  
Liangfang Shen
Keyword(s):  
Intraoperative Ultrasound ◽  
Diagnostic Ability ◽  
Glioma Surgery

scholarly journals The Role of Gestational Diabetes Mellitus and Pelvic Floor 3D-Ultrasound Markers at the Second and Third Trimester of Pregnancy Predicting 6-18 Months Postpartum Urinary Incontinence: Preliminary Results From a Prospective Cohort

2021 ◽  
Author(s):  
Carlos Izaias Sartorão Filho ◽  
Fabiane Affonso Pinheiro ◽  
Luiz Takano ◽  
Raghavendra Hallur Lakshmana Shetty ◽  
Sthefanie K. Nunes ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pelvic Floor ◽  
Univariate Analysis ◽  
3D Ultrasound ◽  
Third Trimester ◽  
The Third ◽  
Hiatal Area

Abstract Background Gestational Diabetes Mellitus and long-term urinary incontinence (UI) have a severe impact on women's health. New methods to identify pregnant predictor risk factors of UI are needed. Our study investigated clinical and pelvic floor 3D-ultrasound markers in pregnant women at the second and third trimesters to predict 6-18 months postpartum UI. Methods This ongoing prospective cohort study included one hundred five nulliparous pregnant women with universal GDM screening and diagnosis, treated with nutritional and healthy lifestyle intervention. Pelvic floor 3DUltrasound was performed at the second and third trimesters of gestation. Clinical and pelvic floor 3DUltrasound biometry were collected. The ICIQ-SF and ISI questionnaires for UI were applied in the third trimester and 6-18 months postpartum. We performed univariate analysis (P<.20) to extract risk factors variables and multivariate logistic regression analysis (P<.05) to obtain the adjusted relative ratio for 6-18 months postpartum UI. Results In a preliminary result, a total of 93 participants concluded the follow-up. Using the variables obtained by the univariate analysis and after the adjustments for potential confounders, logistic regression analysis revealed that Gestational Diabetes Mellitus exposure was a strong and independent risk factor for 6-18 months postpartum UI (Adjusted RR 8.088; 95%CI 1.17-55.87; P:.034). In addition, higher hiatal area distension at rest from the second to the third trimester was negatively correlated with 6-18 months postpartum UI (Adjusted RR 0.966; 95%CI 0.93-0.99; P: .023). Conclusion Gestational Diabetes Mellitus was positively correlated with 6-18 months postpartum UI, and a higher hiatal area distension was negatively correlated with 6-18 months postpartum UI development. Trial registration: Regulatory approval was obtained from the Institutional Review Board (number 1.716.895) by “Botucatu Medical School of São Paulo State University (Unesp)” Ethics Committee.

Intraoperative ultrasound for resection control in transsphenoidal surgery

2013 ◽  
Vol 121 (03) ◽  
Author(s):  
J Rolfes ◽  
WD Reinbold ◽  
C Jaspers ◽  
R Santen ◽  
J Feldkamp ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Intraoperative Ultrasound ◽  
Resection Control

Pitfalls of Clinical Diagnosis Strategies for Heparin-Induced Thrombocytopenia (HIT) After Cardiac Surgery (CS).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3516-3516
Author(s):  
Fareen Din ◽  
Michael J. Kovacs ◽  
Ron Butler ◽  
Alejandro Lazo-Langner
Keyword(s):  
Cardiac Surgery ◽  
Optical Density ◽  
Roc Curve ◽  
Posterior Probability ◽  
Conflicts Of Interest ◽  
Univariate Analysis ◽  
Positive Likelihood Ratio ◽  
Categorical Variables ◽  
Elisa Assay ◽  
4T Score

Abstract Abstract 3516 Poster Board III-453 Background HIT is an infrequent but potentially serious complication of heparin therapy. Its diagnosis is complex and depends on a combination of clinical suspicion and laboratory confirmation through ELISA and functional tests such as the serotonin release assay (SRA). The 4Ts score comprises 4 clinical parameters (severity and timing of onset of thrombocytopenia, development of thrombosis, and clinician's appraisal of the likelihood of alternate causes for thrombocytopenia) and has been proposed to predict the probability of HIT in patients deemed to be at risk. However, the validity of the 4Ts score in patients undergoing cardiac surgery (CS) is questionable considering the numerous other factors that predispose such patients to thrombocytopenia and thrombosis. In addition, in CS patients the HIT ELISA assay has been reported to have 25 - 50% false positive results making it less useful. Objectives To determine the usefulness of the 4T score in the post cardiac surgical population and the value of the HIT ELISA optical density for predicting HIT. Methods Retrospective case-control study of patients admitted for cardiac surgery to the London Health Sciences Centre between January 2006 and December 2008 and for whom a HIT ELISA assay was requested. Patients with an equivocal or positive ELISA test were tested by SRA which considered the gold standard. Information collected included clinical variables related to the surgery and post-operative period, calculated 4T scores, ELISA optical density (OD) and SRA results. Categorical variables were compared using chi2 or Fisher's exact tests as appropriate. Continuous variables were compared using a Mann-Whitney U test. Covariates achieving a p value ≤0.1 in univariate analysis and the components of the 4Ts score were incorporated in logistic regression models using stepwise forward selection. Finally, we constructed a Receiver Operating Characteristic (ROC) curve for the ELISA OD. Results 73 patients were included in the analysis. Results of the univariate analysis are shown in the table. On regression analysis only the ELISA optical density (per each OD arbitrary unit increase) was correlated with a diagnosis of HIT (OR 37.266; 95% CI 2.342-593.013; p=0.010). For the ELISA OD the area under the ROC curve was 0.990 (SE 0.013) (Figure). A cutoff value for the OD of 0.475 had a Sensitivity of 1, a specificity of 0.9, a positive likelihood ratio (LR) of 10 and a negative LR of 0.00. Assuming a prevalence proportion of 0.082 the posterior probability of HIT if the ELISA has an OD <0.475 is 0 (95% CI 0 – 9). On the other hand, an OD >0.92 resulted in a LR+ of 20 with a posterior probability of 64% (95% CI 35 – 80). Conclusions In this study, we found that the 4T score does not accurately predict HIT in post CS patients. Limitations of this study include a reduced sample size and its retrospective nature. Our findings suggest that in post CS patients developing thrombocytopenia between 10 and 100 × 109 or a platelet drop of 50% or more (100% of our population) a HIT ELISA with an OD < 0.475 could be used to rule out HIT. Our findings need to be confirmed in prospective studies. Disclosures: No relevant conflicts of interest to declare.

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