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Hobayan CGP, Gray AN, Waters MF, Mager LA, Kobayashi S, Essien EW, Ulman CA, Kaffenberger BH. Diagnostic accuracy of high-frequency ultrasound for cutaneous neoplasms: a narrative review of the literature. Arch Dermatol Res 2024; 316:419. [PMID: 38904763 PMCID: PMC11192820 DOI: 10.1007/s00403-024-03179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/07/2024] [Accepted: 06/08/2024] [Indexed: 06/22/2024]
Abstract
High-frequency ultrasound has been used to visualize depth and vascularization of cutaneous neoplasms, but little has been synthesized as a review for a robust level of evidence about the diagnostic accuracy of high-frequency ultrasound in dermatology. A narrative review of the PubMed database was performed to establish the correlation between ultrasound findings and histopathologic/dermoscopic findings for cutaneous neoplasms. Articles were divided into the following four categories: melanocytic, keratinocytic/epidermal, appendageal, and soft tissue/neural neoplasms. Review of the literature revealed that ultrasound findings and histopathology findings were strongly correlated regarding the depth of a cutaneous neoplasm. Morphological characteristics were correlated primarily in soft tissue/neural neoplasms. Overall, there is a paucity of literature on the correlation between high-frequency ultrasound and histopathology of cutaneous neoplasms. Further studies are needed to investigate this correlation in various dermatologic conditions.
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Affiliation(s)
| | - Ashley N Gray
- Department of Dermatology, The Ohio State University, 540 Officecenter Place, Suite 240, Columbus, OH, 43230, USA
| | - Margo F Waters
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Layna A Mager
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sonja Kobayashi
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ellen W Essien
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Catherine A Ulman
- Department of Dermatology, The Ohio State University, 540 Officecenter Place, Suite 240, Columbus, OH, 43230, USA
| | - Benjamin H Kaffenberger
- Department of Dermatology, The Ohio State University, 540 Officecenter Place, Suite 240, Columbus, OH, 43230, USA.
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2
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Gonzalez C, Wortsman X. How to Start on Dermatologic Ultrasound: Basic Anatomical Concepts, Guidelines, Technical Considerations, and Best Tips. Semin Ultrasound CT MR 2024; 45:180-191. [PMID: 38056787 DOI: 10.1053/j.sult.2023.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Dermatologic ultrasound has grown exponentially during the last decades and has passed from the experimental phase to the routine daily practice in multiple countries. The performance of this imaging technique requires color Doppler ultrasound devices working with high-frequency probes, a trained operator on imaging and dermatologic conditions, and the performance of standardized protocols for obtaining the anatomical data properly. In this review, we analyze the ultrasonographic anatomy of the skin, hair, and nails, the technical requirements and considerations, the guidelines, and the recommended protocols, and provide the best tips for practicing this type of examination confidently.
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Affiliation(s)
| | - Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile; Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile; Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
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3
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Crisan D, Tarnowietzki E, Bernhard L, Möller M, Scharffetter-Kochanek K, Crisan M, Schneider LA. Rationale for Using High-Frequency Ultrasound as a Routine Examination in Skin Cancer Surgery: A Practical Approach. J Clin Med 2024; 13:2152. [PMID: 38610917 PMCID: PMC11012407 DOI: 10.3390/jcm13072152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Ultrasound and high-frequency ultrasound assessment of melanoma and non-melanoma skin cancer in the pre-therapeutical setting is becoming increasingly popular in the field of dermatosurgery and dermatooncology, as it can provide clinicians with relevant, "in vivo" parameters regarding tumor lateral and depth extension as well as potential locoregional spread, cancelling the need of more extensive imaging methods and avoiding a delay in diagnosis. Furthermore, preoperative sonography and color Doppler can aid in orienting the clinical diagnosis, being able in numerous situations to differentiate between benign and malignant lesions, which require a different therapeutic approach. This preoperative knowledge is of paramount importance for planning an individualized treatment regimen. Using sonography at the time of diagnosis, important surgical complications, such as neurovascular damage, can be avoided by performing a preoperative neurovascular mapping. Furthermore, sonography can help reduce the number of surgical steps by identifying the lesions' extent prior to surgery, but it can also spare unnecessary surgical interventions in cases of locally advanced lesions, which infiltrate the bone or already present with locoregional metastases, which usually require modern radiooncological therapies in accordance to European guidelines. With this review, we intend to summarize the current indications of sonography in the field of skin cancer surgery, which can help us improve the therapeutic attitude toward our patients and enhance patient counseling. In the era of modern systemic radiooncological therapies, sonography can help better select patients who qualify for surgical procedures or require systemic treatments due to tumoral extension.
