|
1
|
Aslan HS, Arslan M, Alver KH, Vurgun S, Demirci M, Tekinhatun M. Role of Superb Microvascular Imaging (SMI) vascularity index values and vascularity patterns in the differential diagnosis of malignant liver lesions. Abdom Radiol (NY) 2025; 50:2426-2439. [PMID: 39576317 DOI: 10.1007/s00261-024-04711-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 11/02/2024] [Accepted: 11/19/2024] [Indexed: 05/13/2025]
Abstract
PURPOSE To evaluate the Superb Microvascular Imaging (SMI) vascular patterns and vascularity index (VI) values of malignant focal liver lesions (FLLs), assess their role in differential diagnosis, and examine interobserver agreement. MATERIALS AND METHODS A total of 107 patients (52 males, 55 females; mean age 62 ± 12.8 years, range 25-87) referred to the interventional radiology clinic for FLL biopsy between April 2022 and April 2023 were analyzed. Two radiologists independently assessed the SMI vascular patterns and calculated VI values. Differences among three lesion groups - hepatocellular carcinoma (HCC, n = 16), non-HCC primary liver malignancies (n = 16), and metastases (n = 75) - were evaluated, and interobserver agreement was assessed. RESULTS Most metastases (88%) demonstrated hypovascular patterns, while HCCs predominantly exhibited hypervascular patterns (68.7-81.3%). Non-HCC primary malignancies showed no dominant vascular pattern. Significant differences in SMI patterns were observed among lesion types (p = 0.001-0.035). VI values for HCCs (7.53-7.73) were significantly higher than those for non-HCC malignancies (2.73-2.93) and metastases (1.35-1.36) (p = 0.0001). ROC analysis based on VI values yielded AUCs of 0.886-0.887, with a cutoff of 2.92 providing 81.3% sensitivity and 79.1-80.2% specificity for HCC diagnosis. The inter-reader agreement for SMI patterns had a kappa score of 0.634, while the intraclass correlation coefficient (ICC) for VI values was 0.959. CONCLUSION HCCs displayed more hypervascular SMI patterns and significantly higher VI values compared to other malignant FLLs, emphasizing the diagnostic potential of VI in distinguishing HCC from non-HCC tumors. Although metastases primarily exhibited hypovascular patterns and low VI values, no dominant vascular pattern was identified in non-HCC primary liver malignancies. Assessing VI values provided higher interobserver agreement compared to SMI patterns, enhancing objectivity and reproducibility.
Collapse
|
|
2
|
Mohindra N, Soni N. Ultrasound-Based Noncontrast Microvascular Imaging for Evaluation of Breast Lesions: Imaging Techniques and Review of Diagnostic Criteria. Indian J Radiol Imaging 2024; 34:702-713. [PMID: 39318571 PMCID: PMC11419773 DOI: 10.1055/s-0044-1782162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024] Open
Abstract
Vascularity plays a pivotal role in the progression of breast lesions and may be associated with their aggressiveness and likelihood of being malignant. Contrast-enhanced imaging techniques are necessary to evaluate vascularity due to the limited sensitivity of conventional color Doppler techniques, in which motion artifacts are eliminated using wall filters. However, in this process, low-flow signals from small vessels also get removed unintentionally. Advancements in technology have revolutionized the way ultrasound images are generated, resulting in tremendous improvements in Doppler imaging techniques. The new, ultrasound-based noncontrast microvascular imaging techniques overcome the limitations of conventional Doppler, and are highly sensitive for detecting microvessels and low flow. The resultant high Doppler sensitivity leads to detection of vascularity in more breast lesions. It is important for radiologists to understand the imaging principles and the clinical implications of the new techniques, to optimally utilize them and aid correct diagnosis. Angio-PLUS is one such recent advancement, which uses unfocused or plane waves and three-dimensional wall filtering to analyze tissue motion in time, space, and amplitude domains that effectively distinguish between blood flow and tissue. The information is beneficial for assessing the lesion vascularity without using contrast. This article aims to explain the Doppler imaging techniques, their clinical applications, scanning methods, and review the common Doppler-based diagnostic criteria used in the evaluation of breast lesions.
Collapse
Affiliation(s)
- Namita Mohindra
- Department of Radio-diagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, Uttar Pradesh, India
| | - Neetu Soni
- Radiology, Mayo Clinic, Jacksonville, Florida, United States
| |
Collapse
|
|
3
|
Zhu Y, Li Y, Tang Y, Zhang J, Jia S, Jiang Z, Luo X, Ishikawa M, Kato T. Comparing qSMI and qCEUS for assessing vascularization in uterine cervical cancer: operable versus non-operable group. Front Oncol 2024; 14:1380725. [PMID: 39188687 PMCID: PMC11345174 DOI: 10.3389/fonc.2024.1380725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/26/2024] [Indexed: 08/28/2024] Open
Abstract
Objective The present study aimed to compare the effectiveness and reliability of quantified superb microvascular imaging (qSMI) and quantified contrast-enhanced ultrasonography (qCEUS) in assessing vascularization in both operable and non-operable uterine cervical cancer. Methods A case-control study included 64 patients with pathology-proven and untreated cervical cancer, who underwent transvaginal ultrasonography combined with qSMI and qCEUS between January 2022 and June 2023. SMI results were quantified as the vascular index (VI), which were compared to 12 quantitative parameters of CEUS calculated with time-intensity curves (TIC). Results According to FIGO staging and different treatment regimens, 64 patients with cervical cancer were divided into operable group (IA ~ IIA, n = 19) and non-operable group (IIB ~ IV, n = 45). In comparison to the operable group, the non-operable group showed significantly higher values in VI, peak intensity (PI), area under the curve (AUC), wash-in area (iAUC), wash-out area (oAUC), wash-in rate (WiR), mean intensity (Mean Int), and standard deviation (STD) (all P < 0.05). VI demonstrated strong correlations with CEUS parameters, notably PI (r = 0.854, P < 0.001) and AUC (r = 0.635, P < 0.001). Furthermore, VI showed a better predictive performance for treatment-group assignment than qCEUS parameters, with an 80.7% accuracy, 64.4% sensitivity and 89.5% specificity. Conclusion Both qSMI and qCEUS exhibit significant and comparable utility in detecting microvascular hyperplasia and predicting treatment-group assignments in cervical cancer. Furthermore, qSMI may offer added convenience in implementation.
Collapse
Affiliation(s)
- Yi Zhu
- Department of Ultrasound, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Yanjie Li
- Department of Ultrasound, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
- Graduate School, Chengdu Medical College, Chengdu, China
| | - Yixin Tang
- Department of Ultrasound, Suining Central Hospital, Suining, China
| | - Jie Zhang
- Department of Gynecological Oncology, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Shijun Jia
- Department of Pathology, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Zhuolin Jiang
- Department of Ultrasound, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
- Graduate School, Chengdu Medical College, Chengdu, China
| | - Xinyi Luo
- Department of Ultrasound, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
- Graduate School, Chengdu Medical College, Chengdu, China
| | - Mitsuya Ishikawa
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoyasu Kato
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
|
4
|
Huang Z, Liu D, Mo S, Hong X, Xie J, Chen Y, Liu L, Song D, Tang S, Wu H, Xu J, Dong F. Multimodal PA/US imaging in Rheumatoid Arthritis: Enhanced correlation with clinical scores. PHOTOACOUSTICS 2024; 38:100615. [PMID: 38817689 PMCID: PMC11137597 DOI: 10.1016/j.pacs.2024.100615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/25/2024] [Accepted: 05/05/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Accurate assessment of Rheumatoid Arthritis (RA) activity remains a challenge. Multimodal photoacoustic/ultrasound (PA/US) joint imaging emerges as a novel imaging modality capable of depicting microvascularization and oxygenation levels in inflamed joints associated with RA. However, the scarcity of large-scale studies limits the exploration of correlating joint oxygenation status with disease activity. OBJECTIVE This study aimed to explore the correlation between multimodal PA/US imaging scores and RA disease activity, assessing its clinical applicability in managing RA. METHODS In this study, we recruited 111 patients diagnosed with RA and conducted examinations of seven small joints on their clinically dominant side using a PA/US imaging system. The PA and power Doppler ultrasound (PDUS) signals were semi-quantitatively assessed using a 0-3 grading system. The cumulative scores for PA and PDUS across these seven joints (PA-sum and PDUS-sum) were calculated. Relative oxygen saturation (So2) values of inflamed joints on the clinically dominant side were measured, and categorized into four distinct PA+So2 patterns. The correlation between PA/US imaging scores and disease activity indices was systematically evaluated. RESULTS Analysis of 777 small joints in 111 patients revealed that the PA-sum scores exhibited a strong positive correlation with standard clinical scores for RA, including DAS28 [ESR] (ρ = 0.682), DAS28 [CRP] (ρ = 0.683), CDAI (ρ = 0.738), and SDAI (ρ = 0.739), all with p < 0.001. These correlations were superior to those of the PDUS-sum scores (DAS28 [ESR] ρ = 0.559, DAS28 [CRP] ρ = 0.555, CDAI ρ = 0.575, SDAI ρ = 0.581, p < 0.001). Significantly, in patients with higher PA-sum scores, notable differences were observed in the erythrocyte sedimentation rate (ESR) (p < 0.01) and swollen joint count 28 (SJC28) (p < 0.01) between hypoxia and intermediate groups. Notably, RA patients in the hypoxia group exhibited higher clinical scores in certain clinical indices. CONCLUSION Multi-modal PA/US imaging introduces potential advancements in RA assessment, especially regarding So2 evaluations in synovial tissues and associated PA scores. However, further studies are warranted, particularly with more substantial sample sizes and in multi-center settings. SUMMARY This study utilized multi-modal PA/US imaging to analyze Rheumatoid Arthritis (RA) patients' synovial tissues and affected joints. When juxtaposed with traditional PDUS imaging, the PA approach demonstrated enhanced sensitivity, especially concerning detecting small vessels in thickened synovium and inflamed tendon sheaths. Furthermore, correlations between the derived PA scores, PA+So2 patterns, and standard clinical RA scores were observed. These findings suggest that multi-modal PA/US imaging could be a valuable tool in the comprehensive assessment of RA, offering insights not only into disease activity but also into the oxygenation status of synovial tissues. However, as promising as these results are, further investigations, especially in larger and diverse patient populations, are imperative. KEY POINTS ⸸ Multi-modal PA/US Imaging in RA: This novel technique was used to assess the So2 values in synovial tissues and determine PA scores of affected RA joints.⸸ Correlation significantly with Clinical RA Scores: Correlations significantly were noted between PA scores, PA+So2 patterns, and standard clinical RA metrics, hinting at the potential clinical applicability of the technique.
Collapse
Affiliation(s)
- Zhibin Huang
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| | - Dongzhou Liu
- Department of Rheumatology and Immunology, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| | - Sijie Mo
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| | - Xiaoping Hong
- Department of Rheumatology and Immunology, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| | - Jingyi Xie
- Department of Rheumatology and Immunology, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| | - Yulan Chen
- Department of Rheumatology and Immunology, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| | - Lixiong Liu
- Department of Rheumatology and Immunology, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| | - Di Song
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| | - Shuzhen Tang
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| | - Huaiyu Wu
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| | - Jinfeng Xu
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| | - Fajin Dong
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| |
Collapse
|
|
5
|
Luo R, Wang Q, Zhang Y, Jiang W, Wang Y, Luo Y. Value of Contrast-Enhanced Microflow Imaging in Diagnosis of Breast Masses in Comparison with Contrast-Enhanced Ultrasound. Acad Radiol 2024; 31:2217-2227. [PMID: 38065749 DOI: 10.1016/j.acra.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 07/01/2024]
Abstract
RATIONALE AND OBJECTIVES To investigate the value of contrast-enhanced microflow imaging (CEUS-MFI) in distinguishing benign and malignant breast masses. METHODS A total of 116 breast masses classified as Breast Imaging Reporting and Data System (BI-RADS) category 3-5 by ultrasound (US) were included. Both contrast-enhanced ultrasound (CEUS) and CEUS-MFI were performed before excision or biopsy, with features and diagnostic efficiency analyzed. The US and CEUS BI-RADS 4A masses were also re-assessed by CEUS-MFI. RESULTS The features of CEUS-MFI including both interior and peripheral enlarged, twisted vessels (both P < 0.05), penetrating vessels (P = 0.007), and radial/spiculated vessels (P < 0.001) were more frequently detected in malignant masses, while peripheral annular vessels were mostly observed in benign masses (P < 0.001). Interestingly, a significant difference in the orientation of penetrating vessels between benign and malignant masses was found (P < 0.001), with parallel orientation mostly displayed in benign masses, while vertical or multiple-direction orientation mostly displayed in malignant masses. The microvascular architecture of breast masses was categorized into five patterns: avascular, line-like, tree-like, root hair-like, and crab claw-like pattern. Benign masses mainly displayed tree-like pattern (77.1% vs 10.9%, P < 0.05); malignant masses mainly displayed root hair-like (34.8% vs 5.7%, P < 0.05) and crab claw-like patterns (50.0% vs 1.4%, P < 0.05). The diagnostic efficiency of CEUS-MFI was higher relative to CEUS and US. In addition, CEUS-MFI decreased the biopsy rates of US and CEUS BI-RADS 4A masses without missing malignancies. CONCLUSION CEUS-MFI could be a valuable and promising technique in diagnosis of breast masses, and could provide more diagnostic information for radiologists.
