Superb micro-vascular imaging combined with TI-RADS in differential diagnosis of benign and malignant thyroid nodules / 中国医学影像技术

Objective: To explore the value of superb micro-vascular imaging (SMI) combined with the 2017 American Radiological Society thyroid imaging reporting and data system (TI-RADS) in differential diagnosis of benign and malignant thyroid nodules. Methods: A total of 187 thyroid nodules in 179 patients were classified into TR types 1 to 5 according to TI-RADS with conventional ultrasound, and then TI-RADS classification was re-adjusted in combination with SMI technology. The optimal diagnostic boundary was determined by ROC curve, and the diagnostic efficacy of the two methods was compared. Results: Before correction, the actual malignant rates of TR 1 to 5 was 0, 0, 5.00%, 37.74% and 64.29%. After correction with SMI technology, the actual malignant rates of TR 1 to 5 was 0, 0, 5.56%, 23.26% and 66.36%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy before and after correction with SMI technology was 75.00%, 66.02%, 64.29%, 76.40%, 70.05% and 86.91%, 64.08%, 66.36%, 85.71%, 74.33%, respectively. AUC and sensitivity after correction were both higher than before (Z=-2.616, -1.988; P=0.009, 0.047). Conclusion: SMI technology can show perforating blood flow in thyroid nodules, which combined with TI-RADS can improve the diagnostic efficacy of thyroid nodules.

Differential diagnosis of polypoid lesions of gallbladder by superb micro-vascular imaging combined with conventional ultrasound / 中华超声影像学杂志

Objective@#To explore the value of superb micro-vascular imaging(SMI) combined with conventional ultrasound in differential diagnosis of polypoid lesions of gallbladder.@*Methods@#The ultrasonographic and pathological datas of 67 patients with polypoid lesions of gallbladder (of ≥1 cm) in diameter were analyzed retrospectively. According to the pathological results, the patients were divided into tumorous polyp group and non-tumorous polyp group.Conventional ultrasound, SMI and contrast-enhanced ultrasound (CEUS) were performed in all patients before operation, and the basal width, continuity of cystic wall and internal blood flow morphology of polyps were evaluated. The ROC curve was used to calculate the area under the curve and the optimum boundary value of tumorous polyps, the sensitivity and specificity of SMI combined with conventional ultrasound in the diagnosis of neoplastic polyps were calculated according to the optimal threshold. Kappa consistency test was used to analyze the consistency between microblood flow ability and CEUS shown by SMI technique.@*Results@#Of the 67 patients, 22 cases were neoplastic polyps, and 45 cases were non-neoplastic polyps.The polyps were scored quantitatively by SMI combined with conventional ultrasound (0-9 points) and the ROC curve was plotted with, area under curve 0.893(95% CI 0.792-0.994). The sensitivity, specificity and accuracy of diagnosing neoplastic polyps with score (≥4.5) were 77.3%, 93.3% and 88.1%, respectively. Compared with the score of CEUS for microblood flow display (0-4 points), the Kappa values of CDFI, SMI was 0.186, 0.688. SMI and CEUS have good consistency.@*Conclusions@#SMI combined with conventional ultrasound is helpful in differential diagnosis of polypoid lesions of gallbladder, with a high diagnostic value. SMI and CEUS have good consistency in the display of micro-blood flow. It can provide a new diagnostic basis for differential diagnosis of polypoid lesions of gallbladder.

Feasibility Study on Screening Neovascularization of Carotid Plaque by Ultrasound Superb Micro-vascular Imaging / 中山大学学报(医学科学版)

@#【Objective】 We sought to compare ultrasound superb micro- vascular imaging （SMI） and contrast- enhanced ultrasound（CEUS）in the evaluation of carotid plaque neovascularization，and to understand the feasibility of SMI as a method to screen neovascularization of plaque.【Methods】A total of 60 cases，with a total of 109 plaques underwent SMI and CEUS to detect neovascularization of plaque.【Results】SMI and CEUS examination results were consistent in 101 of 109 plaques. The cost of SMI was less than CEUS（￥150 vs. ￥900）. There was significant difference in examination time between SMI and CEUS［（5.0 ± 1.4 vs. 18.5 ± 2.2）min，P < 0.05］.【Conclusion】Preliminary results showed that these two methods have good consistency. SMI also has advantages ：simple ，less time-consuming ，cheap and low risk. It indicates that SMI may be an effective screening method for neovascularization in plaques.