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Affiliation(s)
- Diana Crisan
- Clinic of Dermatology and Allergology, University Clinic Ulm, 89081 Ulm, Germany
| | - Evelyne Tarnowietzki
- Clinic of Dermatology and Allergology, University Clinic Ulm, 89081 Ulm, Germany
| | - Lukas Bernhard
- Clinic of Dermatology and Allergology, University Clinic Ulm, 89081 Ulm, Germany
| | - Melina Möller
- Clinic of Dermatology and Allergology, University Clinic Ulm, 89081 Ulm, Germany
| | | | - Maria Crisan
- Department of Dermatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
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4
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de Almeida CÁ, Nakamura R, Leverone A, Costa F, Estrada BD, Haui P, Luz F, Yamada AF, Werner H, Canella C. Imaging features for the evaluation of skin and nail infections. Skeletal Radiol 2024:10.1007/s00256-023-04557-4. [PMID: 38194095 DOI: 10.1007/s00256-023-04557-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024]
Abstract
Clinical manifestations of dermatological and musculoskeletal conditions can sometimes overlap, leading to confusion in diagnosis. Patients with nail and skin infections may undergo imaging examinations with suspicions of muscle, tendon, or joint injuries. Dermatological infections often involve soft tissues and musculoskeletal structures, and their etiology can range from fungi, bacteria, viruses, to protozoa. Relying solely on physical examination may not be sufficient for accurate diagnosis and treatment planning, necessitating the use of complementary imaging exams. The objective of this paper is to present and discuss imaging findings of the main infectious conditions affecting the nail apparatus and skin. The paper also highlights the importance of imaging in clarifying diagnostic uncertainties and guiding appropriate treatment for dermatological conditions.
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Affiliation(s)
- Carolina Ávila de Almeida
- Diagnósticos da América S/A, DASA, Avenida das Américas 4666, Sala 325, Rio de Janeiro, RJ, 22640-100, Brazil.
| | - Robertha Nakamura
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia Do Rio de Janeiro, Rio de Janeiro, Brazil
- Centro de Estudos das Unhas (CEU), Santa Casa de Misericórdia Do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andreia Leverone
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia Do Rio de Janeiro, Rio de Janeiro, Brazil
- Centro de Estudos das Unhas (CEU), Santa Casa de Misericórdia Do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flávia Costa
- DASA, Clínica Alta Excelência Diagnóstica, Rio de Janeiro, Brazil
| | - Bruna Duque Estrada
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia Do Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Evidence-Based, Health of the Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Priscilla Haui
- Diagnósticos da América S/A, DASA, Avenida das Américas 4666, Sala 325, Rio de Janeiro, RJ, 22640-100, Brazil
| | - Flavio Luz
- Department of Dermatology, Universidade Federal Fluminense (UFF), Rio de Janeiro, Brazil
| | - Andre Fukunishi Yamada
- Department of Radiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- Hospital Do Coração, HCOR, São Paulo, Brazil
| | - Heron Werner
- Diagnósticos da América S/A, DASA, Avenida das Américas 4666, Sala 325, Rio de Janeiro, RJ, 22640-100, Brazil
- Bio Design Laboratory, Pontifícia Universidade Católica (PUC-Rio), Rio de Janeiro, Brazil