Collapse
Affiliation(s)
- Runlan Luo
- Medical College, Yangzhou University, No. 136 Jiangyang Middle Rd, Hanjiang District, Yangzhou, Jiangsu, China (R.L.); Department of Ultrasound, Division of First Medical Center, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Rd, Haidian District, Beijing, China (R.L., Q.W., Y.Z., W.J., Y.W., Y.L.)
| | - Qingyao Wang
- Department of Ultrasound, Division of First Medical Center, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Rd, Haidian District, Beijing, China (R.L., Q.W., Y.Z., W.J., Y.W., Y.L.)
| | - Yan Zhang
- Department of Ultrasound, Division of First Medical Center, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Rd, Haidian District, Beijing, China (R.L., Q.W., Y.Z., W.J., Y.W., Y.L.)
| | - Wenli Jiang
- Department of Ultrasound, Division of First Medical Center, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Rd, Haidian District, Beijing, China (R.L., Q.W., Y.Z., W.J., Y.W., Y.L.)
| | - Yiru Wang
- Department of Ultrasound, Division of First Medical Center, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Rd, Haidian District, Beijing, China (R.L., Q.W., Y.Z., W.J., Y.W., Y.L.)
| | - Yukun Luo
- Department of Ultrasound, Division of First Medical Center, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Rd, Haidian District, Beijing, China (R.L., Q.W., Y.Z., W.J., Y.W., Y.L.).
| |
Collapse
|
|
6
|
Nakatsukasa T, Ishizu T, Hayakawa R, Ouchi M, Kawamatsu N, Sato K, Yamamoto M, Machino-Ohtsuka T, Kawanishi K, Seo Y. Assessment of renal congestion in a rat model with congestive heart failure using superb microvascular imaging. J Med Ultrason (2001) 2024; 51:159-168. [PMID: 38206492 PMCID: PMC11928411 DOI: 10.1007/s10396-023-01396-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/01/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE Renal congestion is a therapeutic target in congestive heart failure. However, its detailed evaluation in a clinical setting is challenging. This study sought to assess renal congestion impairment using superb microvascular imaging (SMI), a simple and accessible method. METHODS Dahl salt-sensitive rats, used as a model for congestive heart failure, underwent central venous pressure (CVP) measurements. Renal congestion was evaluated through measurements of renal medullary pressure (RMP) and assessment of renal perfusion using contrast-enhanced ultrasonography at both the early (control group) and heart failure phases (HF group). All rats were assessed with SMI. The region of interest (ROI) was set in interlobular vessels, interlobar vessels, and a combination of these areas. The area ratio was calculated from the color pixel count in the ROI divided by the total pixel count in the ROI. Intrarenal perfusion index (IRPI) was defined as (maximum area ratio-minimum area ratio) / maximum area ratio. RESULTS There were no significant differences in renal function and left ventricular ejection fraction between the two groups. CVP, time-to-peak (TTP) in the medulla, and RMP were higher in the HF group than in the control group. In the HF group, IRPI, evaluated in the interlobular vessels, was significantly higher than in the control group. IRPI was positively correlated with TTP in the medulla (p = 0.028, R = 0.60) and RMP (p < 0.001, R = 0.84), indicating that IRPI reflected renal congestion. CONCLUSIONS IRPI is a useful tool for assessing renal congestion in rats with congestive heart failure.
Collapse
Affiliation(s)
- Tomofumi Nakatsukasa
- Department of Cardiology, Institute of Medicine, University of Tsu Kuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tomoko Ishizu
- Department of Cardiology, Institute of Medicine, University of Tsu Kuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Ruriko Hayakawa
- Department of Medical Science, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masumi Ouchi
- Department of Medical Science, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Naoto Kawamatsu
- Department of Cardiology, Institute of Medicine, University of Tsu Kuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kimi Sato
- Department of Cardiology, Institute of Medicine, University of Tsu Kuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masayoshi Yamamoto
- Department of Cardiology, Institute of Medicine, University of Tsu Kuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tomoko Machino-Ohtsuka
- Department of Cardiology, Institute of Medicine, University of Tsu Kuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kunio Kawanishi
- Department of Experimental Pathology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| |
Collapse
|
|
7
|
Shi H, Chee CCH, Seng APY, Koh XH, Teoh WC, Mahmood RD. Contrast-Enhanced Ultrasound in the Evaluation of Complex Cystic and Solid Breast Masses-A Feasibility Study. JOURNAL OF BREAST IMAGING 2024; 6:149-156. [PMID: 38423093 DOI: 10.1093/jbi/wbae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Complex cystic and solid breast mass (CCSBM) is a radiological diagnosis based on grayscale B-mode sonographic features. Because of potential for malignancy, biopsy is typically recommended. We examined the feasibility of contrast-enhanced US (CEUS) as a tool to identify benign CCSBMs. METHODS This Institutional Review Board-approved prospective observational study performed targeted CEUS of 14 CCSBMs that were subsequently biopsied. CEUS images were independently reviewed by two readers blinded to other sonographic features, noting presence or absence of enhancement and time to perceived optimal enhancement. Interobserver agreement for presence or absence of enhancement was analyzed using Cohen's kappa coefficient. From retrospective review of initial diagnostic US examinations, descriptive CCSBM sizes, subtypes, and Doppler information were recorded. Histopathologies were categorized as benign, benign with upgrade potential (BWUP), and malignant. Measures of diagnostic accuracy and 95% CIs were calculated for CEUS enhancement. RESULTS Of 14 CCSBMs, 12 were nonmalignant (9 benign, 3 BWUP) and 2 were malignant. There was perfect interobserver agreement (Cohen's kappa 1.00) between the 2 readers for CEUS enhancement. CEUS was 100% sensitive, 25% specific, with an area under the receiver operating characteristic curve (AUROC) of 0.625 (95% CI, 0.50-0.75) in differentiating nonmalignant from malignant lesions. It was 100% sensitive, 33.3% specific, with an AUROC of 0.667 (95% CI, 0.50-0.85) in differentiating benign from surgically significant (BWUP and malignant) CCSBMs. CONCLUSION This small feasibility study highlighted the potential of CEUS as a safe noninvasive tool to identify the proportion of CCSBMs that are benign and can avoid tissue biopsy.
Collapse
Affiliation(s)
- Haiyuan Shi
- Department of Radiology, Changi General Hospital, Singapore
| | | | | | - Xuan Han Koh
- Department of Health Services Research, Changi General Hospital, Singapore
| | - Wey Chyi Teoh
- Department of Radiology, Changi General Hospital, Singapore
| | - Rameysh Danovani Mahmood
- Department of Radiology, Changi General Hospital, Singapore
- Specialist Women's Imaging, Camden Medical, Singapore
| |
Collapse
|
|
8
|
Matsui M, Jikuzono T, Kure S, Ishibashi O, Akasu H, Sugitani I. Usefulness of Ultrasonographic Detective Flow Imaging for Detecting Parathyroid Tumors: A Report of Two Cases. J NIPPON MED SCH 2024; 90:460-464. [PMID: 36273907 DOI: 10.1272/jnms.jnms.2023_90-604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Parathyroid tumors (PTs) are sometimes difficult to diagnose because they are small and have low-velocity blood flow, which can be missed by current imaging modalities. PTs consist of parathyroid adenoma (PA), parathyroid cyst, and parathyroid carcinoma (PC). Detective flow imaging (DFI) is a new imaging technology that displays low-velocity blood flow. Herein, we report two cases in which DFI was useful for diagnosis of PTs. One patient had a PA and a parathyroid cyst in close proximity, and the other had a PC. To our knowledge, this is the first report to demonstrate the usefulness of DFI in the diagnosis of PTs.
Collapse
Affiliation(s)
- Mami Matsui
- Department of Endocrine Surgery, Nippon Medical School
| | - Tomoo Jikuzono
- Department of Endocrine Surgery, Nippon Medical School
- Laboratory of Biological Macromolecules, Department of Applied Life Sciences, Graduate School of Life & Environmental Sciences, Osaka Prefecture University
| | - Shoko Kure
- Department of Integrated Diagnostic Pathology, Nippon Medical School
| | - Osamu Ishibashi
- Department of Endocrine Surgery, Nippon Medical School
- Laboratory of Biological Macromolecules, Department of Applied Life Sciences, Graduate School of Life & Environmental Sciences, Osaka Prefecture University
| | - Haruki Akasu
- Department of Endocrine Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School
| |
Collapse
|
|
9
|
Luo R, Zhang Y, Jiang W, Wang Y, Luo Y. Value of micro-flow imaging and high-definition micro-flow imaging in differentiating malignant and benign breast lesions. Clin Radiol 2024; 79:e48-e56. [PMID: 37932209 DOI: 10.1016/j.crad.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 09/03/2023] [Accepted: 10/08/2023] [Indexed: 11/08/2023]
Abstract
AIM To evaluate the value of non-contrast micro-flow imaging (MFI) and high-definition micro-flow imaging (HD-MFI) in differentiating malignant and benign breast lesions. MATERIALS AND METHODS One hundred and thirty-three patients with 138 breast lesions (80 benign and 58 malignant lesions) were examined using colour Doppler flow imaging (CDFI), MFI, and HD-MFI before biopsy, with blood flow signals graded into four types (grade 0, 1, 2, and 3) and penetrating vessels evaluated. The micro-vascular patterns of MFI and HD-MFI were evaluated and classified into five patterns: avascular, line-like, tree-like, root hair-like, and crab claw-like pattern. The diagnostic efficiency of micro-vascular patterns was analysed. Moreover, ultrasound Breast Imaging Reporting and Data System (BI-RADS) 4A lesions were also re-assessed according to the micro-vascular patterns of MFI or HD-MFI. RESULTS The capability of detecting blood flow and penetrating vessels from high to low was HD-MFI, MFI, and CDFI, respectively (p<0.05). Rich blood flow signals, penetrating vessels, and root hair-like or crab claw-like pattern were more likely in malignant breast lesions, while few blood flow signals, tree-like pattern were mostly in benign lesions (p<0.05). The diagnostic efficiency of HD-MFI and MFI were higher than CDFI (p>0.05). MFI could reduce unnecessary biopsy of 52 US BI-RADS 4A lesions but with two malignancies missed, while 56 ultrasound BI-RADS 4A lesions could be downgraded by HD-MFI with none malignancies missed. CONCLUSIONS MFI and HD-MFI can detect more blood flow in breast lesions than CDFI, and could help distinguish benign and malignant breast lesions. HD-MFI could reduce the unnecessary biopsy of US BI-RADS 4A lesions without missed malignancy.
Collapse
Affiliation(s)
- R Luo
- Medical College, Yangzhou University, Yangzhou, Jiangsu, China; Department of Ultrasound, Division of First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Y Zhang
- Department of Ultrasound, Division of First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - W Jiang
- Department of Ultrasound, Division of First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Y Wang
- Department of Ultrasound, Division of First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Y Luo
- Department of Ultrasound, Division of First Medical Center, Chinese PLA General Hospital, Beijing, China.
| |
Collapse
|
|
10
|
Zhong J, Huang L, Su M, Wu M, Lin X, Shui X, Jiang Y, Zhang X. Ultrasound Microvessel Visualization in Cervical Cancer: Association Between Novel Ultrasound Techniques and Histologic Microvessel Densities. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2537-2547. [PMID: 37730477 DOI: 10.1016/j.ultrasmedbio.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/27/2023] [Accepted: 08/23/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE The aim of the work described here was to evaluate the feasibility of superb microvascular imaging (SMI) and vascular endothelial growth factor receptor 2 (VEGFR2)-targeted microbubble (MBVEGFR2)-based ultrasound molecular imaging (USMI) for visualizing microvessels in cervical cancer. METHODS Hela cells were used to establish subcutaneous cervical cancer models. SMI and MBVEGFR2-based USMI were performed, and the results were compared with intratumoral microvessel density (MVD) in four groups based on tumor diameter (<3 mm, 3-5 mm, 5-7 mm and ≥7 mm). The vascularization index (VI, %) was evaluated for SMI, and the normalized intensity difference (NID) for USMI. RESULTS Tumors with diameters ranging from 3 to 5 mm had the highest VI (39.07 ± 1.58) in SMI, and VI significantly decreased with increasing tumor size (all p values <0.001). The strongest signal intensity was observed in very early tumors (d < 3 mm: 43.80 ± 3.58%) after MBVEGFR2 administration; the NID gradually decreased with increasing diameter of tumors (all p values = 0.007). However, no significant differences were observed in NID after administration of non-targeted (control) microbubbles (MBCon) (all p values = 0.125). MBVEGFR2-based USMI had the strongest correlation with MVD in displaying microvessels of cervical cancer compared with SMI and MBCon (R2 = 0.78 vs. R2 = 0.40 and R2 = 0.38). CONCLUSION These findings validate the superiority and accuracy of MBVEGFR2-based USMI for microvessel imaging and monitoring of angiogenesis in cervical cancer compared with SMI and MBCon. Nonetheless, SMI remains an alternative to microvessel imaging when ultrasonic contrast agent use is contraindicated.
Collapse
Affiliation(s)
- Junlin Zhong
- Department of Ultrasound, Laboratory of Novel Optoacoustic (Ultrasonic) Imaging, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Licong Huang
- Department of Ultrasound, Laboratory of Novel Optoacoustic (Ultrasonic) Imaging, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Manting Su
- Department of Ultrasound, Laboratory of Novel Optoacoustic (Ultrasonic) Imaging, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Manli Wu
- Department of Ultrasound, Laboratory of Novel Optoacoustic (Ultrasonic) Imaging, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xin Lin
- Department of Ultrasound, Laboratory of Novel Optoacoustic (Ultrasonic) Imaging, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xing Shui
- Department of Cardiovascular Medicine, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ye Jiang
- Department of Pathology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xinling Zhang
- Department of Ultrasound, Laboratory of Novel Optoacoustic (Ultrasonic) Imaging, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
| |
Collapse
|
|
11
|
Horgan R, Sinkovskaya E, Saade G, Kalafat E, Rice MM, Heeze A, Abuhamad A. Longitudinal assessment of spiral and uterine arteries in normal pregnancy using novel ultrasound tool. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:860-866. [PMID: 37470712 PMCID: PMC10801897 DOI: 10.1002/uog.26312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/09/2023] [Accepted: 06/22/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVES To use superb microvascular imaging (SMI) to evaluate longitudinally spiral artery (SA) and uterine artery (UtA) vascular adaptation in normal human pregnancy, and to develop reference ranges for use at various gestational ages throughout pregnancy. METHODS The data for this study were obtained from the National Institutes of Health (NIH)-funded Human Placenta Project. Women aged 18-35 years, with a body mass index < 30 kg/m2 , without comorbidities, with a singleton gestation conceived spontaneously, and gestational age at or less than 13 + 6 weeks were eligible for inclusion. The current analysis was restricted to uncomplicated pregnancies carried to term. Exclusion criteria included maternal or neonatal complications, fetal or umbilical cord anomalies, abnormal placental implantation or delivery < 37 weeks. Women who fulfilled the inclusion criteria formed the reference population of the Human Placenta Project study. Each participant underwent eight ultrasound examinations during pregnancy. The pulsatility index (PI) of both the left and right UtA were obtained twice for each artery and the presence or absence of a notch was noted. Using SMI technology, the total number of SA imaged was recorded in a sagittal placental section at the level of cord insertion. The PI and peak systolic velocity (PSV) were also measured in a total of six SA, including two in the central portion of the placenta, two peripherally towards the uterine fundal portion, and two peripherally towards the lower uterine segment. RESULTS A total of 90 women fulfilled the study criteria. Maternal UtA-PI decreased throughout the first half of pregnancy from a mean ± SD of 1.39 ± 0.50 at 12-13 weeks' gestation to 0.88 ± 0.24 at 20-21 weeks' gestation. The mean number of SA visualized in a sagittal plane of the placenta increased from 8.83 ± 2.37 in the first trimester to 16.99 ± 3.31 in the late-third trimester. The mean SA-PI was 0.57 ± 0.12 in the first trimester and decreased progressively during the second trimester, reaching a nadir of 0.40 ± 0.10 at 24-25 weeks, and remaining constant until the end of pregnancy. SA-PSV was highest in early pregnancy with a mean of 57.16 ± 14.84 cm/s at 12-13 weeks' gestation, declined to a mean of 49.38 ± 17.88 cm/s at 20-21 weeks' gestation and continued to trend downward for the remainder of pregnancy, reaching a nadir of 34.50 ± 15.08 cm/s at 36-37 weeks' gestation. A statistically significant correlation was noted between SA-PI and UtA-PI (r = 0.5633; P < 0.001). Multilevel regression models with natural cubic splines were used to create reference ranges of SA-PSV and SA-PI for given gestational ages. CONCLUSION From early gestation, we have demonstrated the ability to image and quantify SA blood flow in normal pregnancy, and have developed reference ranges for use at various gestational ages throughout pregnancy. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- R Horgan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - E Sinkovskaya
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - G Saade
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - E Kalafat
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey
| | - M M Rice
- George Washington University Biostatistics Center, Milken Institute School of Public Health, Washington, DC, USA
| | - A Heeze
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - A Abuhamad
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| |
Collapse
|
|
12
|
Gun Koplay T, Uysal E. Evaluation of nipple vascularity using superb microvascular imaging in patients with reduction mammoplasty. Medicine (Baltimore) 2023; 102:e35796. [PMID: 37904398 PMCID: PMC10615389 DOI: 10.1097/md.0000000000035796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/04/2023] [Indexed: 11/01/2023] Open
Abstract
We aimed to investigate the effect of the chosen pedicle on nipple vascularity by evaluating changes in the microvascular circulation of the nipples in patients undergoing reduction mammoplasty through superb microvascular imaging study (SMI). 70 nipples were included in this retrospective study. There were 15 patients (30 nipples) in Group A using the inferior pedicle and 20 patients (40 nipples) in Group B using the superomedial pedicle. The vascular index (VI) of each nipple were evaluated preoperatively and at the third postoperative month using SMI. The mean VI in Group A was 1.25 (0.5-3.6) preoperatively and 1.3 (0.4-3.2) at the third postoperative month (P > .05). The mean VI in Group B was 1.65 (0.7/2.9) preoperatively and 1.15 (0.2/1.9) at the third postoperative month (P < .05). While the VI increased by 11.3% in Group A, it decreased by 30.6% in Group B (P < .001). The changing of the VI was analyzed between comparable groups, and decreasing microvascular circulation of the nipple with use of the superomedial pedicle was detected by quantitative values, which can be useful in at-risk patient groups, the planning of surgical procedures, and early revisions at postoperative month 3.
