16 Jun Progresses and clinical application of super-resolution ultrasound imaging: a narrative review
Progresses and clinical application of super-resolution ultrasound imaging: a narrative review
16 June 2025
Jia-yi Gao & Chao Hou
Abstract
Microcirculation plays a crucial role in maintaining normal physiological functions in the human body by facilitating the exchange of materials between tissues and blood through a network of microvessels with diameters less than 100 μm.
It regulates local hemodynamics and participates in important pathophysiological processes, such as inflammatory reactions and immune responses.
In recent years, the monitoring of super-resolution ultrasound (SRUS) in microcirculation has significantly enhanced our understanding of microvascular structure and function, while also providing insights into the noninvasive evaluation of organ conditions at the micro-level, thereby promoting the diagnosis and treatment of related diseases.
This review summarizes the development and clinical application progress of SRUS, offering valuable insights into future research directions.
Background
Microcirculation refers to the blood circulation that occurs between arterioles and venules.
It is characterized by capillaries with a diameter of less than 10 μm, where the exchange of substances between blood and tissue cells takes place. When structural or functional impairments in microcirculation lead to a reduction in microcirculatory blood perfusion, the supply of nutrients and oxygen becomes insufficient to meet the metabolic demand of tissues. Therefore, the structural and hemodynamic conditions of the microvasculature play a crucial role in diagnosing and assessing a wide range of diseases and pathologies [1, 2].
Abnormal changes in the structure or function of the microvascular system have been identified as key evidence for the development of several critical diseases, including cancer, inflammation, atherosclerotic plaques, and neurodegenerative disorders, etc. [3]. Multimodal ultrasound technologies, including color Doppler flow imaging (CDFI), contrast-enhanced ultrasound (CEUS), and super microvascular imaging (SMI), facilitate noninvasive monitoring of circulatory information pertinent to the functional status of organ structures. However, these methods exhibit certain limitations.
For instance, CDFI is restricted to visualizing vessels at the millimeter scale and is susceptible to the angle of the ultrasound beam. CEUS relies on the backscatter intensity of microbubble (MB), which may be affected by biocompatibility and the surrounding microenvironment, complicating the differentiation between noise and artifacts in practical applications [4].
Furthermore, both CEUS and SMI encounter challenges in identifying features smaller than the wavelength of ultrasound, thereby constraining their ability to visualize capillaries. In recent years, a novel ultrasound technology known as super-resolution ultrasound imaging (SRUS) has emerged, which isolates source echoes that exceed the classical diffraction limit [5]. This technology effectively tracks MB signals and their motion trajectories within blood flow, generating images that accurately reflect their positional information. Such capabilities facilitate the measurement of density and velocity distributions within the microvascular system, enabling the visualization and quantification of blood flow information at a micro level.
Currently, SRUS has been applied in various animal experiments, with several instruments having been commercialized [6, 7], demonstrating the potential of using SRUS in clinical practice. Consequently, this article aims to review the latest advancements in the applications of SRUS.
Conclusions
In the past decade, SRUS technology has successfully surpassed the diffraction barrier of ultrasound imaging, overcoming the limitations associated with traditional resolution.
This advancement has enabled high-precision imaging of micro-blood flow and comprehensive assessment and monitoring of its structural and functional alterations, thereby providing a robust means for elucidating the mechanisms underlying disease generation and development.
Although the imaging process and practical applications of SRUS still encounter numerous challenges, current research suggests that SRUS demonstrates significant potential in disease diagnosis, assessment, treatment, and efficacy monitoring.
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