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Huang DM, Wang SH. In Situ Monitoring and Assessment of Ischemic Skin Flap by High-Frequency Ultrasound and Quantitative Parameters. SENSORS (BASEL, SWITZERLAND) 2024; 24:363. [PMID: 38257456 PMCID: PMC10820102 DOI: 10.3390/s24020363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Skin flap surgery is a critical procedure for treating severe skin injury in which post-surgery lesions must well monitored and cared for noninvasively. In the present study, attempts using high-frequency ultrasound imaging, quantitative parameters, and statistical analysis were made to extensively assess variations in the skin flap. Experiments were arranged by incising the dorsal skin of rats to create a skin flap using the chamber model. Measurements, including photographs, 30 MHz ultrasound B-mode images, skin thickness, echogenicity, Nakagami statistics, and histological analysis of post-surgery skin flap, were performed. Photograph results showed that color variations in different parts of the skin flap may readily correspond to ischemic states of local tissues. Compared to post-surgery skin flap on day 7, both integrated backscatter (IB) and Nakagami parameter (m) of the distal part of tissues were increased, and those of the skin thickness were decreased. Overall, relative skin thickness, IB, and m of the distal part of post-surgery skin flap varied from 100 to 67%, -66 to -61 dB, and 0.48 to 0.36, respectively. These results demonstrate that this modality and quantitative parameters can be feasibly applied for long-term and in situ assessment of skin flap tissues.
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Affiliation(s)
- Da-Ming Huang
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan 70101, Taiwan;
| | - Shyh-Hau Wang
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan 70101, Taiwan;
- Institute of Medical Informatics, National Cheng Kung University, Tainan 70101, Taiwan
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2
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Hernández Montilla I, Medela A, Mac Carthy T, Aguilar A, Gómez Tejerina P, Vilas Sueiro A, González Pérez AM, Vergara de la Campa L, Luna Bastante L, García Castro R, Alfageme Roldán F. Automatic International Hidradenitis Suppurativa Severity Score System (AIHS4): A novel tool to assess the severity of hidradenitis suppurativa using artificial intelligence. Skin Res Technol 2023; 29:e13357. [PMID: 37357665 PMCID: PMC10240185 DOI: 10.1111/srt.13357] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/13/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a painful chronic inflammatory skin disease that affects up to 4% of the European adult population. International Hidradenitis Suppurativa Severity Score System (IHS4) is a dynamic scoring tool that was developed to be incorporated into the doctor's daily clinical practice and clinical studies. This helps measure disease severity and guides the therapeutic strategy. However, IHS4 assessment is a time-consuming and manual process, with high inter-observer variability and high dependence on the observer's expertise. MATERIALS AND METHODS We introduce the Automatic International Hidradenitis Suppurativa Severity Score System (AIHS4), an automatic equivalent of IHS4 that deploys a deep learning model for lesion detection, called Legit.Health-IHS4net, based on the YOLOv5 architecture. AIHS4 was trained on Legit.Health-HS-IHS4, a collection of HS images manually annotated by six specialists and processed by a novel knowledge unification algorithm. RESULTS Our results show that, with the current dataset size, our tool assesses the severity of HS cases with a performance comparable to that of the most expert physician. Furthermore, the model can be implemented into CADx systems to support doctors in their clinical practice and act as a new endpoint in clinical trials. CONCLUSION Our work proves the potential usefulness of artificial intelligence in the practice of evidence-based dermatology: models trained on the consensus of large clinical boards have the potential to empower dermatologists in their daily practice and replace current standard clinical endpoints.