Differential diagnosis of polypoid lesions of gallbladder by superb micro-vascular imaging combined with conventional ultrasound / 中华超声影像学杂志

Objective To explore the value of superb micro-vascular imaging(SMI)combined with conventional ultrasound in differential diagnosis of polypoid lesions of gallbladder.Methods The ultrasonographic and pathological datas of 67 patients with polypoid lesions of gallbladder (of ≥1 cm) in diameter were analyzed retrospectively.According to the pathological results,the patients were divided into tumorous polyp group and non-tumorous polyp group.Conventional ultrasound,SMI and contrast-enhanced ultrasound (CEUS) were performed in all patients before operation,and the basal width,continuity of cystic wall and internal blood flow morphology of polyps were evaluated.The ROC curve was used to calculate the area under the curve and the optimum boundary value of tumorous polyps,the sensitivity and specificity of SMI combined with conventional ultrasound in the diagnosis of neoplastic polyps were calculated according to the optimal threshold.Kappa consistency test was used to analyze the consistency between microblood flow ability and CEUS shown by SMI technique.Results Of the 67 patients,22 cases were neoplastic polyps,and 45 cases were non-neoplastic polyps.The polyps were scored quantitatively by SMI combined with conventional ultrasound(0-9 points) and the ROC curve was plotted with,area under curve 0.893 (95％ CI 0.792-0.994).The sensitivity,specificity and accuracy of diagnosing neoplastic polyps with score(≥4.5) were 77.3％,93.3％ and 88.1％,respectively.Compared with the score of CEUS for microblood flow display(0-4 points),the Kappa values of CDFI,SMI was 0.186,0.688.SMI and CEUS have good consistency.Conclusions SMI combined with conventional ultrasound is helpful in differential diagnosis of polypoid lesions of gallbladder,with a high diagnostic value. SMI and CEUS have good consistency in the display of micro-blood flow.It can provide a new diagnostic basis for differential diagnosis of polypoid lesions of gallbladder.

Clinical value of ultrasonographic superb micro‐vascular imaging assessment for abdominal branch arteries in Stanford B aortic dissection / 中华超声影像学杂志

To investigate the clinical diagnostic value of ultrasonographic superb micro‐vascular imaging ( SM I) for abdominal branch arteries′involvement in Stanford B aortic dissection ( AD ) . Methods A total of 34 AD patients underwent conventional ultrasound ,SMI and CTA . The characteristics of the ultrasonographic images of branch artery involvement including coeliac artery ,superior mesenteric artery ,left and right renal artery were analyzed . T he diagnostic performance of conventional ultrasound and SM I were compared and CT A was used as the reference standard . Results Among the 34 patients with AD ,according to the ultrasonographic images′characteristics ,136 branch arteries were categorized into four classes :Class Ⅰ (81/136) ,branch artery perfusion supplied from the aortic true lumen ; Class Ⅱ ( 27/136) , dissection extending into the branch ; Class Ⅲ ( 16/136 ) ,branch artery perfusion supplied from the aortic false lumen ; Class Ⅳ ( 12/136) ,branch artery perfusion supplied from the aortic true and false lumens . T he diagnostic accordance rate of the conventional ultrasound and SM I were 76 .5% ( 104/136 ) and 92 .6%( 126/136) and had significant differences ( P ＜0 .001) . Conclusions SMI can be used to evaluate branch artery involvement in AD patients w hich will guide the practice of pre‐operation and post‐operation .

The application of superb micro-vascular imaging in evaluating the therapeutic efficacy of uterine fibroids treated with high intensity focused ultrasound / 中华超声影像学杂志

Objective To evaluate the value of superb micro-vascular imaging( SMI) in evaluating the efficacy of uterine fibroids treated with high intensity focused ultrasound( HIFU) . Methods Forty patients with single fibroid were selected before and after HIFU treatment ,color Doppler flow imaging(CDFI) ,SMI and contrast-enhanced ultrasound ( CEUS ) pattern were used to detect the lesions . CEUS was used as standard . The correlation of different blood flow levels in the fibroids with SMI and the efficacy of HIFU were evaluated . Results Before HIFU treatment ,the blood flow signals of different degrees were found in the uterine fibroids . SMI showed that 4 fibroids( 10 .0％ ) were in the first degree ,21 fibroids( 52 .5％ ) were in the second degree and 15 fibroids ( 37 .5％ ) were in the third degree . CEUS showed that 8 fibroids ( 20 .0％ ) were hypo-enhanced ,19 fibroids( 47 .5％ ) were iso-enhanced and 13 fobroids(32 .5％ ) were hyper-enhanced . The correlation analysis showed that there was close relationship between the results of SMI and CEUS( Kappa = 0 .754 , P = 0 .00) . After HIFU treatment ,SMI and CEUS had no statistical difference in evaluating the efficacy of HIFU( P > 0 .05) . The ratio of non-perfused volume and the ratio of the volume reduction at 6 months after HIFU in the third degree of SMI were lower than those in the first and second degrees( P < 0 .05) . Conclusions There are some relationships between SMI and CEUS in evaluating the blood flow signal of uterine fibroids . SMI can prompt therapeutic efficacy of uterine fibroids ablated by HIFU and provide some clinical reference values .