Collapse
Affiliation(s)
- Tugba Gun Koplay
- University of Health Sciences, Konya City Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Konya, Turkey
| | - Emine Uysal
- Selcuk University, Medical Faculty, Department of Radiology, Konya, Turkey
| |
Collapse
|
|
13
|
Gün Koplay T, Uysal E, Köksal H, Babalıoğlu İ. Superb Microvascular Imaging at Evaluation of Nonvisible Buried De-epitelized Flap Vascularization in Breast Reconstruction. Eurasian J Med 2023; 55:213-217. [PMID: 37909195 PMCID: PMC10724750 DOI: 10.5152/eurasianjmed.2023.23063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/22/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE Superb microvascular imaging is a Doppler technique that increases the visibility of small vessels and gives quantitative information about tissue blood supply by measuring the vascular index. In this study, it is aimed to evaluate the long-term and postradiotherapy changes in blood flow of buried de-epitelized flaps in breast reconstruction by using the quantitative values obtained through superb microvascular imaging. MATERIALS AND METHODS Retrospective review of the 14 patients who underwent nipple-sparing breastconserving surgery and immediately breast reconstruction with a de-epitelized extended latissimus dorsi flap was done. In order to demonstrate the effect of radiotherapy on flaps microvascular circulation, patients were evaluated using superb microvascular imaging postoperative first week, first month, and postradiotherapy first week and sixth month. The normal distribution of the data was evaluated with the Shapiro-Wilk test. Paired samples t-test was used for comparisons. RESULTS According to the paired samples t-tests, postoperative first week mean vascular index was higher than postoperative first month and postradiotherapy first week (P < .05). Besides, postradiotherapy first week mean vascular index was higher than postoperative first month and also than postradiotherapy sixth month (P < .05). CONCLUSION Radiotherapy can affect the results of breast reconstruction by endothelial and fibrotic injury. In this study, the changes in the microvascular circulation of the latissimus dorsi flap were discussed and found to increase at postoperative and postradiotherapy early period related to inflammation and not decreased significantly at long-term follow-up after radiotherapy.
Collapse
Affiliation(s)
- Tuğba Gün Koplay
- Department of Plastic Reconstructive and Aesthetic Surgery, Konya City Hospital, Konya, Turkey
| | - Emine Uysal
- Department of Radiology, Selçuk University Medical Faculty, Konya, Turkey
| | - Hande Köksal
- Department of General Surgery, Selçuk University Faculty of Medicine, Konya, Turkey
| | | |
Collapse
|
|
14
|
Wang X, He Y, Wang L. Diagnostic value of shear wave elastography combined with super microvascular imaging for BI-RADS 3-5 nodules. Front Oncol 2023; 13:1192630. [PMID: 37731632 PMCID: PMC10508847 DOI: 10.3389/fonc.2023.1192630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023] Open
Abstract
Background To investigate the diagnostic value of shear wave elastography (SWE) and super microvascular imaging (SMI) integrated with the traditional ultrasound breast imaging reporting and data system (BI-RADS) classification in differentiating between benign and malignant breast nodules. Methods For analysis, 88 patients with 110 breast nodules assessed as BI-RADS 3-5 by conventional ultrasound were selected. SWE and SMI evaluations were conducted separately, and all nodules were verified as benign or malignant ones by pathology. Receiver operating characteristic (ROC) curves were plotted after obtaining quantitative parameters of different shear waves of nodules, including maximum (Emax), mean (Emean), minimum (Emin) Young's modulus, modulus standard deviation (SD), and modulus ratio (Eratio). The best cut-off value, specificity, sensitivity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for diagnosing malignant nodules employing Emax were obtained, and the diagnostic value of combining Emax and BI-RADS classification was compared. SMI graded nodule based on the Alder blood flow grading standard, whereas the BI-RADS classification was based on microvascular morphology. We assessed the diagnostic value of SMI for breast nodules and investigated the diagnostic efficacy of SWE combined with SMI in differentiating benign and malignant breast nodules with BI-RADS classification 3-5. Results The adjusted the BI-RADS classification using SMI and SWE technologies promoted the sensitivity, specificity, and accuracy of discriminating benign and malignant breast nodules (P < 0.05). The combination of traditional ultrasound BI-RADS classification with SWE and SMI technologies offered high sensitivity, specificity, accuracy, PPV, and NPV for identifying benign and malignant breast lesions. Moreover, combining SWE and SMI technologies with the adjusted BI-RADS classificationhad the best diagnostic efficacy for distinguishing benign and malignant breast nodules with BI-RADS 3-5. Conclusion The combination of SWE and SMI with the adjusted BI-RADS classification is a promising diagnostic method for differentiating benign and malignant breast nodules.
Collapse
Affiliation(s)
| | | | - Liangyu Wang
- Department of Ultrasound, Shantou Central Hospital, Shantou, Guangdong, China
| |
Collapse
|
|
15
|
Chen SH, Xiang XZ, Che PF, Hu B, Shui DY, Zhao Y, Wang L. Superb Microvascular Imaging for the Differentiation of Benign and Malignant Breast Lesions: A System Review and Meta-Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1385-1399. [PMID: 36579829 DOI: 10.1002/jum.16159] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To evaluate the diagnostic performance of SMI in the diagnosis of benign and malignant breast lesions. METHODS A systematic search of PubMed, EMBASE, Cochrane, OVID, SCI, and SCOPUS was performed to find relevant studies which applied SMI to differentiate benign and malignant breast lesions. All the studies were published before October 10, 2022. Only studies published in English were collected. Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was applied to assess the quality of the included studies. Summary receiver operating characteristic (SROC) modeling was also performed to the diagnostic performance of SMI in the diagnosis of benign and malignant breast lesions. Subgroup analyses and meta-regression were performed to find out the heterogeneity. RESULTS Twenty studies which include a total of 2873 lesions (1748 benign and 1125 malignant) in 2740 patients were evaluated in this meta-analysis. The summary sensitivity and specificity were 0.82 (95% confidence interval [CI]: 0.76-0.86), 0.70 (95% CI: 0.64-0.76) for SMI vascular degree, 0.77 (95% CI: 0.67-0.84), 0.79 (95% CI: 0.75-0.83) for SMI vascular distribution, 0.78 (95% CI: 0.70-0.84), 0.75 (95% CI: 0.69-0.80) for SMI vascular morphology, 0.81 (95% CI: 0.72-0.87), 0.80 (95% CI: 0.75-0.85) SMI penetration vessel. For SMI overall vascular features, the summary sensitivity and summary specificity were 0.74 (95% CI: 0.61-0.84) and 0.80 (95% CI: 0.76-0.84). The result of subgroup analysis and meta-analysis showed malignant rate and country might be the cause of heterogeneity of diagnostic accuracy of vascular grade and morphology. CONCLUSION SMI vascular features have high sensitivity and specificity in the differentiation of benign and malignant lesions. Future international multicenter studies in various regions with large sample size are required to confirm these findings.
Collapse
Affiliation(s)
- Si-Han Chen
- Department of Ultrasonic Imaging, Affiliated Renhe Hospital, China Three Gorges University, Yichang, Hubei, China
| | - Xiao-Zhen Xiang
- Department of Ultrasonic Imaging, Affiliated Renhe Hospital, China Three Gorges University, Yichang, Hubei, China
| | - Peng-Fei Che
- Department of Ultrasonic Imaging, Affiliated Renhe Hospital, China Three Gorges University, Yichang, Hubei, China
| | - Bing Hu
- Department of Ultrasonic Imaging, Affiliated Renhe Hospital, China Three Gorges University, Yichang, Hubei, China
| | - Dian-Ya Shui
- Department of Ultrasonic Imaging, Yichang Second People's Hospital, Yichang, Hubei, China
| | - Yun Zhao
- Medical School of China, Three Gorges University, Yichang, Hubei, China
| | - Li Wang
- Department of Ultrasonic Imaging, Affiliated Renhe Hospital, China Three Gorges University, Yichang, Hubei, China
| |
Collapse
|
|
16
|
Oh S, Kwon H, Lim K, Cho J, Kang E, Kim S, Baek Y. The feasibility of early response evaluation using superb microvascular imaging one day after transcatheter arterial chemoembolization for hepatocellular carcinoma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:866-875. [PMID: 36897661 DOI: 10.1002/jcu.23449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE The purpose of this study was to determine the feasibility of early Superb microvascular imaging (SMI) for prediction of the effect of HCC treatment after transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS A total of 96 HCCs (70 patients) treated with TACE between September 2021 and May 2022 were included in this study. SMI, Color Doppler imaging (CDI), and Power Doppler imaging (PDI) were performed the day after TACE for evaluation of intratumoral vascularity of the lesion using an Aplio500 ultrasound scanner (Toshiba Medical Systems, Corporation, Tochigi, Japan). Grading of the vascular presence was performed using a five-point scale. A dynamic CT image taken after 29-42 days was used for comparison of sensitivity, specificity, and accuracy for detection of tumor vascularity between SMI, CDI, and PDI. Univariate and multivariate analysis were performed for assessment of factors affecting intratumoral vascularity. RESULTS Fifty-eight lesions (60%) showed complete remission (CR) and 38 lesions (40%) showed partial response (PR) or no response at 29-42 days on Multi-detector Computed Tomography (MDCT) after TACE. SMI showed sensitivity of 86.84% for detection of intratumoral flow, which was significantly higher compared with that of CDI (10.53%, p < 0.001) and PDI (36.84%, p < 0.001). The results of multivariate analysis indicated that tumor size was a significant factor in detection of blood flow using the SMI technique. CONCLUSION Early SMI may be utilized as an adjunctive diagnostic test for evaluation of treated lesions after TACE, particularly when the location of the tumor is in an area of the liver where a suitable sonic window can be identified.
Collapse
Affiliation(s)
- Soeui Oh
- Department of Radiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Heejin Kwon
- Department of Radiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Kyungjae Lim
- Department of Radiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Jinhan Cho
- Department of Radiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Eunju Kang
- Department of Radiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Sanghyun Kim
- Department of Radiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Yanghyun Baek
- Department of Internal Medicine, Dong-A University Hospital, Busan, Republic of Korea
| |
Collapse
|
|
17
|
Cai S, Xing H, Wang Y, Wang Y, Ma W, Jiang Y, Li J, Wang H. Intraoperative shear-wave elastography and superb microvascular imaging contribute to the glioma grading. J Clin Neurosci 2023; 110:92-99. [PMID: 36848737 DOI: 10.1016/j.jocn.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/14/2023] [Accepted: 02/20/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND To explore the diagnostic value and feasibility of shear wave elastography and superb microvascular imaging in the grading diagnosis of glioma intraoperatively. MATERIALS AND METHODS Forty-nine patients with glioma were included in this study. B-mode ultrasonography, Young's modulus in shear-wave elastography (SWE) and vascular architecture in superb microvascular imaging(SMI) of tumor tissue and peritumoral tissue were analyzed. Receiver operating characteristic(ROC) curve analysis was used to evaluate the diagnostic effect of SWE. Logistic regression model was used to calculate the prediction probability of HGG diagnosis. RESULTS Compared with LGG, HGG was often characterized by peritumoral edema in B mode (P < 0.05). There was a significant difference in Young's modulus between HGG and LGG; the diagnostic threshold of HGG and LGG was 13.05 kPa, the sensitivity was 78.3%, and the specificity was 76.9%. The vascular architectures of the tumor tissue and peritumoral tissues of HGG and LGG were significantly different (P < 0.05). The vascular architectures of peritumoral tissue in HGG often characterized by distorted blood flow signals surrounding the tumor (14/26,53.8%); in the tumor tissue, HGG often presents as dilated and bent vessels(19/26,73.1%). The elasticity value of SWE and the tumor vascular architectures of SMI were correlated with the diagnosis of HGG. CONCLUSION Intraoperative ultrasound (ioUS), especially SWE, and SMI are beneficial for the differentiation of HGG and LGG and may help optimize clinical surgical procedures.
