Produção Nacional
Revisado por pares
Radiologic Approach for Skin US
2022; Radiological Society of North America; Volume: 42; Issue: 2 Linguagem: Inglês
10.1148/rg.210163
ISSN1527-1323
AutoresLuciana Zattar-Ramos, Isabela dos Santos Alves, Eduarda Castelo Branco Araújo Bernal, Gabrielle Aline Zattar, Antônio Sérgio Zafred Marcelino, Luciana Mendes de Oliveira Cerri, Giovanni Guido Cerri, Natally Horvat,
Tópico(s)Lymphadenopathy Diagnosis and Analysis
ResumoHomeRadioGraphicsVol. 42, No. 2 PreviousNext Multisystem RadiologyFree AccessRadioGraphics FundamentalsRadiologic Approach for Skin USLuciana Carmen Zattar , Isabela dos Santos Alves, Eduarda Castelo Branco Araújo Bernal, Gabrielle Aline Zattar, Antônio Sergio Zafred Marcelino, Luciana Mendes de Oliveira Cerri, Giovanni Guido Cerri, Natally HorvatLuciana Carmen Zattar , Isabela dos Santos Alves, Eduarda Castelo Branco Araújo Bernal, Gabrielle Aline Zattar, Antônio Sergio Zafred Marcelino, Luciana Mendes de Oliveira Cerri, Giovanni Guido Cerri, Natally HorvatAuthor AffiliationsFrom the Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050, Bela Vista, São Paulo-SP, Brazil (L.C.Z., I.d.S.A., E.C.B.A.B., A.S.Z.M., L.M.d.O.C., G.G.C., N.H.); RADIODERM, Florianópolis, Santa Catarina, Brazil (G.A.Z.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.).Address correspondence to L.C.Z. (e-mail: [email protected]).Luciana Carmen Zattar Isabela dos Santos AlvesEduarda Castelo Branco Araújo BernalGabrielle Aline ZattarAntônio Sergio Zafred MarcelinoLuciana Mendes de Oliveira CerriGiovanni Guido CerriNatally HorvatPublished Online:Feb 11 2022https://doi.org/10.1148/rg.210163MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractThe full digital presentation is available online.TEACHING POINTS■ High-frequency US allows optimal definition of the skin layers, similar to histologic sections.■ High-frequency US can add value in providing differential diagnosis of skin lesions, guiding treatment planning, and being a road map for skin aesthetics.■ In order to maximize the relevance of US, radiologists should be knowledgeable about relevant anatomy, main skin lesions patterns, and different types and appearances of skin aesthetics procedures.Evaluation of the skin and its pathologic conditions can sometimes be difficult with only physical or dermatologic examination. To achieve accurate evaluation of the skin, high-resolution diagnostic US with high-frequency linear transducers (24–33 MHz) is a unique imaging method for providing optimal in vivo anatomic information and detail in the submillimetric range and in real time. In this online presentation, a practical step-by-step radiologic approach to skin US is proposed to facilitate understanding of the role of US in skin evaluation.The spatial resolution of US nowadays allows optimal definition of the skin layers, similar to histologic sections, according to the main components: epidermis (keratin), dermis (collagen), and subcutaneous (fat), which have different echogenicities (Figure). It is possible to assess the normal anatomy of the skin, including its appendages such as glands, hair follicles, hair, and nails, as well as all adjacent structures, from the nerves, vessels, and cartilage, to muscle-tendon structures.Figure. Normal skin anatomy. US image and photomicrograph (hematoxylin-eosin stain; original magnification, ×40) side by side show how US resolution nowadays allows optimal definition of the skin layers, similar to histologic sections, according to the main components: epidermis (superficial hyperechoic line indicates keratin), dermis (less bright intermediate hyperechoic line indicates collagen), and hypoechoic subcutaneous (deep hypoechoic layer indicates fat).Figure.Download as PowerPointOpen in Image Viewer Using US in the context of skin disease, it is possible to achieve accurate disease localization according to the affected skin layer and composition of the lesion (cystic, solid, or vascular). The precise diagnosis of the pathologic condition, whether congenital or acquired, has also become possible, including that of aplasia cutis congenita, dermal sinus (including branchial, thyroglossal, and sacral), fistulae and cysts, hemangiomas, arteriovenous malformations, inflammatory conditions (hidradenitis suppurativa, morphea, and scleroderma), tumor lesions (skin or appendage, or benign or malignant such as basal and squamous cell carcinomas and melanoma), and photodamage due to skin aging.In addition to helping provide a differential diagnosis, US can also provide disease characterization that is relevant for treatment planning. For example, it can be used to measure primary lesion thickness, size, and depth; help predict high-risk histologic subtypes; and provide local-regional staging. In inflammatory diseases, it can be used to define disease activity and to guide biopsies. In the case of flap surgeries, perforating vessels can be depicted at Doppler US, and the donor area to be resected can be identified before surgery, consequently reducing surgical time and patient morbidity. Posttreatment monitoring of injury or disease can also be performed, whereby high-frequency US can be used