In vivo proton relaxation times analysis of the skin layers by magnetic resonance imaging

Methods for objective assessment of skin involvement in systemic sclerosis

PURPOSE OF REVIEW

Skin fibrosis is the most prominent disease manifestation of systemic sclerosis (SSc). Although the treatment for other SSc manifestations has expanded over the years, there is limited progress in identifying effective treatment options for SSc skin involvement. This is in part due to limitations in the utilized outcome measures for assessment of skin fibrosis. This review focuses on different emerging assessment tools for SSc skin involvement and their potential use for clinical care and multicenter trials.

RECENT FINDINGS

Durometer and other device-based methodologies requiring application of direct pressure to the affected skin have been studied in SSc. However, there are concerns that the required application of pressure might be a source of variability. Ultrasound-based methods have been compared with modified Rodnan Skin Score in several studies, indicating acceptable construct validity. However, few studies have examined their criterion validity by providing comparisons to skin histology. Optical coherence-based methods show promising preliminary results for simultaneous assessment of skin fibrosis and vasculopathy. Further standardization and validation (including comparison to skin histology) of these promising novel assessment tools in large, longitudinal SSc cohort studies are needed to establish them as clinically useful outcome measures with acceptable sensitivity to change.

SUMMARY

Recent advances in imaging techniques provide a promising opportunity for development of a valid and reliable assessment tool for quantification of SSc skin fibrosis, which can pave the way for approval of effective treatment options for this high burden disease manifestation.

Skin Cancer Pathobiology at a Glance: A Focus on Imaging Techniques and Their Potential for Improved Diagnosis and Surveillance in Clinical Cohorts

Early diagnosis is essential for completely eradicating skin cancer and maximizing patients' clinical benefits. Emerging optical imaging modalities such as reflectance confocal microscopy (RCM), optical coherence tomography (OCT), magnetic resonance imaging (MRI), near-infrared (NIR) bioimaging, positron emission tomography (PET), and their combinations provide non-invasive imaging data that may help in the early detection of cutaneous tumors and surgical planning. Hence, they seem appropriate for observing dynamic processes such as blood flow, immune cell activation, and tumor energy metabolism, which may be relevant for disease evolution. This review discusses the latest technological and methodological advances in imaging techniques that may be applied for skin cancer detection and monitoring. In the first instance, we will describe the principle and prospective clinical applications of the most commonly used imaging techniques, highlighting the challenges and opportunities of their implementation in the clinical setting. We will also highlight how imaging techniques may complement the molecular and histological approaches in sharpening the non-invasive skin characterization, laying the ground for more personalized approaches in skin cancer patients.

An Anthropomorphic Digital Reference Object (DRO) for Simulation and Analysis of Breast DCE MRI Techniques

Advances in accelerated magnetic resonance imaging (MRI) continue to push the bounds on achievable spatial and temporal resolution while maintaining a clinically acceptable image quality. Validation tools, including numerical simulations, are needed to characterize the repeatability and reproducibility of such methods for use in quantitative imaging applications. We describe the development of a simulation framework for analyzing and optimizing accelerated MRI acquisition and reconstruction techniques used in dynamic contrast enhanced (DCE) breast imaging. The simulation framework, in the form of a digital reference object (DRO), consists of four modules that control different aspects of the simulation, including the appearance and physiological behavior of the breast tissue as well as the MRI acquisition settings, to produce simulated k-space data for a DCE breast exam. The DRO design and functionality are described along with simulation examples provided to show potential applications of the DRO. The included simulation results demonstrate the ability of the DRO to simulate a variety of effects including the creation of simulated lesions, tissue enhancement modeled by the generalized kinetic model, T1-relaxation, fat signal precession and saturation, acquisition SNR, and changes in temporal resolution.

MR Imaging of Hair and Scalp for the Evaluation of Androgenetic Alopecia

Purpose:

Although androgenetic alopecia (AGA) is a common cause of hair loss, little is known regarding the magnetic resonance imaging (MRI) of the AGA or scalp. This study aimed to analyze whether MRI for hair and scalp (MRH) can evaluate anatomical changes in the scalp caused by AGA.

Methods:

Twenty-seven volunteers were graded for the severity of AGA using the Hamilton–Norwood Scale (HNS), commonly used classification system. All subjects underwent MRH; two radiologists independently analyzed the images. As a quantitative measurement, the number of hair follicles was analyzed and compared with the HNS. As a qualitative analysis, each MRH scan was visually graded in terms of the severity of alopecia, using a 4-point MR severity score. The scores were compared with the HNS.

Results:

The volunteers were divided into two groups of 12 and 15 males without and with AGA at their vertex, respectively. Inter-observer agreements for the hair count and the MR severity score were excellent. The mean hair count on MRI in the normal group was significantly higher than that in the AGA group (P < 10⁻⁴). The MR severity score in the AGA group was significantly more severe than that in the control group (P < 10⁻⁴). In terms of the presence or absence of thinning hair, the MR severity score was consistent with the HNS determined by a plastic surgeon in 96% of cases. MR severity scores of clinically moderate AGA cases were significantly lower than those of severe cases (P = 0.022).

Conclusion:

MRH could depict scalp anatomy showing a clear difference between AGA and normal scalps, in both hair count and subjective visual assessment. The MR severity score was in good agreement with the clinical stages by HNS. The results support the potential of MRH as a promising imaging technique for analyzing healthy and pathological scalps.

Review of Modern Techniques for the Assessment of Skin Hydration

Skin hydration is a complex process that influences the physical and mechanical properties of skin. Various technologies have emerged over the years to assess this parameter, with the current standard being electrical probe-based instruments. Nevertheless, their inability to provide detailed information has prompted the use of sophisticated spectroscopic and imaging methodologies, which are capable of in-depth skin analysis that includes structural and composition details. Modern imaging and spectroscopic techniques have transformed skin research in the dermatological and cosmetics disciplines, and are now commonly employed in conjunction with traditional methods for comprehensive assessment of both healthy and pathological skin. This article reviews current techniques employed in measuring skin hydration, and gives an account on their principle of operation and applications in skin-related research.

