Microvascular evaluation in MSK ultrasound

Abstract Musculoskeletal ultrasound (MSK US) is a valuable imaging modality for evaluating superficial structures such as muscles, tendons, and joints. Doppler techniques, particularly advanced microvascular imaging methods, have enhanced diagnostic capabilities by detecting low-velocity blood flow, which is often present in subclinical inflammation and pathological neovascularization. Microvascular technologies have demonstrated higher sensitivity compared to conventional Power Doppler. The clinical use of these technologies has significantly impacted the diagnosis and monitoring of rheumatic diseases (including rheumatoid arthritis, psoriatic arthritis, gout, and osteoarthritis), tendinopathies (such as epicondylitis, patellar and Achilles tendinopathy), adhesive capsulitis, and carpal tunnel syndrome. In particular, microvascular techniques have proven effective in detecting synovial inflammation even in patients considered to be in clinical remission, enabling more accurate disease activity assessment. Despite their advantages, some limitations remain, including the lack of standardized imaging protocols, variability among different ultrasound systems, and limited access in low-resource settings. Future directions include the development of validated quantitative metrics, integration with artificial intelligence to improve diagnostic accuracy, and implementation in portable ultrasound devices. The primary purpose of this review article was to offer an overview of microvascular technologies (MVT) with particular reference to applications in the musculoskeletal field.