T HE U SE OF S UPERB M ICROVASCULAR I MAGING (SMI) T ECHNIQUE FOR E - PowerPoint PPT Presentation

T HE U SE OF S UPERB M ICROVASCULAR I MAGING (SMI) T ECHNIQUE FOR E VALUATING O VARIAN B LOOD F LOW AND C OMPARISON OF S UPERB M ICRO -V ASCULAR I MAGING AND C ONVENTIONAL D OPPLER I MAGING T ECHNIQUES Fatma Zeynep Arslan(1), Mehmet Sedat Durmaz(1), Serdar Arslan(1), Funda Gökgöz Durmaz(2) 1-University of Health Sciences, Konya Education and Research Hospital, Department of Radiology, Konya, Turkey 2-Turkish Ministery of Health, Public Health Institution Karatay 37th family health centre, Konya, Turkey

I NTRODUCTION Superb microvascular imaging (SMI) is a new vascularity imaging technique used to detect subtle low-flow components. Blood flow and tissue motion, called clutter, produce ultrasonic Doppler signals. SMI can differentiate flow signals from underlying clutter by using an adaptive algorithm. SMI has recently developed to overcome limitations of the conventional Doppler technique.

The cSMI mode simultaneously displays conventional grayscale ultrasound(US) with color-encoded Doppler signals. The mSMI mode improving sensitivity by subtracting away the background signals, and focuses only on the vasculature signals

A IM : � Comparing the sensivity of Superb Micro-Vascular Imaging(SMI) technique in detecting intra-ovarian vasculary signal with that of conventional Doppler technique in healthy girls.

PATIENTS AND METHODS: � After the study was approved by the local ethics committee, an informed oral and written consent was obtained from all patients and healthy volunteers. � ….test was used statistical analysis � All patients prospectively examined on axial and longitudinal planes using convex probe. � Totally 81 patients between 1 and 408 months (mean age 178.9 months), and 162 ovaries were included in the study. � The examination began with an ovarian volume measurement on the grayscale subsequently we evaluated BF in the ovaries via Color Doppler(CD), Power Doppler(PD), cSMI and mSMI techniques.

� A seven-step grading system was established based on the appearance on conventional Doppler and SMI technique…

� grade0: 0 dot � grade1: 1 dot, without linear microvasculary vessel being demonstrated � grade 2: 2,3,4 dots, without linear microvasculary vessel being demonstrated � grade 3: more than 4 dots without linear microvasculary vessel being demonstrated � grade 4: less than or equal to 4 dots and linear microvasculary vessel being demonstrated � grade 5: more than 4 dots and linear microvasculary vessel being demonstrated � grade 6: more than one linear microvasculary vessel being demonstrated with or without dots

� The accuracy of each four modalities for detecting intraovarian BF was interrogated on both plane using convex probe.

a b a.On gray scale imaging; left ovary of 1-month-old female healthy girl is seen, b.on color Doppler; no color doppler signal could be obtained in healthy ovarian tissue except for the artefactic color doppler signal, c. on Power Doppler; doppler signal can not be seen. c

a. On color SMI imaging; left ovary of 1-month-old female healthy girl intra-ovarian signal which represent normal blood flow is absent, b. on monochrome SMI; 3 apparent dots, without lineer microvasculary vessel are demonstrated(Grade2). a b b

a. On gray scale imaging; right ovary of 14-year-old female healthy girl is shown, (demonstrating volume of RO was 10 cc) , b. on color Doppler; no color doppler signal could be obtained in healthy ovarian tissue , c. on Power Doppler; doppler signal can not be seen. a b c

a. On color SMI imaging; right ovary of 14-year-old female healthy girl intra-ovarian signal which represent normal blood flow is absent(grade 2), b. on monochrome SMI; 3 apparent dots, without a linear microvasculary vessel are demonstrated(grade 5). b

R ESULTS : � SMI was found better for showing the vascular flows. � The comparison of SMI with CD and PD revealed that SMI was mostly superior to CD and PD in terms of detecting intraovarian BF. � We made a comparison between each of the four methods. The most superior method to determine the intraovarian blood flow was mSMI. mSMI>cSMI>PD>CD

Table 1. � On Longitudinal plane examination using Convex Probe ; while grade 5 was detected in 4 patients on CD, mSMI demonstrated 21 percent of all patients were grade 5.

R ESULTS : � As the ovaries volume decreases; a significant increase is observed in mSMI when compared to other examinations in showing vascularity.

C ONCLUSION : � By detecting pediatric ovarian vascularity more accurately in all ages with SMI, especially in pediatric populations and in younger children, SMI renders more detailed vascular information in screenning BF in the ovaries than either CD or PD imaging because SMI can detect slow motion blood flows of microvascular structures. � As the ovaries volume decreases, the priority of SMI showing especially BF increases significantly. � Thanks to these modalities, it is possible to provide prompt decision and early laparoscopic exploration;thus, as much more ovarian tissue as possible could salvage from the necrosis-inducing effect of ovarian torsion.

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