Determination of Normal Skin Elasticity by Using Real-time Shear Wave Elastography

OBJECTIVES

To define the reference ranges of normal skin elasticity measurements associated with shear wave elastography (SWE) in healthy volunteers and analyze the factors that may affect SWE.

METHODS

Mean skin thickness and elastic modulus values from 90 healthy volunteers were evaluated with B-mode ultrasonography and SWE in the right fingers and forearms, anterior chest, and abdominal walls. Reference ranges of normal skin elasticity were calculated by using lower and upper limits at the 2.5th and 97.5th percentiles. To investigate the effects of potential factors (site, sex, age, body mass index, and skin thickness) on skin elasticity measurements, a 1-way analysis of variance, the Student t test, and the Pearson correlation test were performed.

RESULTS

Skin elasticity was significantly different at different sites (P < .05). Mean elastic modulus values were 30.3 kPa for the finger, 14.8 kPa for the forearm, 17.8 kPa for the chest wall, and 9.5 kPa for the abdominal wall, and reference ranges of normal skin elasticity were 12.1 to 48.4kPa for the finger, 3.5 to 26.0 kPa for the forearm, 6.6 to 28.9 kPa for the chest wall, and 3.5 to 15.5 kPa for the abdominal wall. Our study revealed that men had higher skin elasticity measurements than women (P < .05), and they were more elevated in participants aged 20 to 50 years than in the other groups at the finger (P < .05). The body mass index and skin thickness had a negligible impact on skin elasticity measurements (P > .05).

CONCLUSIONS

This study revealed that the site, sex, and age should be taken into account when determining the reference ranges of normal skin elasticity by skin elasticity measurements.

The Temporal Muscle of the Head Can Cause Artifacts in Optical Imaging Studies with Functional Near-Infrared Spectroscopy

Background: Extracranial signals are the main source of noise in functional near-infrared spectroscopy (fNIRS) as light is penetrating the cortex but also skin and muscles of the head. Aim: Here we performed three experiments to investigate the contamination of fNIRS measurements by temporal muscle activity. Material and methods: For experiment 1, we provoked temporal muscle activity by instructing 31 healthy subjects to clench their teeth three times. We measured fNIRS signals over left temporal and frontal channels with an interoptode distance of 3 cm, in one short optode distance (SOD) channel (1 cm) and electromyography (EMG) over the edge of the temporal muscle. In experiment 2, we screened resting state fNIRS-fMRI (functional magnetic resonance imaging) data of one healthy subject for temporal muscle artifacts. In experiment 3, we screened a dataset of sound-evoked activity (n = 33) using bi-temporal probe-sets and systematically contrasted subjects presenting vs. not presenting artifacts and blocks/events contaminated or not contaminated with artifacts. Results: In experiment 1, we could demonstrate a hemodynamic-response-like increase in oxygenated (O2Hb) and decrease in deoxygenated (HHb) hemoglobin with a large amplitude and large spatial extent highly exceeding normal cortical activity. Correlations between EMG, SOD, and fNIRS artifact activity showed only limited evidence for associations on a group level with rather clear associations in a sub-group of subjects. The fNIRS-fMRI experiment showed that during the temporal muscle artifact, fNIRS is completely saturated by muscle oxygenation. Experiment 3 showed hints for contamination of sound-evoked oxygenation by the temporal muscle artifact. This was of low relevance in analyzing the whole sample. Discussion: Temporal muscle activity e.g., by clenching the teeth induces a large hemodynamic-like artifact in fNIRS measurements which should be avoided by specific subject instructions. Data should be screened for this artifact might be corrected by exclusion of contaminated blocks/events. The usefulness of established artifact correction methods should be evaluated in future studies. Conclusion: Temporal muscle activity, e.g., by clenching the teeth is one major source of noise in fNIRS measurements.

Terahertz Imaging of Cutaneous Edema: Correlation With Magnetic Resonance Imaging in Burn Wounds

OBJECTIVE

In vivo visualization and quantification of edema, or 'tissue swelling' following injury, remains a clinical challenge. Herein, we investigate the ability of reflective terahertz (THz) imaging to track changes in tissue water content (TWC)-the direct indicator of edema-by comparison to depth-resolved magnetic resonance imaging (MRI) in a burn-induced model of edema.

METHODS

A partial thickness and full thickness burns were induced in an in vivo rat model to elicit unique TWC perturbations corresponding to burn severity. Concomitant THz surface maps and MRI images of both burn models were acquired with a previously reported THz imaging system and T₂-weighted MRI, respectively, over 270 min. Reflectivity was analyzed for the burn contact area in THz images, while proton density (i.e., mobile TWC) was analyzed for the same region at incrementally increasing tissue depths in companion, transverse MRI images. A normalized cross correlation of THz and depth-dependent MRI measurements was performed as a function of time in histologically verified burn wounds.

RESULTS

For both burn types, strong positive correlations were evident between THz reflectivity and MRI data analyzed at greater tissue depths (>258 μm). MRI and THz results also revealed biphasic trends consistent with burn edema pathogenesis.

CONCLUSION

This paper offers the first in vivo correlative assessment of mobile TWC-based contrast and the sensing depth of THz imaging.

SIGNIFICANCE

The ability to implement THz imaging immediately following injury, combined with TWC sensing capabilities that compare to MRI, further support THz sensing as an emerging tool to track fluid in tissue.

Objective Assessment of Skin Changes in Lower Limb Venous Disease Using a Tissue Tonometer

Background:

Chronic venous disease (CVD) of the lower limbs is a major problem in the western world with 1% of the adult population estimated to be affected at any one time. No objective method is currently available to assess the skin changes of chronic venous disease. We have devised a tissue tonometer to compare skin compliance in patients with venous disease with that in control subjects.

