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Hwang SM, Yoo SY, Jeong WK, Lee MW, Jeon TY, Kim JH. Superb Microvascular Imaging in Pediatric Focal Nodular Hyperplasia. J Pediatr Hematol Oncol 2024; 46:e233-e240. [PMID: 38408130 PMCID: PMC10956684 DOI: 10.1097/mph.0000000000002826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 01/02/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE To investigate superb microvascular imaging (SMI), a novel Doppler ultrasound technique that can visualize low-velocity microvascular flow, for assessing pediatric focal nodular hyperplasia (FNH). PATIENTS AND METHODS Nine FNH lesions in 6 patients were enrolled. On SMI and color Doppler imaging (CDI), intralesional vascularity was assessed visually and categorized as typical spoke-wheel pattern (central vessel radiating from the center to the periphery), multifocal spoke-wheel pattern, and nonspecific pattern. We compared the vascular features of the lesions between SMI and CDI and evaluated vascular patterns according to lesion size. RESULTS In terms of vascularity pattern, the typical spoke-wheel pattern of FNH was noted more frequently on SMI (67%) than on CDI (11%; P < 0.05). In addition, a multifocal spoke-wheel pattern was noted in all remaining lesions (33%) on SMI. On the contrary, a nonspecific vascular pattern was detected in the majority (78%) of CDI. Regarding the lesion size and vascularity on SMI, the typical spoke-wheel pattern was seen more frequently in the small FNH group than in the large FNH group. The intralesional vascular signal was detected more frequently on SMI (100%) than on CDI (89%). CONCLUSION SMI is feasible in evaluating FNH in children and has a greater ability to demonstrate the spoke-wheel pattern than CDI.
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Affiliation(s)
- Sook Min Hwang
- Department of Radiology, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University
| | - So-Young Yoo
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Tae Yeon Jeon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Ji Hye Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
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Cannella R, Pilato G, Mazzola M, Bartolotta TV. New microvascular ultrasound techniques: abdominal applications. LA RADIOLOGIA MEDICA 2023; 128:1023-1034. [PMID: 37495910 PMCID: PMC10473992 DOI: 10.1007/s11547-023-01679-6] [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: 03/31/2023] [Accepted: 07/03/2023] [Indexed: 07/28/2023]
Abstract
Microvascular ultrasound (MVUS) is a new ultrasound technique that allows the detection of slow-velocity flow, providing the visualization of the blood flow in small vessels without the need of intravenous contrast agent administration. This technology has been integrated in the most recent ultrasound equipment and applied for the assessment of vascularization. Compared to conventional color Doppler and power Doppler imaging, MVUS provides higher capability to detect intralesional flow. A growing number of studies explored the potential applications in hepatobiliary, genitourinary, and vascular pathologies. Different flow patterns can be observed in hepatic and renal focal lesions providing information on tumor vascularity and improving the differential diagnosis. This article aims to provide a detailed review on the current evidences and applications of MVUS in abdominal imaging.
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Affiliation(s)
- Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
| | - Giulia Pilato
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Mariasole Mazzola
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Tommaso Vincenzo Bartolotta
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
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Rónaszéki AD, Dudás I, Zsély B, Budai BK, Stollmayer R, Hahn O, Csongrády B, Park BS, Maurovich-Horvat P, Győri G, Kaposi PN. Microvascular flow imaging to differentiate focal hepatic lesions: the spoke-wheel pattern as a specific sign of focal nodular hyperplasia. Ultrasonography 2023; 42:172-181. [PMID: 36420572 PMCID: PMC9816699 DOI: 10.14366/usg.22028] [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] [Received: 02/18/2022] [Accepted: 07/09/2022] [Indexed: 11/25/2022] Open
Abstract
Microvascular flow imaging (MVFI) is an advanced Doppler ultrasound technique designed to detect slow-velocity blood flow in small-caliber microvessels. This technique is capable of realtime, highly detailed visualization of tumor vessels without using a contrast agent. MVFI has been recently applied for the characterization of focal liver lesions and has revealed typical vascularity distributions in multiple types thereof. Focal nodular hyperplasia (FNH) constitutes an important differential diagnosis of malignant liver tumors. In this essay, we provide iconographic documentation of the MVFI appearance of FNH and other common solid liver lesions. Identifying the typical patterns of vascularity, including the spoke-wheel pattern with MVFI, can expedite the diagnosis, spare patients from unnecessary procedures, and save costs.