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Affiliation(s)
| | - Alfonso Medela
- Department of Medical Computer Vision and PROMsLEGIT.HEALTHBilbaoSpain
| | - Taig Mac Carthy
- Department of Clinical Endpoint InnovationLEGIT.HEALTHBilbaoSpain
| | - Andy Aguilar
- Department of Clinical Endpoint InnovationLEGIT.HEALTHBilbaoSpain
| | | | | | | | | | | | - Rubén García Castro
- Dermatology UnitFundacion Jiménez Díaz Teaching University HospitalMadridSpain
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Russo GM, Russo A, Urraro F, Cioce F, Gallo L, Belfiore MP, Sangiovanni A, Napolitano S, Troiani T, Verolino P, Sica A, Brancaccio G, Briatico G, Nardone V, Reginelli A. Management of Non-Melanoma Skin Cancer: Radiologists Challenging and Risk Assessment. Diagnostics (Basel) 2023; 13:diagnostics13040793. [PMID: 36832281 PMCID: PMC9955870 DOI: 10.3390/diagnostics13040793] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Basal cell carcinoma, squamous cell carcinoma, and Merkel cell carcinoma are the three main types of nonmelanoma skin cancers and their rates of occurrence and mortality have been steadily rising over the past few decades. For radiologists, it is still difficult to treat patients with advanced nonmelanoma skin cancer. Nonmelanoma skin cancer patients would benefit greatly from an improved diagnostic imaging-based risk stratification and staging method that takes into account patient characteristics. The risk is especially elevated among those who previously received systemic treatment or phototherapy. Systemic treatments, including biologic therapies and methotrexate (MTX), are effective in managing immune-mediated diseases; however, they may increase susceptibility to NMSC due to immunosuppression or other factors. Risk stratification and staging tools are crucial in treatment planning and prognostic evaluation. PET/CT appears more sensitive and superior to CT and MRI for nodal and distant metastasis as well as in surveillance after surgery. The patient treatment response improved with advent and utilization of immunotherapy and different immune-specific criteria are established to standardized evaluation criteria of clinical trials but none of them have been utilized routinely with immunotherapy. The advent of immunotherapy has also arisen new critical issues for radiologists, such as atypical response pattern, pseudo-progression, as well as immune-related adverse events that require early identification to optimize and improve patient prognosis and management. It is important for radiologists to have knowledge of the radiologic features site of the tumor, clinical stage, histological subtype, and any high-risk features to assess immunotherapy treatment response and immune-related adverse events.
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Affiliation(s)
- Gaetano Maria Russo
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
- Correspondence:
| | - Anna Russo
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Fabrizio Urraro
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Fabrizio Cioce
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Luigi Gallo
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Maria Paola Belfiore
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Angelo Sangiovanni
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Stefania Napolitano
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Teresa Troiani
- Unit of Plastic Surgery, Multidisciplinary Department of Medical Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80120 Naples, Italy
| | - Pasquale Verolino
- Unit of Plastic Surgery, Multidisciplinary Department of Medical Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80120 Naples, Italy
| | - Antonello Sica
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Gabriella Brancaccio
- Unit of Dermatology, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Giulia Briatico
- Unit of Dermatology, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Valerio Nardone
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy
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Crisan D, Wortsman X, Alfageme F, Catalano O, Badea A, Scharffetter-Kochanek K, Sindrilaru A, Crisan M. Ultraschall in der Dermatochirurgie: Enthüllen des Verborgenen für optimierte chirurgische Planung. J Dtsch Dermatol Ges 2022; 20:913-927. [PMID: 35881098 DOI: 10.1111/ddg.14781_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/02/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Diana Crisan
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Ulm, Deutschland
| | - Ximena Wortsman
- Klinik für Dermatologie, Institut für diagnostische Bildgebung und Erforschung der Haut und Weichteilgewebe, Medizinische Fakultät, Chile Universität, Santiago, Chile
| | - Fernando Alfageme
- Klinik für Dermatologie, Universitätsklinikum Puerta del Hierro, EFSUMB Dermatologisches Ultraschall-Lernzentrum, Majahonda, Madrid, Spanien
| | - Orlando Catalano
- Klinik für Radiologie, Diagnostisches Institut Varelli, Neapel, Italien
| | - Alexandru Badea
- Institut für Anatomie, Iuliu Hatieganu" Universität für Medizin und Pharmazie, Klausenburg, Rumänien
