Ultrasonography.  2018 Apr;37(2):98-106. 10.14366/usg.17043.

Up-to-date Doppler techniques for breast tumor vascularity: superb microvascular imaging and contrast-enhanced ultrasound

• Park AY
• Seo BK

• KMID: 2409560
• DOI: http://doi.org/10.14366/usg.17043

Abstract

Ultrasonographic Doppler techniques have improved greatly over the years, allowing more sophisticated evaluation of breast tumor vascularity. Superb microvascular imaging (SMI) and contrast-enhanced ultrasound (CEUS) with second-generation contrast agents are two representative up-to-date techniques. SMI is a sensitive Doppler technique that adopts an intelligent filter system to separate low-flow signals from artifacts. With the development of second-generation contrast agents, CEUS has also emerged as a useful Doppler technique for evaluating tumor microcirculation. Both techniques can improve the diagnostic performance of gray-scale ultrasonography by providing vascular information useful not only for the morphologic assessment of microvessels, but also for the quantitative analysis of perfusion. In this review, we explain the imaging principles and previous research underlying these two vascular techniques, and describe our clinical experiences.

Keyword

Breast; Ultrasonography, Doppler; Contrast media; Microvessels

MeSH Terms

Artifacts
Breast Neoplasms*
Breast*
Contrast Media
Microcirculation
Microvessels
Perfusion
Ultrasonography*
Ultrasonography, Doppler
Contrast Media

Reference

References

1. Yadav L, Puri N, Rastogi V, Satpute P, Sharma V. Tumour angiogenesis and angiogenic inhibitors: a review. J Clin Diagn Res. 2015; 9:XE01–XE05.

2. Folkman J. Angiogenesis and breast cancer. J Clin Oncol. 1994; 12:441–443.

3. Banerjee S, Dowsett M, Ashworth A, Martin LA. Mechanisms of disease: angiogenesis and the management of breast cancer. Nat Clin Pract Oncol. 2007; 4:536–550.

4. Schneider BP, Miller KD. Angiogenesis of breast cancer. J Clin Oncol. 2005; 23:1782–1790.

5. Lee SW, Choi HY, Baek SY, Lim SM. Role of color and power Doppler imaging in differentiating between malignant and benign solid breast masses. J Clin Ultrasound. 2002; 30:459–464.

6. Kook SH, Park HW, Lee YR, Lee YU, Pae WK, Park YL. Evaluation of solid breast lesions with power Doppler sonography. J Clin Ultrasound. 1999; 27:231–237.

7. Giuseppetti GM, Baldassarre S, Marconi E. Color Doppler sonography. Eur J Radiol. 1998; 27 Suppl 2:S254–S258.

8. Schroeder RJ, Bostanjoglo M, Rademaker J, Maeurer J, Felix R. Role of power Doppler techniques and ultrasound contrast enhancement in the differential diagnosis of focal breast lesions. Eur Radiol. 2003; 13:68–79.

9. Park AY, Seo BK, Cha SH, Yeom SK, Lee SW, Chung HH. An innovative ultrasound technique for evaluation of tumor vascularity in breast cancers: superb micro-vascular imaging. J Breast Cancer. 2016; 19:210–213.

10. Kruskal JB, Newman PA, Sammons LG, Kane RA. Optimizing Doppler and color flow US: application to hepatic sonography. Radiographics. 2004; 24:657–675.

11. Ma Y, Li G, Li J, Ren WD. 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. Medicine (Baltimore). 2015; 94:e1502.

12. Yongfeng Z, Ping Z, Wengang L, Yang S, Shuangming T. Application of a novel microvascular imaging technique in breast lesion evaluation. Ultrasound Med Biol. 2016; 42:2097–2105.

13. Zhan J, Diao XH, Jin JM, Chen L, Chen Y. Superb microvascular imaging: a new vascular detecting ultrasonographic technique for avascular breast masses: a preliminary study. Eur J Radiol. 2016; 85:915–921.

14. Ma Y, Li J, Ren W, Deng L. Correlation between superb microvascular imaging and pathological microvessel density in breast tumors. Xiangya Med. 2016; 1:30.

15. Adler DD, Carson PL, Rubin JM, Quinn-Reid D. Doppler ultrasound color flow imaging in the study of breast cancer: preliminary findings. Ultrasound Med Biol. 1990; 16:553–559.

