Superb microvascular imaging is a rational choice for accurate Bosniak classification of renal cystic masses

Abstract

Objective: Bosniak classification system provides a fine imaging evaluation for the malignant cystic renal masses. Superb microvascular imaging (SMI) is a new ultrasonic technique which apply advanced clutter suppression to reflect microflow information. The aim of this study was to evaluate the performance of ultrasound Bosniak classification aided by SMI in diagnosis of cystic renal masses. Methods: By comparing with contrast-enhanced ultrasound (CEUS) and pathology, we evaluated the sensitivity, specificity and accuracy of conventional ultrasound and SMI combination in the diagnosis of renal cystic masses. Results: Color Doppler Flow image (CDFI) and SMI had significant difference in evaluation the blood flow and Bosniak classification for cystic renal mass of IIf, III and IV (p = 0.020). SMI was consistent with CEUS for cystic renal mass Bosniak classification of IIf, III and IV. Although, CEUS had highest sensitivity of 97.4%, SMI had the highest area under curve in differential diagnosis malignance from benign masses [area under curve = 0.869 (0.743 – 0.995), p < 0.001]. Conclusion: SMI can display better in observing blood flow in septa and solid structures of renal cystic lesions compared with CDFI, thus, it can perform more accurate Bosniak classification for renal cystic mass. SMI and CEUS are consistent in Bosniak classification. Bosniak classification aided by SMI maybe an accurate non-invasive ultrasonic examination in distinguishing benign and malignant renal cystic lesions. Advances in knowledge: Conventional ultrasound had limited ability to distinguish malignance in Bosniak classifications IIf and III. SMI can display better in observing blood flow in septa and solid structures of renal cystic lesions compared with CDFI.

Superb Microvascular Imaging Improves Detection of Vascularity in Indeterminate Renal Masses

“…These findings suggest that both cSMI and mSMI should be used, as both modalities have strengths that complement each other and can increase the diagnostic yield during renal US procedures. Overall, our results are consistent with previously reported studies suggesting the advantages of SMI over CDI and PDI in the detection of vascular flow …”

“…We believe this is because there were no strict criteria for the inclusion of iRMs in our study, and we included all consecutive patients who required CEUS evaluations. As such, complex masses with a thickened wall, multiple septa, and small nodules that could not be accurately assessed by SMI alone were included as well . Conversely, whereas SMI showed an advantage over standard Doppler imaging, our results suggest this advantage to be minimal.…”

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

“…[7][8][9][10] In recent years, the utility of SMI to detect microvascular flow in different organs has been reported. [13][14][15][16] SMI is an algorithm for eliminating visual noise without subtracting low-velocity flow. The technique uses an adaptive wall filter that is different from conventional ultrasound and minimizes flash artifacts.…”

Ultrasound 2020 – Diagnostics & Therapy: On the Way to Multimodal Ultrasound: Contrast-Enhanced Ultrasound (CEUS), Microvascular Doppler Techniques, Fusion Imaging, Sonoelastography, Interventional Sonography

“…Beispielsweise zeigen Dubin sky et al, dass mikrovaskuläre Dopplerverfahren bei der Beurteilung der Vaskularisation kleiner HCC-Läsionen der Leber (< 2 cm) dem regulären Farb-/Powerdoppler überlegen sind [14]. Gegenüber den konventionellen Dopplermodalitäten zeigt sich des Weiteren eine Überlegenheit mikrovaskulärer Dopplerverfahren bei der Beurteilung der Dignität von zervikalen Lymphknoten [15] sowie bei Nierenläsionen wie Nierenzellkarzinomen [16] oder der Vaskularisation komplexer Zysten [17].…”