Superb Microvascular Imaging: Added Value and Novel Applications

Abstract

Determining the presence and characteristics of vascular flow is an essential part of sonography interrogation. However, small vessels and low velocities are not always possible to depict with conventional color and power Doppler ultrasound. This can be frustrating, especially when the diagnosis depends mainly on the existence of vascular flow, the sonographic examination will be inconclusive, further imaging examinations will be required and diagnosis delayed. Superb microvascular imaging (SMI) is a novel vascular imaging mode, which provides visualization of low velocity and microvascular flow. SMI uses a clutter suppression algorithm to extract flow signals and depicts this information as a color overlay image or as a monochrome or color map of flow. By using SMI, high frame rates and high-resolution images remain maintained. With SMI, it is possible to visualize small vessels including their branches that, until now, it is possible to demonstrate only using contrast-enhanced ultrasound. Availability of this additional technology on all ultrasound machines may make some of the computed tomography scans unnecessary. In our paper, we describe six patients, aged 16–73 years, in which final diagnosis was achieved only with SMI and where conventional color and power Doppler failed. All these examinations were performed using Aplio 500 Platinum ultrasound unit (Toshiba Medical Systems, Tokyo, Japan).

Additional value of superb microvascular imaging for assessing hepatic arterial blood flow after pediatric liver transplantation

“…Conventional color Doppler imaging utilizes a wall filter to remove clutter artifacts caused by background tissue motion; meanwhile, low-velocity flow will also be removed from the image. 11,12 SMI uses a proprietary algorithm to remove clutter artifacts while having a high sensitivity to low blood flow velocities. Some researchers have utilized SMI to assess the tiny vessels in breast masses, thyroid nodules, carotid plaques, and rheumatoid arthritis and have achieved promising results.…”

Microvascular Invasion in HCC: The Molecular Imaging Perspective

“…A novel vascular imaging model based on the Doppler technique is very useful in the real-time visualization of microvascular flow and slower blood flows in general, thanks to an advanced clutter suppression algorithm, high frame rates, and high-resolution images [ 53 ]. In other words, with SMI, it is possible to visualize small vessels and their branches that were only visible via CEUS [ 54 ].…”

Musculoskeletal Imaging: Current Practice and Future Directions

“…SMI provides visualization of low velocity and microvascular flow previously not detected by standard power Doppler. 97 Initial experience in MSK imaging is promising, demonstrating low-grade inflammation in arthritis not detectable by standard power Doppler ultrasound (PDUS), 98 improved detection of neovascularization in tendinopathy, 99 and improved diagnosis of CTS. 100…”