What Future for Ultrasound in Medicine?

What comes to mind when asked the question: “Welche Zukunft für Ultraschall in der Medizin” (What Future for Ultrasound in Medicine? )? I guess all of us would think about the editorial policies, publisher’s choices and administrative issues of our beloved journal and might frown. However, at the beginning of the year 2018, the future of the journal is fortunately very bright. It is quite successful and, therefore, the goal of this article is to review some new achievements and exciting future prospects of ultrasound techniques in the various medical fields, including those currently poised to be implemented in daily practice and those that are still only on the distant horizon. We hope readers will be able to discover future ultrasound applications that they are unaware of but may soon have a chance to use. We only regret that this overview will probably seem incomplete due to the limited publication space and the speed of change in these fields. Cardiology is perhaps the most paradigmatic example of the manifold applications of ultrasound. With improvements in 3 D and 4D interactive ultrasound techniques, the preoperative workup for transcatheter valve replacement/repair has gained a simple and noninvasive tool [1]. Even more remarkably, 3 D printing companies are showing interest in printing models from ultrasound images, for instance from transesophageal exams, which could help with preoperative planning [2]. 3 D echocardiography is expected to progressively become more integrated into the clinical guidelines and routine practice. Indeed, primary rather than secondary prevention is still the preferred approach in cardiovascular diseases. With the current obesity epidemic, many developed countries around the world are seeking ways to improve weight loss. Ultrasound might play an unexpected role even in this setting. Researchers from the United States recently described an innovative gene delivery therapy that produces an increase in fat and glucose oxidation and weight loss in diabetic rats, by genetically inducing a brown adipose tissue phenotype. In particular, a gene ‘cocktail’ was delivered into skeletal muscles of Zucker obese diabetic rats via tiny gas-filled microbubbles using ultrasound-targeted microbubble destruction (UTMD) [3]. This approach systemically infuses transgenes precoupled to gas-filled lipid microbubbles that are burst within the microvasculature of target tissues via an ultrasound signal, resulting in the release of DNA and transfection of neighboring cells within the tissue [3]. The therapeutic role of ultrasound has been established in the neurosciences, with focused ultrasound (FUS) having being approved for refractory essential tremor by the Food and Drug Administration (FDA) in 2016 [4]. It is currently under investigation as a possible treatment for disabling dyskinesia in Parkinson’s disease, neuropathic pain, obsessive-compulsive disorder, and epilepsy [4]. Its ability to transiently open the blood-brain barrier in localized brain regions also offers a promising route for targeted drug delivery, potentially leading to novel therapeutic approaches in chemotherapy delivery for brain cancers [5] and in albumin-mediated plaque clearance in Alzheimer’s disease [6]. FUS is not the only example of a medical use of ultrasound beyond mere imaging. Functional assessment might become a further application. In particular, Ultrasound Optical Tomography (UOT) has recently shown promising results in the assessment of the blood oxygen saturation of deep sites, such as the front side of the myocardial tissue [7]. With sufficient improvement, this technique Francesco Tovoli Vito Cantisani Cosima Schiavone Fabio Piscaglia Editorial