Method Synthesis

Ultrasound diagnostics allows us to study almost all the components of our body, not just for finding indications regarding the study of bone and hollow viscera.
I should like to highlight how, unlike other methods, ultrasound scans are totally free from the risk of exposure to ionizing radiation or radiological contrast media, deriving only from a process of compression and rarefaction of acoustic waves generated by the ultrasound probe that impact our body, which and then are reworked at the time of their reflection by powerful software that finally give us a two-dimensional image of our organs and mechanisms, in a grayscale colouration. 
Another huge advantage of ultrasound scans is that they allow us to have a real-time image of our body (the study of intestinal peristalsis is quite fascinating) and, with active or passive movements, they also allow us to evaluate the dynamism of organs and musculoskeletal segments.

I would like to now briefly discuss the organs and mechanisms that can be viewed through ultrasound scans, starting with the abdominal organs. The study of the abdomen is carried out with the aid of the low-frequency Convex probe. Only in particularly slim and well-prepared subjects can a high-frequency linear probe approach be attempted, which greatly increases diagnostic accuracy.
Worth noting is that the left adrenal lodge, the deep region of the pancreatic tail and the intermediate tract of the ureter, are areas of difficult ultrasound access, even in the presence of good intestinal preparation by the patient. Another exploratory difficulty is constituted by the fibroadipose sinus, where due to the barrage of involutional fatty lobules, the definition of the deep breast levels is lost.

Liver (segmentation, suprahepatic veins, intrahepatic biliary branches)      


Gallbladder and biliary ducts         


Pancreas (sections, main duct, secondary ducts, portal splenic axis)


Renal arteries and aorta



Kidneys and ureters (intramural distal proximal tract)       


Spleen     


Colic walls   

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.


Example of a small angiomyolipoma-like renal tumour identified thanks to the mass effect exerted on the peripheral microcirculation.


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