Method:

Eighty-six limbs of 69 patients (34 men, 35 women; mean age 62 years, range 28-90 years) with venous disease confirmed by duplex ultrasonography and 42 limbs of 37 normal controls (23 men, 14 women; mean age 42 years, range 20-90 years) were studied. Patients were assigned to one of three clinical groups based on the Clinical, (a) Etiological, Anatomical and Pathophysiological (CEAP) method of classification and grading of chronic venous disease in the lower limbs: C3, oedema; C4a, pigmentation alone; C4b, lipodermato-sclerosis (LDS). Normal controls were assigned C0. A 4 mm diameter plunger loaded with a 30 g weight was applied to the skin 5 cm proximal to the medial malleolus or over the most severe region of skin change. The movement of the plunger was measured for 5 min using a linear variable differential transformer position detector. The initial displacement of the plunger (within 1 s) reflects the compliance of the skin.

Results:

In C4b patients with LDS, skin compliance is substantially reduced (median plunger displacement in 1 s = 0.81 mm, interquartile range (IQR) 0.67–1.18) compared with C0 control subjects (2.85 mm, IQR 2.39–3.22) (p<0.0005, Mann-Whitney), C4a patients with pigmentation alone without LDS (2.35 mm, IQR 2.04–2.91) (p<0.0005, Mann-Whitney) or C3 patients with venous disease (2.49 mm, IQR 1.58–3.13) (p<0.0005, Mann-Whitney). There were no statistically significant differences between the C0, C3 and C4a groups.

Conclusion:

Tissue tonometry provides an objective means of assessing skin changes in patients with lower limb chronic venous disease. This may be a useful method of measuring skin compliance as a research tool but will have limited clinical application.

In vivo assessment of aged human skin with a unilateral NMR scanner

Human skin undergoes morphological and biochemical changes as a result of chronological aging and exposure to solar ultraviolet irradiation (photoaging). Noninvasive detection of these changes may aid in the prevention and treatment of both types of aging. This article presents a noninvasive method for the evaluation of aging skin with a unilateral stray field NMR scanner. These portable and inexpensive scanners may be suitable for in-depth skin characterization. In vivo profiles of sun-protected and sun-exposed skin from the forearms of female subjects of different ages (n = 9) were measured. Skin biopsies for histopathological examination were used as reference. T2 analysis with a bi-exponential decay model was applied and the extracted parameters were examined as markers for dermal aging. In the upper reticular dermis, a significant increase in the fraction of the slow T2 component and in the T2 value itself was found to correlate with chronological aging. For most subjects, there was an additional increase in the values of the slow T2 component and the T2 values from the sun-exposed forearm, superimposed on that measured for the sun-protected forearm. These results are in agreement with the decline in collagen content and the increase in free water content with aging. The results suggest that such a technique can be used as a tool for the assessment of aging, and that bi-exponential fitting can produce sensitive fingerprint parameters for the dermal alterations that occur during aging.

In vivo MR imaging of the human skin at subnanoliter resolution using a superconducting surface coil at 1.5 Tesla

PURPOSE

To demonstrate the feasibility of a highly sensitive superconducting surface coil for microscopic MRI of the human skin in vivo in a clinical 1.5 Tesla (T) scanner.

MATERIALS AND METHODS

A 12.4-mm high-temperature superconducting coil was used at 1.5T for phantom and in vivo skin imaging. Images were inspected to identify fine anatomical skin structures. Signal-to-noise ratio (SNR) improvement by the high-temperature superconducting (HTS) coil, as compared to a commercial MR microscopy coil was quantified from phantom imaging; the gain over a geometrically identical coil made from copper (cooled or not) was theoretically deduced. Noise sources were identified to evaluate the potential of HTS coils for future studies.

RESULTS

In vivo skin images with isotropic 80 μm resolution were demonstrated revealing fine anatomical structures. The HTS coil improved SNR by a factor 32 over the reference coil in a nonloading phantom. For calf imaging, SNR gains of 380% and 30% can be expected over an identical copper coil at room temperature and 77 K, respectively.

CONCLUSION

The high sensitivity of HTS coils allows for microscopic imaging of the skin at 1.5T and could serve as a tool for dermatology in a clinical setting.

A parallel imaging approach to wide-field MR microscopy

Magnetic resonance microscopy, suggested in the earliest papers on MRI, has always been limited by the low signal-to-noise ratio resulting from the small voxel size. Magnetic resonance microscopy has largely been enabled by the use of microcoils that provide the signal-to-noise ratio improvement required to overcome this limitation. Concomitant with the small coils is a small field-of-view, which limits the use of magnetic resonance microscopy as a histological tool or for imaging large regions in general. This article describes initial results in wide field-of-view magnetic resonance microscopy using a large array of narrow, parallel coils, which provides a signal-to-noise ratio enhancement as well as the ability to use parallel imaging techniques. Comparison images made between a volume coil and the proposed technique demonstrate reductions in imaging time of more than 100 with no loss in signal-to-noise ratio or resolution.

Low-gradient single-sided NMR sensor for one-shot profiling of human skin

This paper describes a shimming approach useful to reduce the gradient strength of the magnetic field generated by single-sided sensors simultaneously maximizing its uniformity along the lateral directions of the magnet. In this way, the thickness of the excited sensitive volume can be increased without compromising the depth resolution of the sensor. By implementing this method on a standard U-shaped magnet, the gradient strength was reduced one order of magnitude. In the presence of a gradient of about 2 T/m, slices of 2mm could be profiled with a resolution that ranges from 25 μm at the center of the slice to 50 μm at the borders. This sensor is of particular advantage for applications, where the scanning range is of the order of the excited slice. In those cases, the full profile is measured in a single excitation experiment, eliminating the need for repositioning the excited slice across the depth range to complete the profile as occurs with standard high gradient sensors. Besides simplifying the experimental setup, the possibility to move from a point-by-point measurement to the simultaneous acquisition of the full profile led to the shortening of the experimental time. A further advantage of performing the experiment under a smaller static gradient is a reduction of the diffusion attenuation affecting the signal decay measured with a CPMG sequence, making it possible to measure the T(2) of samples with high diffusivity (comparable to the water diffusivity). The performance of the sensor in terms of resolution and sensitivity is first evaluated and compared with conventional singled-sided sensors of higher gradient strength using phantoms of known geometry and relaxation times. Then, the device is used to profile the structure of human skin in vivo. To understand the contrast between the different skin layers, the distribution of relaxation times T(2) and diffusion coefficients is spatially resolved along the depth direction.

