High Resolution Ultrasound: Hope Or Hype?

It offers more proactive diagnostics. It offers a more precise diagnostic view. It’s more portable. It fosters better patient compliance. These are just some of the claims that have been made about the potential impact of using high resolution ultrasound (or ultrasound biomicroscopy) in both diagnosing, monitoring and, in some cases, facilitating effective treatment for certain conditions you may see in your practice. Speaking strictly from a layman’s perspective, the possibilities of using this modality for some podiatric applications do sound intriguing. I was particularly struck by the October, 2002 cover story, “Getting A Better View With High Resolution Ultrasound,” in which the author, Paul Quintavalle, DPM, noted that using this diagnostic tool enabled him to detect pressure ulcers two to three days before the appearance of clinical signs. Due to the device’s sensitivity in detecting tissue fluid changes, Dr. Quintavalle says this aids in the use of “pressure relief measures before the ulcer breaks through the skin.” In addition to its potential proactive value, ultrasonography may facilitate less invasive treatment options for certain conditions. A recent study presented at the 88th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA) shed some interesting light on this subject (see “News And Trends” on page 6). In the study of 400 patients with various ligament, muscle and tendon injuries (including Achilles tendon problems), the researchers found that employing ultrasound-guided needle therapy resulted in improvement for 65 percent of the patients. The study authors also pointed out that many of the patients were able to resume athletic and other activities 12 weeks after undergoing the minimally invasive treatment option. The diagnostic capability of the device may also lead to a more precise surgical excision for removing foreign bodies. In his October cover story, Dr. Quintavalle noted that high resolution ultrasound allows you to “see the exact tissue plane involved and measure the exact depth.” The ultrasound may also prove to be valuable for those who see more than a fair share of patients with chronic wounds. Dr. Quintavalle says this device can help you check for undermining, sinus tract formation and assess abscesses and wound depth. It also allows you to monitor tissue edema, one of the primary culprits in chronic wounds, and make subsequent treatment adjustments if necessary, according to Dr. Quintavalle. In the aforementioned “News And Trends” article, Dr. Quintavalle notes that high resolution ultrasound may eventually emerge as a mainstream standard for monitoring the progress of soft tissue injuries, similar to how serial X-rays are used to assess the healing of fractures. While there seems to be a consensus of opinion that obtaining an MRI remains the standard of care for tendon injuries, high resolution ultrasound may provide a cost-effective option in some cases without affecting the diagnostic conclusion. Richard Bouche, DPM, points out in the “News And Trends” article that this modality “could be superior or equal to MRI” for some conditions such as Morton’s neuroma. There’s also a sentiment that the high resolution ultrasound can be an effective educational tool that can help facilitate patient compliance. This makes sense. Most people are visual learners. If the ultrasound can show a real-time view of a given pathology and the motion of joints and tendons, I think this, in concert with a DPM’s explanation, would go a long way toward educating patients and perhaps convincing them to stick with a given treatment regime. Certainly, the possibilities of high resolution ultrasound are worth further exploration.