16. Greis C. Technology overview: SonoVue (Bracco, Milan). Eur Radiol. 2004; 14 Suppl 8:P11–P15.

17. Chung YE, Kim KW. Contrast-enhanced ultrasonography: advance and current status in abdominal imaging. Ultrasonography. 2015; 34:3–18.

18. Claudon M, Dietrich CF, Choi BI, Cosgrove DO, Kudo M, Nolsoe CP, et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver: update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol. 2013; 39:187–210.

19. Wan C, Du J, Fang H, Li F, Wang L. Evaluation of breast lesions by contrast enhanced ultrasound: qualitative and quantitative analysis. Eur J Radiol. 2012; 81:e444–e450.

20. Drudi FM, Cantisani V, Gnecchi M, Malpassini F, Di Leo N, de Felice C. Contrast-enhanced ultrasound examination of the breast: a literature review. Ultraschall Med. 2012; 33:E1–E7.

21. Liu H, Jiang YX, Liu JB, Zhu QL, Sun Q. Evaluation of breast lesions with contrast-enhanced ultrasound using the microvascular imaging technique: initial observations. Breast. 2008; 17:532–539.

22. Du J, Wang L, Wan CF, Hua J, Fang H, Chen J, et al. Differentiating benign from malignant solid breast lesions: combined utility of conventional ultrasound and contrast-enhanced ultrasound in comparison with magnetic resonance imaging. Eur J Radiol. 2012; 81:3890–3899.

23. Zhao H, Xu R, Ouyang Q, Chen L, Dong B, Huihua Y. Contrastenhanced ultrasound is helpful in the differentiation of malignant and benign breast lesions. Eur J Radiol. 2010; 73:288–293.

24. Cao XL, Bao W, Zhu SG, Wang LH, Sun MH, Wang L, et al. Contrastenhanced ultrasound characteristics of breast cancer: correlation with prognostic factors. Ultrasound Med Biol. 2014; 40:11–17.

25. Ricci P, Cantisani V, Ballesio L, Pagliara E, Sallusti E, Drudi FM, et al. Benign and malignant breast lesions: efficacy of real time contrastenhanced ultrasound vs. magnetic resonance imaging. Ultraschall Med. 2007; 28:57–62.

26. Sorelli PG, Cosgrove DO, Svensson WE, Zaman N, Satchithananda K, Barrett NK, et al. Can contrast-enhanced sonography distinguish benign from malignant breast masses? J Clin Ultrasound. 2010; 38:177–181.

27. Caproni N, Marchisio F, Pecchi A, Canossi B, Battista R, D'Alimonte P, et al. Contrast-enhanced ultrasound in the characterisation of breast masses: utility of quantitative analysis in comparison with MRI. Eur Radiol. 2010; 20:1384–1395.

28. Lassau N, Chami L, Benatsou B, Peronneau P, Roche A. Dynamic contrast-enhanced ultrasonography (DCE-US) with quantification of tumor perfusion: a new diagnostic tool to evaluate the early effects of antiangiogenic treatment. Eur Radiol. 2007; 17 Suppl 6:F89–F98.

29. Liu H, Jiang YX, Liu JB, Zhu QL, Sun Q, Chang XY. Contrastenhanced breast ultrasonography: imaging features with histopathologic correlation. J Ultrasound Med. 2009; 28:911–920.

30. Kedar RP, Cosgrove D, McCready VR, Bamber JC, Carter ER. Microbubble contrast agent for color Doppler US: effect on breast masses: work in progress. Radiology. 1996; 198:679–686.

31. Clevert D, Jung EM, Jungius KP, Ertan K, Kubale R. Value of tissue harmonic imaging (THI) and contrast harmonic imaging (CHI) in detection and characterisation of breast tumours. Eur Radiol. 2007; 17:1–10.

32. Miyamoto Y, Ito T, Takada E, Omoto K, Hirai T, Moriyasu F. Efficacy of sonazoid (perflubutane) for contrast-enhanced ultrasound in the differentiation of focal breast lesions: phase 3 multicenter clinical trial. AJR Am J Roentgenol. 2014; 202:W400–W407.

33. Xiao XY, Chen X, Guan XF, Wu H, Qin W, Luo BM. Superb microvascular imaging in diagnosis of breast lesions: a comparative study with contrast-enhanced ultrasonographic microvascular imaging. Br J Radiol. 2016; 89:20160546.