Collapse
Affiliation(s)
- Siman Cai
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| | - Hao Xing
- Department of Neurosurgery Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Yuekun Wang
- Department of Neurosurgery Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| | - Yu Wang
- Department of Neurosurgery Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| | - Wenbin Ma
- Department of Neurosurgery Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Yuxin Jiang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| | - Jianchu Li
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| | - Hongyan Wang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| |
Collapse
|
|
18
|
Kim DG, Lee JY, Ahn JH, Lee T, Eom M, Cho HS, Ku J. Quantitative ultrasound for non-invasive evaluation of subclinical rejection in renal transplantation. Eur Radiol 2023; 33:2367-2377. [PMID: 36422649 DOI: 10.1007/s00330-022-09260-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/25/2022] [Accepted: 10/19/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aimed to investigate the predictive efficacy of shear-wave elastography, superb microvascular imaging (SMI), and CEUS for allograft rejection in kidney transplants without graft dysfunction. METHODS From January 2021 to November 2021, 72 consecutive patients who underwent both allograft biopsy and ultrasound were evaluated. Blood test results were obtained within a week of the ultrasound examinations, which were performed before the protocol biopsy. Resistive index (RI), tissue viscoelasticity, vascular index, and quantitative CEUS parameters were measured. Patients were divided based on biopsy results into the rejection and non-rejection groups. RESULTS Among the 72 patients, 21 patients had pathological characteristics of acute rejection. RI of allograft was significantly higher in the rejection group (p = 0.007), compared to the non-rejection group. There were no significant between-group differences in vascular indices of SMI, mean elasticity, and mean viscosity. Meanwhile, among the parameters obtained by the time-intensity curve on CEUS, the cortical and medullary ratios of average contrast signal intensity, peak enhancement, wash-in area AUC, wash-in perfusion index, wash-out AUC, and wash-in and wash-out AUC were significantly different between the two groups (p < 0.05). In the receiver operating characteristic curve analysis for predicting allograft rejection, the AUC was 0.853 for the combination of six CEUS parameters, RI, and blood urea nitrogen. CONCLUSIONS Among non-invasive quantitative ultrasound measurements, CEUS parameters are the most useful for diagnosing subclinical allograft rejection. Furthermore, the combination of CEUS parameters, RI, and blood urea nitrogen may be helpful for the early detection of renal allograft rejection. KEY POINTS • Among non-invasive quantitative ultrasound measurements, CEUS parameters are the most useful for the diagnosis of subclinical allograft rejection. • On CEUS, the C/M ratios of MeanLin, PE, WiAUC, WiPI, WoAUC, and WiWoAUC are significantly lower in the rejection group; the combination of these showed reliable predictive performance for rejection. • The combination of CEUS parameters, RI, and BUN has a high predictive capability for subclinical allograft rejection.
Collapse
Affiliation(s)
- Deok-Gie Kim
- Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Young Lee
- Transplantation Center, Wonju Severance Christian Hospital, Wonju, Korea.,Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Korea.,Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea
| | - Jhii-Hyun Ahn
- Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
| | - Taesic Lee
- Division of Data Mining and Computational Biology, Institute of Global Health Care and Development, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Minseob Eom
- Department of Pathology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyun Seok Cho
- Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jihye Ku
- Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| |
Collapse
|
|
19
|
Gürbüz AF, Keven A, Elmalı A, Toru S, Apaydın A, Çeken K. A comparison between the superb microvascular imaging technique and conventional Doppler ultrasound in evaluating chronic allograft damage in renal transplant recipients. Diagn Interv Radiol 2023; 29:212-218. [PMID: 36960635 PMCID: PMC10679701 DOI: 10.5152/dir.2022.21555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 12/29/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE The present study comparatively evaluates the performance of conventional Doppler ultrasound and superb microvascular imaging (SMI) in delineating the cortical microvessels of the transplanted kidney and compares the chronic allograft damage index (CADI) based on the examination of biopsy specimens with Doppler ultrasound and SMI findings. METHODS Sixty-eight renal transplant recipients underwent kidney biopsy with the pre-diagnosis of rejection before undergoing renal Doppler ultrasound examination between January 2020 and October 2020. The distance between the kidney capsule and the vascular structure closest to the kidney capsule was measured at the level of the lower pole in the transplanted kidney using color Doppler ultrasound (CDUS), power Doppler ultrasound (PDUS), and the SMI technique. The kidney size, resistive index at the level of the arcuate artery in the lower pole of the kidney, and renal artery flow rates were also measured. RESULTS The mean distance between the kidney capsule and the vessel was 2.44 ± 2.0 mm on CDUS, 1.34 ± 1.2 mm on PDUS, 0.99 ± 1.8 mm using the color SMI (cSMI) technique, and 0.86 ± 1.8 mm using the monochrome SMI (mSMI) technique. The study found that the SMI technique was superior to CDUS and PDUS in delineating the cortical microvasculature of the kidney. Both Doppler ultrasound examinations and the SMI technique proved effective in predicting the CADI (P = 0.006 for CDUS, P = 0.002 for PDUS, P = 0.018 for cSMI, and P = 0.027 for mSMI). Among conventional Doppler ultrasound examinations and the SMI technique, PDUS had the highest sensitivity, and cSMI had the highest specificity in differentiating high and low CADI values. Both the cSMI and mSMI techniques had similar sensitivity values, whereas only cSMI exhibited high specificity. CDUS had the lowest specificity value (P = 0.003 for CDUS, P = 0.002 for PDUS, P = 0.005 for cSMI, and P = 0.004 for mSMI). CONCLUSION The present study is the first in the literature to demonstrate the utility of the distance between the kidney capsule and the vessels in predicting the CADI score and to compare the Doppler ultrasound examinations and SMI technique in doing so.
Collapse
Affiliation(s)
- Ahmet Faruk Gürbüz
- Department of Radiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Ayşe Keven
- Department of Radiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Aygül Elmalı
- Department of Radiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Serap Toru
- Department of Pathology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Ali Apaydın
- Department of Radiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Kağan Çeken
- Department of Radiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| |
Collapse
|
|
20
|
Guo Y, Wang X, Wang L, Wei X, Duan Y, Yang X, Zhang M, Zhao B. The Value of Superb Microvascular Imaging and Contrast-enhanced Ultrasound for the Evaluation of Neovascularization in Carotid Artery Plaques. Acad Radiol 2023; 30:403-411. [PMID: 36123231 DOI: 10.1016/j.acra.2022.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To compare the consistency between superb microvascular imaging (SMI) and contrast-enhanced ultrasound (CEUS) for the detection of neovascularization in carotid plaques of different thicknesses and to evaluate the applied value of these two methods for detecting neovascularization in carotid plaques in the clinic. METHODS A total of 45 patients with carotid artery plaques who were diagnosed in our hospital involving 76 hypoechoic plaques with a thickness ≥2.0 mm were selected. According to thickness, the plaques were divided into three groups: 2.0-2.5 mm, 2.5-3.0 mm and ≥3.0 mm. Each group underwent both SMI and CEUS, and two experienced sonographers (A and B) analyzed the ultrasound images to evaluate the neovascularization of carotid plaques. The amount of the neovascular signal was assessed using a semi-quantitative grading scale (vascularity grade: grade 0-3). SMI and CEUS were graded respectively according to the visual methods as follows: grade 0: no blood flow signal/enhancement within plaques; grade 1: a few blood flow signals/enhancement within plaques; grade 2: medium blood flow signals/enhancement within plaques; and grade 3: extensive blood flow signals/enhancement within plaques. Kappa consistency test was used to analyze the consistency of the grade of neovascularization in plaques between SMI with CEUS. Gamma rank correlation analysis was used to examine the correlation between neovascularization grade by SMI and CEUS in plaque and plaque thickness. RESULTS Of these patients, 14 had unilateral plaques and 31 had bilateral plaques. The two sonographers were highly consistent in terms of applying SMI and CEUS methods for diagnosing neovascularization in carotid plaques (Kappa values were 0.736 and 0.680>0). Consistency was found between SMI and CEUS by sonographers (sonographer A: Kappa=0.823; sonographer B: Kappa=0.842) in evaluating the neovascular grade in the carotid plaques. SMI and CEUS grades were positively correlated with plaque thickness (sonographer A: γ = 0.735 and 0.772; sonographer B: γ = 0.805 and 0.798). CONCLUSION Neovascularization in carotid plaques was successfully detected by SMI in a manner that concurred well with CEUS results. Our data indicate that both CEUS and SMI have high diagnostic value for assessing the neovascularization of plaques.
Collapse
Affiliation(s)
- Yanqin Guo
- the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xinghua Wang
- the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Lu Wang
- Shanxi Medical University School and Hospital of Stomatology, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, China
| | - Xiaoli Wei
- the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yinling Duan
- the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaohuan Yang
- the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Min Zhang
- the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Bin Zhao
- Shanxi Medical University School and Hospital of Stomatology, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, China.
| |
Collapse
|
|
21
|
Zhu Y, Tang Y, Zhang G, Zhang J, Li Y, Jiang Z. Quantitative analysis of superb microvascular imaging for monitoring tumor response to chemoradiotherapy in locally advanced cervical cancer. Front Oncol 2023; 12:1074173. [PMID: 36686825 PMCID: PMC9848652 DOI: 10.3389/fonc.2022.1074173] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
Objectives As an ultrasound (US) image processing method, superb microvascular imaging (SMI) extracts and visualizes flow signals from vessels through advanced clutter suppression technology. We investigated the feasibility of SMI in monitoring treatment response in patients with locally advanced cervical cancer (LACC) undergoing chemoradiotherapy (CRT). Methods Forty-nine patients underwent CRT and received SMI examination at 3 time points: before therapy (baseline), 3 weeks during, and 1 month after CRT. The maximum tumor diameter (Dmax), vascularity index (VI), and their percentage changes (ΔDmax and ΔVI) were calculated. ΔDmax was compared with MRI results as the reference standard. Results Based on the MRI findings, 44 were classified as complete response (CR) group and 5 as partial response (PR) group. The Dmax and ΔDmax showed decrease in CR and PR groups at 3 weeks during CRT (P< 0.05), but no significant difference between the two groups (P > 0.05). Compared to the baseline, significant decrease in VI and ΔVI were observed at during and after treatment in the two groups (P< 0.05). Moreover, there were significant differences in VI and ΔVI at 3 weeks during CRT between the CR and PR groups (P< 0.05). ΔVI at 3 weeks during CRT showed a better predictive performance for responder prognosis than VI (AUC = 0.964, AUC = 0.950, respectively, P = 0.001), with a cut-off value of 41.6% yielding 100% sensitivity and 86.4% specificity. Conclusions The SMI parameters (VI and ΔVI) have potential for monitoring treatment response in LACC.
Collapse
Affiliation(s)
- Yi Zhu
- Outpatient Department (Ultrasound), The Affiliated Cancer Hospital, University of Electronic Science and Technology of China, Sichuan Cancer Hospital and Institute, Chengdu, China
| | - Yixin Tang
- Outpatient Department (Ultrasound), The Affiliated Cancer Hospital, University of Electronic Science and Technology of China, Sichuan Cancer Hospital and Institute, Chengdu, China,Department of Ultrasound, Suining Central Hospital, Suining, China
| | - Guonan Zhang
- Department Gynecological Oncology, The Affiliated Cancer Hospital, University of Electronic Science and Technology of China, Sichuan Cancer Hospital and Institute, Chengdu, China,*Correspondence: Guonan Zhang,
| | - Jie Zhang
- Department Gynecological Oncology, The Affiliated Cancer Hospital, University of Electronic Science and Technology of China, Sichuan Cancer Hospital and Institute, Chengdu, China
| | - Yanjie Li
- Outpatient Department (Ultrasound), The Affiliated Cancer Hospital, University of Electronic Science and Technology of China, Sichuan Cancer Hospital and Institute, Chengdu, China,Graduate School, Chengdu Medical College, Chengdu, China
| | - Zhuolin Jiang
- Outpatient Department (Ultrasound), The Affiliated Cancer Hospital, University of Electronic Science and Technology of China, Sichuan Cancer Hospital and Institute, Chengdu, China,Graduate School, Chengdu Medical College, Chengdu, China
| |
Collapse
|
|
22
|
Qiu YJ, Cheng J, Zuo D, Zhang Q, Tian XF, Lu XY, Chen S, Dong Y, Wang WP. Non-invasive evaluation of vascular architecture of focal liver lesions by micro vascular imaging. Clin Hemorheol Microcirc 2023; 84:43-52. [PMID: 36683501 DOI: 10.3233/ch-221682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To explore the value of vascular architecture detected by micro vascular imaging (MVI) in preoperative diagnosis of focal liver lesions (FLLs). METHODS In this retrospective study, patients with surgery and histopathologically proved or radiologically confirmed FLLs were included. Vascular architecture of FLLs were acquired by color Doppler flow imaging (CDFI) and MVI on LOGIQ™ E20 ultrasound machine (C1-6 convex array probes). Alder semiquantitative analysis (grade 0-3) and morphologic features of blood vessels (pattern a-f) were used to assess the blood flow within the FLLs. Interobserver agreement for evaluating blood flow of FLLs was analyzed. Using Adler's grading or morphologic patterns as diagnostic criteria for malignant FLLs, the diagnostic efficiency was analyzed and compared. RESULTS From October 2021 and February 2022, 50 patients diagnosed with 40 malignant FLLs and 10 benign FLLs were finally included. The Kappa value within two observers for evaluating the blood flow of FLLs was 0.78 for MVI and 0.55 for CDFI. According to Alder semiquantitative analysis, more high-level blood flow signals (grade 2-3) were detected by MVI than CDFI (P < 0.05). Based on high-level blood flow signals (grade 2-3) and hypervascular supply patterns (pattern e and f), the diagnostic accuracy for malignant FLLs were 76% and 68% for MVI, 56% and 38% for CDFI, respectively. CONCLUSION MVI is superior to CDFI in evaluating vascular architecture of FLLs. The high-level flow signals and hypervascular pattern detected by MVI have a useful and complementary value in preoperative non-invasive identification of malignant FLLs.