| | - Clarissa Canella
- DASA, Clínica Alta Excelência Diagnóstica, Rio de Janeiro, Brazil
- Bio Design Laboratory, Pontifícia Universidade Católica (PUC-Rio), Rio de Janeiro, Brazil
- Department of Radiology of Universidade Federal Fluminense (UFF), Rio de Janeiro, Brazil
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5
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Taleb E, Yélamos O, Ardigo M, Christensen RE, Geller S. Non-invasive Skin Imaging in Cutaneous Lymphomas. Am J Clin Dermatol 2024; 25:79-89. [PMID: 37964050 PMCID: PMC10842086 DOI: 10.1007/s40257-023-00824-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
The diagnosis of cutaneous lymphomas is challenging and requires skin tissue for histology and immunophenotyping using immunohistochemistry and molecular studies. In recent years, the role of non-invasive imaging techniques has been described as part of the clinical assessment of cutaneous lymphoma lesions. Imaging modalities such as dermoscopy, reflectance confocal microscopy (RCM), and high frequency ultrasound (HFUS) have been shown to be very valuable in raising the clinical suspicion for lymphomas of the skin, and in distinguishing cutaneous lymphomas from inflammatory dermatoses such as lupus, psoriasis, or eczema. These non-invasive methods can be used to direct the clinician to the optimal biopsy site to maximize the histopathological results and minimize false negatives. These methods also have a potential place in monitoring treatment response. In this review we present a concise summary of the dermoscopic imaging, RCM, and HFUS features seen in cutaneous T-cell lymphomas (CTCL) and B-cell lymphomas (CBCL).
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Affiliation(s)
- Eyal Taleb
- Division of Dermatology, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oriol Yélamos
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
| | - Marco Ardigo
- San Gallicano Dermatological Institute IRCCS, Rome, Italy
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - Rachel E Christensen
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, New York, NY, 10021, USA
| | - Shamir Geller
- Division of Dermatology, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, New York, NY, 10021, USA.
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6
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Ricci V, Cocco G, Donati D, Farì G, Chang KV, Özçakar L. From Histopathology to High-Resolution Ultrasound Imaging of Skin Scars. Diagnostics (Basel) 2023; 13:3629. [PMID: 38132213 PMCID: PMC10742690 DOI: 10.3390/diagnostics13243629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Nowadays, modern ultrasound machines and high-frequency transducers allow us to accurately assess the superficial soft tissues of the human body. In this sense, sonographic evaluation of the skin and related pathologies is progressively growing in the pertinent literature. To the best of our knowledge, a standardized sonographic protocol focused on the assessment of pathological skin scars is still lacking. As such, the main purpose of the present study was to propose a technical guide to sonographically assess skin scars in the daily practice of clinicians-starting from knowledge on their histopathological features. In order to standardize the ultrasound examination, a superficial-to-deep, layer-by-layer approach has been proposed to optimize its reproducibility and to promote a common language among the different healthcare providers.