| | | | - Anca Sindrilaru
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Ulm, Deutschland
| | - Maria Crisan
- Klinik für Dermatologie, Abteilung Histologie, "Iuliu Hatieganu" Universität für Medizin und Pharmazie, Klausenburg, Rumänien
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Crisan D, Wortsman X, Alfageme F, Catalano O, Badea A, Scharffetter-Kochanek K, Sindrilaru A, Crisan M. Ultrasonography in dermatologic surgery: revealing the unseen for improved surgical planning. J Dtsch Dermatol Ges 2022; 20:913-926. [PMID: 35616215 DOI: 10.1111/ddg.14781] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/02/2022] [Indexed: 11/28/2022]
Abstract
Ultrasonography (US) is a modern, in vivo imaging method, which is increasingly being used in dermatology as a complementary tool to clinical examination and dermoscopy. At higher frequencies (15 MHz and above), US is an established method for assessing benign and malignant skin lesions, locoregional staging, monitoring the therapeutic efficacy in various inflammatory skin conditions, and patient follow-up. One field, which may increasingly benefit from performant imaging techniques such as US is dermatologic surgery. Preoperative imaging of cutaneous tumors, inflammatory skin conditions (hidradenitis suppurativa, abscesses, etc.), or nail pathology provide dermatologic surgeons with relevant information for an optimal surgical planning, identifying potential complex aspects which might require interdisciplinary approaches, herein sparing unnecessary surgical interventions and increasing patients' compliance. In this review, we discuss the increasing significance of US in the field of dermatologic surgery, as well as the spectrum of cutaneous pathology where sonography can aid in the preoperative setting to provide a more precise, individualized surgical planning for better counseling to our patients and improved surgical results.
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Affiliation(s)
- Diana Crisan
- Department of Dermatology and Allergic Diseases, University Clinic Ulm, Germany
| | - Ximena Wortsman
- Department of Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Fernando Alfageme
- Department of Dermatology, University Hospital Puerta del Hierro, EFSUMB Dermatologic Ultrasound Learning Center, Majahonda, Madrid, Spain
| | - Orlando Catalano
- Department of Radiology, Istituto Diagnostico Varelli, Naples, Italy
| | - Alexandru Badea
- Department of Anatomy, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Anca Sindrilaru
- Department of Dermatology and Allergic Diseases, University Clinic Ulm, Germany
| | - Maria Crisan
- Departments of Dermatology and Histology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Ceballos-Francisco D, García-Carrillo N, Cuesta A, Esteban MÁ. Ultrasonography study of the skin wound healing process in gilthead seabream (Sparus aurata). JOURNAL OF FISH DISEASES 2021; 44:1091-1100. [PMID: 33760262 DOI: 10.1111/jfd.13370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
This work aimed to carry out an in vivo study of the skin healing process in gilthead seabream (Sparus aurata) after being experimentally wounded. Firstly, the structure of normal skin was studied by real-time ultrasonography (Vevo Lab, VisualSonics) and light microscopy. Besides this, experimental wounds were made on the left flank of each fish with a circular biopsy punch (8 mm diameter) below the lateral line. The healing process was assessed on live fish at 0, 6, 11 and 23 days post-wounding using the real-time ultrasonography in B-mode and Power Doppler mode (Vevo 3100 FUJIFILM, VisualSonics). Through the ultrasonography images, both the skin structure and the evolution of the changes that wounds originated in the surrounding tissues were studied in vivo over time. Concomitantly, the pattern of neovascularization in the wounded area was followed during the healing process and it was demonstrated that, although the neovascularization started very early after the skin damage, it was increased in wounded areas from day 11 post-wounding onwards. The results obtained proved the utility and power of using ultrasounds in fish to evaluate in vivo complex biological processes in real time, which are difficult to study by other methodologies. The present data shed some light on the reparation of external injuries in aquatic vertebrates.
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Affiliation(s)
- Diana Ceballos-Francisco
- Immunobiology for Aquaculture Group, Department of Cell Biology and Histology, Faculty of Biology, University of Murcia, Murcia, Spain
| | - Nuria García-Carrillo
- Integrated Center for Biomedical Research (CEIB), Health Sciences Campus, University of Murcia, Murcia, Spain
| | - Alberto Cuesta
- Immunobiology for Aquaculture Group, Department of Cell Biology and Histology, Faculty of Biology, University of Murcia, Murcia, Spain
| | - María Ángeles Esteban
- Immunobiology for Aquaculture Group, Department of Cell Biology and Histology, Faculty of Biology, University of Murcia, Murcia, Spain
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