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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (4): 636-640. doi: 10.19723/j.issn.1671-167X.2023.04.011

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Methodology and clinical use of superb microvascular imaging in assessing micro-circulation changes of fingertips in systemic sclerosis

Zhuo-hua LIN1,Ru-yi CAI2,Yang SUN1,Rong MU2,*(),Li-gang CUI1,*()   

  1. 1. Department of Medical Ultrasound, Peking University Third Hospital, Beijing 100191, China
    2. Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
  • Received:2022-12-23 Online:2023-08-18 Published:2023-08-03
  • Contact: Rong MU,Li-gang CUI E-mail:murongster@163.com;cuiligang_bysy@126.com

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Abstract:

Objective: To explore the feasibility of superb microvascular imaging (SMI) in evaluating microcirculation damage of the finger of systemic sclerosis (SSc), and determining the optimal scanning method by assessing the effect of scanning position (finger pulp or nail bed), plane (transverse or sagittal) and Doppler gain on the results. Methods: In the study, 32 SSc patients and 32 non-SSc volunteers admitted to Peking University Third Hospital from February to October 2022 were included. The SMI image under different gain set (40 dB or 35 dB) of the third fingertip (sagittal scans or transverse scan of nail bed or pulp) of both hands were collected while vascular index (VI) was measured. Results: Non-SSc volunteer presented abundant SMI signal distributed in the third fingertip. Arteriole of nail bed was observed on the dorsal side of the distal phalanx under SMI and gave off multiple vertical branches towards the nail. The arteriole of finger pulp ran parallel to the skin and gave off vertical branches towards the skin distributing subcutaneously as a network. In SSc group, the SMI signal in nail bed and finger pulp was reduced. The arteriole of nail bed and finger pulp was discontinuous and presented as sporadic dots and short rod-like color signal under SMI. The vascular index of the SSc patients was significantly lower than that of the non-SSc controls (P < 0.001). Among different positions and sections, the area under the receiver operating characteristic curve (AUC) of the sagittal plane of nail bed was the highest. Under low gain, the AUC of sagittal plane of nail bed was 0.871, the cut-off value was 5.4%, the sensitivity was 90.6%, and the specificity was 74.2%. Under high gain, the AUC was 0.893, the cut-off value was 14.0%, the sensitivity was 75.0%, and the specificity was 93.6%. Multivariate analysis showed that there was statistical significance on the diagnostic impact of the sagittal plane of nail bed (P < 0.005 for high gain condition; P < 0.05 for low gain condition). Conclusion: SMI can be used to evaluate the abnormal changes of vascular in patients with SSc. Using the sagittal scan of nail bed with high gain can evaluate the vascular loss of the fingertip in SSc patient accurately and specifically.

Key words: Systemic sclerosis, Superb microvascular imaging, Microcirculation

CLC Number: 

  • R593.25

Figure 1

SMI of the fingertip of a female from control group (A-D) and a SSc patient (a-d) Scale: 1.5 cm/s; Gain: 40 dB. SSc, systemic sclerosis; SMI, super microvascular imaging."

Table 1

Comparison of vascular index (%) between SSc group and control group"

Scanning method SSc group Control group P
Low gain (35 dB)
  Sagittal plane of finger pulp 2.8 (0.6, 6.7) 12.0 (7.1, 14.3) ＜0.001
  Transverse plane of finger pulp 4.2 (0.8, 8.6) 10.8 (6.8, 16.9) ＜0.001
  Sagittal plane of nail bed 1.0 (0.6, 3.5) 14.2 (4.8, 20.0) ＜0.001
  Transverse plane of nail bed 2.4 (0.9, 4.3) 12.8 (7.2, 16.7) ＜0.001
High gain (40 dB)
  Sagittal plane of finger pulp 14.1 (5.0, 21.4) 26.0 (17.3, 36.5) ＜0.001
  Transverse plane of finger pulp 10.6 (7.5, 20.4) 34.7 (20.4, 50.4) ＜0.001
  Sagittal plane of nail bed 10.4 (5.9, 14.5) 38.2 (22.5, 58.0) ＜0.001
  Transverse plane of nail bed 18.1 (8.1, 32.9) 41.1 (23.6, 60.2) ＜0.001

Table 2

Diagnostic value of SMI under different gain and scanning plane"

Scanning method Cut-off value/% AUC (95%CI) Sensitivity/% Specificity/%
Low gain (35 dB)
  Transverse plane of nail bed 6.6 0.861 (0.751-0.935) 93.8 77.4
  Sagittal plane of nail bed 5.4 0.871 (0.763-0.942) 90.6 74.2
  Transverse plane of finger pulp 5.1 0.793 (0.673-0.885) 71.9 83.9
  Sagittal plane of finger pulp 6.1 0.805 (0.686-0.894) 75.0 80.7
High gain (40 dB)
  Transverse plane of nail bed 45.3 0.790 (0.669-0.882) 96.9 48.4
  Sagittal plane of nail bed 14.0 0.893 (0.790-0.957) 75.0 93.6
  Transverse plane of finger pulp 20.8 0.836 (0.721-0.917) 78.1 74.2
  Sagittal plane of finger pulp 23.9 0.765 (0.641-0.863) 90.6 54.8

Figure 2

ROC curve of vascular index in sagittal plane of nail bed ROC, receiver operating characteristic."

Table 3

Logistic regression of different scanning plane"

Scanning method Exp (B) P
Low gain (35 dB)
  Sagittal plane of finger pulp 0.940 0.529
  Transverse plane of finger pulp 1.048 0.645
  Sagittal plane of nail bed 0.779 0.017
  Transverse plane of nail bed 0.928 0.334
High gain (40 dB)
  Sagittal plane of finger pulp 0.930 0.467
  Transverse plane of finger pulp 0.984 0.709
  Sagittal plane of nail bed 0.884 0.004
  Transverse plane of nail bed 1.048 0.492
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