Ximena Wortsman

Clinical usefulness of variable-frequency ultrasound in localized lesions of the skin

BACKGROUND High variable-frequency ultrasound is a recently available technique capable of clearly defining skin layers and deeper structures that also provides local perfusion patterns obtained in real time. OBJECTIVES The aim of the study was to assess the performance of variable-frequency ultrasound in the evaluation of skin lesions. METHODS We performed a retrospective study of 4338 skin ultrasound examinations in predominantly localized skin lesions, and in a group of 130 healthy controls. We determined ultrasound sensitivity, specificity, and statistical level of certainty, and compared ultrasound diagnoses with clinical diagnoses. RESULTS Referring diagnosis was correct in 73% of the lesions, and addition of ultrasound increased correctness to 97% (P < .001 for the difference). Ultrasound overall sensitivity was 99%, specificity was 100%, and statistical diagnostic certainty was 99% LIMITATIONS Ultrasound in its current version cannot detect lesions that are epidermal only or that measure less than 0.1 mm in depth. CONCLUSIONS Ultrasound is a reliable adjuvant for the accurate and precise diagnosis of skin lesions.

High-Frequency Sonography in the Evaluation of Psoriasis Nail and Skin Involvement

Objective. The purpose of this study was to show the potential of the latest sonographic equipment using high‐frequency probes and a very sensitive power Doppler (PD) technique in depicting both skin and nail changes in patients affected by psoriasis. Methods. The study was conducted in 30 patients with a diagnosis of psoriasis clinically performed by an experienced dermatologist and 15 healthy participants, using a currently available sonography system equipped with a variable‐frequency transducer ranging from 6 to 18 MHz and a Doppler frequency ranging from 7 to 14 MHz. Results. The images illustrated in this presentation are representative examples of the ability of sonography to show and characterize even minimal morphostructural and blood flow changes in patients with both psoriatic plaques and onychopathy. Conclusions. This report provides pictorial evidence that high‐resolution gray scale sonography with a PD technique is a real‐time and noninvasive imaging technique that can be used as an adjunct to the clinical evaluation in assessing psoriatic disease.

Real‐time spatial compound ultrasound imaging of skin

Purpose:  The aim of our study was to evaluate the potential of real‐time spatial compound imaging (RTSCI) in dermatology.

Pre-surgical high resolution ultrasound of facial basal cell carcinoma: correlation with histology

Abstract The aim of this study was to analyze the scope of pre-surgical high resolution ultrasound in basal cell carcinoma (BCC). BCC is the most common human cancer. According to recent large prospective studies incomplete excision of BCC is higher than expected. Pre-operative imaging may aid surgical planning by identifying the extent and location of a neoplasm, which can be interesting at zones with higher risk of recurrences such as the face. These are slow growing tumors but there are some aggressive types described that can involve deeper structures. Twenty-five patients were studied (10 F/15 M, 48–91 years old; mean age 69.5 ± 11.5 years) with suspicious facial lesions ≤1.5 cm. Pre-surgical ultrasound with compact linear 15–7 MHz probe was performed. Ultrasound reported the morphology and thickness of the tumors. The results were correlated with the histology. Ultrasound identified 29 suspicious facial lesions that were removed with tumor-free borders at the first surgery and confirmed by histology. The main location was the nose. Two subclinical satellite lesions at the nasal zone were detected under ultrasound which led to a change in the surgery plan. The intraclass correlation coefficient (ICC) value was used to compare tumor thickness measurements between ultrasound and histology. ICC was considered as very good (0.9). Therefore, ultrasound can be useful to plan BCC surgery, it can recognize lesions, layers of involvement and vascularity patterns in a non-invasive way. It can show subclinical satellite lesions, even though the number of subclinical cases is small and require further investigations. It has a good thickness correlation with histology and may be used as a technique to monitor disease changes following non-invasive medical treatments in the future.

Ultrasound detection and identification of cosmetic fillers in the skin.

Background  While the incidence of cosmetic filler injections is rising world‐wide, neither exact details of the procedure nor the agent used are always reported or remembered by the patients. Thus, although complications are reportedly rare, availability of a precise diagnostic tool to detect cutaneous filler deposits could help clarify the association between the procedure and the underlying pathology.

Activity assessment in morphea using color Doppler ultrasound.

