Donald School Journal of Ultrasound in Obstetrics and Gynecology

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VOLUME 15 , ISSUE 3 ( July-September, 2021 ) > List of Articles


Superb Microvascular Imaging Assessment of Placenta Using an 18-MHz Probe

Emiko Nitta

Keywords : 18-MHz probe, Circumvallate placenta, Placenta, Placenta accreta spectrum, Retained placenta, Superb microvascular imaging, Subchorionic hematoma, Uterine fundal incision

Citation Information : Nitta E. Superb Microvascular Imaging Assessment of Placenta Using an 18-MHz Probe. Donald School J Ultrasound Obstet Gynecol 2021; 15 (3):312-322.

DOI: 10.5005/jp-journals-10009-1714

License: CC BY-NC 4.0

Published Online: 30-09-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Superb microvascular imaging (SMI) can detect low-velocity blood flow in the placenta by significantly reducing motion artifacts. Moreover, SMI using an 18-MHz probe generates a high-resolution image of the placental microvasculature in normal and abnormal placentas. In the normal placenta, the increased density of the placental microvasculature with advancing gestation was evident using SMI with an 18-MHz probe. The placental baseline between the placenta and myometrium was also clearly identified. In the first-trimester placenta with an extremely large subchorionic hematoma, decreased vascularity in the placenta adjacent to the hematoma was clearly recognized. In the circumvallate placenta, the placental microvasculature using 18-MHz-SMI was more precisely noted compared with conventional SMI. In a case of pregnancy after a previous uterine fundal incision, a high-resolution SMI with an 18-MHz probe could clearly identify the very thin uterine wall. In cases of placenta accreta spectrum (PAS) during pregnancy and in the retained placenta after birth, various types of PAS were noted, and unique microvasculature was also demonstrated using SMI with an 18-MHz probe. Superb microvascular imaging with an 18-MHz probe may become a future modality to provide novel information on the antenatal evaluation of normal and abnormal placentas, and the physiologic progress of normal placental microvascular development, and precise pathologic findings of placental abnormality in clinical practice and future research.

  1. Hasegawa J, Suzuki N. SMI for imaging of placental infarction. Placenta 2016;47:96–98. DOI: 10.1016/j.placenta.2016.08.092.
  2. Hata T, Mori N, AboEllail MAM, et al. SMI with Doppler luminance in obstetrics. Donald School J Ultrasound Obstet Gynecol 2019;13(2):69–77. DOI: 10.5005/jp-journals-10009-1588.
  3. Hasegawa J, Yamada H, Kawasaki E, et al. Application of superb micro-vascular imaging (SMI) in obstetrics. J Matern Fetal Neonatal Med 2018;31(2):261–263. DOI: 10.1080/14767058.2016.1278206.
  4. Hata T, Kanenishi K, Yamamoto K, et al. Microvascular imaging of thick placenta with fetal growth restriction. Ultrasound Obstet Gynecol 2018;51(6):837–839. DOI: 10.1002/uog.18837.
  5. Mack LM, Mastrobattista JM, Gandhi R, et al. Characterization of placental microvasculature using superb microvascular imaging. J Ultrasound Med 2019;38(9):2485–2491. DOI: 10.1002/jum.14919.
  6. Furuya N, Hasegawa J, Homma C, et al. Novel ultrasound assessment of placental pathological function using superb microvascular imaging. J Matern Fetal Neonatal Med 2020. 1–4. DOI: 10.1080/14767058.2020.1795120.
  7. Sainz JA, Carrera J, Borrero C, et al. Study of the development of placental microvascularity by Doppler SMI (superb microvascular imaging): a reality today. Ultrasound Med Biol 2020;46(12):3257–3267. DOI: 10.1016/j.ultrasmedbio.2020.08.017.
  8. Inoue A, Horinouchi T, Yoshizato T, et al. Peculiar blood flow profiles among placental chorionic villous vessels of an abnormally thick placenta in a case of systemic lupus erythematosus characterized using microvascular imaging. J Obstet Gynaecol Res 2020(12). DOI: 10.1111/jog.14502.
  9. Sun L, Li N, Jia L, et al. Comparison of superb microvascular imaging and conventional Doppler imaging techniques for evaluating placental microcirculation: a prospective study. Med Sci Monit 2020;10:e926215. DOI: 10.12659/MSM.926215.
  10. Horinouchi T, Yoshizato T, Kojiro-Sanada S, et al. Missing decidual Doppler signals as a new diagnostic criterion for placenta accreta spectrum: a case described using superb microvascular imaging. J Obstet Gynaecol Res 2020(1). DOI: 10.1111/jog.14441.
  11. Hata T, Mori N, AboEllail MAM, et al. Advances in color Doppler in obstetrics. J South Asian Feder Obst Gynae 2019;11(1):1–12. DOI: 10.5005/jp-journals-10006-1641.
  12. Hata T, Hanaoka U, Mori A, et al. Superb microvascular imaging of retained placenta with placenta accreta spectrum. Donald School J Ultrasound Obstet Gynecol 2019;13(3):85–87. DOI: 10.5005/jp-journals-10009-1600.
  13. Hasegawa J, Kurasaki A, Hata T, et al. Sono-histological findings of the placenta accreta spectrum. Ultrasound Obstet Gynecol 2019;54(5):705–707. DOI: 10.1002/uog.20207.
  14. Hata T, Koyanagi A, Yamanishi T, et al. Superb microvascular imaging with Doppler luminance using 18-MHz probe to visualize fetal intra-abdominal blood vessels and organ microvasculature. J Perinat Med 2020;48(2):184–188. DOI: 10.1515/jpm-2019-0411.
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