Collapse
Affiliation(s)
- Yi-Jie Qiu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Juan Cheng
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dan Zuo
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi Zhang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao-Fan Tian
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiu-Yun Lu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Sheng Chen
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
|
23
|
Liu FJ, Ci WP, Cheng Y. Clinical study of carotid superb microvascular imaging in evaluating the activity of Takayasu's arteritis. Front Cardiovasc Med 2023; 10:1051862. [PMID: 36950292 PMCID: PMC10025289 DOI: 10.3389/fcvm.2023.1051862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/16/2023] [Indexed: 03/08/2023] Open
Abstract
Objective The goal of this study is to use superb microvascular imaging (SMI) to observe neovascularization in the carotid vessel wall to identify potential Takayasu's arteritis (TAK) inflammation markers. Methods Bilateral carotid arteries from 96 patients with TAK were imaged by a Doppler ultrasound and SMI. The one-way analysis of variance (ANOVA) was used to document significant differences between the activity and inactivity stages of TAK and the factors closely related to its activity in the binary logistics regression equation. Clinical and laboratory data included age, gender, duration of disease, treatment history, NIH score, erythrocyte sedimentation rate (ESR), and high-sensitivity C-reactive protein. Imaging data included the arterial wall thickness, degree of lesion, SMI grade, and arterial aneurysm formation. Results There were 45 patients in the active TAK stage and 51 in the inactive stage. The one-way ANOVA showed significant differences in SMI (p = 0.001) and ESR (p = 0.022) between the active and inactive groups. The binary logistics regression analysis showed that SMI was an independent risk factor for TAK activity (B = -1.505, S.E = 0.340, Wald = 19.528, OR = 0.222 95%, CI = 0.114-0.433, p < 0.01). Using SMI G1 or G2 as the cutoff values for the diagnosis of active TAK, the positive predictive value, sensitivity, and specificity were 60 and 86%, 84% and 56%, and 54% and 92%, respectively. Conclusion The SMI grade is a potential marker of disease activity in patients with TAK.
Collapse
Affiliation(s)
- Feng-Ju Liu
- Department of Ultrasound, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing, China
- *Correspondence: Feng-Ju Liu,
| | - Wei-Ping Ci
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Yi Cheng
- Department of Ultrasound, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing, China
| |
Collapse
|
|
24
|
Kurt SA, Besli LU, Kayadibi Y, Samanci C, Nazari A, Ozturk T, Kocael P, Sayman H. Is there a potential biomarker in distinguishing invasive breast carcinomas with elevated Ki-67 levels among 2D-SWE, SMI, and 18F-FDG PET-CT/MRI-derived parameters?: A single-center data. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:148-157. [PMID: 36053896 DOI: 10.1002/jcu.23300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/18/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To investigate the strength of quantitative imaging and metabolic parameters in differentiating invasive breast carcinomas with elevated Ki-67 levels. MATERIALS AND METHODS A total of 123 patients with 129 breast lesions confirmed as invasive breast carcinoma underwent shear wave elastography (SWE), superb microvascular imaging (SMI) and positron emission tomography (PET)/CT or MRI. Adler's grade (classifying the microvascularity into four types) and Vascular Index (VI) was obtained by SMI as microvascular parameters. In addition, the stiffness value (Emean ) was evaluated in kilopascal by SWE. The average of consecutive measurements was recorded as mean VI and mean Emean . PET scan parameters were obtained as SUVmax and SULpeak . Lesions were divided into two groups according to the Ki-67 expression, low as ≤ 14 and high as >14. RESULTS Adler's grading was the most correlated imaging parameter with high Ki-67 expression (p < 0.05), while VI and Emean had poor correlation (p > 0.05). SUVmax and SULpeak indicated a significant linear correlation with Ki-67 but a moderate correlation with the high levels of Ki-67 (p < 0,001). The sensitivity of VI, Emean , SUVmax and SULpeak was 64.6%, 66.7%, 65.7%, and 66.7% when the cut-off point was set to 5.25, 102.5, 6.59, and 2.63, respectively. SUVmax had the highest AUC value of 0.740, according to the ROC curve analysis. CONCLUSIONS Our results suggest that the quantitative parameters obtained by advanced imaging methods may be useful in predicting the high proliferation in invasive breast carcinomas. But none of them is eligible to be used as an independent biomarker in distinguishing aggressive behavior. Nevertheless, as a noninvasive method, visual assessment of microvascular morphology using SMI increases the prognostic efficiency in invasive breast carcinomas.
Collapse
Affiliation(s)
- Seda Aladag Kurt
- Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Lebriz Uslu Besli
- Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Yasemin Kayadibi
- Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cesur Samanci
- Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Azizullah Nazari
- Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tulin Ozturk
- Department of Pathology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Pinar Kocael
- Department of General Surgery, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Haluk Sayman
- Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| |
Collapse
|
|
25
|
Huang X, Nie F, Zhu J, Liu L, Wang N. Application value of shear-wave elastography combined with monochrome superb microvascular imaging in renal allograft chronic rejection. Clin Hemorheol Microcirc 2022; 82:303-311. [PMID: 36057814 DOI: 10.3233/ch-221443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Conventional ultrasound (US), which include gray scale US and Doppler US, is the first-line imaging modality for the evaluation of renal allograft; however, conventional US indicators have limitations. OBJECTIVE To explore the application value of shear-wave elastography (SWE) combined with monochrome superb microvascular imaging (mSMI) in renal allograft chronic rejection (CR). METHODS From November 2021 to February 2022 in the Lanzhou University Second Hospital, the US features of 54 patients with renal allograft were retrospectively analyzed. Patients were categorized into two groups: stable group(n = 44) and CR group(n = 10), with clinical diagnosis as reference standard. The vascular index (VI) on mSMI and parenchymal stiffness were measured in the middle cortex of all renal allografts and receiver operating characteristic (ROC) curves were drawn to evaluate the feasibility of differentiation. Statistically significant US features and biochemical indicators such as creatinine were scored, and the results of the scores were analyzed by ROC curve. RESULTS The VI on mSMI of the stable group (49.5±2.0) was significantly greater than that of the CR group (33.8±5.9) (P = 0.028). There was a statistically significant difference in parenchymal stiffness between stable group (16.2kPa±1.2) and CR group (33.9kPa±6.6) (P = 0.027). The sensitivity was 90% and specificity was 81.8% of the scores in the differentiation of stable group from CR group (cut-off value, 2; P = 0.000). CONCLUSION SWE combined with mSMI may help differentiate stable renal allograft from renal allograft CR and have the potential application value in the diagnosis of renal allograft CR.
Collapse
Affiliation(s)
- Xiao Huang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen, Chengguan District, Lanzhou, China.,Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen, Chengguan District, Lanzhou, China.,Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Ju Zhu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen, Chengguan District, Lanzhou, China.,Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Luping Liu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen, Chengguan District, Lanzhou, China.,Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Nan Wang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen, Chengguan District, Lanzhou, China.,Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| |
Collapse
|
|
26
|
Feng J, Lu J, Jin C, Chen Y, Chen S, Guo G, Gong X. Diagnostic Value of Superb Microvascular Imaging in Differentiating Benign and Malignant Breast Tumors: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:2648. [PMID: 36359491 PMCID: PMC9689350 DOI: 10.3390/diagnostics12112648] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 08/04/2024] Open
Abstract
PURPOSE We performed a systematic review and meta-analysis of studies that investigated the diagnostic performance of Superb Microvascular Imaging (SMI) in differentiating between benign and malignant breast tumors. METHODS Studies published between January 2010 and March 2022 were retrieved by online literature search conducted in PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine Disc, China National Knowledge Infrastructure, Wanfang, and Vip databases. Pooled sensitivity, specificity, and diagnostic odd ratios were calculated using Stata software 15.0. Heterogeneity among the included studies was assessed using I2 statistic and Q test. Meta-regression and subgroup analyses were conducted to investigate potential sources of heterogeneity. Influence analysis was conducted to determine the robustness of the pooled conclusions. Deeks' funnel plot asymmetry test was performed to assess publication bias. A summary receiver operating characteristic curve (SROC) was constructed. RESULTS Twenty-three studies involving 2749 breast lesions were included in our meta-analysis. The pooled sensitivity and specificity were 0.80 (95% confidence interval [CI], 0.77-0.84, inconsistency index [I2] = 28.32%) and 0.84 (95% CI, 0.79-0.88, I2 = 89.36%), respectively. The pooled diagnostic odds ratio was 19.95 (95% CI, 14.84-26.82). The area under the SROC (AUC) was 0.85 (95% CI, 0.81-0.87). CONCLUSION SMI has a relatively high sensitivity, specificity, and accuracy for differentiating between benign and malignant breast lesions. It represents a promising supplementary technique for the diagnosis of breast neoplasms.
Collapse
Affiliation(s)
- Jiaping Feng
- Graduate School, Guangzhou Medical University, Guangzhou 510180, China
- Department of Ultrasound, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Sungang West Road 3002, Futian District, Shenzhen 518025, China
| | - Jianghao Lu
- Department of Ultrasound, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Sungang West Road 3002, Futian District, Shenzhen 518025, China
| | - Chunchun Jin
- Department of Ultrasound, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Sungang West Road 3002, Futian District, Shenzhen 518025, China
| | - Yihao Chen
- Department of Ultrasound, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Sungang West Road 3002, Futian District, Shenzhen 518025, China
| | - Sihan Chen
- Department of Ultrasound, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Sungang West Road 3002, Futian District, Shenzhen 518025, China
| | - Guoqiang Guo
- Department of Ultrasound, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Sungang West Road 3002, Futian District, Shenzhen 518025, China
| | - Xuehao Gong
- Graduate School, Guangzhou Medical University, Guangzhou 510180, China
- Department of Ultrasound, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Sungang West Road 3002, Futian District, Shenzhen 518025, China
| |
Collapse
|
|
27
|
Superb Microvascular Imaging (SMI) Compared with Color Doppler Ultrasound for the Assessment of Hepatic Artery in Pediatric Liver Transplants: A Feasibility Study. Diagnostics (Basel) 2022; 12:diagnostics12061476. [PMID: 35741286 PMCID: PMC9221873 DOI: 10.3390/diagnostics12061476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Despite progression in surgical techniques and immunological treatments, hepatic artery (HA) thrombosis and stenosis still develop as an early or late liver transplant (LT) complication. We aimed to compare superb microvascular imaging (SMI) with conventional Doppler imaging (CDI) in the assessment of HA in a cohort of pediatric patients undergoing follow-up ultrasound (US) for LT. (2) Methods: This prospective, observational study included 73 pediatric LT recipients (median age, 7 years; IQR, 5.8 years; 35 females) who underwent US during LT follow-up from March to December 2019. For each examination, CDI and SMI were separately assessed in terms of HA visibility and spectral waveform morphology (SWM). The former was scored based on HA discrimination from the blooming signal of the surrounding vessels, as follows: 0, not visible; 1, majority course hardly distinguishable; and 2, majority course clearly distinguishable. The latter was scored on a two-point scale: 0, combined venous and arterial SWM, and 1, pure arterial SWM. The patient’s overall score was finally calculated by adding the two individual scores. (3) Results: Both the absolute scores and frequency of overall scores equal to 3 (maximum global score) were higher using SMI compared with CDI. The median overall score was 3 for SMI and 2 for CDI (p = 0.011; IQR = 1). An overall score equal to 3 was obtained in 74% and 49.3% of the study population using SMI and CDI, respectively (p = 0.002). This was attributable to a better score in HA visibility (p = 0.007). (4) Conclusions: SMI has shown promise for assessing HA in pediatric LT recipients, possibly serving as a complementary non-invasive tool of CDI in everyday practice.
Collapse
|
|
28
|
Tang K, Liu M, Zhu Y, Zhang M, Niu C. The clinical application of ultrasonography with superb microvascular imaging-a review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:721-732. [PMID: 35358353 DOI: 10.1002/jcu.23210] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 06/14/2023]
Abstract
Superb microvascular imaging (SMI) is among the latest doppler ultrasound methods. It uses an advanced clutter filter to eliminate artifacts caused by breathing, movement and retains the low-speed blood signals in microvessels. The great advantage of SMI is that it can intuitively detect very slow blood signals in microvessels, providing clinicians with more significant information about flow distribution in the target area. Therefore, it is speculated that SMI has important application value. The purpose of this article is to outline the application of SMI in different parts of the body.
Collapse
Affiliation(s)
- Kui Tang
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Minghui Liu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yun Zhu
- Department of Ultrasound Imaging, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Ming Zhang
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chengcheng Niu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| |
Collapse
|
|
29
|
Gao L, Zhang X, Jiang Y, Wang H, Zheng Y, Li W, Li J, Zhang B. Assessment of Carotid Body Tumors by Superb Microvascular Imaging of Feeding Arteries During Preoperative Evaluation. Front Surg 2022; 9:816768. [PMID: 35558392 PMCID: PMC9090302 DOI: 10.3389/fsurg.2022.816768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/30/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: Superb microvascular imaging (SMI) has led to new advances in vascular imaging applications. This study aimed to explore the blood supply and feeding arteries of carotid body tumors (CBTs) on SMI to improve the accuracy of information available to surgeons. Methods Twenty-six CBT lesions were subjected to color Doppler flow imaging (CDFI) and SMI and were later confirmed by pathology. The blood flow patterns and feeding arteries of the CBTs on CDFI and SMI were graded and compared. Results The feeding arteries of two CBT lesions, which were not visible on CDFI, were identified as the internal carotid artery (ICA) on SMI. The feeding arteries of three CBTs were judged to stem from both the ICA and the external carotid artery (ECA) (MIX) based on SMI compared to the ICA or ECA on CDFI. We classified the feeding arteries of CBTs as originating from the ICA or others (including the ECA and MIX). One hundred percent (3/3) of the CBT lesions stemming from the ICA had Adler I or Adler II blood flow patterns, and 100% (23/23) of the CBT lesions stemming from other arteries had Adler II or Adler III blood flow patterns. Higher Adler categories were assigned based on SMI than CDFI (P < 0.001). Conclusion SMI may be superior to CDFI in detecting the vascularity of CBTs, and SMI revealed more potential feeding arteries of CBTs than CDFI. CBTs originating from the ICA are less vascular than those originating from the ECA.
Collapse
Affiliation(s)
- Luying Gao
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyan Zhang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuxin Jiang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongyan Wang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuehong Zheng
- Department of Vascular Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wanying Li
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianchu Li
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Jianchu Li
| | - Bo Zhang
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, China
- Bo Zhang
| |
Collapse
|
|
30
|
An Innovative Ultrasound Technique for Early Detection of Kidney Dysfunction: Superb Microvascular Imaging as a Reference Standard. J Clin Med 2022; 11:jcm11040925. [PMID: 35207202 PMCID: PMC8878179 DOI: 10.3390/jcm11040925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/26/2022] [Accepted: 02/04/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Superb microvascular imaging (SMI) is an innovative ultrasound image processing technique that provides greater detail and better visualization of small branching vessels. We assume that SMI will provide sufficient information regarding the severity of chronic kidney disease (CKD) and reflecting histological changes. Aims: The aims was to assess the capabilities of SMI imaging regarding the early detection of kidney dysfunction and renal fibrosis in comparison to the reference standard renal biopsy for the early diagnosis of kidney fibrosis. Methods: SMI was performed in patients (n = 52) with CKD stage 2–5, where some of them underwent biopsy proven CKD and fibrosis as part of the diagnosis. In addition, biochemical tests were performed, including kidney function tests, urine collection for proteinuria, and the estimation of GFR by MDRD or CKD-EPI eGFR in CKD patients and healthy controls (n = 17). All subjects underwent SMI, where vascularity is expressed as the SMI index (a low index reflects low vascularity/fibrosis and vice versa). Results: The SMI vascular index was significantly lower in CKD patients as compared with healthy controls (72.2 ± 12.9 vs. 49.9 ± 16.7%, p < 0.01). Notably, a moderate correlation between the SMI index and eGFR was found among the CKD patients (r = 0.56, p < 0.001). Similarly, a strong correlation was found between SCr and the SMI index of the diseased subjects (r = −0.54, p < 0.001). In patients who underwent renal biopsy, the SMI index corresponded with the histological alterations and CKD staging. Conclusions: This study demonstrated that SMI imaging may be utilized in CKD patients of various stages for the evaluation of chronic renal morphological changes and for differentiation between CKD grades.