to evaluate therapeutic response, relapse, and posttreatment complications.In addition to the aforementioned applications, US can also be used in the context of promoting skin aesthetics. In the pretreatment setting, it can be used to evaluate the skin regions that will be manipulated, in search of relevant anatomic details and variants. It can also be used to depict thread lifts and aesthetic fillers, being the only imaging method that allows in vivo identification of the filler substance used, in addition to accessing, monitoring, and treating complications.High-frequency US is the best radiologic method for assessing the skin, its appendages, and soft tissues, currently providing more information and better spatial resolution than any other available radiologic diagnostic tool. To maximize the valuable information provided by this modality, radiologists must be knowledgeable about the relevant anatomic details and specific characteristics of skin lesions as well as their deeper soft-tissue changes.In this online presentation, a practical step-by-step radiologic approach for skin US is proposed to facilitate understanding of the role of US in skin evaluation. The normal anatomy of the skin and its appendages as well as the main imaging patterns of the most common skin lesions are also presented with sample cases, charts, and tables.AcknowledgmentThe authors would like to express their deepest gratitude to Joanne Chin, MFA, ELS, for her editorial support on this manuscript.All authors have disclosed no relevant relationships.Suggested Readings Alfageme F , Wortsman X , Catalano O , et al . European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Position Statement on Dermatologic Ultrasound. Ultraschall Med 2021;42(1):39–47. Crossref, Medline, Google Scholar Beaman FD , Kransdorf MJ , Andrews TR , Murphey MD , Arcara LK , Keeling JH . Superficial soft-tissue masses: analysis, diagnosis, and differential considerations. RadioGraphics 2007;27(2):509–523. Link, Google Scholar Catalano O , Roldán FA , Varelli C , Bard R , Corvino A , Wortsman X . Skin cancer: findings and role of high-resolution ultrasound. J Ultrasound 2019;22(4):423–431. Crossref, Medline, Google Scholar Catalano O , Varelli C , Sbordone C , et al . A bump: what to do next? Ultrasound imaging of superficial soft-tissue palpable lesions. J Ultrasound 2020;23(3):287–300. Crossref, Medline, Google Scholar Catalano O , Wortsman X . Dermatology ultrasound: imaging technique, tips and tricks, High-Resolution Anatomy. Ultrasound Q 2020;36(4):321–327. Crossref, Medline, Google Scholar Dasgeb B , Kainerstorfer J , Mehregan D , Van Vreede A , Gandjbakhche A . An introduction to primary skin imaging. Int J Dermatol 2013;52(11):1319–1330. Crossref, Medline, Google Scholar Hibler BP , Qi Q , Rossi AM . Current state of imaging in dermatology. Semin Cutan Med Surg 2016;35(1):2–8. Crossref, Medline, Google Scholar Mandava A , Ravuri PR , Konathan R . High-resolution ultrasound imaging of cutaneous lesions. Indian J Radiol Imaging 2013;23(3):269–277. Crossref, Medline, Google Scholar Wortsman X . Atlas of Dermatologic Ultrasound. New York, NY: Springer, 2018. Crossref, Google Scholar Wortsman X . Ultrasound in dermatology: why, how, and when? Semin Ultrasound CT MR 2013;34(3):177–195. Crossref, Medline, Google Scholar Wortsman XJemec GBE, eds. Dermatologic ultrasound with clinical and histologic correlations. In: Dermatologic Ultrasound with Clinical and Histologic Correlations. New York, NY: Springer, 2013; 1–623. Crossref, Google Scholar Zattar LC , Cerri GG . Ultrassonografia Dermatológica São Paulo, Brazil: Manole, 2021. Google ScholarArticle HistoryReceived: May 3 2021Revision requested: June 25 2021Revision received: July 27 2021Accepted: Aug 4 2021Published online: Feb 11 2022Published in print: Mar 2022 FiguresReferencesRelatedDetailsAccompanying This ArticleRadiologic Approach for Skin USFeb 11 2022Default Digital Object SeriesRecommended Articles Ultrasonography of Superficial Soft-Tissue Masses: Society of Radiologists in Ultrasound Consensus Conference StatementRadiology2022Volume: 304Issue: 1pp. 18-30Mature Cystic Teratoma: AIRP Best Cases in Radiologic-Pathologic CorrelationRadioGraphics2017Volume: 37Issue: 5pp. 1401-1407Palpable Lumps after Mastectomy: Radiologic-Pathologic Review of Benign and Malignant MassesRadioGraphics2021Volume: 41Issue: 4pp. 967-989Connective Tissue Disorders in Childhood: Are They All the Same?RadioGraphics2019Volume: 39Issue: 1pp. 229-250US for Traumatic Nerve Injury, Entrapment Neuropathy, and Imaging-guided Perineural InjectionRadioGraphics2022Volume: 42Issue: 5pp. 1546-1561See More RSNA Education Exhibits The Skinny on Cutaneous Disorders of the BreastDigital Posters2019Skin Ultrasound in Lipolytic Aesthetic ProceduresDigital Posters2022Skin Ultrasound (US): Not Everything Is Cellulitis Nor LipomaDigital Posters2022 RSNA Case Collection PilomatricomaRSNA Case Collection2022BI-RADS 2 - Steatocytoma multiplex RSNA Case Collection2022Spindle Cell LipomaRSNA Case Collection2022 Vol. 42, No. 2 Slide PresentationMetrics Altmetric Score PDF download
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