The device used by the unit is a Toshiba Aplio 300, equipped with new software that allows to study microcirculation: the Superb Micro-Vascular Imaging (SMI acronym).
The principle used by this innovative vascular module is based on an algorithm that separates slow-flowing arterial signals from artifacts due to the motility of the vascular walls and adjacent tissues, thus trying to preserve the image of the microcirculation. The traditional Doppler applies wall filters to remove these movement artifacts, yet it reduces the definition of the microcirculation itself (basically it cannot distinguish the artifacts from the slow-flow circles).
The SMI module is capable of analysing the characteristics of any type of motion artifact by ultimately extracting only clinically relevant information and allowing to analyse flows at a low speed using high frame rates.
The SMI can be used in two manners: the colour module (cSMI) that simultaneously shows the information in B-mode and in colour mode; the grayscale module (mSMI) that focuses only on the micro-vascularization tissue, eliminating the background information.
This innovative vascular study method, while not replacing a contrast injected into the venous system and therefore not adding actual information on intralesional vascularization, based on my work experience allows to identify small renal, liver and pancreatic tumours thanks to the mass effect that these lesions exert on the peripheral microcirculation, thus enabling to have a sort of negative ultrasound of the neoplastic mass to be analysed even if small, greatly increasing the diagnostic sensitivity of the method.
IMAGE - Example of a small angiomyolipoma-like renal tumour identified thanks to the mass effect exerted on the peripheral microcirculation.