Collapse
|
|
31
|
Aziz MU, Robbin ML. Improved Detection of Gallbladder Perforation Using Ultrasound Small Vessel Slow Flow "Perfusion" Imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:511-518. [PMID: 33885191 DOI: 10.1002/jum.15729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 06/12/2023]
Abstract
Gallbladder (GB) perforation is a potentially fatal cause of acute abdomen. Higher morbidity and mortality are associated with this entity due to delayed diagnosis and treatment. Ultrasound with color/power Doppler and contrast sonography can detect wall discontinuity; however, sometimes it can be subtle or unavailable. Small vessel slow flow "perfusion" imaging allows improved microvascular perfusion detection using different filters, which result in increased spatial resolution and vessel visualization. Noncontrast perfusion imaging was of immense clinical value in the diagnosis of GB perforation in the six cases presented here. To the best of our knowledge, this is the first case report describing efficacy of noncontrast "perfusion" imaging in detection of GB perforation.
Collapse
Affiliation(s)
- Muhammad U Aziz
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michelle L Robbin
- Departments of Radiology and Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
|
32
|
Zehui FMD, Siqi WMD, Jian ZMD, Yejun LMD, Xiaomin MMD, Ye HMD, Chong WMD, Hui CMD. Diagnostic Performance of Superb Microvascular Imaging for Breast Masses: A Systematic Review and Meta-analysis. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2022. [DOI: 10.37015/audt.2022.210028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
|
33
|
Lin J, Lin W, Xu L, Lin T. Diagnostic value of various vascular features of breast cancer by age. Clin Hemorheol Microcirc 2022; 80:317-325. [PMID: 34719486 DOI: 10.3233/ch-211258] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Tumor angiogenesis plays a critical role in the growth and metastasis of breast cancer. Evaluating the added value of vascular features to Breast Imaging Reporting and Data System (BI-RADS) in differentiating malignant masses from benign ones is essential. Micro-flow Imaging (MFI) is a promising noninvasive diagnostic method for the microvessels in breast tumors, but its precise value is still uncertain. OBJECTIVES Understanding whether malignant tumor vascular characteristics by MFI are associated with breast cancer and whether the diagnostic efficiency varies by age. MATERIALS AND METHODS B-mode ultrasound and MFI were performed for 153 solid breast lesions. The vessels images by MFI were reviewed and assessed by two investigators, respectively. Then the diagnostic efficacy of different vascular features combined with BI-RADS was evaluated in different age groups. RESULTS The mean size of lesions is 19.4 (range 18-78) mm. There were 94 breast masses in benign, while 59 breast masses in malignant by pathology. III Adler classification, penetrating vessels, and complex flow pattern showed a positive association with a high risk of malignant breast lesions (p < 0.05). BI-RADS combined with vessel characteristics show better improvement of diagnostic performance of breast lesions in the elderly group than in the young group. CONCLUSIONS Vascular features by MFI contribute to malignant breast masses' diagnosis, and the association might be modified by age.
Collapse
Affiliation(s)
- Jia Lin
- Department of Ultrasound, First Affiliated Hospital, Shantou Unviersity Medical College, Shantou, Guangdong, China
| | - Wenqiang Lin
- Department of Ultrasound, First Affiliated Hospital, Shantou Unviersity Medical College, Shantou, Guangdong, China
| | - Liang Xu
- Shantou University Medical College, Shantou, Guangdong, China
| | - Teng Lin
- Department of Ultrasound, First Affiliated Hospital, Shantou Unviersity Medical College, Shantou, Guangdong, China
| |
Collapse
|
|
34
|
Bartolotta TV, Orlando AAM, Schillaci MI, Spatafora L, Marco MD, Matranga D, Firenze A, Cirino A, Ienzi R. Ultrasonographic Detection of Vascularity of Focal Breast Lesions: Microvascular Imaging Versus Conventional Color and Power Doppler Imaging. ULTRASONIC IMAGING 2021; 43:273-281. [PMID: 34236008 DOI: 10.1177/01617346211029542] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
To compare microvascular flow imaging (MVFI) to conventional Color-Doppler (CDI) and Power-Doppler (PDI) imaging in the detection of vascularity of Focal Breast Lesions (FBLs). A total of 180 solid FBLs (size: 3.5-45.2 mm) detected in 180 women (age: 21-87 years) were evaluated by means of CDI, PDI, and MVFI. Two blinded reviewers categorized lesion vascularity in absent or present, and vascularity pattern as (a) internal; (b) vessels in rim; (c) combined. The presence of a "penetrating vessel" was assessed separately. Differences in vascularization patterns (chi2 test) and intra- and inter-observer agreement (Fleiss method) were calculated. ROC analysis was performed to assess performance of each technique in differentiating benign from malignant lesions. About 103/180 (57.2%) FBLs were benign and 77/180 (42.8%) were malignant. A statistically significant (p < .001) increase in blood flow detection was observed for both readers with MVFI in comparison to either CDI or PDI. Benign FBLs showed mainly absence of vascularity (p = .02 and p = .01 for each reader, respectively), rim pattern (p < .001 for both readers) or combined pattern (p = .01 and p = .04). Malignant lesions showed a statistically significant higher prevalence of internal flow pattern (p < .001 for both readers). The prevalence of penetrating vessels was significantly higher with MVFI in comparison to either CDI or PDI (p < .001 for both readers) and in the malignant FBLs (p < .001). ROC analysis showed MVFI (AUC = 0.70, 95%CI = [0.64-0.77]) more accurate than CDI (AUC = 0.67, 95%CI = [0.60-0.74]) and PDI (AUC = 0.67, 95%CI = [0.60-0.74]) though not significantly (p = .5436). Sensitivity/Specificity values for MVFI, PDI, and CDI were 76.6%/64.1%, 59.7%/73.8% and 58.4%/74.8%, respectively. Inter-reader agreement with MVFI was always very good (k-score 0.85-0.96), whereas with CDI and PDI evaluation ranged from good to very good. No differences in intra-observer agreement were noted. MVFI showed a statistically significant increase in the detection of the vascularization of FBLs in comparison to Color and Power-Doppler.
Collapse
Affiliation(s)
- Tommaso Vincenzo Bartolotta
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital Policlinico P. Giaccone, Palermo, Italy
- Fondazione Istituto G.Giglio di Cefalù, Contrada Pietrapollastra, Cefalù, Italy
| | - Alessia Angela Maria Orlando
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital Policlinico P. Giaccone, Palermo, Italy
| | - Maria Ilenia Schillaci
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital Policlinico P. Giaccone, Palermo, Italy
| | - Luigi Spatafora
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital Policlinico P. Giaccone, Palermo, Italy
| | - Mariangela Di Marco
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital Policlinico P. Giaccone, Palermo, Italy
| | - Domenica Matranga
- ProMISE Department (Department of Health Promotion and Mother and Child Care, Internal Medicine and Medical Specialties), University Hospital Policlinico P. Giaccone, Palermo, Italy
| | - Alberto Firenze
- ProMISE Department (Department of Health Promotion and Mother and Child Care, Internal Medicine and Medical Specialties), University Hospital Policlinico P. Giaccone, Palermo, Italy
| | - Alessandra Cirino
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital Policlinico P. Giaccone, Palermo, Italy
| | - Raffaele Ienzi
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital Policlinico P. Giaccone, Palermo, Italy
| |
Collapse
|
|
35
|
Cai S, Wang H, Zhang X, Zhang L, Zhu Q, Sun Q, Li J, Jiang Y. Superb Microvascular Imaging Technology Can Improve the Diagnostic Efficiency of the BI-RADS System. Front Oncol 2021; 11:634752. [PMID: 34249681 PMCID: PMC8263934 DOI: 10.3389/fonc.2021.634752] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 06/08/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To explore whether superb microvascular imaging (SMI)SMI can improve the diagnostic efficiency by evaluating the vascular index (VI) and vascular architecture (VA) in breast lesions. METHODS This is a retrospective study of data collected prospectively for research use. Taking 225 consecutive cases of breast lesions from November 2016 to December 2017 as a training set, the VI values and VA types of benign and malignant lesions were calculated based on the pathological results. Taking 238 consecutive cases of breast lesions from January 2018 to October 2018 as the verification set, the diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated to compare the diagnostic efficacy. RESULTS The training set included 225 breast lesions and the validation set 238 breast lesions. The VI value in the malignant group (10.3 ± 8.0) was significantly higher than that in the benign group (4.3 ± 5.0)(P<0.001). A VI value of 4.05 was used as the diagnostic threshold for differentiating benign from malignant lesions, with a sensitivity of 80.5%, a specificity of 61.9%, an accuracy of 71.1%, a PPV of 62.9%, a NPV of 76.9%, and an area under the curve of 0.758 (0.696-0.819). There was a significant difference in the types of benign and malignant VA (P < 0.001), and the PPV of the root hair-like and crab claw-like VAs were 93.9% and 100.0%, respectively. The diagnostic sensitivity, specificity, accuracy, PPV, NPV and area under the AUC curve were 58.0%, 98.2%, 97.0%, 70.3% and 0.781, respectively (95%CI: 0.719-0.844). SMI combined with conventional ultrasound improved the diagnostic specificity (70.0% vs. 90.0%), accuracy (87.4% vs. 96.6%), and PPV (82.5% vs. 93.2%) without decreasing the diagnostic sensitivity (99.3%), yielded higher diagnostic performance with the area under the ROC curve was 0.941 (95%CI: 0904-0.979) compared with conventional US alone (P < 0.001). CONCLUSION A VI value 4.05 is a cut-off value with good diagnostic efficacy. The residual root-like and crab claw-like VAs are the characteristic VAs of malignant lesions. Conventional ultrasound combined with the VI and VA can improve the diagnostic specificity, accuracy and PPV without reducing the diagnostic sensitivity.
Collapse
Affiliation(s)
- Siman Cai
- Department of Medical Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hongyan Wang
- Department of Medical Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiaoyan Zhang
- Department of Medical Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Li Zhang
- Department of Medical Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qingli Zhu
- Department of Medical Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jianchu Li
- Department of Medical Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yuxin Jiang
- Department of Medical Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| |
Collapse
|
|
36
|
Zuopeng D, Weiyong L, Chunmei H, Tao W, Mingming W. Qualitative Diagnosis of Solid Breast Mass by Blood Flow in Solid Breast Mass Based on Color Doppler Ultrasound. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The incidence of breast cancer ranks first among female malignant tumor. With the increase of the sensitivity of color Doppler ultrasound blood flow, the blood flow distribution in and around the tumor can be clearly displayed, and the analysis of hemodynamic parameters is provided,
which provides convenience for the study of tumor blood flow characteristics. Studies have shown that tumor cells can secrete a substance called angiogenesis factor, which makes the tumor site form a rich vascular network to promote tumor growth and metastasis. The tumor has many new blood
vessels, abnormal structure, thin wall, lack of muscle layer, and is prone to form arteriovenous rash. These characteristics provide a pathological basis for color Doppler flow imaging (CDFI) for the diagnosis of breast cancer. This article discusses the role of two-dimensional sonographic
features in the differential diagnosis of benign and malignant breast masses, CDFI was used to study the blood flow distribution and hemodynamic characteristics in benign and malignant breast masses; explore the value of blood flow characteristics and blood flow parameters in the differential
diagnosis of breast masses. The experimental results show that the detection rate of blood flow signals and the classification of blood flow signals in the malignant group are higher than those in the benign group, mainly level II and III blood flow, and the irregular branched blood flow is
more common, especially when the tumor appears penetrating blood flow supports the diagnosis of malignancy. PSV, RI and PI have a certain differential meaning in the diagnosis of benign and malignant breast masses. PSV, RI and PI of malignant masses are higher than benign masses. For tumors
without obvious necrosis, the larger the tumor diameter, the richer the blood flow and the higher the blood flow grade is. The malignant tumors have more blood flow than the benign ones.
Collapse
Affiliation(s)
- Ding Zuopeng
- Department of Ultrasound Medicine of the First Affiliated Hospital of University of Science and Technology of China, He Fei An Hui, 230036, China
| | - Liu Weiyong
- Department of Ultrasound Medicine of the First Affiliated Hospital of University of Science and Technology of China, He Fei An Hui, 230036, China
| | - Hu Chunmei
- Department of Ultrasound Medicine of the First Affiliated Hospital of University of Science and Technology of China, He Fei An Hui, 230036, China
| | - Wang Tao
- Department of Ultrasound Medicine of the First Affiliated Hospital of University of Science and Technology of China, He Fei An Hui, 230036, China
| | - Wang Mingming
- Department of Ultrasound Medicine of Guo yang County People’s Hospital, Bo Zhou An Hui, 233600, China
| |
Collapse
|
|
37
|
Uysal E, Öztürk M, Kilinçer A, Koplay M. Comparison of the Effectiveness of Shear Wave Elastography and Superb Microvascular Imaging in the Evaluation of Breast Masses. Ultrasound Q 2021; 37:191-197. [PMID: 34057918 DOI: 10.1097/ruq.0000000000000562] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT This study aims to determine the diagnostic performance of superb microvascular imaging (SMI) and shear wave elastography methods in evaluating breast lesions. We will also compare the effectiveness of the stiffness, velocity, and vascular index (VI) parameters in distinguishing malignancy.From January to June 2019, 121 patients with 121 solid breast masses (category 4 and 5 lesions according to the Breast Imaging-Reporting and Data System) detected during the routine grayscale sonographic examination were included in the study. Stiffness and velocity values were obtained using shear wave elastography for all lesions, and VI was obtained using SMI. The receiver operating characteristic curves were obtained to set the best cutoff values for the stiffness, velocity, and VI to differentiate patients with malignant breast lesions.All 121 lesions were pathologically verified by US-guided core needle biopsy. Forty-seven (38.9%) of the lesions were malignant, and 74 (61.1%) were benign. Median stiffness, velocity, and VI values were significantly lower in benign masses compared with malignant masses (P < 0.001). The optimum cutoff values for the stiffness, velocity, and VI were determined to be 58.3 kPa, 4.5 m/s, and 1.1%, respectively. The areas under the curves were 0.897 for stiffness, 0.884 for velocity, and 0.687 for VI.Shear wave elastography and SMI are noninvasive methods that may be used to evaluate breast masses. Although both methods' quantitative data are beneficial in differentiating malignant from benign masses, stiffness is the best parameter to be used.
