Purpose
Ultrasound with its various applications has revolutionsed radiological diagnoses over the past few decades.
More so recently,
with improved resolution,
better appreciation of the value of dynamic assessments and increased awareness of the risks of radiation.
SMi allows for assessment of micro vascularity,
tissue perfusion and underlying physiological distribution of vascularity.
Its algorithm minimizes motion artifact,
offers high frame rate imaging,
allowing simultaneous assessment of the underlying tissues with improved spatial resolution when compared to other vascular US platforms (power/colour Doppler).
Methods and Materials
We reflect on our experience of utilizing SMi (color SMi (cSMi) and monochrome SMi (mSMi),
as a novel adjuvant tool when performing US on patients to gain valuable insight into the underlying functional and physiological changes which are influenced by loco-regional conditions,
the underlying region of interest tissues are affected by.
We elaborate on the technology behind this novel platform of US imaging and discuss potential pitfalls and how to avoid them.
We explore the potential advantages SMi can offer with examples from our practice.
Results
In our experience,
SMi can assess:
1. Vascularity for neoangiogenesis,
proven to be a pain generator.
2. Early inflammation in tendons and joints.
3.Tissue healing,
particularly in muscles.
SMi can differentiate scarring,
necrosis and tissue repair.
This is particularly useful in athletes.
4.It provides information about differential perfusion patterns,
which are affected by physiological factors such as body temperature & exercise as well as pathological factors such as septicaemia
5. Small vascular lesions: e.g.
glomus tumours.
6. Granulomas,
characterizing their chronicity
7. Tumour recurrence versus...
Conclusion
SMi provides an adjuvant tool to grey scale imaging,
with high sensitivity and specificity to assess structural anatomy,
tissue architecture,
dimensions,
characteristics and to differentiate fluid from solid lesions and allows for assessment of tendon and muscle tears,
enhanced by panoramic imaging.
Its superior sensitivity,
novelty and unique ability to depict both physiological and pathological changes in the imaged tissues,
requires interpretation of findings with caution.
Sequential imaging is therefore advised to focus on patterns,
rather than absolute observations.
Contralateral SMi,
correlation with previous or...
References
1.SteveMcNally.anz.medical.canon/wpcontent/uploads/sites/17/2016/09/SMI-%E2%80%93-A-New-Tool-for-the-Sports-Physician.pdf
2.Artul S,
Nseir W,
Armaly Z,
Soudack M.
Superb Microvascular Imaging: Added Value and Novel Applications.Journal of Clinical Imaging Science.
2017;7:45.
doi:10.4103/jcis.JCIS_79_17.
3.
Kong J,
Li JC,
Wang HY,
Wang YH,
Zhao RN,
Zhang Y,Jin J.
Role ofSuperbMicro-VascularImagingin the Preoperative Evaluation of Thyroid Nodules: Comparison With Power Doppler FlowImaging.J Ultrasound Med.2017 Jul;36(7):1329-1337.
Personal Information
Dr Amanda Isaac
Consultant Musculoskeletal Radiologist,
Guy's & St Thomas' NHS Foundation Trust,
London,
UK
Hon Senior Clinical Lecturer,
Kings College London,
UK
Dr Danoob Dalili
Specialist Registrar Clinical Radiology,
Imperial College London,
UK
Research fellow,
Guy's & St Thomas' NHS Foundation Trust,
London,
UK
Special thanks to Canon Medical & Dr Steve McNally