Characterization of skin abnormalities in a mouse model of osteogenesis imperfecta using high resolution magnetic resonance imaging and Fourier transform infrared imaging spectroscopy

Evaluation of the skin phenotype in osteogenesis imperfecta (OI) typically involves biochemical measurements, such as histologic or biochemical assessment of the collagen produced from biopsy-derived dermal fibroblasts. As an alternative, the current study utilized non-invasive magnetic resonance imaging (MRI) microscopy and optical spectroscopy to define biophysical characteristics of skin in an animal model of OI. MRI of skin harvested from control, homozygous oim/oim and heterozygous oim/+ mice demonstrated several differences in anatomic and biophysical properties. Fourier transform infrared imaging spectroscopy (FT-IRIS) was used to interpret observed MRI signal characteristics in terms of chemical composition. Differences between wild-type and OI mouse skin included the appearance of a collagen-depleted lower dermal layer containing prominent hair follicles in the oim/oim mice, accounting for 55% of skin thickness in these. The MRI magnetization transfer rate was lower by 50% in this layer as compared to the upper dermis, consistent with lower collagen content. The MRI transverse relaxation time, T2, was greater by 30% in the dermis of the oim/oim mice compared to controls, consistent with a more highly hydrated collagen network. Similarly, an FT-IRIS-defined measure of collagen integrity was 30% lower in the oim/oim mice. We conclude that characterization of phenotypic differences between the skin of OI and wild-type mice by MRI and FT-IRIS is feasible, and that these techniques provide powerful complementary approaches for the analysis of the skin phenotype in animal models of disease.

A robust methodology for in vivo T1 mapping

In this article, a robust methodology for in vivo T(1) mapping is presented. The approach combines a gold standard scanning procedure with a novel fitting procedure. Fitting complex data to a five-parameter model ensures accuracy and precision of the T(1) estimation. A reduced-dimension nonlinear least squares method is proposed. This method turns the complicated multi-parameter minimization into a straightforward one-dimensional search. As the range of possible T(1) values is known, a global grid search can be used, ensuring that a global optimal solution is found. When only magnitude data are available, the algorithm is adapted to concurrently restore polarity. The performance of the new algorithm is demonstrated in simulations and phantom experiments. The new algorithm is as accurate and precise as the conventionally used Levenberg-Marquardt algorithm but much faster. This gain in speed makes the use of the five-parameter model viable. In addition, the new algorithm does not require initialization of the search parameters. Finally, the methodology is applied in vivo to conventional brain imaging and to skin imaging. T(1) values are estimated for white matter and gray matter at 1.5 T and for dermis, hypodermis, and muscle at 1.5 T, 3 T, and 7 T.

Magnetic resonance microimaging of human skin vasculature in vivo at 3 Tesla

MRI can be used to investigate human skin microvasculature in vivo, provided adequate spatial resolution. Therefore, the sensitivity of the experiment has to be optimized to achieve sufficient signal-to-noise ratio (SNR) within reasonable measurement time to minimize motion artifacts, improve patient comfort and save costs. In this work, the high sensitivity of a 15 mm surface coil and the signal strength of a 3 Tesla scanner, together with a three-dimensional gradient echo sequence and post-processing have been combined to obtain high SNR. Images of human skin with isotropic spatial resolution of 100 μm were acquired within 10 min and the cutaneous vasculature could be visualized in 3D [Correction made here after initial online publication.], based on three averaged scans. The presented method can be used for diagnosis and, due to its non-invasiveness, treatment monitoring of vascular pathologies in the skin, such as inflammation, vascular malformation, or neoangiogenesis in superficial tumors.

Jet fuel toxicity: skin damage measured by 900-MHz MRI skin microscopy and visualization by 3D MR image processing

The toxicity of jet fuels was measured using noninvasive magnetic resonance microimaging (MRM) at 900-MHz magnetic field. The hypothesis was that MRM can visualize and measure the epidermis exfoliation and hair follicle size of rat skin tissue due to toxic skin irritation after skin exposure to jet fuels. High-resolution 900-MHz MRM was used to measure the change in size of hair follicle, epidermis thickening and dermis in the skin after jet fuel exposure. A number of imaging techniques utilized included magnetization transfer contrast (MTC), spin-lattice relaxation constant (T1-weighting), combination of T2-weighting with magnetic field inhomogeneity (T2*-weighting), magnetization transfer weighting, diffusion tensor weighting and chemical shift weighting. These techniques were used to obtain 2D slices and 3D multislice-multiecho images with high-contrast resolution and high magnetic resonance signal with better skin details. The segmented color-coded feature spaces after image processing of the epidermis and hair follicle structures were used to compare the toxic exposure to tetradecane, dodecane, hexadecane and JP-8 jet fuels. Jet fuel exposure caused skin damage (erythema) at high temperature in addition to chemical intoxication. Erythema scores of the skin were distinct for jet fuels. The multicontrast enhancement at optimized TE and TR parameters generated high MRM signal of different skin structures. The multiple contrast approach made visible details of skin structures by combining specific information achieved from each of the microimaging techniques. At short echo time, MRM images and digitized histological sections confirmed exfoliated epidermis, dermis thickening and hair follicle atrophy after exposure to jet fuels. MRM data showed correlation with the histopathology data for epidermis thickness (R(2)=0.9052, P<.0002) and hair root area (R(2)=0.88, P<.0002). The toxicity of jet fuels on skin structures was in the order of tetradecane>hexadecane>dodecane. The method showed a sensitivity of 87.5% and a specificity of 75%. By MR image processing, different color-coded skin structures were extracted and 3D shapes of the epidermis and hair follicle size were compared. In conclusion, high-resolution MRM measured the change in skin epidermis and hair follicle size due to toxicity of jet fuels. MRM offers a three-dimensional spatial visualization of the change in skin structures as a method of toxicity evaluation and for comparison of jet fuels.