BACKGROUND Morphea (circumcripted cutaneous scleroderma) can be difficult to assess for lesion activity. Because variable-frequency ultrasound with color Doppler provides details of skin morphology and function, it may help in the categorization of morphea. OBJECTIVE We sought to evaluate color Doppler ultrasound as a probing tool for assessing activity in morphea lesions. METHODS Consecutive patients with cutaneous morphea referred by dermatologists were studied with color Doppler ultrasound, and the assessment of lesion activity was compared with histologic findings. Normal skin controls were obtained by performing ultrasound scans of healthy subjects or of unaffected areas of the patients themselves. Measurements included cutaneous layer thickness, relative echogenicity, and blood flow with peak systolic velocity. Ultrasound sensitivity and specificity were determined for each phase of morphea activity and the results correlated with histology. RESULTS Fifty-one patients had a total of 104 morphea lesions. Of the lesions, 20% were active, 22% were atrophic, and 58% were inactive. Five of the patients had the Parry-Romberg syndrome with ipsilateral parotid gland inflammatory involvement, and one had an asymptomatic but sonographically active morphea lesion. Sensitivity and specificity for ultrasound diagnosis were 100% and 98.8%, respectively. The most accurate sonographic signs of lesion activity were increased subcutaneous tissue echogenicity and increased cutaneous blood flow (sensitivity and specificity 100% and 100% for each one). LIMITATIONS Ultrasound cannot define lesions less than 0.1-mm deep. CONCLUSIONS The morphologic and functional data obtained noninvasively and in real time with color Doppler ultrasound provide new insight into the pathogenesis of morphea. The technique represents a useful counterpart to histologic examination for the assessment of lesion activity.

Ultrasound in-depth characterization and staging of hidradenitis suppurativa.

BACKGROUND The clinical diagnosis of fistulous tracts and recurrent fluid collections in hidradenitis suppurativa (HS) may be complex. Information on subclinical involvement and grading of severity may improve management. OBJECTIVE To study HS lesions and evaluate the relevance of adding ultrasound (US) to the clinical examination. METHODS AND MATERIALS We reviewed the sonograms of consecutive patients with HS from January 1, 2010 to May 31, 2012. The abnormalities observed in the US examinations were organized, classified, and integrated into a clinical‐sonographic scoring system (SOS‐HS), to stage the disease. RESULTS Thirty‐four patients with HS with a total of 142 lesional areas were evaluated. US findings included subclinical fluid collections in 76.4% of the patients, fistulous tracts in 29.4%, dermal pseudocysts in 70.6%, and widening of the hair follicles in 100%. Concordance with the clinical HS scoring performed by dermatologists showed a significant fair agreement (k = 0.30; p < .001); concordance of SOS‐HS with clinical scores was acceptable but significantly lower (k = 0.27; p = .02) because clinical scores consistently underestimated disease stage and severity. CONCLUSION US examination of HS lesions provides anatomic information that is clinically unavailable. HS is possible to stage sonographically.

Ultrasound in Dermatology: Why, How, and When?

Nowadays, there are several applications of ultrasound in the field of dermatology, and the numbers continue to grow. This imaging technique can allow the study of the skin, the nail, and even the hair. The objective of this review is to provide an insight into the reasons for performing this examination, including technical considerations, the sonographic anatomy, and to discuss the sonographic characteristics of common dermatologic entities.

Benign Tumors and Pseudotumors of the Nail A Novel Application of Sonography

Objective. The purpose of this study was to determine the scope of high‐resolution sonography in the detection of benign tumors and pseudotumors of the nail unit. Methods. We performed a retrospective study of the sonographic findings in 103 consecutive patients with benign tumors and pseudotumors of the nail that were medically derived and confirmed histologically. Statistical analysis (Student t test) was performed comparing clinical and sonographic diagnoses. Results. Common benign tumors and pseudotumors of the nail can be detected on sonography, and they present different sonographic morphologic characteristics. According to origin, the lesions were considered ungual in 73% (n = 75) and periungual in 27% (n = 28) of the cases. Sonography showed their nature (solid or cystic), location, and extension as well as regional blood flow. In 35% of the cases, the use of sonography modified the clinical diagnosis, although the detailed anatomic information provided by sonography was useful in the planning of surgery in all cases. The addition of sonography was significant (P < .001) for the diagnosis of subungual exostosis and granulomas in comparison to clinical diagnosis. Conclusions. Sonography is a noninvasive imaging method that can reliably detect common benign tumors and pseudotumors of the nail and provide precise data about their characteristics. This imaging modality can support diagnosis and surgery and can allow a better definition and improvement of the cosmetic outcome of the treatment.

Lymph Nodes in Hidradenitis Suppurativa

Background: Hidradenitis suppurativa (HS) is an inflammatory disease, and yet palpable lymph nodes are rarely found. This may be due to lack of lymph node swelling or to the inability to palpate lymph node regions due to overlying disease. Ultrasound was used to identify and measure regional lymph nodes in HS patients. Methods: High-resolution ultrasound scanning was carried out with compact linear 15–7 MHz and linear 12–5 MHz probes in both axillae and inguinal regions following informed consent. Results: A total of 198 lymph nodes were identified in 6 HS patients in Hurley stage II and 4 in stage III, and 101 from regional control scans in healthy controls. All the lymph nodes in both HS patients and controls showed a normal oval shape, with a hypoechoic rim and a hyperechoic center, and all were located in the deep subcutaneous tissue. The overall mean lymph node number per region was not significantly different. The overall mean lymph node diameter was not significantly different, but in patients with Hurley stage III disease it was significantly increased (1.3 ± 0.4 cm, p = 0.03). Conclusion: Lymph node involvement only occurs with late-stage HS and may therefore reflect secondary infection rather than primary etiological involvement.