Collapse
Affiliation(s)
- Emine Uysal
- Department of Radiology, Selçuk University Faculty of Medicine, Konya, Turkey
| | | | | | | |
Collapse
|
|
38
|
Meng Q, Xie X, Li L, Jiang C, Zhao K, Bai Z, Zheng Z, Yang Y, Yu Y, Zhang H, Zhao X. Assessment of neovascularization of carotid artery atherosclerotic plaques using superb microvascular imaging: a comparison with contrast-enhanced ultrasound imaging and histology. Quant Imaging Med Surg 2021; 11:1958-1969. [PMID: 33936978 DOI: 10.21037/qims-20-933] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background This study aimed to investigate the usefulness of superb microvascular imaging (SMI), a novel non-contrast-enhanced ultrasound technique, in characterizing neovessels within carotid atherosclerotic plaques through comparison with contrast-enhanced ultrasound (CEUS) and histology. Methods Patients with carotid plaque were recruited and underwent SMI and CEUS ultrasound imaging of the carotid arteries. The maximum plaque thickness, length, and stenosis of each plaque were measured. Grade of the neovessels was determined by SMI and CEUS, respectively. Grade 0 was defined as no blood flow signal/microbubbles within plaques; grade 1 was defined as moderate blood flow signals/microbubbles confined to the shoulder and/or adventitial side of the plaque; and grade 2 was defined as extensive intraplaque signals/microbubbles. Patients with symptomatic carotid stenosis (stenosis ≥50%) or asymptomatic carotid stenosis (stenosis ≥70%) underwent endarterectomy, and plaque specimens were subjected to immunohistochemical analysis of CD31 expression. The neovessels were quantified by histology. The agreement of SMI with CEUS and histology in characterizing neovessels was analyzed using weighted Kappa statistic and Spearman's correlation analyses. Results Seventy-eight patients (mean age: 67.3±8.9 years old, 63 males) were recruited. Of these patients, 52 (66.7%) had a unilateral plaque and 26 (33.3%) had bilateral plaques in the carotid arteries. For the 104 carotid plaques detected, the mean plaque thickness and length were 4.3±1.1 and 18.8±6.6 mm, respectively. The prevalence of <50%, 50-69%, and ≥70% stenosis was 43.3%, 24.0%, and 32.7%, respectively. Excellent agreement was found between SMI and CEUS (κ=0.825 at the plaque level; κ=0.820 at the patient level) in evaluating the neovessel grade within the carotid plaques. Of the 25 patients who underwent carotid endarterectomy, a strong correlation (r=0.660, P<0.001) was found between SMI and histology in the evaluation of intraplaque neovessels. SMI had excellent scan-rescan (κ=0.857), intra-reader (κ=0.810), and inter-reader (κ=0.754) agreement in the assessment of intraplaque neovessels. Conclusions The SMI technique is capable of reliably characterizing neovessels within carotid atherosclerotic plaques and demonstrates good to excellent agreement with histology and CEUS.
Collapse
Affiliation(s)
- Qi Meng
- Department of Ultrasound, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xia Xie
- Department of Ultrasound, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Li Li
- Department of Pathology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Chao Jiang
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Keqiang Zhao
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Zhiyong Bai
- Department of Ultrasound, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Zhuozhao Zheng
- Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yu Yang
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yan Yu
- Department of Pathology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Huabin Zhang
- Department of Ultrasound, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| |
Collapse
|
|
39
|
Fu Z, Zhang J, Lu Y, Wang S, Mo X, He Y, Wang C, Chen H. Clinical Applications of Superb Microvascular Imaging in the Superficial Tissues and Organs: A Systematic Review. Acad Radiol 2021; 28:694-703. [PMID: 32418782 DOI: 10.1016/j.acra.2020.03.032] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/13/2020] [Accepted: 03/20/2020] [Indexed: 12/12/2022]
Abstract
Superb microvascular imaging (SMI) is an innovative Doppler technique for vascular examination. It uses an intelligent algorithm that efficiently separates low-speed flow signals from motion artifacts so that it can assess microvessels and the vessel distribution in detail. This article reviews the clinical applications of SMI in the disorders of superficial tissues and organs including thyroid nodules, breast tumors and lymph node diseases etc. More information of diseases that are closely associated with angiogenesis can be shown by SMI than other noninvasive examinations. Although some limitations exist, this safe and convenient technique is becoming acceptable and would play a more important role in disease diagnosis and therapeutic responses evaluation.
Collapse
Affiliation(s)
- Zehui Fu
- Department of Ultrasound, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou 213003, China
| | - Jian Zhang
- Department of Ultrasound, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou 213003, China
| | - Yejun Lu
- Department of Ultrasound, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou 213003, China
| | - Siqi Wang
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Xiaomin Mo
- Department of Ultrasound, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou 213003, China
| | - Ye He
- Department of Ultrasound, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou 213003, China
| | - Chong Wang
- Department of Ultrasound, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou 213003, China
| | - Hui Chen
- Department of Ultrasound, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou 213003, China.
| |
Collapse
|
|
40
|
Kandemirli SG, Cicek F, Erdemli Gursel B, Bilgin C, Kilic SS, Yazici Z. Superb Microvascular Imaging in Assessment of Synovitis and Tenosynovitis in Juvenile Idiopathic Arthritis. Ultrasound Q 2021; 37:56-62. [PMID: 33661799 DOI: 10.1097/ruq.0000000000000516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ABSTRACT The aim of this study is to evaluate the diagnostic utility of superb microvascular imaging (SMI) in assessment of synovitis/tenosynovitis in juvenile idiopathic arthritis in comparison to power Doppler ultrasound. Thirty juvenile idiopathic arthritis cases with active clinical findings and ultrasound features of effusion and/or tenosynovitis were further imaged with power Doppler and SMI. For classification of synovial inflammation, a semiquantitative scale (4 points) adopted by Outcome Measures in Rheumatology was used.A total of 35 knee, 2 hip, 2 ankle, 2 wrist, 2 elbow joints, and 6 flexor hallucis longus/tibialis posterior tenosynovitis were assessed. In knee joint, power Doppler and SMI scales were the same for 23 (65.7%) joints, SMI upgraded scale from 0 to 2 in single joint (2.9%); 1 to 2 (14.3%) in 5 joints; and 2 to 3 (17.1%) in 6 joints. For other joints, power Doppler and SMI scales were the same for 5 (62.5%) joints. Superb microvascular imaging upgraded scale from 1 to 2 (25%) in 2 joints and 1 to 3 (12.5%) in a single joint. For flexor hallucis longus/tibialis posterior tenosynovitis, power Doppler and SMI scales were the same for two cases (33.3%). Superb microvascular imaging upgraded scale from 0 to 2 in two cases (33.3%); and 2 to 3 (33.3%) in 2 cases. There was no case of SMI scale downgraded compared with power Doppler scale.Superb microvascular imaging is a feasible technique in the assessment of synovial inflammation and tenosynovitis in juvenile idiopathic arthritis. Superb microvascular imaging has higher sensitivity compared with power Doppler ultrasound in depiction of increased vascularity.
Collapse
Affiliation(s)
| | - Fatih Cicek
- Department of Pediatrics, Uludag University Faculty of Medicine, Bursa, Turkey
| | | | | | - Sara Sebnem Kilic
- Department of Pediatrics, Uludag University Faculty of Medicine, Bursa, Turkey
| | | |
Collapse
|
|
41
|
Tek C, Öztekin PS, Celepli P, Uçar F, Koşar PN. Using the Superb Microvascular Imaging Method in the Distinction of Intraductal Papilloma and Duct Ectasia With Secretion. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:269-277. [PMID: 32681668 DOI: 10.1002/jum.15396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/26/2020] [Accepted: 06/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To investigate the diagnostic value of a Superb Microvascular Imaging (SMI; Toshiba Medical Systems, Tokyo, Japan) Doppler examination for distinguishing intraductal papilloma (IDP) from duct ectasia with secretion in lesions smaller than 1 cm compared to color Doppler imaging (CDI) and power Doppler imaging (PDI). METHODS Fifty-nine lesions were evaluated by grayscale ultrasound, CDI, PDI, and SMI. Biopsied tissue samples were analyzed. Ultrasound evaluations and Doppler examinations were performed with a Toshiba Aplio 500 device. The lesions were divided into 2 groups, secretion and IDP, according to the pathologic results. Color Doppler imaging, PDI, and SMI data were compared statistically to investigate their diagnostic values. RESULTS Of the 59 lesions, 22 were secretion, and 37 were IDP. The mean diameters ± SDs were 4.7 ± 0.6 mm in the secretion group and 4.9 ± 0.8 mm in the IDP group (P = .315). There was no significant difference in grayscale ultrasound features such as shape or margin between the groups (P > .05). No significant difference was found between the groups in CDI or PDI characteristics (P > .999; P = .702, respectively). The color SMI evaluation results showed no vascularity in 18 (81.8%) lesions in the secretion group. Vascularity was detected in 32 patients (86.5%) in the IDP group. In the receiver operating characteristic analysis, the areas under the curve were calculated as 0.842 (95% confidence interval [CI], 0.728-0.925) for SMI, 0.522 (95% CI, 0.388-0.654) for PDI, and 0.518 (95% CI, 0.384-0.650) for CDI. CONCLUSIONS Superb Microvascular Imaging is more accurate and has more diagnostic ability than CDI or PDI in distinguishing small IDPs from duct ectasia with secretion because of its ability to visualize slow flow speeds of vascular structures.
Collapse
Affiliation(s)
- Cihat Tek
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Pelin Seher Öztekin
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Pınar Celepli
- Department of Pathology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Funda Uçar
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Pınar Nercis Koşar
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
|
42
|
Sui P, Wang X, Sun L, Wang H. Diagnostic accuracy of ultrasound superb microvascular imaging for focal liver lesions: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24411. [PMID: 33546085 PMCID: PMC7837924 DOI: 10.1097/md.0000000000024411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 01/04/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Superb microvascular imaging (SMI) is a new ultrasound vascular imaging technology, which uses a new Doppler algorithm, it has the characteristics of high sensitivity and high resolution to detect low velocity blood flow; it is easier to detect microvessels with low-velocity flow compared with color Doppler flow imaging in theory; and it can image the microvessels of the lesion without angiography.[1] Previous studies showed that SMI can detect tumor neovascularization to differentiate benign from malignant focal liver lessions (FLLs). However, the results of these studies have been contradictory with low sample sizes. This meta-analysis tested the hypothesis that SMI is accurate in distinguishing benign and malignant FLLs. METHODS We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to the November 30, 2020, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata14.0 software will be used for data analysis. RESULTS This systematic review will determine the accuracy of SMI in the differential diagnosis between benign and malignant FLLs. CONCLUSION Its findings will provide helpful evidence for the accuracy of SMI in the differential diagnosis between benign and malignant FLLs. SYSTEMATIC REVIEW REGISTRATION INPLASY2020120081.
Collapse
|
|
43
|
Park AY, Seo BK, Han MR. Breast Ultrasound Microvascular Imaging and Radiogenomics. Korean J Radiol 2021; 22:677-687. [PMID: 33569931 PMCID: PMC8076833 DOI: 10.3348/kjr.2020.1166] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/13/2020] [Accepted: 12/10/2020] [Indexed: 02/07/2023] Open
Abstract
Microvascular ultrasound (US) techniques are advanced Doppler techniques that provide high sensitivity and spatial resolution for detailed visualization of low-flow vessels. Microvascular US imaging can be applied to breast lesion evaluation with or without US contrast agents. Microvascular US imaging without a contrast agent uses a sophisticated wall filtering system to selectively obtain low-flow Doppler signals from overlapped artifacts. Microvascular US imaging with second-generation contrast agents amplifies flow signals and makes them last longer, which facilitates hemodynamic evaluation of breast lesions. In this review article, we will introduce various microvascular US techniques, explain their clinical applications in breast cancer diagnosis and radiologic-histopathologic correlation, and provide a summary of a recent radiogenomic study using microvascular US.
Collapse
Affiliation(s)
- Ah Young Park
- Department of Radiology, Bundang CHA Medical Center, CHA University, Seongnam, Korea
| | - Bo Kyoung Seo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
| | - Mi Ryung Han
- Division of Life Sciences, College of Life Sciences and Bioengineering, Incheon National University, Incheon, Korea
| |
Collapse
|
|
44
|
Mantella LE, Liblik K, Johri AM. Vascular imaging of atherosclerosis: Strengths and weaknesses. Atherosclerosis 2021; 319:42-50. [PMID: 33476943 DOI: 10.1016/j.atherosclerosis.2020.12.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 12/16/2022]
Abstract
Atherosclerosis is an inflammatory disease that can lead to several complications such as ischemic heart disease, stroke, and peripheral vascular disease. Therefore, researchers and clinicians rely heavily on the use of imaging modalities to identify, and more recently, quantify the burden of atherosclerosis in the aorta, carotid arteries, coronary arteries, and peripheral vasculature. These imaging techniques vary in invasiveness, cost, resolution, radiation exposure, and presence of artifacts. Consequently, a detailed understanding of the risks and benefits of each technique is crucial prior to their introduction into routine cardiovascular screening. Additionally, recent research in the field of microvascular imaging has proven to be important in the field of atherosclerosis. Using techniques such as contrast-enhanced ultrasound and superb microvascular imaging, researchers have been able to detect blood vessels within a plaque lesion that may contribute to vulnerability and rupture. This paper will review the strengths and weaknesses of the various imaging techniques used to measure atherosclerotic burden. Furthermore, it will discuss the future of advanced imaging modalities as potential biomarkers for atherosclerosis.