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Affiliation(s)
- Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
| | - Giulio Cocco
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University, 66100 Chieti, Italy;
| | - Danilo Donati
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Giacomo Farì
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), Università del Salento, 73100 Lecce, Italy;
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10617, Taiwan;
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, 06100 Ankara, Turkey;
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7
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Jiang L, Yuan L, Su X, Zhen Q, Jia Y, Hu J, Chai H. The Application of High-frequency Ultrasonic Imaging in Identifying Fillers in the Temporal Region. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5269. [PMID: 38152712 PMCID: PMC10752488 DOI: 10.1097/gox.0000000000005269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/21/2023] [Indexed: 12/29/2023]
Abstract
Background This study aimed to evaluate the ultrasonic manifestations of diversified corium fillers in the temporal region and to provide clinicians with suggestions for diagnosis and treatment. Methods The facial ultrasound images of 116 patients, including 110 women and six men, 20-61years of age, were analyzed at the Chinese Academy Medical Sciences and Peking Union Medical College from November 2014 to November 2021. Results We identified 48 cases of polyacrylamide, 31 cases of fat, 27 cases of hyaluronic acid, seven cases of hydroxyapatite, two cases of silicone oil, and one case of prosthesis. Polyacrylamide mainly showed irregular flocculent hypoechoic or fine punctate hypoechoic in ultrasound; it could be aggregated as a cystic hypoechoic area or diffused in the tissue space, and the probe could be pressurized to see the echo floating or dislocation flow. Fat mainly showed lobulated hypoechoic deposition with some hyperechoic linear intervals. Hyaluronic acid mainly showed an anechoic structure with a clear boundary, uniform internal echo, and no obvious blood flow signal. If diffused in the surrounding tissues, it was mainly characterized by anechoic or low-echo areas in the stratified tissues. Hydroxyapatite mainly showed strongly hyperechoic patch areas with posterior acoustic shadowing artifacts. Silicone oil was mostly found under the epidermis, showing a high echo in the form of clouds and causing unclear displays of deep tissue. Prosthesis showed hypoechoic prosthesis structure. Conclusion High-frequency ultrasound had a certain significance in the identification of the fillers of the temporal region.
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Affiliation(s)
- Liya Jiang
- From the Department of Cosmetic Injection Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Beijing, China
| | - Li Yuan
- Department of Ultrasonography, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xueshang Su
- From the Department of Cosmetic Injection Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Beijing, China
| | - Qiaoyuan Zhen
- College of Clinical Medicine, Fudan University, Shanghai, China
| | - Ying Jia
- Department of Ultrasonography, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jintian Hu
- From the Department of Cosmetic Injection Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Beijing, China
| | - Hongli Chai
- Department of Ultrasonography, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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8
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Salvia G, Zerbinati N, Manzo Margiotta F, Michelucci A, Granieri G, Fidanzi C, Morganti R, Romanelli M, Dini V. Ultra-High-Frequency Ultrasound as an Innovative Imaging Evaluation of Hyaluronic Acid Filler in Nasolabial Folds. Diagnostics (Basel) 2023; 13:2761. [PMID: 37685298 PMCID: PMC10486997 DOI: 10.3390/diagnostics13172761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Dermal hyaluronic acid (HA) fillers are used for nasolabial fold correction, but no study is still available on the use of ultra-high-frequency ultrasound (UHFUS) with 70 MHz probes for the evaluation of HA distribution and wrinkle amelioration. We selected 13 patients who received HA filler, evaluated before (Time (T) 0) and after injection (T1), and after 24 weeks (T2). The dermal thickness and distribution of HA were registered, as well as the Wrinkle Severity Rating Scale (WSRS), Global Aesthetic Improvement Scale (GAIS), and wrinkle 3D fullness. The UHFUS dermal thickness was increased by 11% for both sides at T1 and by 7.4% and 6.8% for the right and left side, respectively, at T2 (p < 0.01). The 3D wrinkle fullness showed a T1 increase (+0.59 cc and +0.79 cc for the right and left side, respectively) with a T2 maintenance of 45% of the T1 fullness (p-value < 0.001). The only clinical score significantly modified was WSRS, with a reduction of 56% at T1 and of 47.1% at T2 (p-value < 0.001). Our study then demonstrated the efficacy of UHFUS in the assessment of nasolabial fold correction, representing also the first multi-modal evaluation of HA persistence and its visual subsequent aesthetic results.
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Affiliation(s)
- Giorgia Salvia
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (F.M.M.); (A.M.); (G.G.); (C.F.); (M.R.); (V.D.)
| | - Nicola Zerbinati
- Dermatologic Unit, Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy;
| | - Flavia Manzo Margiotta
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (F.M.M.); (A.M.); (G.G.); (C.F.); (M.R.); (V.D.)
| | - Alessandra Michelucci
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (F.M.M.); (A.M.); (G.G.); (C.F.); (M.R.); (V.D.)
| | - Giammarco Granieri
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (F.M.M.); (A.M.); (G.G.); (C.F.); (M.R.); (V.D.)
| | - Cristian Fidanzi
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (F.M.M.); (A.M.); (G.G.); (C.F.); (M.R.); (V.D.)
| | - Riccardo Morganti
- Section of Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Marco Romanelli
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (F.M.M.); (A.M.); (G.G.); (C.F.); (M.R.); (V.D.)
| | - Valentina Dini
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (F.M.M.); (A.M.); (G.G.); (C.F.); (M.R.); (V.D.)