Robust optimal design of diffusion-weighted magnetic resonance experiments for skin microcirculation

Skin microcirculation plays an important role in several diseases including chronic venous insufficiency and diabetes. Magnetic resonance (MR) has the potential to provide quantitative information and a better penetration depth compared with other non-invasive methods such as laser Doppler flowmetry or optical coherence tomography. The continuous progress in hardware resulting in higher sensitivity must be coupled with advances in data acquisition schemes. In this article, we first introduce a physical model for quantifying skin microcirculation using diffusion-weighted MR (DWMR) based on an effective dispersion model for skin leading to a q-space model of the DWMR complex signal, and then design the corresponding robust optimal experiments. The resulting robust optimal DWMR protocols improve the worst-case quality of parameter estimates using nonlinear least squares optimization by exploiting available a priori knowledge of model parameters. Hence, our approach optimizes the gradient strengths and directions used in DWMR experiments to robustly minimize the size of the parameter estimation error with respect to model parameter uncertainty. Numerical evaluations are presented to demonstrate the effectiveness of our approach as compared to conventional DWMR protocols.

Gadolinium toxicity: epidermis thickness measurement by magnetic resonance imaging at 500 MHz

PURPOSE

Regional epidermal thickening and hair follicle width measurement by delayed gadolinium contrast magnetic resonance imaging (MRI) may assess the contrast agent gadolinium toxicity on mice skin.

MATERIALS AND METHODS

Delayed contrast in vivo MRI was performed in mice. Six mice skin samples were removed and exposed to a gadolinium contrast agent at different times after 2, 4, 6 and 8 h. The relaxation constants of each skin structure were measured. The thickness of the epidermis and hair follicle on follow-up ex vivo delayed-contrast MRI served as an index of gadolinium toxicity on the skin.

RESULTS

In vivo MRI by fast low-angle shot imaging technique showed distinct skin layers. High-resolution gradient echo T1-weighted and multislice multiecho proton density-weighted MRI intensities in the epidermis and hair follicle showed a positive correlation with delayed gadolinium-enhanced MRI hyperintensities (Pearson's correlation coefficient r(2)=0.81, P<0.0001) in the excised mice skin tissues. Delayed contrast-enhanced mice skin MRI after 2-4 h showed epidermis swelling and hair follicle regions with a size measurement accuracy of 65%, a sensitivity of 95%, a specificity of 25%, a positive predictive value of 65% and a negative predictive value of 65%. Areas under the receiver operating characteristic curves by MRI were 0.92-0.94 for hair and epidermis as good discriminators. MRI visualized distinct relaxation constants of the epidermis, sebaceous gland, skin papillary and reticular dermis layers and hair follicle.

CONCLUSION

Gadolinium contrast-enhanced MRI may visualize the thickening of the epidermis wall and hair follicle as an index of viable mice skin. Gadolinium enhanced the MRI visibility of skin structures. Gadolinium treatment showed skin toxicity as epidermis thickening the first time due to the undesirable use of high concentrations of gadolinium in microimaging.

Skin age testing criteria: characterization of human skin structures by 500 MHz MRI multiple contrast and image processing

Ex vivo magnetic resonance microimaging (MRM) image characteristics are reported in human skin samples in different age groups. Human excised skin samples were imaged using a custom coil placed inside a 500 MHz NMR imager for high-resolution microimaging. Skin MRI images were processed for characterization of different skin structures. Contiguous cross-sectional T1-weighted 3D spin echo MRI, T2-weighted 3D spin echo MRI and proton density images were compared with skin histopathology and NMR peaks. In all skin specimens, epidermis and dermis thickening and hair follicle size were measured using MRM. Optimized parameters TE and TR and multicontrast enhancement generated better MRI visibility of different skin components. Within high MR signal regions near to the custom coil, MRI images with short echo time were comparable with digitized histological sections for skin structures of the epidermis, dermis and hair follicles in 6 (67%) of the nine specimens. Skin % tissue composition, measurement of the epidermis, dermis, sebaceous gland and hair follicle size, and skin NMR peaks were signatures of skin type. The image processing determined the dimensionality of skin tissue components and skin typing. The ex vivo MRI images and histopathology of the skin may be used to measure the skin structure and skin NMR peaks with image processing may be a tool for determining skin typing and skin composition.

In vivo high-resolution magnetic resonance skin imaging at 1.5 T and 3 T

As a noninvasive modality, MR is attractive for in vivo skin imaging. Its unique soft tissue contrast makes it an ideal imaging modality to study the skin water content and to resolve the different skin layers. In this work, the challenges of in vivo high-resolution skin imaging are addressed. Three 3D Cartesian sequences are customized to achieve high-resolution imaging and their respective performance is evaluated. The balanced steady-state free precession (bSSFP) and gradient echo (GRE) sequences are fast but can be sensitive to off-resonance artifacts. The fast large-angle spin echo (FLASE) sequence provides a sharp depiction of the hypodermis structures but results in more specific absorption rate (SAR). The effect of increasing the field strength is assessed. As compared to 1.5 T, signal-to-noise ratio at 3 T slightly increases in the hypodermis and almost doubles in the dermis. The need for fat/water separation is acknowledged and a solution using an interleaved three-point Dixon method and an iterative reconstruction is shown to be effective. The effects of motion are analyzed and two techniques to prevent motion and correct for it are evaluated. Images with 117 x 117 x 500 microm(3) resolution are obtained in imaging times under 6 min.

Magnetic resonance imaging of the skin

A thorough examination of the skin is essential to screen various diseases accurately, evaluate the effectiveness of topically applied drugs and assess the results of dermatological surgeries such as skin grafts. The assessment of skin properties is also crucial in the cosmetics industry, where it is important to evaluate the effects skin care products have on these properties. The simplest and most widely used method of skin evaluation, the 'naked eye' assessment, enables researchers to assess only the skin surface and involves a large amount of inter-observer variability. Thanks to a great progress that has been made in physics, electronics and computer engineering in recent years, sophisticated imaging methods are increasingly available in day-to-day studies. The aim of this review was to present one of these techniques, namely the magnetic resonance imaging (MRI), and to discuss its possible use in skin examination and analysis. We present basic principles of MRI, as well as several interesting applications in the field of dermatology, and discuss the advantages and limitations of this method.

