Superb microvascular imaging (ultrasound)

Superb microvascular imaging (SMI) 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 breast masses
• evaluate thyroid nodules

SMI 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.