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Lee H, Lee Y, Jung SW, Lee S, Oh B, Yang S. Deep Learning-Based Evaluation of Ultrasound Images for Benign Skin Tumors. SENSORS (BASEL, SWITZERLAND) 2023; 23:7374. [PMID: 37687830 PMCID: PMC10490539 DOI: 10.3390/s23177374] [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: 07/19/2023] [Revised: 08/07/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023]
Abstract
In this study, a combined convolutional neural network for the diagnosis of three benign skin tumors was designed, and its effectiveness was verified through quantitative and statistical analysis. To this end, 698 sonographic images were taken and diagnosed at the Department of Dermatology at Severance Hospital in Seoul, Korea, between 10 November 2017 and 17 January 2020. Through an empirical process, a convolutional neural network combining two structures, which consist of a residual structure and an attention-gated structure, was designed. Five-fold cross-validation was applied, and the train set for each fold was augmented by the Fast AutoAugment technique. As a result of training, for three benign skin tumors, an average accuracy of 95.87%, an average sensitivity of 90.10%, and an average specificity of 96.23% were derived. Also, through statistical analysis using a class activation map and physicians' findings, it was found that the judgment criteria of physicians and the trained combined convolutional neural network were similar. This study suggests that the model designed and trained in this study can be a diagnostic aid to assist physicians and enable more efficient and accurate diagnoses.
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Affiliation(s)
- Hyunwoo Lee
- Department of Biomedical Engineering, Yonsei University, Wonju 26493, Republic of Korea
| | - Yerin Lee
- Department of Precision Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Seung-Won Jung
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Solam Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Byungho Oh
- Department of Dermatology, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sejung Yang
- Department of Precision Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
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10
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Tavelli L, Yu N, Mancini L, Barootchi S. Keratinized mucosa width assessment at implant sites using high-frequency ultrasonography. J Periodontol 2023; 94:956-966. [PMID: 36800257 DOI: 10.1002/jper.23-0014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND The aim of this study was to describe the application of high-frequency ultrasonography (HFUS) for assessing keratinized mucosa (KM) width at implant sites. METHODS KM width was measured at 28 implant sites exhibiting a peri-implant soft tissue dehiscence at baseline and 12 months after soft tissue augmentation. KM width assessment was performed with a periodontal probe [clinical assessment (clKM)] and with HFUS, based on the echointensity of the keratinized epithelium compared to the adjacent structures. KM width measurements on ultrasound scans were performed linearly (lnKM) and along the soft tissue profile [surface distance (sdKM)]. RESULTS No statistically significant differences were observed between clKM, lnKM, and sdKM at baseline, while at 12 months, sdKM (5.313 ± 1.188 mm) was significantly higher than clKM (3.98 ± 1.25 mm) and lnKM (4.068 ± 1.197 mm) (P < 0.001 for both comparisons). A linear relationship between mucosal thickness (MT) and the difference between sdKM and lnKM was observed. In 95.2% of cases with MT > 2.51 mm, the discrepancy between sdKM and lnKM was at least 1 mm. CONCLUSIONS HFUS is a noninvasive and valuable tool for measure KM width at implant site. Evaluating KM width along the soft tissue profile as a surface distance may improve the accuracy of the assessment.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Boston, USA
| | - Ning Yu
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- The Forsyth Institute, Cambridge, Massachusetts, USA
| | - Leonardo Mancini
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Boston, USA
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Boston, USA
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11
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Wortsman X. Key Points to Select a Device for Dermatologic Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:521-545. [PMID: 36394307 DOI: 10.1002/jum.16000] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 05/26/2023]
Abstract
What points to consider when selecting a device for practicing dermatologic ultrasound is an excellent question. After we met the requisites published in the guidelines for practicing dermatologic ultrasound, it is necessary to consider the main objective of the use because it is not the same to be focused mostly on the avoidance of the puncture of important facial vessels such as the case of injectors of cosmetic fillers in comparison to the use of operators that need to deal with the diagnosis and monitoring of a wide range of dermatologic pathologies. Currently, a broad variety of ultrasound devices meets the minimum requirements for practicing these examinations in the market. Thus, small, portable, and high-end devices may present advantages and limitations that must be balanced according to the primary purposes and the budget. Moreover, the shape and footprint of the probes can make difficult or facilitate a dermatologic procedure. Other points to consider are the type of storage and the need for technical service. In summary, there are key points that we need to consider when we select a dermatologic ultrasound device in dermatology or aesthetics.