Feasibility study of 3-T MR imaging of the skin

The purpose of this study was to assess the quality of 3-T magnetic resonance (MR) imaging of the skin, to describe skin anatomy at 3 T and to discuss future prospects of skin MRI. A 7-cm single-element surface receiver coil was developed for our 3-T MRI system. Thin sections were obtained with a three-dimensional FIESTA acquisition sequence and a spin-echo T1-weighted sequence (SET1). Prospective analysis was performed twice by two radiologists independently. Thirty-six healthy volunteers were included and underwent MRI on the face and the calf. Image quality was assessed regarding visibility of skin layers and quantification of artefacts. High field strength MR enables imaging of the skin with a high spatial in-plane resolution (87-180 microm), the total examination lasting 15-20 min. Image quality was excellent for the calf (mean SET1 quality = 96%) with a high intra- and interobserver correlation (SET1 kappa coefficient concerning visibility of epidermis, dermis and hypodermis > or = 0.84). Motion artefacts resulted in a small loss of quality and reproducibility for the face. In conclusion, 3-T MR allows high spatial resolution imaging of the skin and can potentially provide an accurate noninvasive means of analysing the skin.

[High resolution MR imaging of the skin: normal imaging features]

PURPOSE

To describe the qualitative and quantitative MR imaging features of normal skin.

MATERIALS AND METHODS

Thirty-one normal subjects underwent MR evaluation on a 1.5 Tesla magnet using a dedicated coil. Several skin sites were evaluated (back at the scapular level, posterior calf and inferior heel). Two pulse sequences were acquired: a SE T1W and a gradient-echo sequence (FIESTA). Qualitative and quantitative analysis was performed for all three sites.

RESULTS

In normal subjects, the different skin layers (callus, epidermis, dermis, hypodermis and pilosebaceous follicles) can be separated and measured on MR. Epidermis and hypodermis are hyperintense whereas dermis is hypointense. Our results confirm the presence of qualitative and quantitative variations between different skin regions. In some cases, a differentiation between papillary and reticular dermis can be achieved. Pilosebaceous follicles and the deep vascular network were clearly depicted on the FIESTA sequence. Measurements for each skin layer were compared based on sex, site and MR pulse sequence.

CONCLUSION

MRI provides evaluation of the different skin layers, epidermis, dermis, and hypodermis, and their different components.

Magnetic resonance methods and applications in pharmaceutical research

This review presents an overview of some recent magnetic resonance (MR) techniques for pharmaceutical research. MR is noninvasive, and does not expose subjects to ionizing radiation. Some methods that have been used in pharmaceutical research MR include magnetic resonance spectroscopy (MRS) and magnetic resonance imaging (MRI) methods, among them, diffusion-weighted MRI, perfusion-weighted MRI, functional MRI, molecular imaging and contrast-enhance MRI. Some applications of MR in pharmaceutical research include MR in metabonomics, in vivo MRS, studies in cerebral ischemia and infarction, degenerative joint diseases, oncology, cardiovascular disorders, respiratory diseases and skin diseases. Some of these techniques, such as cardiac and joint imaging, or brain fMRI are standard, and are providing relevant data routinely. Skin MR and hyperpolarized gas lung MRI are still experimental. In conclusion, considering the importance of finding and characterizing biomarkers for improved drug evaluation, it can be expected that the use of MR techniques in pharmaceutical research is going to increase in the near future.

Millimeter wave dosimetry of human skin

To identify the mechanisms of biological effects of mm waves it is important to develop accurate methods for evaluating absorption and penetration depth of mm waves in the epidermis and dermis. The main characteristics of mm wave skin dosimetry were calculated using a homogeneous unilayer model and two multilayer models of skin. These characteristics included reflection, power density (PD), penetration depth (delta), and specific absorption rate (SAR). The parameters of the models were found from fitting the models to the experimental data obtained from measurements of mm wave reflection from human skin. The forearm and palm data were used to model the skin with thin and thick stratum corneum (SC), respectively. The thin SC produced little influence on the interaction of mm waves with skin. On the contrary, the thick SC in the palm played the role of a matching layer and significantly reduced reflection. In addition, the palmar skin manifested a broad peak in reflection within the 83-277 GHz range. The viable epidermis plus dermis, containing a large amount of free water, greatly attenuated mm wave energy. Therefore, the deeper fat layer had little effect on the PD and SAR profiles. We observed the appearance of a moderate SAR peak in the therapeutic frequency range (42-62 GHz) within the skin at a depth of 0.3-0.4 mm. Millimeter waves penetrate into the human skin deep enough (delta = 0.65 mm at 42 GHz) to affect most skin structures located in the epidermis and dermis.

The use of a spectrophotometric intracutaneous analysis device in the real-time diagnosis of melanoma in the setting of a melanoma screening clinic

BACKGROUND

Skin imaging devices to aid melanoma diagnosis have been developed in recent years but few have been assessed clinically.

OBJECTIVES

To investigate if a spectrophotometric skin imaging device, the SIAscope, could increase a dermatologist's ability to distinguish melanoma from nonmelanoma in a melanoma screening clinic.

METHODS

Eight hundred and eighty-one pigmented lesions from 860 patients were prospectively assessed clinically and with the aid of the spectrophotometric device by a dermatologist. Assessment before and after spectrophotometric imaging was made and compared with histology, where available, or with the clinical diagnosis of a dermatologist with 20 years of experience.

RESULTS

One hundred and seventy-nine biopsies were performed, with 31 melanomas diagnosed. Sensitivity and specificity for melanoma diagnosis before and after spectrophotometry were 94% and 91% vs. 87% and 91%, respectively, with no significant difference in the area under the receiver operating characteristic curves (0.932 and 0.929).

CONCLUSIONS

Our study provides no evidence for the use of SIAscope by dermatologists to help distinguish melanoma from benign lesions.

