Ultrasound-guided medical procedures: a growing field with new opportunities

Ultrasonography (B-mode and higher modes) has been employed since the early 1970 s for the visualization and guidance of invasive medical procedures in clinical practice. The growing interest in ultrasound-guided applications is reflected by the increasing number of scientific publications per year ([Fig. 1]). There is overlap with “interventional ultrasound” (INVUS), which refers to ultrasound-guided applications with penetration of the skin or orifice of the body [1]. However, the term “ultrasound guidance” used here also includes procedures without such penetration. The first reported ultrasound-guided procedures were percutaneous biopsy of the kidney and liver, amniocentesis, and puncture to aspirate renal abscesses [2] [3] [4] [5]. In the following decades numerous further target organs for ultrasound-guided puncture/aspiration or biopsy have been reported, many of them in Ultraschall in der Medizin [6] [7] [8] [9] [10]. The next milestone in this field was the ultrasound guidance and real-time monitoring of percutaneously applied therapies involving easily accessible targets, such as fetal transfusion [11], the intra-tumor application of immune-, chemo- and radio-therapeutics [8] [12] [13], and radiofrequency ablation of unresectable malignancies [14]. Ultrasound then became a tool in obstetrics, surgery, and angiology to intraoperatively monitor and adapt specific instrumental and intravascular procedures [15] [16] [17] [18]. The beneficial use of ultrasound guidance for vessel puncture, demonstrated already in the early 1990 s [19], is meanwhile a widely accepted standard, especially for the placement of central venous catheters in the intensive care unit [20]. With technological advancements, image resolution was further improved, allowing for the ultrasonic visualization of peripheral nerves. This opened the door to ultrasound-guided anesthesia of the nerve plexus and single nerves [21] [22]. Consequently, sonographically monitored therapeutic interventions and biopsies of nerves and neural tumors were established [23]. The availability of portable ultrasound devices with sufficient B-mode image quality enabled the ultrasound-guided intramuscular botulinum toxin injection into small and deep muscles, performed in pain and movement disorder clinics [24]. Contrast-enhanced ultrasound (CEUS) guidance techniques improved the targeting of biopsies of lesions in the liver, lung, and mediastinum [25] [26]. In the past decade, fusion imaging and navigation technologies have become increasingly available, matching a previously acquired MRI or CT volume data set with ultrasound imaging in real-time. With this technique simultaneously displaying both imaging modalities superimposed and/or side-by-side, novel imaging guidance applications were developed, e. g., for brain tumor surgery [27], intraoperative monitoring of deep brain stimulation electrode placement [28], precise biopsy for prostate cancer [29], and thermal ablation for hepatocellular carcinoma [30].

Publikationsverlauf

Artikel online veröffentlicht:
12. August 2022

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