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Affiliation(s)
- Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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12
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Bellinato F, Gisondi P, Filippucci E, Tozzi F, Fassio A, Adami G, Idolazzi L. Systematic study on nail plate assessment: differences in nail plate shape, thickness, power Doppler signal and scanning approach. Arch Dermatol Res 2023; 315:593-600. [PMID: 36271200 PMCID: PMC10020276 DOI: 10.1007/s00403-022-02404-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/27/2022] [Accepted: 10/11/2022] [Indexed: 11/02/2022]
Abstract
Ultrasonography (US) of the nail is raising interest in the last years and its feasibility, quickness and amount of descriptive data may provide valuable information. Different authors presented several scanning approaches to nail complex in different pathological conditions, such as psoriasis, but no scanning protocol was ever proposed using healthy subjects as population of reference. The aim of the study was to establish a protocol for the US of nail plate and to assess whether the measurement of the nail plate is influenced by longitudinal vs transverse scan, sex, digit and hand dominance. Using high frequency probe and a Canon Aplio i800 machine, ultrasonographers took scans of nail plates of the hands from healthy subjects. Nail plate shape, thickness and power Doppler signal (PDUS) were evaluated and scans were taken both on longitudinal and transverse axis, at distal, middle and proximal portion of the nail plate or at a fixed angles of - 45°, 0° or + 45°. All the images were then revised and scored using a DICOM software, in order to allow good standards of accuracy and reproducibility. A total of 27 subjects (14 females and 13 males) were assessed. The measures did not result to differ in different portions or angles. Furthermore, no difference appears in sex or dominant vs not dominant hand. A decreasing and significant trend for nail plate thickness was found from the first to the fifth finger. Doppler signal was found in all but one subjects, with a range from almost absent to very evident. No difference was found between groups regarding PDUS. The data provided suggest that a proper scan protocol should include all the nails and evaluation should be done both on longitudinal and transverse axis. Since Doppler signal is highly variable in healthy subjects, its presence should be carefully considered as pathological finding. Observations provided by this study clarify important points of the scanning technique and solve doubts related to which nails should be scanned and where to evaluate quantitative parameters.