Human skin permittivity determined by millimeter wave reflection measurements

Millimeter wave reflection from the human skin was studied in the frequency range of 37-74 GHz in steps of 1 GHz. The forearm and palm data were used to model the skin with thin and thick stratum corneum (SC), respectively. To fit the reflection data, a homogeneous unilayer and three multilayer skin models were tested. Skin permittivity in the mm-wave frequency range resulted from the permittivity of cutaneous free water which was described by the Debye equation. The permittivity increment found from fitting to the experimental data was used for determination of the complex permittivity and water content of skin layers. Our approach, first tested in pure water and gelatin gels with different water contents, gave good agreement with literature data. The homogeneous skin model fitted the forearm data well. Permittivity of the forearm skin obtained with this model was close to the skin permittivity reported by others. To fit reflection from the palmar skin with a thick SC, a skin model containing at least two layers was required. Multilayer models provided better fitting to both the forearm and palmar skin reflection data. The fitting parameters obtained with different models were consistent with each other.

Advances in MR imaging of the skin

MR imaging of the skin is challenging because of the small size of the structures to be visualized. By increasing the gradient amplitude and/or duration, skin layers can be visualized with a voxel size of the order of 20 microm, clearly the smallest obtained for in vivo images in a whole-body imager. Currently, the gradient strength of most commercial systems enables acquisition of such a small voxel size, and the main difficulty has thus become to achieve sufficient detection sensitivity. The signal-to-noise ratio (SNR) can be increased either by increasing the magnetic field strength or by minimizing noise with small coils; cooling copper coils or superconducting coils can enhance the SNR by a factor of 3 or more. MR imaging, because of the large number of parameters it is able to measure, can provide more than the microscopic architecture of the skin: physical parameters such as relaxation times, magnetization transfer or diffusion, and chemical parameters such as the water and fat contents or phosphorus metabolism. In spite of the amount of information they have provided to date, MR imaging and spectroscopy have had limited clinical applications, mainly because cutaneous pathologies are easily accessible to the naked eye and surgery. However, MR technologies indeed represent powerful research tools to study normal and diseased skin.

Fiber optic near-infrared Raman spectroscopy for clinical noninvasive determination of water content in diseased skin and assessment of cutaneous edema

Currently, measuring Raman spectra of tissues of living patients online and in real time, collecting the spectra in a very short measurement time, and allowing diagnosis immediately after the spectrum is recorded from any body region, are specific advantages that fiber optic near-infrared Raman spectroscopy (NIR RS) might represent for in vivo clinical applications in dermatology. We discuss various methodological aspects and state of the art of fiber optic NIR RS in clinical and experimental dermatology to outline its present advantages and disadvantages for measuring skin in vivo, particularly its water content. Fiber optic NIR Fourier transform (FT) RS has been introduced to dermatological diagnostics to obtain information regarding the molecular composition of the skin up to several hundred micrometers below the skin surface in a relatively fast nondestructive manner. This has been especially important for probing for in vivo assessment of cutaneous (intradermal) edema in patients patch test reactions. Fiber optic NIR FT Raman spectrometers still require further technological developments and optimization, extremely accurate water concentration determination and its intensity calculation in skin tissue, and for clinical applications, a reduction of measurement time and their size. Another promising option could be the possibility of applying mobile and compact fiber optic charge-coupled device (CCD)-based equipment in clinical dermatology.

Skin imaging: is it clinically useful?

Non-invasive skin imaging techniques have proliferated over the last decade. Whilst most have a research role, some are routinely used in dermatology clinics. Of these, the skin surface microscope (dermatoscope), a diagnostic aid for pigmented lesions, has had most clinical impact. Such devices, when linked to a videomicroscope for computer analysis, have been dubbed as 'mole scanners'. Mole scanners are increasingly available on a commercial basis even though computer diagnosis of pigmented lesions is currently no better than diagnosis by human experts. Meanwhile, other imaging techniques, such as high-resolution ultrasonography, spectroscopy and optical coherence tomography, may yet find a role in diagnosis and disease monitoring.

In vivo quantitative analysis of the effect of hydration (immersion and Vaseline treatment) in skin layers using high-resolution MRI and magnetisation transfer contrast

BACKGROUND/AIMS

Many claims are made as to the efficacy of topical preparations in moisturising the skin, yet most of these claims cannot be substantiated by scientific study for the skin layers beneath the stratum corneum, and yield no information on the remainder of the epidermis and dermis. This argues for an in vivo quantitative method for measuring the effect of water loading extended to various layers of the skin.

METHODS

Detailed high-resolution in vivo MRI studies of hydration and dehydration of finger pad skin layers were conducted on one normal subject using two moisturisation methods (topical white soft paraffin (Vaseline) and water immersion). The dehydration study was carried out immediately following removal from prolonged skin moisturisation. Inter-individual variability for skin hydration (group study) was studied in seven healthy volunteers at 0 and 7 h hydration with Vaseline. Location dependence in skin hydration was investigated on the same subject by looking into the hydration of forearm and finger pad skin. System stability and measurement reproducibility was verified through a detailed phantom study.

RESULTS

Images of normal and hydrated human skin were obtained in vivo at voxel dimensions of 50 micromx150 micromx1000 microm. The effect of hydration and dehydration as a function of exposure to moisturiser (i.e. water and Vaseline) on the image signal intensity, observed T1, and interaction of free and bound water in specific tissues were identified and correlated with existing physiological knowledge. Swelling of stratum corneum due to hydration was expressed as an in vivo model of tissue hydration.

CONCLUSION

Results of the dehydration study showed that the changes due to the previous hydration of the skin are reversible for all skin layers. For both moisturisation methods (i.e. Vaseline and skin bathing), the effects of hydration and dehydration on the skin were similar. The trends of the MRI parameters for finger pad and arm skin were similar. The group study showed low inter-subject variability of hydration on stratum corneum and epidermis.

