Case series of mobile structures detected vividly by using superb microvascular imaging

BACKGROUND: Superb microvascular imaging (SMI) is a new imaging technique that can reveal low-velocity blood flow without use of a contrast agent. SMI is based on an original algorithm and effectively removes tissue motion artifacts (clutter motion) from the background, thereby preserving visibility of low-velocity blood flow. SMI is expected to be useful for the evaluation of heart diseases, as well as blood vessels. CASE SUMMARY: Here, we report three cases in which a mobile structure in the heart or a blood vessel was detected easily by strong enhancement on SMI. In the heart, the entire mass was strongly enhanced by colour-SMI and had the appearance of ‘a fire ball’. In the abdominal aorta and carotid artery, SMI captured a strongly enhanced echo image of a mass and revealed hyperechoic mobile plaque. It was hard to detect with the conventional echocardiography. DISCUSSION: It is important to detect mobile intravascular and intracardiac structures as they are risk factors of thrombosis. Echo images are often strongly affected by the skill of the examiner, the patient's body habitus, and the presence of intestinal gas; thus, it is often difficult to detect a small mass with conventional echocardiography. With the use of SMI, even small mobile structures can be displayed at high intensity in comparison with the surrounding blood flow. Therefore, the non-invasive SMI was useful for the detection of mobile intravascular and intracardiac structures. Our findings of the current report may lead to new developments in SMI for imaging in the cardiac region.