Superb microvascular imaging technique in depicting vascularity in focal liver lesions: more hypervascular supply patterns were depicted in hepatocellular carcinoma

Abstract

PurposeTo investigate the capacity of Superb Microvascular Imaging (SMI) to detect microvascular details and to explore the different SMI features in various focal liver lesions (FLLs) and the correlation between SMI and microvessel density (MVD).Method: Eighty-three liver lesions were enrolled in our study, including 35 hepatocellular carcinomas (HCCs) and 48 non-HCCs. All patients underwent color Doppler flow imaging (CDFI) and SMI examination and were categorized into subgroups according to Adler semiquantitative grading (grade 0–3) or the microvascular morphologic patterns (pattern a-f). The correlation between SMI blood flow signal percentage and MVD was assessed.ResultsCompared with CDFI, SMI detected more high-level blood flow signals (grade 2–3) and more hypervascular supply patterns (pattern e-f) in HCCs (p < 0.05). Furthermore, more hypervascular supply patterns and fewer hypovascular supply patterns were detected in HCC compared with non-HCC (p < 0.05). Based on Adler’s grading or microvascular morphologic patterns, the areas under the receiver operating characteristic curve were 0.696 and 0.760 for SMI, 0.583 and 0.563 for CDFI. The modality of “SMI-microvascular morphologic pattern” showed the best diagnostic performance. There was significant correlation between MVD and the SMI blood flow signal percentage (vascular index, VI) in malignant lesions (r = 0.675, p < 0.05).ConclusionSMI was superior to CDFI in detecting microvascular blood flow signals. More hypervascular supply patterns were depicted in HCC than in non-HCC, suggesting a promising diagnostic value for SMI in the differentiation between HCC and non-HCC. Meanwhile, we were the first to demonstrate that SMI blood flow signal percentage (VI) was correlated with MVD in malignant lesions.

Fibroscan and Doppler Ultrasonography in the Assessment of Hepatocellular Carcinoma Interventional Therapy

“…These results are similar to previous studies which proved that power Doppler sonography was significantly successful in showing color signals in the residual portion of the tumors after treatment [13,14]. This also agrees with Tanaka, 2020 [14] who stated that power Doppler sonography was nearly equal to CT in showing tumor vascularity, as the color signals revealed by color or power Doppler sonography corresponded to the enhanced areas that were not ablated seen on CT.…”

Novel High-Quality Sonographic Methods to Diagnose Muscle Wasting in Long-Stay Critically Ill Patients: Shear Wave Elastography, Superb Microvascular Imaging and Contrast-Enhanced Ultrasound

“…It is an innovative software US technique specifically designed for imaging very low flow states, which uses a unique algorithm that allows for the visualization of diminutive vessels at slow velocity without using a contrast agent [ 9 ]. To date, although SMI has been used to detect blood flow signals in various serious clinical conditions (mainly in breast lesions [ 9 , 10 , 11 ]), as far as we know, no clinical research using SMI has been reported in muscle blood flow studies in critically ill patients with neuromuscular damage due to secondary sarcopenia associated with ICUAW. We found that around half of the studied patients had significantly lower QRF muscle microvascular angiogenic activity, as detected by SMI, than the control patients, who had normal vascularization.…”

“…Superb microvascular imaging (SMI) is an innovative US technique specifically designed for imaging very low-flow states, which uses a unique algorithm that allows for the visualization of diminutive vessels with slow velocity without using a sonographic contrast agent [ 9 ]. To date, although SMI has been used to detect blood flow signals in various conditions such as breast lesions [ 9 ], lymph nodes [ 10 ] or carcinomas [ 11 ], as far as we know, no clinical research with SMI technology for microvascular assessment has previously been reported in muscle blood flow studies in critically ill patients with neuromuscular secondary sarcopenia associated with ICUAW.…”

Diagnosis of cervical plexus tumours by high-frequency ultrasonography

“…Adler grading [ 9 , 10 ] was used to classify Doppler blood flow in the tumour as follows: Adler 0 refers to that no obvious blood flow signal; Adler I refers to 1 or 2 small blood vessels with a diameter of 1 mm are detected; Adler II refers to that 3 or 4 small blood vessels are detected; Adler III refers to that more than 4 blood vessels, or the blood vessels are intertwined into a network are detected.…”