Evaluation of skin tumors by magnetic resonance imaging

In vivo magnetic resonance imaging (MRI) is a powerful noninvasive technique in medical diagnosis; however, its application to analyze skin disorders is still at initial stages. To check whether MRI can be used as a noninvasive tool to analyze skin tumors, we carried out MRI of mice after treatment with benzo[a]pyrene (BP), a well known carcinogen. MRI was done on whole mice and was particularly focused on various layers and regions of interest of the skin: dermis, epidermis, and tumor. Initial MRIs of mice bearing skin tumors of 4, 8, 12, and 16 weeks after inducing BP clearly revealed the appearance of tumor. The MRIs of tumor-bearing mice with 20-week-old tumor development showed invasion to adjacent internal anatomic structures. The MRI data were in good agreement with the extent of cellular atypia and neoplastic changes that are typical of squamous cell carcinoma as noticed from the histopathologic findings. Therefore, MRI seems to have the potential to evaluate the tumor invasions equally well as that of histopathology or other clinical findings.

Quantitative assessment of skin aging

Noninvasive methods have allowed physicians to give an objective description of aged skin in terms of functional and esthetic properties. The relative influence of environment (mainly sun) on the true aging process can be assessed through the obtained data. It is also possible to measure the efficacy of topical preparations (cosmetics or drugs) designed for treating the various cutaneous aging marks.

Hemangiomas of the fingers: MR imaging evaluation

PURPOSE

To report the magnetic resonance (MR) imaging features of finger hemangiomas.

MATERIALS AND METHODS

Sixteen patients clinically suspected of having hemangioma of the finger underwent 1.5-T MR imaging with a customized local gradient coil. The location, size, margins, signal intensity, and enhancement patterns of the lesions were noted. In accordance with the literature on MR imaging of deep hemangiomas, the authors' findings could be divided into those with typical features-that is, high signal intensity at T1- and T2-weighted imaging, lobulated appearance, strong enhancement, and heterogeneous pattern with flow void artifacts-and those with atypical features. The reference standard was surgery (n = 12) or clinical outcome (n = 4).

RESULTS

One posttraumatic hematoma was excluded. Most lesions were in the fingertip (n = 10), with involvement of the nail bed and/or the pulp (n = 5). Hemangiomas were classified as typical in ten cases and atypical in five. The mean size of typical lesions was larger than that of atypical lesions. The unique imaging features of atypical hemangiomas included a masslike appearance, which was either homogeneous with diffuse enhancement-suggestive of hypervascularity (n = 2)-or heterogeneous with poor enhancement (n = 3).

CONCLUSION

MR imaging characteristics of finger hemangiomas can be classified as typical or atypical. Knowledge of both patterns can be helpful in the distinction of soft-tissue abnormalities at this location.

High-resolution spectroscopic imaging of the human skin

High-resolution water, fat and chemical shift artefact-free images of different areas of the skin were obtained on a whole-body MR unit (1.5 T) with commercial receiver surface coil with a diameter of 25 mm and high-power gradients (23 mT/m). Sufficient signal-to-noise ratio was achieved by lowering receiver bandwidth to +/-10 kHz or lower and shortening the echo time to 11 (13) ms. Spectroscopic image data sets were acquired with resolution 0.102 x 0.133 mm in plane and slice thickness 0.5 mm. The results demonstrate that it is possible to produce high-quality water and fat micro-images of the skin layers using only a few chemical shift encoding steps in a clinically reasonable time (approximately 2 minutes per slice).

Dermal organization in scleroderma: the fast Fourier transform and the laser scatter method objectify fibrosis in nonlesional as well as lesional skin

Scleroderma, a chronic, progressive disorder, is characterized by dermal fibrosis with collagen bundles orientated parallel to the epidermis. Simple objective parameters to evaluate disease progression and therapies are needed. We describe two methods, the laser scatter method and the fast Fourier transform (FFT), to measure collagen bundle orientation and spacing. Lesional sclerodermic skin (LS), nonlesional sclerodermic skin (nonLS), and control skin (CS) sections were evaluated for orientation ratio using the laser scatter method. The FFT was used to calculate orientation ratio, variation, and spacing of collagen bundles. Parameters were correlated with local and mean skin score measurements, on a scale of 0 (normal) to 3 (severely sclerotic). With both the laser scatter method and the FFT, orientation ratios of LS (respectively, 2.16 +/- 0.33 and 1.83 +/- 0.62) were significantly higher than CS (respectively, 1.70 +/- 0.35 and 1.38 +/- 0.15). NonLS orientation ratios (respectively, 1.92 +/- 0.15 and 1.48 +/- 0.44) were between LS and CS ratios. Orientation variation and bundle spacing of LS (respectively, 57.3 +/- 19.4 and 15.7 +/- 5.6 microm) were significantly reduced compared to CS (respectively, 73.8 +/- 15.0 and 18.9 +/- 1.9 microm). NonLS orientation ratios (respectively, 57.2 +/- 29.0 and 15.6 +/- 6.1 microm) were similar to LS. Bundles in LS are more parallel, show less variation in orientation, and are more densely packed than in CS. There was a linear correlation between mean skin score and orientation ratio. Local skin score was not linearly correlated to orientation ratio. Our findings suggest that nonLS dermis without clinical sclerosis already shows fibrotic characteristics. Both techniques were easy to use and suitable for objectifying dermal fibrosis in scleroderma lesions. FFT is more accurate and reproducible than the laser scatter method and allows simultaneous pathological evaluation of the location of the analyzed tissue sections. Future studies will need to focus on the correlation between clinical disease severity and collagen bundle characteristics.

Penetration of electromagnetic fields of an open-ended coaxial probe between 1 MHz and 1 GHz in dielectric skin measurements

An open-ended coaxial probe is often used for investigating the dielectric properties of biological tissues. The present study indicates that in addition to the probe size, the penetration of the electromagnetic (EM) fields of an open-ended coaxial probe in contact with the skin is dependent on the applied frequency between 1 MHz and 1 GHz. At high frequencies, above 100 MHz, the measured dielectric parameters are functions of the dielectric properties of different cutaneous layers and subcutaneous fat. At lower frequencies, less than 10 MHz, the measurement is mainly dependent on the dielectric properties of superficial structures of the skin. The reason for this is that the probe, the surface of the skin, mainly stratum corneum, and underlying skin form a capacitance where the stratum corneum with low water content lies between the well-conducting dermis and the probe. The situation is equivalent to the frequency-dependent Maxwell-Wagner interfacial polarization. This result is verified by experimental dielectric measurements and with human skin in vivo.