The Diagnostic Value of Superb Microvascular Imaging (SMI) in Detecting Blood Flow Signals of Breast Lesions: A Preliminary Study Comparing SMI to Color Doppler Flow Imaging

Abstract

The correlation between color Doppler flow imaging (CDFI) and Superb Microvascular Imaging (SMI) for detecting blood flow in breast lesions was investigated, as was the diagnostic value of SMI in differentiating benign from malignant breast lesions.These lesions were evaluated using both CDFI and SMI according to Adler's method. Pathologic examination showed 57 malignant lesions and 66 benign lesions. The number of blood vessels in a single mass was detected by 2 techniques (SMI and CDFI), and the difference between the 2 values (SMI-CDFI) was calculated. The optimal threshold for the diagnosis of malignant neoplasms and the diagnostic performances of SMI, CDFI, and SMI-CDFI were calculated.For the total lesions and malignant lesions alone, the difference between SMI and CDFI for detecting blood flow was significant (P < 0.01), but the difference was not significant for benign lesions (P = 0.15). The area under the receiver operating characteristic curve was 0.73 (95% confidence interval [CI]: 0.64-0.82) for CDFI; 0.81 (95% CI: 0.74-0.89) for SMI; and 0.89 (95% CI: 0.82-0.95) for SMI-CDFI. Furthermore, the modality of "SMI-CDFI" showed the best diagnostic performance.SMI provides further microvessel information in breast lesions. The diagnostic modality of "SMI-CDFI" can improve the diagnostic performance of ultrasound in the differentiation between benign and malignant masses.

FIGURE 1

A 38-year-old woman with fibroadenoma. The vascularity of the breast mass was investigated using CDFI (A), and the map showed that 1 vessel was detected, which was grade 1 according to Adler's method. The vascularity of the breast mass was investigated using SMI (B), and the map showed that 1 vessel was detected, which was grade 1 according to Adler's method. CDFI = color Doppler flow imaging, SMI = Superb Microvascular Imaging.

FIGURE 2

A 36-year-old woman with invasive ductal carcinoma. The vascularity of the breast mass was investigated using CDFI (A), and the map showed that 4 vessels were detected, which were grade 3 according to Adler's method. The vascularity of the breast mass was investigated using SMI (B), and the map showed that 7 vessels were detected, which were grade 3 according to Adler's method. CDFI = color Doppler flow imaging, SMI = Superb Microvascular Imaging.