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Affiliation(s)
- Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Emilio Filippucci
- Clinica Reumatologica, Università Politecnica Delle Marche, Ospedale "Carlo Urbani", Jesi, Ancona, Italy
| | - Francesca Tozzi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Angelo Fassio
- Section of Rheumatology, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Adami
- Section of Rheumatology, Department of Medicine, University of Verona, Verona, Italy
| | - Luca Idolazzi
- Section of Rheumatology, Department of Medicine, University of Verona, Verona, Italy
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Wortsman X. Aplicaciones frecuentes de la ecotomografía Doppler color en dermatología que permiten ayudar al diagnóstico y manejo. REVISTA MÉDICA CLÍNICA LAS CONDES 2023. [DOI: 10.1016/j.rmclc.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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14
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Haykal D, Cartier H, Benzaquen M, Damiani G, Habib SM. The growing importance of ultrasonography in cosmetic dermatology: An update after the 23rd IMCAS Annual World Congress (2022). J Cosmet Dermatol 2023; 22:222-225. [PMID: 36374262 DOI: 10.1111/jocd.15503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/09/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ultrasound (US) has been used for many years in the field of medicine. Many specialties have embraced US as a quick, painless, and relatively inexpensive tool to assist the clinician in determining anatomy, pathology, and aid in diagnostic or therapeutic procedures. US allows for precise mapping of cutaneous and subcutaneous structures in the face, in particular vascular structures. The use of US leads to reduced chances of complications and clinical failures, rendering more safety and high quality. METHODS US is considered the first-imaging technique for dealing with fillers and managing their potential complications. US can be deployed for vascular mapping, safe placement of fillers, and directed low-dose hyaluronidase reversal of vascular adverse events. It is a noninvasive imaging modality that provides a good definition for studying the skin, deeper layers, and blood flow in real time. In other words, we go from static to dynamic anatomy. In addition, US can guide with the application of botulinum toxin, in order to define the muscular planes. US may contribute to a more personalized procedure, better cosmetic results, and help to avoid complications. In general, physicians tend to use it for prevention. Last, for research purposes, US examination provides valuable information on the behavior, longevity, and interaction of the filler within the tissues. CONCLUSION This new approach for US-guided treatments is a very practical and an effective method in cosmetic dermatology. As doctors, we owe it to our patients to do our best to prevent any harm. We feel that in near future, US will be an essential diagnostic tool in any dermatology or cosmetic doctor's office to both ensure safety and provide legal protection for the professional.
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Affiliation(s)
| | | | | | - Giovanni Damiani
- Dermatology Unit, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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High-Frequency Ultrasound of Facial Filler Materials in the Nasolabial Groove. Aesthetic Plast Surg 2022; 46:2972-2978. [PMID: 35699759 DOI: 10.1007/s00266-022-02967-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/19/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Various dermal fillers are often used for nasolabial groove filling. High-frequency ultrasonography might be a valuable tool for assessing facial filler materials. METHODS The facial ultrasound images of plastic surgery hospital of the Chinese Academy of Medical Sciences from November 2014 to November 2021 were analyzed and judged. RESULTS A total of 94 patients who underwent high-frequency ultrasound with a nasolabial groove filler were included in the study. Hyaluronic acid was detected in 35 cases, polyacrylamide in 34 cases, lipofilling in 10 cases, silicon oil in seven cases, calcium hydroxyapatite in six cases, and silicone implant in two cases. The ultrasonic performance of hyaluronic acid was divided into four types: aggregation, diffusion, mixed pattern, and associated infection; of polyacrylamide was divided into five types: aggregation and inclusion, aggregation and non-inclusion, diffusion, mixed pattern, and associated infection; and of lipofilling was divided into four types: aggregation, diffusion, fat liquefaction necrosis, and cystic change. Echo intensity, echo characteristics, boundary clarity, fluidity, and blood flow signals can be used as the basis for identifying filler materials. CONCLUSION High-frequency ultrasound has an identification significance for the filling materials in the area of nasolabial groove. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Granieri G, Oranges T, Morganti R, Janowska A, Romanelli M, Manni E, Dini V. Ultra-high frequency ultrasound detection of the dermo-epidermal junction: Its potential role in dermatology. Exp Dermatol 2022; 31:1863-1871. [PMID: 36017602 DOI: 10.1111/exd.14664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/02/2022] [Accepted: 08/18/2022] [Indexed: 12/14/2022]
