Superb Microvascular Imaging (SMI) - Doppler Technique in the Evaluation of the Endometrial Polyp and Submucosal Myoma in Postmenopausal Overweight Women

Abstract

Ultrasonography (USG) is an important diagnostic method in the practice of gynaecology. The evaluation of endometrial morphology with Doppler sonography in addition to the two-dimensional USG is important for the diagnosis of endometrial lesions. 1 While the conventional colour Doppler is insufficient to identify vessels smaller than 1 mm and flows lower than 3-5 cm/sec, power Doppler is useful in low flow imaging. 2 Superb Micro Vascular Imaging (SMI) is a new Doppler technique. It displays low blood flow in vessels with small diameters by eliminating the tissue movement-related artefact compared to the conventional colour and power Doppler. The wall filter existing in conventional Doppler eliminates the interference and tissue motion artefact, however reduces the capture of low velocity flows. 3 Transvaginal USG (TVUSG) is typically used in the evaluation of the endometrial cavity. However, analysis with transabdominal USG (TAUSG) may be required in cases of large fibroids, pathologies in which the uterus has a large size, virgo, vaginismus, vaginal stenosis, etc. 4 Post-menopausal endometrium is seen as an atrophic, thin echogenic line in two-dimensional USG. 5 Endometrial polyp (EP) and submucosal

Superb microvascular imaging Doppler technique in the evaluation of ovarian stromal vascularity in women with polycystic ovary syndrome

“…21 Furthermore, conventional Doppler USG may be insufficient due to weak tissue penetration of Doppler echos. 6 Guerriero et al reported that CDI's ovarian vascularity detection rate was 65(21%) and with PDI, this rate increased. 24 Due to artifacts, such as colour confusion and noise, CDI cannot display all Doppler spectrums and is mostly employed in heart and vascular tissues.…”

“…Some studies have mentioned the SMI Doppler technique's high diagnostic value. 6 A few studies used TAUSG-SMI Doppler imaging in gynaecology cases. 6,9,26 The findings of the current study negated the null hypothesis.…”

“…6 A few studies used TAUSG-SMI Doppler imaging in gynaecology cases. 6,9,26 The findings of the current study negated the null hypothesis. Although the study population consisted of overweight women, ovarian stromal vascularity could still be more effectively detected with TAUSG-SMI than the conventional Doppler technique in PCOS women.…”

“…Colour Doppler imaging (CDI) is insufficient due to artefacts, while power Doppler imaging (PDI) is very sensitive to motion artefacts and is mainly used for external organs. 6 The superior microvascular imaging (SMI) approach surpasses conventional Doppler techniques and decreases artifacts. 7,8 SMI includes two distinctive qualities: monochrome SMI (mSMI), like CDI, has a black ground image to more sharply highlight vascular structures, while colour SMI (cSMI) is a grayscale blend of SMI and B Mode.…”

“…They concluded that the SMI Doppler technique can be useful, but may not be feasible for deeply located myomas and obese women 26. Senyuva et al demonstrated that evaluating endometrial vascularity with the TAUSG-SMI Doppler technique in postmenopausal overweight women was not superior to TAUSG-traditional Doppler imaging using weight, postmenopausal status, and deeply located organs 6. In ovarian imaging, Ayaz et al evaluated ovarian vascularity with conventional and SMI Doppler by transabdominal route in paediatric age groups, and reported that in terms of detecting vascularity, SMI Doppler was more effective than conventional Doppler (p<0.001) 9.…”