Shear wave elastography for intracranial epidermoid tumors

Ultrasound elastography (USE) is a novel technique that assesses the mechanical properties of body tissues in real time. Based on elasticity measurements, USE enables the differentiation of tumor tissue from surrounding normal tissue.We aimed to evaluate an intraoperative SWE technique for differentiating tumor tissue (epidermoid cyst) from the surrounding normal brain tissue based on elastic properties.We prospectively report the intraoperative elasticity assessments of four patients diagnosed with epidermoid cysts. Along with standard ultrasonography, intraoperative shear wave elastography (SWE) was used to identify tumor tissue and assess the elasticity of each tumor and the surrounding normal brain.USE enabled the differentiation between epidermoid cysts and the surrounding normal brain tissue in real time intraoperatively; visual data (SWE elasticity map) and quantitative data (elasticity measurements in kilopascals) were utilized to identify the epidermoid cyst based on its elastic properties. The area representing the epidermoid cyst had an increased elasticity on SWE view and high mean elasticity values (193.7 ± 70.9 kPa in case 1, 168 ± 24.5 kPa in case 2, 205.1 ± 6.7 kPa in case 3, and 101.3 ± 12.6 kPa in case 4). The area representing the adjacent normal brain tissue on SWE view had lower mean elasticity values (14.9 ± 1.9 kPa in case 1, 22.6 ± 8.3 kPa in case 2, and 23.8 ± 1.4 kPa in case 4).This study demonstrates the feasibility and promising value of SWE as an intraoperative tool during epidermoid cyst resection. Epidermoid tissue remnants that are hidden from the microscopic view can be detected using SWE.