Abstract
Traditional high-frequency ultrasound (HFUS; 20 MHz) is a non-invasive method used to study skin in vivo but is not able to measure skin thickness accurately and to identify the dermal-epidermal junction (DEJ). Ultra-high frequency ultrasound (UHFUS; 70-100 MHz) has sub-millimetre resolution comparable to histology. The aim of this study was to identify, by UHFUS, the DEJ and to describe skin differences in healthy individuals by providing a measure of skin thickness, based on age and gender. We also described the bullous pemphigoid lesion. We enrolled 42 patients divided into 2 groups: A and B. Group A included 32 healthy volunteers aged 22-74 years. Group B consisted of 10 patients with bullous pemphigoid. For each patient in group A, 8 ultrasound (US) clips by 70 MHz probe were performed at forehead, cheek, nose, forearm, abdomen, chest, back and leg. For each patient in group B, 5 US images were acquired at blisters roofs and edges. In each US image, we measured thickness of stratum corneum (α-β), epidermis (α-γ) and epidermis plus dermis (α-δ). In both groups, we found the presence of 4 lines delimiting: the stratum corneum (the layer between α-line and β-line), the epidermis (distance between α- and γ-line), and the boundary between dermis and subcutis (δ-line). The γ-line corresponds to the point of detachment of the bullae. The abdominal α-β layer was thicker in males (p = 0.019) and α-δ thickness at cheeks (p < 0.001), chest (p = 0.007), back (p = 0.025) and forearm (p < 0.001). In females, α-γ thickness of the back was greater (p = 0.005). In old people compared to young, we noticed an increase of α-β layer at forehead and chest (p = 0.014), an increase of α-γ layer at forearm (p = 0.001), back (p = 0.024) and leg (p = 0.010) and an increase of α-δ layer at forehead (p = 0.001) and nose (p = 0.049). UHFUS is an advanced imaging technique that can detect both the DEJ and the boundary between dermis and subcutaneous tissue so that epidermal and dermal thickness can be measured with good accuracy. Regarding gender and age, skin differences obtained with UHFUS were comparable to other non-invasive methods.
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Affiliation(s)
| | - Teresa Oranges
- Department of Pediatrics, Meyer Childern's University Hospital, Florence, Italy
| | | | - Agata Janowska
- Department of Dermatology, University of Pisa, Pisa, Italy
| | | | | | - Valentina Dini
- Department of Dermatology, University of Pisa, Pisa, Italy
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Ricci V, Ricci C, Cocco G, Donati D, Farì G, Mezian K, Naňka O, Özçakar L. From Histology to Sonography in Skin and Superficial Tissue Disorders: EURO-MUSCULUS/USPRM* Approach. Pathol Res Pract 2022; 237:154003. [DOI: 10.1016/j.prp.2022.154003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 12/12/2022]
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18
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Chai H, Su X, Yuan L, Li Z, Liu Y, Dou M, Hu J. “Application of High Frequency Ultrasound in Detection and Identification of Nasal Filling Injection Materials”. J Cosmet Dermatol 2022; 21:4276-4287. [PMID: 35279941 DOI: 10.1111/jocd.14912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/06/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Hongli Chai
- Department of Ultrasound Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100144 China
| | - Xueshang Su
- Department of Cicatrix Minimally Invasive Treatment Center Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100144 China
| | - Li Yuan
- Department of Ultrasound Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100144 China
| | - Zehui Li
- Department of Cicatrix Minimally Invasive Treatment Center Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100144 China
| | - Yue Liu
- Department of Cicatrix Minimally Invasive Treatment Center Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100144 China
| | - Maomei Dou
- Department of Cicatrix Minimally Invasive Treatment Center Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100144 China
| | - Jintian Hu
- Department of Cicatrix Minimally Invasive Treatment Center Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100144 China
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Torres US, D'Ippolito G. Superb microvascular imaging: Steering the wheel toward a better sonographic depiction of dermal vascularization-A work in progress. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:128-130. [PMID: 35043437 DOI: 10.1002/jcu.23082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 10/05/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Ulysses S Torres
- Grupo Fleury, São Paulo, Brazil
- Department of Diagnostic Imaging, Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Giuseppe D'Ippolito
- Grupo Fleury, São Paulo, Brazil
- Department of Diagnostic Imaging, Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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