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Affiliation(s)
- Aladár David Rónaszéki
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ibolyka Dudás
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Boglarka Zsély
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Bettina Katalin Budai
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Róbert Stollmayer
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Oszkár Hahn
- Department of Surgery, Transplantation and Gastroenterology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Barbara Csongrády
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Byung-so Park
- Medical Affairs Manager at Samsung Medison, Samsung Medison Co., Ltd., An Affiliate of Samsung Electronics, Seoul, Korea
| | - Pál Maurovich-Horvat
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Gabriella Győri
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Pal Novak Kaposi
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary,Correspondence to: Pál Novák Kaposi, MD, PhD, Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Korányi Sándor str. 2., H-1083 Budapest, Hungary Tel. +36-1-459-1500/61628 Fax. +36-1-459-1500/61626 E-mail:
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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: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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.
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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
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Kang TW, Jeong WK, Kim YY, Min JH, Kim YK, Kim SH, Sinn DH, Kim K. Comparison of Super-Resolution US and Contrast Material-enhanced US in Detection of the Spoke Wheel Sign in Patients with Focal Nodular Hyperplasia. Radiology 2020; 298:82-90. [PMID: 33107798 DOI: 10.1148/radiol.2020200885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Diagnosis of focal nodular hyperplasia (FNH) with US generally requires the use of contrast material. The effect of the super-resolution US technique on the diagnosis of FNH is unknown. Purpose To investigate the equivalence between super-resolution US and contrast material-enhanced US in the detection of spoke wheel sign in patients with FNH by comparing patterns of tumor vascularity. Materials and Methods This is a secondary analysis of a prospective trial (NCT02737865) that enrolled participants diagnosed with FNH between May 2016 and March 2019. These patients underwent super-resolution US and subsequent contrast-enhanced US with perfluorobutane microbubbles on the same day. The primary outcome was the confidence score of detecting spoke wheel sign in patients with FNH at US. Two radiologists used a four-point scale to score their confidence in the presence of the spoke wheel sign based on super-resolution US and contrast-enhanced US findings. Two one-sided tests were used to test the equivalence between super-resolution US and contrast-enhanced US in terms of the score for the confidence level of the spoke wheel sign. Interobserver agreement for both techniques between the two radiologists, using the recorded images, was analyzed by using an intraclass correlation coefficient. Results In 62 patients (mean age, 37 years; range, 20-69 years; 41 women) with FNH, the majority of patients showed a spoke wheel sign at super-resolution US and contrast-enhanced US (63% [39 of 62] and 71% [44 of 62], respectively; P = .36). There was no significant difference between the super-resolution US and contrast-enhanced US techniques regarding the confidence score for the spoke wheel sign (mean score, 1.8 vs 2.0; P = .03 for equivalence test). The intraclass correlation coefficients of super-resolution US and contrast-enhanced US regarding the presence of the spoke wheel sign were 0.82 (95% confidence interval: 0.73, 0.96) and 0.58 (95% confidence interval: 0.41, 0.73), respectively. Conclusion In comparison with contrast-enhanced US, super-resolution US provided a reliable rate of detection of the spoke wheel sign in patients with focal nodular hyperplasia. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Fetzer in this issue.
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Affiliation(s)
- Tae Wook Kang
- From the Department of Radiology and Center for Imaging Science (T.W.K., W.K.J., Y.Y.K., J.H.M., Y.K.K., S.H.K.) and Department of Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea; and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (K.K.)
| | - Woo Kyoung Jeong
- From the Department of Radiology and Center for Imaging Science (T.W.K., W.K.J., Y.Y.K., J.H.M., Y.K.K., S.H.K.) and Department of Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea; and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (K.K.)
| | - Yeun-Yoon Kim
- From the Department of Radiology and Center for Imaging Science (T.W.K., W.K.J., Y.Y.K., J.H.M., Y.K.K., S.H.K.) and Department of Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea; and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (K.K.)
| | - Ji Hye Min
- From the Department of Radiology and Center for Imaging Science (T.W.K., W.K.J., Y.Y.K., J.H.M., Y.K.K., S.H.K.) and Department of Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea; and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (K.K.)
