Fusion Imaging in Musculoskeletal Interventions: Clinical Perspectives and Future Directions (2010–2025)

Ionut Pintilie^(1,*), Razvan Adrian Ionescu⁽²⁾, Horatiu Popoviciu⁽³⁾, Florentin Ananu Vreju⁽⁴⁾

1) Connect Medical, Rheumatology and Rehabilitation Department, Piatra Neamt, Romania
2) Department of Internal Medicine III, Colentina Clinical Hospital; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
3) Rheumatology Department, Mureș County Emergency Hospital, Târgu Mureș, Romania
4) Department of Rheumatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania

Background: Fusion ultrasound (US) imaging, which integrates real-time ultrasonography with previously acquired MRI or CT datasets, has evolved significantly between 2010 and 2025, transitioning from experimental use to a promising clinical tool in musculoskeletal and rheumatologic practice. This narrative review examines the technological advancements, clinical utility, and challenges of fusion imaging, based on a comprehensive analysis of the literature over this 15-year period. Applications span from interventional guidance in anatomically complex regions to diagnostic refinement and training enhancement
Objectives: To critically synthesize the literature from 2010–2025 regarding fusion ultrasound imaging, focusing on its applications in rheumatology, technological challenges, and prospects for clinical integration.
Methods: A narrative review was conducted, drawing on recent expert reviews, meta-analyses, and original research articles addressing fusion ultrasound in rheumatology. Literature was searched in PubMed and complemented with other indexed databases and manual reference screening. From 63 PubMed records and additional sources, 14 relevant studies were selected. No randomized controlled trials (RCTs) were identified.
Results: Fusion ultrasound imaging demonstrates promising utility in guiding interventional procedures, evaluating deep anatomical structures, and correlating MRI-visible lesions with functional ultrasound findings. Evidence supports its role in improving diagnostic accuracy, monitoring disease activity, and facilitating objective outcome measurement in both adult and pediatric rheumatic diseases. Technological advances, including AI-driven image analysis and standardized scoring systems, are enhancing the reliability and reproducibility of fusion imaging. However, challenges remain regarding workflow integration, operator training, and validation in routine clinical practice.
Conclusions: Fusion ultrasound represents a technically mature but still underutilized imaging modality in the field of rheumatology and musculoskeletal interventions. The reviewed evidence highlights its clear utility for guiding procedures in anatomically complex regions, improving diagnostic confidence, and offering real-time image correlation that enhances both accuracy and safety.

Keywords: fusion ultrasound, musculoskeletal imaging, rheumatology, image-guided interventions, MRI-ultrasound fusion, artificial intelligence

Corresponding author(s): Ionut Pintilie, Connect Medical, Rheumatology and Rehabilitation Department, Piatra Neamt, Romania, e-mail: ionutz_pintilie@yahoo.com