Korean J Radiol.  2020 Feb;21(2):146-158. 10.3348/kjr.2019.0500.

Ultrasonographic Demonstration of the Tissue Microvasculature in Children: Microvascular Ultrasonography Versus Conventional Color Doppler Ultrasonography

• Yoo J
• Je BK
• Choo JY

• KMID: 2471632
• DOI: http://doi.org/10.3348/kjr.2019.0500

Abstract

Microvascular ultrasonographic imaging is the most recent and unique Doppler ultrasound technique. It uses an advanced clutter filter that can remove clutter artifacts and preserve the low-velocity microvascular flow signal. The potential advantages of microvascular ultrasonography are its superiority in detection and visualization of the small blood vessels in tissues, providing radiologists with more information on the vascular structures. Therefore, it has shown particular value in the clinical fields. The aim of this study was to provide microvascular ultrasonographic images for the tissue microvasculature, including the brain, thyroid gland, kidney, urinary bladder, small bowel, ovary, testis, lymph node, and hemangiomas in children, focusing on the comparison with conventional color Doppler ultrasonographic images.

Keyword

Children; Ultrasonography; Blood vessels; Microvascular imaging; Ultrasonography, doppler, color

MeSH Terms

Artifacts
Blood Vessels
Brain
Child*
Female
Hemangioma
Humans
Kidney
Lymph Nodes
Microvessels*
Ovary
Testis
Thyroid Gland
Ultrasonography*
Ultrasonography, Doppler, Color*
Urinary Bladder

Figure

• 

  Fig. 1 Comparison of conventional clutter filter of color Doppler ultrasonography and advanced clutter filter of microvascular ultrasonography. A. Conventional clutter filter of color Doppler ultrasonography cannot distinguish between tissues and low-velocity vessels using velocity information. B. Advanced clutter filter of microvascular ultrasonography makes it possible to extract low-velocity vessels by exploiting spatiotemporal coherence information.

• 

  Fig. 2 Normal brain ultrasonography in 2-month-old boy. A. Grayscale ultrasonography. B. Color Doppler ultrasonography shows leptomeningeal vessels covering gyri. C. Illustration indicates intracortical, subcortical, and medullary vessels, as seen on microvascular ultrasonography (D). Parameters on Doppler images: DR = dynamic range, F = filter, FA = frame average, G = gain, P = power

• 

  Fig. 3 Thyroid ultrasonography in 14-year-old girl with toxic Grave's disease. Microvascular ultrasonography image (B) shows status of vascularity better compared to color Doppler ultrasonography image (A).

• 

  Fig. 4 Thyroid ultrasonography in 13-year-old girl with non-toxic simple goiter. Both color Doppler ultrasonography (A) and microvascular ultrasonography images (B) show scanty parenchymal vascularity of thyroid gland, which correlated with normal results of thyroid function tests (not shown here).

• 

  Fig. 5 Normal kidney ultrasonography in 10-year-old girl. A. Grayscale ultrasonography. B. Color Doppler ultrasonography shows interlobar arteries and some arcuate and interlobular arteries. C. Illustration indicates interlobar, arcuate, and peripheral interlobular arteries filling renal cortex tightly, as seen on microvascular ultrasonography (D). Microvascular ultrasonography also defines hypoechoic renal medulla clearly.

• 

  Fig. 6 Kidney ultrasonography in 5-month-old girl with acute pyelonephritis. A. On grayscale ultrasonography, wedge-shaped, hyperechoic lesion is suspected at upper pole. B. Color Doppler ultrasonography shows area of hypoperfusion at upper pole. C. Illustration indicates area of hypoperfusion, interlobular arteries stretched by swollen medulla, and scanty interlobular arteries, as seen on microvascular ultrasonography (D).

• 

  Fig. 7 Microvascular ultrasonography video clips and illustrations of 22-month-old boy with grade 2 vesicoureteral reflux confirmed on voiding cystourethrography. A. Refluxed contrast media from urinary bladder in right ureter, renal pelvis, and calyces without dilatation (arrows). B, C. Normal urine flow from distal ureter to urinary bladder (B; Supplementary Movie 1). D, E. Reversed urine flow from ureterovesical junction to distal ureter (D; Supplementary Movie 2).

• 

  Fig. 8 Small bowel ultrasonography in 3-day-old boy with adenoviral enteritis. Microvascular ultrasonography image (B) shows vasa recta and vessels circumscribing bowel wall better compared to color Doppler ultrasonography image (A).

• 

  Fig. 9 Small bowel ultrasonography in 16-year-old girl with tuberculous enteritis. Microvascular ultrasonography image (B) shows transmural vessels better compared to color Doppler ultrasonography image (A).

• 

  Fig. 10 Ovarian ultrasonography in 30-month-old girl with incarcerated left ovarian hernia. A. Grayscale ultrasonography. B. Color Doppler ultrasonography shows ovarian arteries and veins close to hilum. D. Microvascular ultrasonography shows more arterioles traversing ovarian medulla to cortex, which are indicated on illustration (C).

• 

  Fig. 11 Testicular ultrasonography longitudinal scan in 25-day-old boy with scrotal hydrocele. Microvascular ultrasonography images (B, D) show testicular, cremasteric, capsular, and centripetal arteries better compared to color Doppler ultrasonography images (A, C).

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  Fig. 12 Testicular ultrasonography transverse scan in 2-month-old boy with right inguinal hernia. Perfusion of right testis (R) is lesser than that of left testis (L) because vascular pedicle is compressed by right inguinal hernia (not shown here). Perfusion differences between testes are more pronounced on microvascular ultrasonography (B) than on color Doppler ultrasonography (A).

• 

  Fig. 13 Reactive cervical lymphadenopathy in 4-year-old boy. A. Grayscale ultrasonography. B. Color Doppler ultrasonography shows hilar and paracortical vessels. C. Illustration indicates hilar, paracortical, and peripheral cortical vessels and paracortices, as seen on microvascular ultrasonography (D).

• 

  Fig. 14 Inguinal metastatic lymphadenopathies in 15-year-old boy with desmoplastic small round-cell tumor. A, B. 18F-F-FDG positron emission tomography/CT scans performed at 2-month intervals. Increased 18F-F-FDG uptake (arrows) in bilateral inguinal lymph nodes on follow-up CT (B) suggests metastases. C, D. Right inguinal lymphadenopathy. E, F. Left inguinal lymphadenopathy. Microvascular ultrasonography (D, F) defines increased vascular structures better compared to color Doppler ultrasonography (C, E). CT = computed tomography, 18F-F-FDG = 18F-fluorodeoxyglucose

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  Fig. 15 Infantile hemangioma of right parotid gland in 1-month-old boy. Microvascular ultrasonography video clip (Supplementary Movie 4) (B) shows definition of margin and extent of mass better compared to color Doppler ultrasonography video clip (Supplementary Movie 3) (A).

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  Fig. 16 Cavernous hemangioma of spleen in 10-year-old boy. Microvascular ultrasonography video clip (Supplementary Movie 6) (B) demonstrates small vessels within mass better compared to color Doppler ultrasonography video clip (Supplementary Movie 5) (A).

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