Background: Image contrast between normal tissue and brain tumours may sometimes appear to be low in\nintraoperative ultrasound. Ultrasound imaging of strain is an image modality that has been recently explored for\nintraoperative imaging of the brain. This study aims to investigate differences in image contrast between\nultrasound brightness mode (B-mode) images and ultrasound strain magnitude images of brain tumours.\nMethods: Ultrasound radiofrequency (RF) data was acquired during surgery in 15 patients with glial tumours. The\ndata were subsequently processed to provide strain magnitude images. The contrast in the B-mode images and the\nstrain images was determined in assumed normal brain tissue and tumour tissue at selected regions of interest\n(ROI). Three measurements of contrast were done in the ultrasound data for each patient. The B-mode and strain\ncontrasts measurements were compared using the paired samples t- test.\nResults: The statistical analysis of a total of 45 measurements shows that the contrasts in the strain magnitude\nimages are significantly higher than in the conventional ultrasound B-mode images (P<0.0001).\nConclusions: The results indicate that ultrasound strain imaging provides better discrimination between normal\nbrain tissue and glial tumour tissue than conventional ultrasound B-mode imaging. Ultrasound imaging of tissue\nstrain therefore holds the potential of becoming a valuable adjunct to conventional intraoperative ultrasound\nimaging in brain tumour surgery
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