Real-Time Super-Resolution Ultrasound Imaging for Monitoring Tumor Response During Intensive Care Management of Oncologic Emergencies

<b><i>Background:</i></b> Oncologic emergencies in critically ill cancer patients frequently require rapid, real-time assessment of tumor responses to therapeutic interventions. However, conventional imaging modalities such as computed tomography and magnetic resonance imaging are often impractical in intensive care units (ICUs) due to logistical constraints and patient instability. Super-resolution ultrasound (SR-US) imaging has emerged as a promising noninvasive alternative, facilitating bedside evaluation of tumor microvascular dynamics with exceptional spatial resolution. This study assessed the clinical utility of real-time SR-US imaging in monitoring tumor perfusion changes during emergency management in oncological ICU settings. <b><i>Methods:</i></b> In this prospective observational study, critically ill patients with oncologic emergencies underwent bedside SR-US imaging before and after the initiation of emergency therapy (e.g., corticosteroids, decompression, or chemotherapy). SR-US was employed to quantify microvascular parameters, including perfusion density and flow heterogeneity. Data processing incorporated artificial intelligence for real-time vessel segmentation and quantitative analysis. <b><i>Results:</i></b> SR-US imaging successfully detected perfusion changes within hours of therapy initiation. A significant correlation was observed between reduced tumor perfusion and clinical improvement, including symptom relief and shorter ICU stay. This technology enables visualization of microvessels as small as 30 µm, surpassing conventional ultrasound limits. No adverse events were reported with the use of contrast microbubbles. In addition, SR-US imaging reduces the need for transportation to radiology departments, thereby optimizing ICU workflow. <b><i>Conclusions:</i></b> Real-time SR-US imaging offers a novel, bedside-compatible method for evaluating tumor vascular response during the acute phase of oncological emergencies. Its integration into ICU care pathways could enhance timely decision-making, reduce reliance on static imaging, and support personalized cancer management. Further multicenter validation is required.