Superb microvascular imaging (ultrasound)

Last revised by Mateusz Wilczek on 9 Oct 2023

Superb microvascular imaging (SMI) or microvascular flow imaging (MVI/MV-flow - the name varying by manufacturers) is a recently developed ultrasound imaging technique that aims to visualize low velocity and small diameter blood vessel flow. Unlike conventional color and power Doppler imaging, superb microvascular imaging can suppress noise caused by motion artifacts without removing the weak signal arising from small vessel blood flow, hence it achieves a greater sensitivity than those 1.

Superb microvascular imaging (similarly to power Doppler) typically displays a monochrome map of blood flow superimposed on the B-mode image, though some systems are now capable of providing color-coded directional information as well.

Clinical use

Due to the relative novelty of the superb microvascular imaging (SMI) technique, strong clinical evidence about its use is lacking. Existing research shows that it can be utilized to:

  • characterize focal and diffuse liver lesions

  • assess vascularity of cystic and solid renal lesions3,4

  • assess vascularity of breast masses5

  • evaluate thyroid nodules

Superb microvascular imaging also shows promise as an adjunctive tool in musculoskeletal ultrasound by allowing more sensitive detection of increased vascularity in tendons, joint capsules, and peripheral nerves. Some studies have also demonstrated its potential use in evaluating intraplaque neovascularization and thereby in assessing the risk of hemorrhage in carotid plaques 2

Practical points

Several similar but proprietary microvascular flow imaging methods have been developed by different manufacturers, thus a similar technique can be encountered under various names in the literature:

  • microvascular flow (MV-flow, Samsung Medison)

  • microvascular imaging (MVI, General Electric)

  • superb microvascular imaging (SMI, Canon Medical Systems)

  • Slow flow (Siemens Healthineers)

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Cases and figures

  • Figure 1: Increased neovascularity in recurrent HCC
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  • Figure 2: Evaluation of complex renal cyst
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  • Figure 3: prepatellar bursitis
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  • Figure 4: splenic vascularity
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  • Figure 5: chronic tenosynovitis of the long head of the biceps tendon
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