Comparative study of superb micro-vascular imaging and power Doppler imaging in the diagnosis of different size solid breast tumors / 中华超声影像学杂志

Objective To compare the diagnostic efficiency of superb micro-vascular imaging ( SMI) and power Doppler imaging ( PDI) in differentiating different size breast tumors . Methods Retrospective analysis were performent in a total of 170 cases of breast tumors of 144 patients screened with SMI and PDI in our hospital from August 2016 to July 2017 ,and pathological results were finally obtained . These tumors were divided into two groups according to the maximum diameter 2 .0 cm . SMI and PDI diagnostic efficiency were compared by showing blood flow distribution ,vascular morphology and Alder grade . Results There were 68 benign tumors and 102 malignant tumors .When the maximum diameter was no more than 2 .0 cm ,there were no significant difference in the blood flow distribution ,vascular morphology and Alder grade between PDI and SMI of benign tumors( all P > 0 .05) ;However ,there were significant differences in the vascular morphology and Alder grade of malignant tumors( all P < 0 .05) ,but no difference in blood flow distribution( P = 0 .174) ;The area under the curve of ROC by PDI and SMI were 0 .724 and 0 .844 ,thus , the difference was statistically significant( P = 0 .024) . When the maximum diameter was more than 2 .0 cm ,the between PDI and SMI differences in blood flow distribution ,vascular morphology and Alder grade were not statistically significant ( all P > 0 .05) in benign tumors ,but there was statistical difference in vascular morphology ( P = 0 .001) in malignant tumors ,and there was no significant difference in blood flow distribution ,Alder grade in malignant tumors between PDI and SMI ( all P > 0 .05) . The area under the curve of ROC by PDI and SMI were 0 .768 and 0 .802 ,the difference was not statistically significant ( P = 0 .447) . Conclusions SMI can show the blood flow characteristics more clearly in breast tumors . When the maximum diameter is no more than 2 .0 cm ,SMI diagnostic efficiency is better than PDI .

Application of shear wave elastography combined with superb micro-vascular imaging in diagnosing benign and malignant thyroid masses / 中华超声影像学杂志

Objective To investigate the application value of shear wave elastography (SWE) combined with superb micro-vascular imaging (SMI) in differentiating malignant and benign thyroid masses.Methods Seventy-eight patients diagnosed by ultrasound and verified with postoperative pathological analysis were enrolled.Conventional two-dimensional ultrasound was applied to observe the masses.SWE was performed to evaluate the elasticity and the Young's modulus (AveT1) value acquired.ROC curve was drawn to calculate the sensibility and specificity using the cut-off value of AveT1.SMI was applied to define Adler's grading standard according to the degree of blood supply.The sensitivity,specificity and accuracy of SWE and SWE combined with SMI in differentiating malignant and benign thyroid masses were analyzed.Results ①According to pathological analysis,there were 42 benign and 44 malignant masses;②The AveT1 value between malignant and benign groups were all significantly different (P ＜0.01).41.4 kPa was used as the best cut-off value of AveT1.The area under the ROC curve were 0.83 with sensitivity 86.9％ and specificity 88.1％;③There were more masses with the Alder class Ⅱ-Ⅲ in malignant group than those in benign group,and the difference was statistically significant (P ＜0.01);④Quantified with SWE or SWE combined with SMI,the sensitivity were 86.9％ and 91.3％,specificity were 88.1％ and 92.8％,and accuracy were 87.5％ and 94.1 ％,respectively,and the difference was statistically significant (P ＜ 0.01).Conclusions SWE combined with SMI represents an excellent application value in differentiating malignant and benign thyroid masses,which could improve the sensitivity,specificity and accuracy of the diagnosis for thyroid masses using ultrasound.