| | - Young Kon Kim
- From the Department of Radiology and Center for Imaging Science (T.W.K., W.K.J., Y.Y.K., J.H.M., Y.K.K., S.H.K.) and Department of Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea; and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (K.K.)
| | - Seong Hyun Kim
- From the Department of Radiology and Center for Imaging Science (T.W.K., W.K.J., Y.Y.K., J.H.M., Y.K.K., S.H.K.) and Department of Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea; and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (K.K.)
| | - Dong Hyun Sinn
- From the Department of Radiology and Center for Imaging Science (T.W.K., W.K.J., Y.Y.K., J.H.M., Y.K.K., S.H.K.) and Department of Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea; and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (K.K.)
| | - Kyunga Kim
- From the Department of Radiology and Center for Imaging Science (T.W.K., W.K.J., Y.Y.K., J.H.M., Y.K.K., S.H.K.) and Department of Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea; and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (K.K.)
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Naganuma H, Ishida H, Kuroda H, Suzuki Y, Ogawa M. Hereditary hemorrhagic telangiectasia: how to efficiently detect hepatic abnormalities using ultrasonography. J Med Ultrason (2001) 2020; 47:421-433. [PMID: 32390074 DOI: 10.1007/s10396-020-01022-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/30/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Hereditary hemorrhagic telangiectasia (HHT) is a multiorgan genetic angiodysplastic affection characterized by visceral vascular malformations. It affects mainly the brains, lungs, gastrointestinal tract, and nasal mucosa. Unlike those organs, hepatic involvement, although very frequently occurring, is insufficiently recognized, mainly because of the complex vascular structure of this organ. Thus, treating HHT patients requires a solid understanding of these hepatic anomalies. It is especially important for any general clinicians to be able to recognize clinical findings in HHT, which leads to a high suspicion of HHT and have an index of suspicion for liver abnormalities of HHT. For this purpose, keen awareness of clinical as well as hepatic sonographic (US) findings is paramount. AIM The aim of this review is to summarize previously reported findings on the hepatic US through a thorough analysis of related articles, and to (a) determine the role of US in the diagnosis of hepatic involvement in HHT patients and (b) propose the most simple and easy way to detect HHT-related abnormalities during routine US examinations. CONCLUSION Hepatic US serves to diagnose the detailed complex hepatic changes typical of HHT, and contributes to increased diagnostic confidence of hepatic changes in HHT patients, with the most simple way not to overlook HHT-related abnormalities being to find hepatic artery dilatation.
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Affiliation(s)
- Hiroko Naganuma
- Department of Gastroenterology, Yokote Municipal Hospital, 5-31 Negishi-cho, Yokote, Akita, 013-8602, Japan.
| | - Hideaki Ishida
- Center of Diagnostic Ultrasound, Akita Red Cross Hospital, Akita, Japan
| | - Hidekatsu Kuroda
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Yasuaki Suzuki
- Department of Gastroenterology, Nayoro City General Hospital, Hokkaido, Japan
| | - Masahiro Ogawa
- Department of Gastroenterology and Hepatology, Nihon University Hospital, Tokyo, Japan
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Jiang ZZ, Huang YH, Shen HL, Liu XT. Clinical Applications of Superb Microvascular Imaging in the Liver, Breast, Thyroid, Skeletal Muscle, and Carotid Plaques. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2811-2820. [PMID: 30953387 DOI: 10.1002/jum.15008] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/21/2019] [Accepted: 02/25/2019] [Indexed: 06/09/2023]
Abstract
This article reviews the clinical applications of Superb Microvascular Imaging (SMI; Canon Medical Systems, Otawara, Japan) in the liver, breast, thyroid, skeletal muscle, and carotid plaques. Diseases that are closely associated with angiogenesis can be diagnosed by SMI in a relatively early phase, and using SMI can prevent adverse reactions associated with the contrast agents used in contrast-enhanced ultrasound. Super Microvascular Imaging also shows particular value in grading disease activities and monitoring therapeutic responses. Although SMI has some limitations, such as a lack of clinical standards, it can add information to conventional ultrasound examinations and may become a noninvasive alternative to invasive diagnostic procedures for many clinical conditions.
