• Diagnostic sign
• Focal liver lesion
• Focal nodular hyperplasia
• Microvascular Doppler ultrasound

• ACR TI-RADS
• contrast enhanced ultrasound
• multimodal ultrasound imaging
• shear wave elastography
• thyroid nodule
• ultramicro vascular imaging

• Humans
• Thyroid Nodule/pathology
• Artificial Intelligence
• Retrospective Studies
• Ultrasonography/methods

The present study investigated the effectiveness and applicability of superb microvascular imaging (SMI) in determining the degree of liver fibrosis noninvasively in comparison with shear wave elastography (SWE).

Ninety-eight consecutive patients with chronic hepatitis B who underwent ultrasound (US)-guided needle biopsy were examined using US combined with SMI and SWE. The predictive performance of the two US techniques in staging liver fibrosis and inflammation was compared with reference to the histological findings obtained from liver biopsy. The intraobserver and interobserver reproducibility of SMI in vascularity scores were evaluated.

SWE values and SMI vascular scores were statistically significantly different among fibrosis stages (χ²(3)=76.3, χ²(3)=81.5, P<0.001). The SWE and SMI models significantly predicted fibrosis stages separately, and SMI scores alone predicted fibrosis stages better than SWE values (50.1% for SWE, 63.5% for SMI, P<0.001). A model with both SMI scores and SWE values together explained 73.2% of variance in fibrosis stages. When other clinical and laboratory predictors were added to the model (81.5%, P<0.001), SWE values and SMI scores remained the main predictors of fibrosis stages. SWE and SMI were also applicable in predicting inflammatory grades, explaining 31% and 34% of variance, respectively, and 37.7% when used together (P<0.001).

Both SWE and SMI had good diagnostic performance in determining the degree of liver fibrosis in chronic hepatitis B patients. The efficacy of SMI was better than that of SWE. SMI can improve diagnostic performance for staging liver fibrosis and shows potential for estimating necroinflammation of the liver.

• Chronic hepatitis B
• Inflammation
• Liver cirrhosis
• Shear wave US elastography
• Superb microvascular imaging
• Vascularity score

• Doppler
• fetal growth restriction
• intravillous flow
• pre-eclampsia
• spiral artery

• Arterioles
• Female
• Fetal Growth Retardation/diagnostic imaging
• Gestational Age
• Humans
• Hypertension, Pregnancy-Induced/diagnostic imaging
• Longitudinal Studies
• Pre-Eclampsia/diagnostic imaging
• Pregnancy
• Pregnancy Outcome
• Prospective Studies
• Ultrasonography, Prenatal

• U01 HD087213 NICHD NIH HHS

• Superb microvascular imaging (SMI)
• reporting and data system (TI-RADS)
• thyroid imaging
• thyroid nodules
• ultrasonography

• focal liver lessions
• meta-analysis
• superb microvascular imaging

• Blood Flow Velocity/physiology
• Clinical Protocols
• Humans
• Liver/abnormalities
• Liver/diagnostic imaging
• Meta-Analysis as Topic
• Systematic Reviews as Topic
• Ultrasonography/methods
• Ultrasonography/standards

• chorion
• myometrium
• placenta accreta
• systemic lupus erythematosus, ultrasonography

• Intracerebral hemorrhage
• Intraoperative monitoring
• Microvascular imaging
• Ultrasonography

Differential diagnosis of benign and malignant thyroid imaging reporting and data system category 4 (TI-RADS-4) nodules can be difficult using conventional ultrasound (US). This study aimed to evaluate whether multimodal ultrasound imaging can improve differentiation and characterization of benign and malignant TI-RADS-4 nodules.

Multimodal ultrasound imaging, including US, superb microvascular imaging (SMI), and real-time elastography (RTE), were performed on 196 TI-RADS-4 nodules (78, benign; 118, malignant) in 170 consecutive patients. The sensitivity, specificity, accuracy, false negative rate (FNR), and false positive rate (FPR) of each single method and that of multimodal US imaging were determined by comparison with surgical pathology results.

The sensitivity, specificity, accuracy, FNR, and FPR for US were 65.25%, 69.23%, 66.84%, 34.75%, 30.77%, respectively; for SMI were 77.97%, 93.59%, 84.18%, 22.03%, 6.41%, respectively; RTE, 80.51%, 84.62%, 82.14%, 19.49%, 15.38%; and for multimodal US imaging were 94.08%, 87.18%, 91.33%, 6.93%, 12.82%, respectively. The areas under the received operating characteristic curve for US, SMI, RTE, and multimodal US imaging in evaluating benign and malignant TI-RADS-4 nodules were 67.2%, 84.40%, 86.60%, and 95.50%, respectively.