The application of superb micro-vascular imaging in predicting pregnancy outcome in patients with in vitro fertilization-embryo transfer / 中华超声影像学杂志

Objective To investigate the role of endometrial thickness,uterine artery and spiral artery blood flow parameters,endometrial and subendometrial blood flow on pregnancy outcome in vitro fertilization-embryo transfer (IVF-ET) cycle,compare the difference of the endometrial and subendometrial blood flow typing between the superb micro-vascular imaging (SMI) and power doppler ultrasound (PDUS). Methods Forty-one patients undergoing IVF-ET cycles in our hospital were recruited in this study. Transvaginal color Doppler ultrasound was performed to determine and record endometrial thickness,peak systolic velocity(PSV),end diastolic velocity(EDV),pulse index(PI),resistance index(RI), systolic diastolic ratio(S/D) of uterine artery and spiral artery,and degree endometrial and subendometrial blood flow signals were showed under the two blood flow modes of PDUS and SMI respectively on the day of human chorionic gonadotropin(HCG) injection.The degree of the endometrial and subendometrial blood flow was scored using Applehau classification method.According to the pregnancy outcome,patients were divided into pregnancy group and nonpregnancy group,the difference of the above indicators between the two groups were compared,and the degree of endometrial and subendometrial blood flow under two kinds of blood flow mode were observed.Results ①On the day of HCG injection,patients in pregnancy group had lower RI,PI,S/D of spiral artery than those in the nonpregnancy group (P< 0.05). There were no significant difference between the pregnant group and nonpregnant group in endometrial thickness and the blood flow parameters of uterine artery ( P >0.05). ②On the day of HCG injection,there was significant difference between the pregnant group and nonpregnant group in endometrial and subendometrial blood flow degree with SMI mode ( P =0.005).The patients with type Ⅲ in pregnancy group were most (50% ). ③The endometrial and subendometrial blood flow typing (β= 1.085,OR= 1.085,95% CI=1.040 -8.421, P=0.042) of pregnancy group under SMI mode have an independent predictive value.With increased blood flow typing under endometrial and subendometrial blood flow,the higher the possibility of pregnancy in patients.The ROC curve analysis showed that the area under ROC endometrial and subendometrial blood flow typing SMI mode on the HCG day was 0.746( P =0.008).Conclusions SMI is a new and effective type of Doppler ultrasound technique to evaluate the endometrial and subendometrial blood flow in IVF-ET cycle.On the day of HCG injection,the endometrial and subendometrial blood flow typing in SMI mode may predict pregnancy outcomes in IVF-ET cycles,and guide to choose the best embryo transfer time.

Evaluation of the correlation between neovascularization and clinical symptoms in carotid atherosclerotic plaque by superb micro-vascular imaging technique / 新乡医学院学报

Objective To investigate the value of superb micro-vascular imaging (SMI) in evaluating the relationship between neovascularization in carotid atherosclerotic plaque and clinical symptoms.Methods A total of 146 patients with carotid atherosclerotic plaque which were found by ultrasonography were selected from March 2015 to February 2017 in the Central Hospital of Jiading District of Shanghai.The patients were divided into clinical symptom group(n =96) and symptomless group (n =50) according to cerebrovascular events.The neovessels of carotid atherosclerotic plaque was observed and classified by SMI and contrast-enhanced ultrasound (CEUS).The relationship between the degree of neovascularization and clinical symptoms was analyzed by univariate analysis and multivariate analysis.SMI and GEUS were compared by consistency analysis,and the sensitivity and specificity of the two methods were analyzed.Results The average thickness of carotid atherosclerotic plaques in clinical symptoms group and symptomless group was (3.09 ± 0.79) and (2.89 ± 0.49) mm respectively,there was no significant difference between the two groups (P ＞ 0.05).There were 80 (83.33％) patients with neovascularization in carotid atherosclerotic plaque in the clinical symptoms group,and there were 20 (40.00％) patients with neovascularization in carotid atherosclerotic plaque in the symptomless group,the proportion of patients with neovascularization in carotid atherosclerotic plaque in the clinical symptoms group was significantly higher than that in the symptomless group (Z =-6.488,P ＜0.05).The SMI classification was in good agreement with the CEUS classification in the two groups (P ＜ 0.05).SMI showed the blood flow signal within carotid plaque in 100 cases,including 80 cases in the clinical symptoms group and 20 cases in the symptomless group.SMI showed no blood flow signal within the carotid plaques in 46 cases,including 16 cases in the clinical symptoms group and 30 cases in the symptomless group.GEUS showed the blood flow signal within carotid plaque in 109 cases,including 81 cases in the clinical symptoms group and 28 cases in the symptomless group.GEUS showed no blood flow signal within the carotid plaques in 37 cases,including 15 cases in the clinical symptoms group and 22 cases in the symptomless group.The sensitivity and specificity of SMI predicting the occurrence of clinical symptoms was 83.3％ and 40.00％ respectively.The sensitivity and specificity of GEUS predicting the occurrence of clinical symptoms was 84.4％ and 56.00％ respectively.Conclusions SMI can easily detect neovessels in carotid atherosclerotic plaques,and the degree of neovascularization is related to the occurrence of clinical symptoms.SMI technique plays an important role in evaluating the neovascularization in carotid plaques.