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Affiliation(s)
- Zhen-Zhen Jiang
- Department of Ultrasound, Shaoxing People's Hospital, Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing, China
| | - Yan-Hua Huang
- Department of Ultrasound, Shaoxing People's Hospital, Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing, China
| | - Hua-Liang Shen
- Department of Ultrasound, Shaoxing People's Hospital, Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing, China
| | - Xia-Tian Liu
- Department of Ultrasound, Shaoxing People's Hospital, Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing, China
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Han H, Ding H, Ji Z, Zhang W, Wang Q, Wang W. Primary Application of Micro-Flow Imaging Technology in the Diagnosis of Hepatic Tumors. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:395-401. [PMID: 30409471 DOI: 10.1016/j.ultrasmedbio.2018.09.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/13/2018] [Accepted: 09/27/2018] [Indexed: 06/08/2023]
Abstract
The purpose of the study was to evaluate the vascular architecture of focal liver lesions with the newly released non-contrast micro-flow imaging (MFI) technique. Eighty patients with 80 hepatic tumors were enrolled in this study. The richness of displayed blood flow was first compared with color Doppler flow imaging using grades according to Adler's method. The results indicated that MFI outperformed color Doppler flow imaging with a statistically significant difference (p <0.0001). With the enhanced position in arterial phase of contrast-enhanced ultrasound imaging as the ground truth, the displayed blood flow distribution within tumors in MFI was further evaluated. The coincidence rate between MFI and contrast-enhanced ultrasound was 73.75% (59/80), which was higher than that of color Doppler flow imaging (52.5%, 42/80) (p < 0.0001). Moreover, for the five cases of focal nodular hyperplasia, MFI clearly revealed the spoke-wheel or radiating intra-tumoral vasculature, a finding specific to the diagnosis of focal nodular hyperplasia.
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Affiliation(s)
- Hong Han
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Hong Ding
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Zhengbiao Ji
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Weibin Zhang
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Qun Wang
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Wenping Wang
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China.
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Oura K, Kato T, Ohba H, Terayama Y. Evaluation of Intraplaque Neovascularization Using Superb Microvascular Imaging and Contrast-Enhanced Ultrasonography. J Stroke Cerebrovasc Dis 2018; 27:2348-2353. [PMID: 29754774 DOI: 10.1016/j.jstrokecerebrovasdis.2018.04.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/11/2018] [Accepted: 04/19/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Several studies have shown a linkage between intraplaque neovascularization (IPN) and plaque instability. Although contrast-enhanced ultrasonography (CEUS) may help visualize IPN in the carotid artery, its benefits are limited in Japan, where there is no health insurance coverage for contrast agents in medical imaging. Superb microvascular imaging (SMI), however, enables the depiction of low-velocity blood flow. The current study compares the diagnostic accuracy of SMI and CEUS in the evaluation of IPN. METHODS The SMI and CEUS video images were transferred to a workstation and then analyzed to determine whether intraplaque blood flow signals were detected with SMI and whether plaques were contrast-enhanced with carotid artery CEUS. The images generated were independently interpreted by 2 radiologic technologists and 1 neurologist. RESULTS Intraplaque enhancement was observed in 19 patients using CEUS while intraplaque blood flow signals were observed in 12 patients using SMI. A 100% specificity was recorded for SMI (all 12 patients with SMI-detected intraplaque blood flow showed contrast-enhanced plaques), while its sensitivity was 63% (8 of the 15 patients with no SMI-detected intraplaque blood flow showed contrast-enhanced plaques on CEUS). CONCLUSIONS The results of this study show that patients with SMI-detected blood flow will tend to have plaque enhancement using CEUS. This suggests that SMI, as a simpler, safer, and noninvasive technique, can facilitate the visualization of carotid artery IPN without the use of a contrast agent, as well as in the clinical evaluation of plaque instability.