The initial clinical results suggest that multimodal US imaging improves the diagnostic accuracy of TI-RADS-4 nodules and provides additional information for differentiating malignant and benign nodules.

• Multimodal ultrasound Imaging
• Real-time elastography
• Superb microvascular imaging
• Thyroid nodule

To compare superb microvascular imaging (SMI) with contrast-enhanced ultrasonography (CEUS) for evaluating the ablation of benign thyroid nodules.

225 Patients with 256 benign thyroid nodules underwent conventional ultrasound, color Doppler flow imaging (CDFI), CEUS, and SMI before and after laser ablation. They were routinely followed up at 1, 3, 6, and 12 months. The volume and volume reduction rate of the ablated nodules was calculated.

On SMI, the complete ablated nodules had no microvascular perfusion, while the incompletely ablated nodules had microvascular perfusion at the edge of the nodule. The percentages of the detected incompletely ablated nodules of SMI (37/256, 14.45%) and CEUS (41/256, 16.02%) were comparable, and both were significantly higher than CDFI (P< 0.001). CEUS was used as the criterion to determine whether the nodules were completely ablated. The sensitivity, specificity, and accuracy of SMI for detecting incompletely ablated nodules were 90.2, 98.2, and 100%, respectively. The volume of ablated nodules, as measured on ultrasound, was greater than that on CEUS or SMI (both P< 0.001), while CEUS and SMI were similar. The average volume reduction rate of nodules at 1, 3, 6, and 12 months was 40.25, 54.98, 76.83, and 95.43%, respectively.

SMI sensitively detected the capillaries within residual thyroid nodules after laser ablation. The lesion size and detection rate of incompletely ablated nodules via SMI was consistent with that of CEUS. SMI may replace CEUS in certain cases for monitoring the curative effect of laser ablation for benign thyroid nodules.

The aim of the study was to assess the effectiveness of Superb Micro-vascular Imaging (SMI) as an alternative to Contrast-Enhanced Ultrasound (CEUS) and Computed Tomography Angiography (CTA) for endoleak detection and classification in patients followed up after endovascular abdominal aortic aneurysm repair (EVAR).

From May 2015 to January 2017, 30 patients underwent post-EVAR follow-up with Color Doppler Ultrasound (CDUS), CEUS, SMI, and CTA examinations. Aneurysmal sac diameter and graft patency were evaluated; endoleaks were identified and classified. Sensitivity, specificity, and accuracy values were calculated for each of the four diagnostic methods of endoleak detection. A percentage of agreement and Cohen’s Kappa coefficient were calculated for comparison of methods in terms of endoleak identification.

CTA revealed fifteen endoleaks (50%): three type Ia, nine type II, and three type III. The sensitivity of CDUS, CEUS, and SMI relative to CTA was 27%, 100%, and 100%, respectively. Specificity was 93%, 93%, and 93%, respectively. Accuracy was 60%, 97%, and 97%, respectively. There were no differences between SMI and CEUS in terms of sensitivity, specificity, or accuracy (100%, 93%, and 97%). We do not observe statistically significant differences between CTA, CEUS, and SMI concerning endoleak identification ability. The weakest method in endoleak identification was CDUS.

The analysis showed that SMI is effective, repeatable, and comparable with the CEUS modality in identification endoleaks after EVAR; it may be considered as a potential tool to monitor patients after EVAR implantation, especially those with renal insufficiency or with an allergy to any contrast media.

• Abdominal aortic aneurysm
• Endoleak
• Endovascular abdominal aortic aneurysm repair
• Superb Micro-vascular Imaging
• Ultrasound

• Adult
• Case-Control Studies
• Female
• Fetal Growth Retardation/diagnostic imaging
• Gestational Age
• Humans
• Placenta/blood supply
• Placenta/diagnostic imaging
• Placenta/pathology
• Pregnancy
• Pregnancy Trimesters
• Ultrasonography, Doppler, Color
• Ultrasonography, Prenatal

• clinical complications
• hematoma
• needle gauges
• renal biopsy
• ultrasonography

• Pancreas
• Pancreatitis
• Pseudoaneurysm
• Spleen
• Superb microvascular imaging (SMI)
• Ultrasound

• Doppler
• superb microvascular imaging
• ultrasound

To explore the ability of superb microvascular imaging (SMI) in differential diagnosis of focal liver lesions (FLLs) and to compare SMI morphology findings to those of color Doppler ultrasound and enhanced imaging.