Collapse
Affiliation(s)
- Laura E Mantella
- Department of Biomedical and Molecular Sciences, Queen's University, 18 Stuart Street, K7L 3N6, Kingston, ON, Canada
| | - Kiera Liblik
- Department of Medicine, Cardiovascular Imaging Network at Queen's University, 76 Stuart Street, K7L 2V7, Kingston, ON, Canada
| | - Amer M Johri
- Department of Biomedical and Molecular Sciences, Queen's University, 18 Stuart Street, K7L 3N6, Kingston, ON, Canada; Department of Medicine, Cardiovascular Imaging Network at Queen's University, 76 Stuart Street, K7L 2V7, Kingston, ON, Canada.
| |
Collapse
|
|
45
|
Lee EJ, Chang YW. Combination of Quantitative Parameters of Shear Wave Elastography and Superb Microvascular Imaging to Evaluate Breast Masses. Korean J Radiol 2020; 21:1045-1054. [PMID: 32691540 PMCID: PMC7371619 DOI: 10.3348/kjr.2019.0765] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/09/2020] [Accepted: 04/15/2020] [Indexed: 12/18/2022] Open
Abstract
Objective This study aimed to evaluate the diagnostic value of combining the quantitative parameters of shear wave elastography (SWE) and superb microvascular imaging (SMI) to breast ultrasound (US) to differentiate between benign and malignant breast masses. Materials and Methods A total of 200 pathologically confirmed breast lesions in 192 patients were retrospectively reviewed using breast US with B-mode imaging, SWE, and SMI. Breast masses were assessed based on the breast imaging reporting and data system (BI-RADS) and quantitative parameters using the maximum elasticity (Emax) and ratio (Eratio) in SWE and the vascular index in SMI (SMIVI). The area under the receiver operating characteristic curve (AUC) value, sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of B-mode alone versus the combination of B-mode US with SWE or SMI of both parameters in differentiating between benign and malignant breast masses was compared, respectively. Hypothetical performances of selective downgrading of BI-RADS category 4a (set 1) and both upgrading of category 3 and downgrading of category 4a (set 2) were calculated. Results Emax with a cutoff value of 86.45 kPa had the highest AUC value compared to Eratio of 3.57 or SMIVI of 3.35%. In set 1, the combination of B-mode with Emax or SMIVI had a significantly higher AUC value (0.829 and 0.778, respectively) than B-mode alone (0.719) (p < 0.001 and p = 0.047, respectively). B-mode US with the addition of Emax, Eratio, and SMIVI had the best diagnostic performance of AUC value (0.849). The accuracy and specificity increased significantly from 68.0% to 84.0% (p < 0.001) and from 46.1% to 79.1% (p < 0.001), respectively, and the sensitivity decreased from 97.6% to 90.6% without statistical loss (p = 0.199). Conclusion Combining all quantitative values of SWE and SMI with B-mode US improved the diagnostic performance in differentiating between benign and malignant breast lesions.
Collapse
Affiliation(s)
- Eun Ji Lee
- Department of Radiology, Soonchunhyang University Hospital Seoul, Seoul, Korea
| | - Yun Woo Chang
- Department of Radiology, Soonchunhyang University Hospital Seoul, Seoul, Korea.
| |
Collapse
|
|
46
|
Lee EJ, Chang YW, Oh E, Hwang J, Kim HJ, Hong SS. Reproducibility and diagnostic performance of the vascular index of superb microvascular imaging in real-time breast ultrasonography for evaluating breast masses. Ultrasonography 2020; 40:398-406. [PMID: 33455154 PMCID: PMC8217793 DOI: 10.14366/usg.20153] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/27/2020] [Indexed: 11/12/2022] Open
Abstract
Purpose This study aimed to evaluate the reproducibility and diagnostic performance of a quantitative parameter of superb microvascular imaging (SMI) in real-time breast ultrasonography (US) for differentiating benign from malignant breast masses. Methods Eighty-seven breast masses in 75 patients who underwent both B-mode US and SMI before US-guided core needle biopsy were included in this study. Two radiologists performed B-mode US and measured the vascular index (VI) of SMI respectively for each lesion in real time. Intraobserver and interobserver agreements were analyzed for the VI of SMI. The diagnostic performance of B-mode US using the Breast Imaging Reporting and Database System lexicon and combined use with the VI of SMI was evaluated compared to pathology. Results The median VI of malignant masses (n=32) was significantly higher than that of benign masses (n=55) (7.6% and 2.6%, respectively; P<0.001). The intraobserver agreement for VI was excellent regardless of the pathology, size, or depth of the lesion. The interobserver agreement for VI was excellent regardless of the presence of a measurement interval. The interobserver agreement for the final diagnostic decision was improved by combining B-mode US and VI (κ=0.883) in comparison with B-mode US only (κ=0.617). Adding VI led to significant improvements in the specificity (87.2% vs. 52.7%, 83.6% vs. 49.0%), accuracy (89.7% vs. 69.3%, 84.0% vs. 65.9%) and positive predictive value (81.5% vs. 55.1%, 75.6% vs. 52.6%) of B-mode US for both observers compared with B-mode US alone (all, P=0.001). Conclusion The VI of SMI for real-time breast US is highly reproducible and leads to improved diagnostic performance for differentiating between benign and malignant breast lesions in combination with B-mode US.
Collapse
Affiliation(s)
- Eun Ji Lee
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Yun-Woo Chang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Eunsun Oh
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jiyoung Hwang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hyun-Joo Kim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Seong Sook Hong
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| |
Collapse
|
|
47
|
He Z, Chen Z, Tan M, Elingarami S, Liu Y, Li T, Deng Y, He N, Li S, Fu J, Li W. A review on methods for diagnosis of breast cancer cells and tissues. Cell Prolif 2020; 53:e12822. [PMID: 32530560 PMCID: PMC7377933 DOI: 10.1111/cpr.12822] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/10/2020] [Accepted: 03/30/2020] [Indexed: 02/06/2023] Open
Abstract
Breast cancer has seriously been threatening physical and mental health of women in the world, and its morbidity and mortality also show clearly upward trend in China over time. Through inquiry, we find that survival rate of patients with early‐stage breast cancer is significantly higher than those with middle‐ and late‐stage breast cancer, hence, it is essential to conduct research to quickly diagnose breast cancer. Until now, many methods for diagnosing breast cancer have been developed, mainly based on imaging and molecular biotechnology examination. These methods have great contributions in screening and confirmation of breast cancer. In this review article, we introduce and elaborate the advances of these methods, and then conclude some gold standard diagnostic methods for certain breast cancer patients. We lastly discuss how to choose the most suitable diagnostic methods for breast cancer patients. In general, this article not only summarizes application and development of these diagnostic methods, but also provides the guidance for researchers who work on diagnosis of breast cancer.
Collapse
Affiliation(s)
- Ziyu He
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, China
| | - Zhu Chen
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, China.,State Key Laboratory of Bioelectronics, School of Biological and Medical Engineering, Southeast University, Nanjing, China
| | - Miduo Tan
- Surgery Department of Galactophore, Central Hospital of Zhuzhou City, Zhuzhou, China
| | - Sauli Elingarami
- School of Life Sciences and Bioengineering (LiSBE), The Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha, Tanzania
| | - Yuan Liu
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, China.,State Key Laboratory of Bioelectronics, School of Biological and Medical Engineering, Southeast University, Nanjing, China
| | - Taotao Li
- Hunan Provincial Key Lab of Dark Tea and Jin-hua, School of Materials and Chemical Engineering, Hunan City University, Yiyang, China
| | - Yan Deng
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, China
| | - Nongyue He
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, China.,State Key Laboratory of Bioelectronics, School of Biological and Medical Engineering, Southeast University, Nanjing, China
| | - Song Li
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, China
| | - Juan Fu
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Wen Li
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, China
| |
Collapse
|
|
48
|
Liang M, Ou B, Wu J, Xiao X, Ruan J, Tian J, Xu X, Wang B, Yang H, Luo B. Combined use of strain elastography and superb microvascular imaging with grayscale ultrasound according to the BI-RADS classification for differentiating benign from malignant solid breast masses. Clin Hemorheol Microcirc 2020; 74:391-403. [PMID: 31683470 DOI: 10.3233/ch-190693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Ming Liang
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bing Ou
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiayi Wu
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyun Xiao
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingliang Ruan
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Tian
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaolin Xu
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bin Wang
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haiyun Yang
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Baoming Luo
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
|
49
|
Cai SM, Wang HY, Zhang XY, Zhang L, Zhu QL, Li JC, Sun Q, Jiang YX. The Vascular Index of Superb Microvascular Imaging Can Improve the Diagnostic Accuracy for Breast Imaging Reporting and Data System Category 4 Breast Lesions. Cancer Manag Res 2020; 12:1819-1826. [PMID: 32210624 PMCID: PMC7073432 DOI: 10.2147/cmar.s242101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/27/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To investigate whether the vascular index (VI) of superb microvascular imaging (SMI) could improve the diagnostic efficiency for BI-RADS 4 breast lesions and reduce the number of unnecessary biopsies. PATIENTS AND METHODS For this study, we selected 222 consecutive BI-RADS 4 breast lesions detected by ultrasound and confirmed by pathology from January 2016 to October 2018. A VI of 4.0 was set as the cutoff value to degrade BI-RADS classification. We calculated the accuracy, sensitivity and PPV of a BI-RADS diagnosis alone and the combination of BI-RADS and the VI. RESULTS Pathologically, of the 222 lesions, 129 were confirmed to be benign, and 93 were found to be malignant. A VI of 4.0 was set as the cutoff value; when the VI≤4.0, those BI-RADS 4 masses were downgraded one level (4C-4B, 4B-4A, 4A-3) to an integral BI-RADS grade, while the others maintained the conventional grade. A total of 54 BI-RADS 4 lesions were degraded to BI-RADS 3, including 53 benign lesions and 1 malignant lesion. The diagnostic accuracy (65.3% vs 41.9%) and PPV (54.8% vs 41.9%) were significantly improved. The sensitivity decreased slightly (98.9% vs 100%) because 1 of the 54 downgraded BI-RADS 4 lesions, which had a pathological type of invasive ductal carcinoma, was incorrectly downgraded. CONCLUSION SMI is a noninvasive tool for visualizing the vascular structure with high-resolution microvascular images. As a quantitative index, the VI can be used to appropriately downgrade benign lesions classified as BI-RADS 4, which can improve the diagnostic accuracy and PPV and reduce unnecessary biopsies.
Collapse
Affiliation(s)
- Si-Man Cai
- Department of Medical Ultrasound, Peking Union Medical College Hospital and Chinese Academy Medical Sciences, Beijing100730, People’s Republic of China
| | - Hong-Yan Wang
- Department of Medical Ultrasound, Peking Union Medical College Hospital and Chinese Academy Medical Sciences, Beijing100730, People’s Republic of China
| | - Xiao-Yan Zhang
- Department of Medical Ultrasound, Peking Union Medical College Hospital and Chinese Academy Medical Sciences, Beijing100730, People’s Republic of China
| | - Li Zhang
- Department of Medical Ultrasound, Peking Union Medical College Hospital and Chinese Academy Medical Sciences, Beijing100730, People’s Republic of China
| | - Qing-Li Zhu
- Department of Medical Ultrasound, Peking Union Medical College Hospital and Chinese Academy Medical Sciences, Beijing100730, People’s Republic of China
| | - Jian-Chu Li
- Department of Medical Ultrasound, Peking Union Medical College Hospital and Chinese Academy Medical Sciences, Beijing100730, People’s Republic of China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital and Chinese Academy Medical Sciences, Beijing100730, People’s Republic of China
| | - Yu-Xin Jiang
- Department of Medical Ultrasound, Peking Union Medical College Hospital and Chinese Academy Medical Sciences, Beijing100730, People’s Republic of China
| |
Collapse
|
|
50
|
Park AY, Kwon M, Woo OH, Cho KR, Park EK, Cha SH, Song SE, Lee JH, Cha J, Son GS, Seo BK. A Prospective Study on the Value of Ultrasound Microflow Assessment to Distinguish Malignant from Benign Solid Breast Masses: Association between Ultrasound Parameters and Histologic Microvessel Densities. Korean J Radiol 2020; 20:759-772. [PMID: 30993927 PMCID: PMC6470080 DOI: 10.3348/kjr.2018.0515] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/22/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To investigate the value of ultrasound (US) microflow assessment in distinguishing malignant from benign solid breast masses as well as the association between US parameters and histologic microvessel density (MVD). MATERIALS AND METHODS Ninety-eight breast masses (57 benign and 41 malignant) were examined using Superb Microvascular Imaging (SMI) and contrast-enhanced US (CEUS) before biopsy. Two radiologists evaluated the quantitative and qualitative vascular parameters on SMI (vascular index, morphology, distribution, and penetration) and CEUS (time-intensity curve analysis and enhancement characteristics). US parameters were compared between benign and malignant masses and the diagnostic performance was compared between SMI and CEUS. Subgroup analysis was performed according to lesion size. The effect of vascular parameters on downgrading Breast Imaging Reporting and Data System (BI-RADS) category 4A masses was evaluated. The association between histologic MVD and US parameters was analyzed. RESULTS Malignant masses were associated with a higher vascular index (15.1 ± 7.3 vs. 5.9 ± 5.6), complex vessel morphology (82.9% vs. 42.1%), central vascularity (95.1% vs. 59.6%), penetrating vessels (80.5% vs. 31.6%) on SMI (all, p < 0.001), as well as higher peak intensity (37.1 ± 25.7 vs. 17.0 ± 15.8, p < 0.001), slope (10.6 ± 11.2 vs. 3.9 ± 4.2, p = 0.001), area (1035.7 ± 726.9 vs. 458.2 ± 410.2, p < 0.001), hyperenhancement (95.1% vs. 70.2%, p = 0.005), centripetal enhancement (70.7% vs. 45.6%, p = 0.023), penetrating vessels (65.9% vs. 22.8%, p < 0.001), and perfusion defects (31.7% vs. 3.5%, p < 0.001) on CEUS (p ≤ 0.023). The areas under the receiver operating characteristic curve (AUCs) of SMI and CEUS were 0.853 and 0.841, respectively (p = 0.803). In 19 masses measuring < 10 mm, central vascularity on SMI was associated with malignancy (100% vs. 38.5%, p = 0.018). Considering all benign SMI parameters on the BI-RADS assessment, unnecessary biopsies could be avoided in 12 category 4A masses with improved AUCs (0.500 vs. 0.605, p < 0.001). US vascular parameters associated with malignancy showed higher MVD (p ≤ 0.016). MVD was higher in malignant masses than in benign masses, and malignant masses negative for estrogen receptor or positive for Ki67 had higher MVD (p < 0.05). CONCLUSION US microflow assessment using SMI and CEUS is valuable in distinguishing malignant from benign solid breast masses, and US vascular parameters are associated with histologic MVD.
Collapse
Affiliation(s)
- Ah Young Park
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.,Department of Radiology, Bundang CHA Medical Center, CHA University, Seongnam, Korea
| | - Myoungae Kwon
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Ok Hee Woo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyu Ran Cho
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eun Kyung Park
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sang Hoon Cha
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sung Eun Song
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ju Han Lee
- Department of Pathology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - JaeHyung Cha
- Medical Science Research Center, Korea University Ansan Hospital, Ansan, Korea
| | - Gil Soo Son
- Division of Breast Endocrine Surgery, Department of General Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Bo Kyoung Seo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
| |
Collapse
|