Ultrasound microflow imaging for the evaluation of inflammation associated with superficial vein thrombosis: a...

Venous thrombosis is associated with an inflammatory process contributing to thrombus initiation, propagation, venous wall remodeling, and fibrous sequelae. Conventional ultrasound is the gold standard for diagnosing venous thrombosis, but primarily focuses on luminal obstruction and vein compressibility, providing limited information about vascular wall inflammation and microvascular perfusion. This proof-of-concept case study examines the potential of microvascular flow imaging (MVFI), specifically Samsung MV-Flow^®, to evaluate perithrombotic inflammation, quantified by measuring the vascularity index (VI). A 40-year-old male with Behçet's disease and a history of thrombotic episodes presented with acute thigh pain. Conventional ultrasound confirmed an occlusive thrombus in a superficial tributary of the great saphenous vein. MV-Flow imaging with an LA4-18 MHz probe revealed pronounced perivascular hyperemia. Serial follow-ups at 1, 3, and 6 months under immunosuppressive and antithrombotic therapy demonstrated clinical improvement, thrombus regression, and a consistent decrease in the VI from 11.7% to 5.15%, mirroring normalization of C-reactive protein (CRP) levels. This case demonstrates the added diagnostic value of MVFI in detecting and quantifying perithrombotic microvascularization. Compared with conventional Doppler, MVFI offers improved sensitivity for low-velocity blood flow and enables objective monitoring of inflammatory activity via the VI. These findings suggest that MVFI may represent a useful adjunct to standard venous ultrasound for assessing inflammation associated with venous thrombosis and for monitoring disease evolution, supporting further investigation in larger clinical studies.