Comparison of Superb Micro-Vascular Ultrasound Imaging (SMI) and Contrast-Enhanced Ultrasound (CEUS) for Detection of Endoleaks After Endovascular Aneurysm Repair (EVAR)

Abstract

Patient: Male, 68Final Diagnosis: Unusual clinical courseSymptoms: NoneMedication: —Clinical Procedure: Angio CTSpecialty: SurgeryObjective:Challenging differential diagnosisBackground:High-resolution contrast-enhanced ultrasound is one of methods used in the detection and characterization of endoleaks, which is a frequent complication after EVAR. A new technology provided by Toshiba’s AplioTM 500 ultrasound system, called Superb Micro-Vascular Imaging (SMI), is dedicated specifically to imaging very low flow states and appears to be a promising new method for detection of endoleaks.Case Report:After endovascular treatment, a 68-year-old patient who had stent-graft implantation underwent clinical examinations, including contrast-enhanced ultrasound (CEUS), superb micro-vascular imaging (SMI), and computed tomographic angiography (CTA), revealing additional information about abnormal blood flow localized in the periphery of the sack of the left common iliac artery aneurysm. By using CEUS and SMI, the endoleak was clearly visible.Conclusions:This case report illustrates the potential clinical value of this advanced Doppler technology (SMI) and how it could influence clinical management.

Superb Micro-vascular Imaging (SMI): a Doppler ultrasound technique with potential to identify, classify, and follow up endoleaks in patients after Endovascular Aneurysm Repair (EVAR)

“…The first case report about the use of SMI for EVAR surveillance comes from our research team; we demonstrated promising results of using SMI for endoleak detection, comparing the method with CDUS, CEUS, and CTA [4]. Cantisani et al compared SMI with CDUS, CEUS, and CTA.…”

“…Other potential clinical applications of SMI include gynecological and obstetric imaging, evaluation of lymph nodes and abdominal areas, as well as diagnosis of skin lesions, rheumatoid arthritis, and many other medical conditions [4, 5, 13, 27, 28]. …”

“…Finally, CEUS was performed after the administration of an intravenous 2.5-milliliter bolus of ultrasound contrast—SonoVue (Bracco, Milan, Italy); the duration of the CEUS examination is 2–3 min. CTA was performed using a GE 64 VCT Lightspeed multislice angiography scanner (acquisition 64 × 0.625 mm, helical mode, tube voltage 80e140 kV, tube current 300 mAs, CTDI Vol 14 mGy, rotation time 0.32, pitch 0.7, slice collimation 0.6, slice width 1.5 mm in retro-reconstruction) [4]. CTA was performed no later than 2–3 weeks after the CDUS, CEUS, and SMI examinations and was used as the reference method.…”

“…SMI can rapidly confirm blood flow or detect the absence of flow in cases of torsion and ischemia [3, 12]. SMI works in two modes: the monochrome (grayscale) mode (mSMI), which improves sensitivity by subtracting the background information and focusing only on the vasculature, and the color mode (cSMI), which demonstrates B-mode and color information simultaneously [3, 4, 13]. …”

Studies of Superb Microvascular Imaging and Contrast‐Enhanced Ultrasonography in the Evaluation of Vascularization in Early Bone Regeneration

“…Superb microvascular imaging (SMI), a novel technique for displaying very low‐velocity blood flow, allows imaging of microvessels in any location without ultrasound contrast agents at present . Compared with CEUS in the observation of neovascularization in early osteoanagenesis, SMI is simpler and more economical, which is conducive to repeated examination . In the present study, we established an osteoanagenesis model and used the SMI technique and CEUS to observe the neovascularization in early osteoanagenesis.…”