Superb Micro-vascular Imaging (SMI)

Seeing the unseen

SMI is a technology that expands the range of visible blood flow and provides visualization of low microvascular flow never seen before with ultrasound. By enabling detailed visualization of vascular flow signals, SMI supports users during their clinical decision-making processes, reducing routine use of invasive methods.

The advantages of SMI

  • High frame rates
  • High resolution
  • High sensitivity
  • Less motion artifacts

Technology

Traditional color Doppler imaging removes clutter from the images by suppressing low velocity components resulting in a loss of flow in tiny vessels.
SMI is a powerful and intelligent algorithm that effectively separates flow signals from overlaying tissue motion artifacts, while preserving even the subtle low-flow components with detail and definition.
SMI analyzes clutter motion and uses an adaptive algorithm to identify and remove tissue motion and reveal true blood flow. This results in a high resolution ultrasound image in which minute flow signals and low velocity flow can be depicted.

Three modes of SMI

Monochrome mode (mSMI) reveals the fine blood flow patterns with high sensitivity by removing anatomical background information.

Color-coded SMI (cSMI) demonstrates flow and grayscale information with high temporal and spatial resolution simultaneously.

Smart 3D with SMI provides a well-defined rendered image of the blood flow network within the liver.

Evolution of SMI

SMI is an innovative ultrasound technology introduced in 2014.
In 2017, “iSMI” was introduced, allowing simultaneous processing of multiple signals to maintain both noise reduction and high frame rates, even when the ROI is expanded. In 2021, the technology evolved into “SMI Generation 4,” which extended the flow velocity range from low to high speed flows. This advancement enabled high velocity motion artifacts to be reduced and expanded the application of SMI to include the visualization of high velocity blood flow.
In 2025, SMI achieved further progress in visualizing low-velocity blood flow, marking a new stage in its development and expanding its clinical potential.

SMI Angio mode

Seeing the unseen – in finer detail

Building on SMI, Aplio’s new SMI Angio mode delivers superior blood flow visualization, offering finer detail and enhanced separation of flow in small, closely adjacent vessels, supporting more accurate assessment and increased diagnostic confidence in a wide range of use cases.

Conventional SMI

SMI Angio mode

Features

Enhanced visualization of blood flow
SMI Angio mode improves the visualization of blood flow in small vessels by providing finer delineation of individual small vessels.

Increased blood flow sensitivity
By incorporating statistical analysis across frame transitions and adjusting observation timing, SMI Angio mode enhances the signal-to-noise ratio, resulting in improved sensitivity to blood flow.

Preservation of core SMI capabilities
SMI Angio mode is built on the core capabilities of SMI, such as the ability to detect low velocity blood flow while maintaining high frame rates and without the use of a contrast agent.

Clinical Images

SMI proves to be useful in many clinical applications and anatomical regions.

SMI

High Doppler sensitivity and resolution with well-seen flow perfusion in the kidney.

Simultaneous visualization of B-mode, contrast image, SMI, and blend mode.

In this case, increased blood flow to the thickened tendon sheath is well depicted.

Clear depiction of the increased flow in the region of interest within the thyroid lobe.

Well visualized blood flow pattern in the detected breast structure.

In-depth assessment of intraplacental blood flow patterns is enhanced with SMI, empahsizing flow features right through to the placental-myometrial interface.

The tiny branches of the pericallosal artery are visualized while keeping high B-mode image quality throughout the depth of the image.

SMI depicts peripheral lung blood flow and lung architecture even with fetal movement.

Easy to define filling of the vessel lumen using SMI at the carotid bifurcation.

SMI actively displaying microflow within the prostate, supporting with target characterization prior to biopsy.

SMI Angio mode

With SMI Angio mode, hepatic blood flow branching across the liver parenchyma, through to the liver capsule, is displayed with clarity.

In this case, irregular hemodynamic patterns are well depicted within the liver mass. Using SMI Angio mode, high blood flow sensitivity enables the depiction of detailed flow patterns without the use of a contrast agent.

In this case, increased microflow activity within the liver mass is highlighted post contrast injection. Using SMI Angio mode, microflow patterns seen with the use of contrast are enhanced.

This axial renal view using SMI Angio mode highlights flow continuity extending to the cortical edge.

Renal perfusion can be well delineated across the renal cortex, from near to far field.

Using Smart 3D with SMI Angio mode, the blood flow throughout the complex renal vascular branching can be visualized.

SMI Angio mode enhances visibility of difficult-to-detect flows, supporting clinical assessment and interventional MSK applications.

Detailed expression of the thyroid nodule blood flow pattern peripherally and internally.

Detailed fetal hepatic blood flow displayed in SMI Angio mode.

Notable Awards

2015 The Japanese Society of Ultrasonics in Medicine
The 15th technology awards for Superb Micro-vascular Imaging (SMI)

2024 The Japanese Society of Ultrasonics in Medicine
The 24th technology awards for SMI Generation 4 (SMI Gen4)

Education and Resources

Do we really need Microvascular flow imaging?

Prof. Jiro Hata
Kawasaki Medical School, Okayama, Japan

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White Paper

Prof. Jiro Hata

"Seeing the unseen" Never stops!- What you can REALLY see by SMI Angio mode

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Dr. Juan Pablo Niedmann

New tools in ultrasound and their clinical application

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A. Sciarrone, S. Bastonero, A. Pertusio, I. Dusini, E. Fornaciari

Fetal cardiac examinations in the first trimester: The diagnostic role of Superb Micro-vascular Imaging (SMI)

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Giuliana Beneduce, Floriana Mascilini, Antonia Carla Testa, Francesca Moro

Role of ultrasound examination in gynecology oncology: Standard applications and innovative techniques

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Mahtab Zamani, MD; Karolina Skagen, MD, PhD, postdoc; David Russell, MD, Prof.; Mona Skjelland, MD, Prof.

Carotid plaque neovascularization detected with Superb Micro-vascular Imaging (SMI) ultrasound without using contrast media

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Interview report and Case study

Marilyn Zelesco, Lead Sonographer

Portal Vein Thrombosis

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Makoto Wada, MD, PhD

Applications of diagnostic ultrasound systems in the field of orthopaedics

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Akihiro Narita, MD, PhD
Norifumi Sawamukai, MD, PhD

Clinical value of Superb Micro-vascular Imaging and ultra-high frequency linear transducer in musculoskeletal ultrasound:

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Ultrasound assessment of Burns

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