Power Doppler artifacts in evaluating inflammatory arthritis of small joints: comparison with a superb microvascular imaging technique

In recent years, a novel Doppler ultrasonography (US) modality—superb microvascular imaging (SMI)—has been presented as a reliable method to evaluate small vessel blood flow with minimised motion artefacts. In this review, we present the challenges of incorporating SMI in daily practice with detailed and comparable US images of a fingertip. The main focus of this paper is the discussion of all tested US techniques, artefacts, and practical challenges for evaluating Raynaud’s syndrome in systemic sclerosis. Despite a few reports on SMI use in assessing nailfold capillaries, there is still a need for more evidence of its value and possibilities for its standardisation.

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Discrimination of fetal intracranial mass and hemorrhage via superb microvascular imaging in a case and review of literature

Aegean Journal of Obstetrics and Gynecology ◽

10.46328/aejog.v3i1.62 ◽

2021 ◽

Vol 3 (1) ◽

pp. 22-24

Author(s):

Fatih Ateş ◽

Halil İbrahim Sara ◽

Mehmet Sedat Durmaz

Keyword(s):

Blood Flow ◽

Power Doppler ◽

Fetal Mri ◽

Large Mass ◽

Brain Parenchyma ◽

Gray Scale ◽

Intracranial Mass ◽

Superb Microvascular Imaging ◽

Magnetic Resonance Imaging Mri ◽

Microvascular Imaging

In this case we aimed to present use of superb microvascular imaging (SMI) in the discrimination of fetal intracranial mass- haemorrhage with the light of literature. 21 weeks pregnancy woman applied to the clinic for routine obstetrics control. Ultrasonography (US) was applied to the patient. In the gray scale US, intracranial midline a large mass was detected. In the colour doppler (CD), the blood flow (BF) to the mass was not clearly seem. Power doppler (PD) was very artifact. In color SMI (cSMI) and monochrome SMI (mSMI), blood flow (BF) of the mass was seem clearly and fetal intracranial mass was prediagnosed. Magnetic Resonance imaging (MRI) was performed to determine the location of the mass, brain parenchyma and origin of the mass. Intracranial midline a large mass was detected in fetal MRI too. Although there are cases in the literature regarding the use of SMI in obstetrics, there is no case report in which fetal intracranial mass was evaluated by SMI to our knowledge. In our case; we have detected fetal intracranial mass by gray scale US, and we have evaluated vascularization of the mass by CD, PD, cSMI and mSMI. SMI modes were showing superiority when compared to CD and PD. Vascularization could be seen more clearly by mSMI when compared to cSMI.

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Musculoskeletal ultrasound using superb microvascular imaging documents treatment response to biosimilar infliximab in rheumatoid arthritis

BMJ Case Reports ◽

10.1136/bcr-2020-239112 ◽

2021 ◽

Vol 14 (2) ◽

pp. e239112

Author(s):

Julian Alejandro Santos ◽

Cherica Afurong Tee ◽

Romelito Jose Galvan Galsim ◽

Michael Lucas Tee

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Treatment Response ◽

Activity Index ◽

Power Doppler ◽

Musculoskeletal Ultrasound ◽

Joint Effusion ◽

Das 28 ◽

Superb Microvascular Imaging ◽

Microvascular Imaging

A 60-year-old woman with rheumatoid arthritis consulted for acute flare. She had elevated disease activity score 28 - erythrocyte sedimentation rate (DAS 28-ESR) of 6.88 and clinical disease activity index (CDAI) of 32. Her 12-joint ultrasound revealed widespread joint effusion. Synovial vascularity scores measured through superb microvascular imaging (SMI) and power Doppler were universally increased. We documented her treatment response 2 weeks after she received a single dose of biosimilar infliximab using clinical and sonographic data. Her DAS 28-ESR and CDAI scores decreased to 4.21 and 7.0, respectively. Reduction in synovial vascularity scores was demonstrated using SMI. While there was near total resolution in joint effusion and tenosynovitis, SMI was able to demonstrate synovial vascularity in joints with no clinical swelling nor tenderness. Musculoskeletal ultrasound and superb microvascular imaging are useful adjuncts in evaluating synovitis in rheumatoid arthritis and documenting treatment response through documentation of synovial vascularity, effusion and tenosynovitis.

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AB1025 The superb microvascular imaging is more sensitive than conventional power doppler imaging in detection of active synovitis in rheumatoid arthritis patients

10.1136/annrheumdis-2017-eular.4571 ◽

2017 ◽

Author(s):

GY Lee ◽

S Kim ◽

ST Choi ◽

J-S Song

Keyword(s):

Rheumatoid Arthritis ◽

Power Doppler ◽

Doppler Imaging ◽

Power Doppler Imaging ◽

Superb Microvascular Imaging ◽

Microvascular Imaging ◽

Active Synovitis

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Superb Microvascular Imaging: Added Value and Novel Applications

Journal of Clinical Imaging Science ◽

10.4103/jcis.jcis_79_17 ◽

2017 ◽

Vol 7 ◽

pp. 45 ◽

Cited By ~ 11

Author(s):

Suheil Artul ◽

William Nseir ◽

Zaher Armaly ◽

Michalle Soudack

Keyword(s):

Power Doppler ◽

Added Value ◽

Medical Systems ◽

Low Velocity ◽

Sonographic Examination ◽

Small Vessels ◽

Vascular Flow ◽

Superb Microvascular Imaging ◽

Microvascular Imaging ◽

Color And Power Doppler

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).

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