ACCURATE tumor grading in glioma is essential for guiding treatment and predicting outcomes, yet current methods rely heavily on biopsy and histopathology. A recent study introduces an advanced intraoperative imaging technique that may change this approach, using superb microvascular imaging (SMI), a high-resolution Doppler ultrasound modality, to visualize glioma vascular structures in real time.
Researchers applied SMI during glioma surgeries to capture detailed images of tumor microvasculature in 32 patients. Through quantitative analysis of vascular patterns, including vessel density, branching, curvature, angle variation, fractal dimension, and entropy, they identified striking differences between low-grade and high-grade tumors. High-grade gliomas showed significantly more vascular complexity and disorganization. Notably, increased fractal dimension and entropy were strongly associated with markers of aggressive angiogenesis, hallmark features of malignant glioma.
Importantly, these vascular traits could not be detected by conventional MRI. The study’s diagnostic model, combining multiple vascular metrics, achieved a high area under the ROC curve (AUC=0.95), suggesting strong potential for clinical use.
The authors conclude that SMI provides a unique, non-invasive window into glioma vascular architecture, supporting intraoperative decision-making and offering a promising tool for future diagnostic and prognostic strategies. As the need grows for real-time, high-precision tumor characterization, this approach may serve as a valuable adjunct to histology in glioma care.
Reference:
Dixon L et al. Intraoperative superb microvascular ultrasound imaging in glioma: novel quantitative analysis correlates with tumour grade. Acta Neurochir (Wien). 2025;167(1):133.