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Affiliation(s)
- Kazumasa Oura
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Morioka, Japan.
| | - Tadayoshi Kato
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Hideki Ohba
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Yasuo Terayama
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Morioka, Japan
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Yazaki T, Sato S, Tobita H, Isoda K, Miyake T, Kinoshita Y. Elderly Fitz-Hugh-Curtis syndrome observed with superb microvascular imaging system. J Med Ultrason (2001) 2018; 45:611-615. [PMID: 29464468 DOI: 10.1007/s10396-018-0865-2] [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: 10/24/2017] [Accepted: 01/09/2018] [Indexed: 11/09/2022]
Abstract
Fitz-Hugh-Curtis syndrome (FHCS) is defined as inflammation on the surface of the liver following sexually transmitted chlamydia infection. We successfully observed the microvascular structure of the inflamed portion between the abdominal wall and surface of the liver in an elderly patient with FHCS using a superb microvascular imaging (SMI) system, a new technology developed for observing minute vascular flow. An 80-year-old Japanese female with right dorsal to lateral abdominal pain and fever came to our hospital. Anti-chlamydia antibodies were positive. SMI revealed signals suggesting small vessels passing from the liver surface to the hypoechoic space.
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Affiliation(s)
- Tomotaka Yazaki
- Department of Hepatology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Shuichi Sato
- Department of Hepatology, Faculty of Medicine, Shimane University, Izumo, Japan. .,Department of Gastroenterology and Hepatology, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo, Shimane, Japan.
| | - Hiroshi Tobita
- Department of Hepatology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Kazuki Isoda
- Department of Hepatology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Tatsuya Miyake
- Department of Hepatology, Shimane Prefectural Hospital, Izumo, Japan
| | - Yoshikazu Kinoshita
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
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Yamanaka Y, Ishida H, Naganuma H, Komatsuda T, Miyazawa H, Miyauchi T, Takahashi S, Tozawa T, Enomoto K. Superb microvascular imaging (SMI) findings of splenic artery pseudoaneurysm: a report of two cases. J Med Ultrason (2001) 2018; 45:515-523. [PMID: 29383555 DOI: 10.1007/s10396-018-0858-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/11/2017] [Indexed: 01/25/2023]
Abstract
Splenic artery pseudoaneurysm (SAPA) is a relatively infrequently encountered but clinically important vascular change, because it carries a high risk of rupture that warrants prompt treatment regardless of its size. Thus, sufficient knowledge is indispensable when seeing chronic pancreatitis patients or post-traumatic patients. Here, we report two such cases. The first case was a 52-year-old woman known to have chronic pancreatitis who presented with hematemesis and hemodynamic instability in which X-ray computed tomography (CT) and color Doppler sonography (CDS) had difficulty visualizing slow blood flow in SAPA, but superb microvascular imaging (SMI) clearly demonstrated the slow blood flow in SAPA, prompting our therapeutic decision to perform rapid embolization. The second case was a 51-year-old woman with post-traumatic SAPA in which 3D SMI enabled us to understand more clearly the topographic relationship between multiple SAPAs as compared with conventional US, leading to a decision to provide immediate surgical treatment. SMI was thought to provide a new insight into the US diagnosis of SAPA. When examining patients suspected of having a SAPA, SMI is an indispensable diagnostic tool at present.
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Affiliation(s)
- Yumiko Yamanaka
- Center of Diagnostic Ultrasound, Akita Red Cross Hospital, 222-1 Kamikitade, Saruta, Nawashirosawa, Akita, 010-1495, Japan.
| | - Hideaki Ishida
- Center of Diagnostic Ultrasound, Akita Red Cross Hospital, 222-1 Kamikitade, Saruta, Nawashirosawa, Akita, 010-1495, Japan
| | - Hiroko Naganuma
- Department of Gastroenterology, Yokote Municipal Hospital, Yokote, Japan
| | - Tomoya Komatsuda
- Center of Diagnostic Ultrasound, Akita Red Cross Hospital, 222-1 Kamikitade, Saruta, Nawashirosawa, Akita, 010-1495, Japan
| | - Hideaki Miyazawa
- Department of Gastrointestinal Surgery, Akita Red Cross Hospital, Akita, Japan
| | | | - Satoshi Takahashi
- Department of Diagnostic Radiology, Akita University Hospital, Akita, Japan
| | - Tomoki Tozawa
- Department of Diagnostic Radiology, Akita University Hospital, Akita, Japan
| | - Katsuhiko Enomoto
- Department of Diagnostic Pathology, Akita Red Cross Hospital, Akita, Japan
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The utility of superb microvascular imaging for monitoring low-velocity venous flow following pancreas transplantation: report of a case. J Med Ultrason (2001) 2017; 45:171-174. [DOI: 10.1007/s10396-017-0795-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/09/2017] [Indexed: 11/26/2022]
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