Application of superb micro-vascular imaging in gastric cancer / 中国医学影像技术

Objective To evaluate the application value of superb micro-vascular imaging (SMI) technology in gastric cancer.Methods Data of color Doppler flow imaging (CDFI) and SMI of 69 patients with gastric cancer confirmed by pathology were analyzed retrospectively.The positive rate in displaying the blood flow,the thickness of gastric carcer lesion with blood flow signal and the grade of blood flow obtained with CDFI and SMI were compared.Results The positive rate of blood flow was 75.36％ (52/69) of CDFI and 95.65％ (66/69) of SMI,respectively.The difference of positive rate between the two methods was statistically significant (x2 =11.461,P=0.001).The thickness of gastric cancer lesion with blood flow signal measured with CDFI was (19.92±4.54)mm,and that measured with SMI was (16.92±5.77)mm (t=2.048,P=0.043).There was statistical difference of the grades of blood flow between SMI and CDFI (Z=5.354,P＜ 0.001).Conclusion SMI technology is more sensitive for the low flow velocity of micro vessels signal in gastric carcinomas compared with CDFI,which can provide valuable reference for clinic.

Value of superb micro-vascular imaging in TI-RADS 4 thyroid nodules / 中华超声影像学杂志

Objective To evaluate the value of superb micro-vascular imaging(SMI) in the detection of TI-RADS 4 thyroid nodules . Methods A retrospective analysis of 61 patients( 68 thyroid nodules) with grade 4 TI-RADS diagnosed by routine ultrasound and undergone SMI were performed ,and the differences between CDFI and SMI were compared . The TI-RADS level were corrected by CDFI and SMI technology , combined with the pathological results to compare the diagnostic efficacy before and after the correction . At the same time ,the related factors had been collected to evaluate the risk factors and to compare the value of SMI in benign and malignant nodules . Results SMI was more likely to detect the type Ⅲ blood flow ( P =0 .001) of malignant nodules . The area under the ROC curve before TI-RADS correction ,after CDFI correction and SMI correction were 0 .66 ,0 .69 and 0 .78 ,respectively . Compared with before TI-RADS correction and after CDFI correction ,the area under the curve of SMI correction was significant different ( P=0 .002 ,0 .009) . There was no significant difference in the area under the curve between after CDFI correction and before correction ( P = 0 .4196 ) . The sensitivity of SMI was higher ,but there was no significant difference ( P >0 .05) . After single factor analysis and multivariate analysis ,central blood flow and perforating blood flow found by SMI were not independent risk factors for thyroid cancer . Conclusions SMI is more effective than CDFI in detecting TI-RADS 4 thyroid nodules ,and it is expected to be an auxiliary tool for the diagnosis of benign and malignant thyroid nodules .

Comparative Study of Conventional Vascular Ultrasound and Superb Micro Vascular Imaging for Diagnosing Carotid Artery Stenosis in Relevant Patients / 中国循环杂志

Objective: To assess the values of conventional vascular ultrasound (US) and superb micro vascular imaging (SMI) for diagnosing carotid artery stenosis in relevant patients. Methods: A total of 37 patients of extra cranial carotid stenosis (with 70 blood vessels) treated in our hospital from 2014-08 to 2015-03 were retrospectively studied. Digital subtraction angiography (DAS) examination was used as golden standard, the diagnostic efifcacies for carotid artery stenosis by US and by SMI were compared. Results: The accuracy, sensitivity and specificity for diagnosing carotid stenosis by US were 81.42%, 83.33% and 80.95%; by SMI were 91.43%, 92.16% and 89.47% respectively. Conclusion: US and SMI showed good agreement for diagnosing carotid artery stenosis, while SMI was superior to US for accurately assess the degree of carotid stenosis, it might be used as a more reliable method for evaluating carotid plaque and stenosis in relevant patients.