Twenty-four patients with 31 FLLs were included in our study, with diagnoses of hemangioma (HE) (n = 17), hepatocellular carcinoma (HCC) (n = 5), metastatic lesions (n = 5), primary hepatic lymphoma (n = 1), focal nodular hyperplasia (FNH) (n = 2), and adenoma (n = 1). Nine lesions were pathologically diagnosed, and 22 lesions were radiologically confirmed, all of which were evaluated by at least two types of enhanced imaging techniques. All patients had undergone SMI. Patients were divided into subgroups based on pathological and radiological diagnoses to analyze SMI manifestations. We also compared the SMI manifestations of the most common malignant FLLs (HCCs and metastatic lesions) with those of the most common benign FLLs (HEs).

HEs were classified into three SMI subgroups: diffuse dot-like type (n = 6), strip rim type (n = 8), and nodular rim type (n = 3). The sizes of the three types of HEs were significantly different (P = 0.00, < 0.05). HCCs were classified into two subgroups: diffuse honeycomb type (n = 2) and non-specific type (n = 3). Four of the metastatic lesions were the strip rim type, and the other metastatic lesion was the thick rim type, which is the same as that of lymphoma. FNH was described as a spoke-wheel type, and adenoma as a diffuse honeycomb type. The SMI types of HCCs and metastatic lesions were significantly different from those of HEs (P = 0.048, < 0.05).

SMI technology enables microvascular evaluation of FLLs without using any contrast agent. For HEs, lesion size may affect SMI performance. SMI is able to provide useful information for differential diagnosis of HCCs and metastatic lesions from HEs.

• Primary hepatic lymphoma
• Hemangioma
• Color doppler ultrasound
• Focal liver lesions
• Superb microvascular imaging

• Adult
• Aged
• Contrast Media/administration & dosage
• Diagnosis, Differential
• Feasibility Studies
• Female
• Focal Nodular Hyperplasia/diagnostic imaging
• Focal Nodular Hyperplasia/pathology
• Hemangioma/diagnostic imaging
• Hemangioma/pathology
• Humans
• Image Enhancement/methods
• Liver/blood supply
• Liver/diagnostic imaging
• Liver/pathology
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/pathology
• Liver Neoplasms/secondary
• Male
• Microvessels/diagnostic imaging
• Middle Aged
• Ultrasonography/methods
• Ultrasonography, Doppler, Color

• doppler technology
• peripheral hepatic vasculature
• ultrasound

• Breast
• Power Doppler imaging
• Superb Microvascular Imaging
• Ultrasound

• Adolescent
• Adult
• Aged
• Breast/diagnostic imaging
• Breast Neoplasms/diagnostic imaging
• Female
• Humans
• Microvessels/diagnostic imaging
• Middle Aged
• Prospective Studies
• Reproducibility of Results
• Sensitivity and Specificity
• Ultrasonography, Mammary/methods
• Young Adult

Tumor vascularity is an important indicator for differential diagnosis, tumor growth, and prognosis. Superb micro-vascular imaging (SMI) is an innovative ultrasound technique for vascular examination that uses a multidimensional filter to eliminate clutter and preserve extremely low-velocity flows. Theoretically, SMI could depict more vessels and more detailed vascular morphology, due to the increased sensitivity of slow blood flow. Here, we report the early experience of using SMI in 21 breast cancer patients. We evaluated tumor vascular features in breast cancer and compared SMI and conventional color or power Doppler imaging. SMI was superior to color or power Doppler imaging in detecting tumor vessels, the details of vessel morphology, and both peripheral and central vascular distribution. In conclusion, SMI is a promising ultrasound technique for evaluating microvascular information of breast cancers.

• Breast neoplasms
• Doppler imaging
• Ultrasonography

Patient: Male, 68

Final Diagnosis: Unusual clinical course

Symptoms: None

Medication: —

Clinical Procedure: Angio CT

Specialty: Surgery

• Adult
• Area Under Curve
• Breast/pathology
• Breast Neoplasms/blood supply
• Breast Neoplasms/diagnosis
• China
• Diagnosis, Differential
• Female
• Humans
• Image Enhancement/methods
• Microvessels/diagnostic imaging
• Middle Aged
• Neoplasms/blood supply
• Neoplasms/diagnosis
• Prospective Studies
• Regional Blood Flow
• Reproducibility of Results
• Ultrasonography, Doppler, Color/methods