Diagnostic Ultrasound in Dermatology

Foreword I
Foreword II
Foreword III
Outline
Preface
Contents
List of Editors and Contributors
Honorary Editor-in-Chief
Editor-in-Chief
Associate Editor
Editor-in-Chief
Associated Editor
Contributors
1: Overview of Skin Ultrasound
1.1 Development and Overview of Skin Ultrasound
1.2 Ultrasound Wave and Ultrasound Imaging
1.2.1 Ultrasound Wave
1.2.1.1 Basic Concepts
1.2.1.2 Physical Properties
1.2.2 Propagation Properties
1.2.2.1 Acoustic Impedance (Z)
1.2.2.2 Reflection, Refraction, and Scattering
1.2.2.3 Doppler Effect
1.2.2.4 Attenuation
1.2.3 Generation and Reception of Ultrasound Waves
1.2.3.1 Ultrasound Transducer
1.2.3.2 Acoustic Field
1.2.3.3 Focusing of Acoustic Beam
1.2.4 Resolution of Ultrasound Imaging
1.2.4.1 Spatial Resolution
1.2.4.2 Temporal Resolution
1.2.4.3 Contrast Resolution
1.2.5 Basic Principle of Ultrasound Imaging
1.2.6 Gray-Scale Ultrasound
1.2.7 Color Doppler Flow Imaging
1.2.8 Pulse Doppler Imaging
1.2.8.1 Baseline
1.2.8.2 “Window”
1.2.8.3 Frequency Spectrum Bandwidth
1.2.8.4 Systolic Peak
1.2.8.5 End Diastole
1.2.9 Power Doppler Ultrasound
1.3 Layout of Examination Room
1.3.1 Room Requirement
1.3.2 Equipment
1.3.3 Materials
1.3.4 Disinfection Equipment
1.4 Preparation for Examination
1.4.1 Preparation
1.4.2 Position
1.4.3 Selection and Adjustment of Ultrasound Device
1.4.3.1 Selection of Ultrasound Device
1.4.3.2 Selection, Application of Ultrasound Transducer, and Image Interpretation
Selection of Ultrasound Transducer
Utilization of the Ultrasound Transducer and Image Interpretation
1.4.3.3 Adjustment of Ultrasound Devices
Adjustment of Gray-Scale Ultrasound
Adjustment of Color Doppler Flow Imaging
Adjustment of Pulse Wave Doppler Imaging
1.4.4 Influencing Factors for Skin Ultrasound Imaging
1.4.4.1 Pressure
1.4.4.2 Hairs
1.4.4.3 Wrinkles
1.4.4.4 Temperature
1.4.4.5 Precautions
1.5 Cleaning of Ultrasound Device and Personnel Protection
1.5.1 Cleaning of Ultrasound Device
1.5.2 Cleaning of Transducer
1.5.3 Personnel Protection
1.6 New Ultrasound Technology in Skin Ultrasound
1.6.1 Extended Field of View
1.6.2 Ultrasound Elastography
1.6.3 Contrast-Enhanced Ultrasound
1.6.4 Three-Dimensional Ultrasound
1.6.5 Interventional Ultrasound
1.6.6 Artificial Intelligence in Skin Ultrasound
1.6.7 Superb Microvascular Imaging
1.6.8 Tissue Harmonic Imaging
1.7 Indications for Skin Ultrasound
Suggested Reading
2: Anatomy and Ultrasound Manifestation of Normal Skin
2.1 Normal Skin Anatomy
2.2 Ultrasound Manifestation of Normal Skin
2.2.1 Epidermis and Dermis
2.2.2 Skin Appendages
2.2.2.1 Nails
2.2.2.2 Nerves
2.2.2.3 Blood Vessels
2.2.3 Subcutaneous Tissue
2.3 Training and Suggestions
2.3.1 Personnel Training
2.3.2 Ultrasound Device
2.3.3 Disinfection Materials
2.3.4 Image Database
2.3.5 Popularization and Communication
2.3.6 Skin Ultrasound Examination Reporting
2.3.7 Other Suggestions
Suggested Reading
3: Other Imaging Techniques for Skin
3.1 Dermoscopy
3.2 Optical Coherence Tomography
3.3 Confocal Laser Scanning Microscope
3.4 Computed Tomography
3.5 Magnetic Resonance Imaging
3.6 Comparison of Various Skin Imaging Techniques
Suggested Reading
4: Terminology, Image Interpretation, and Artifacts for Skin Ultrasound
4.1 Terminology and Image Interpretation
4.1.1 Gray-Scale Ultrasound
4.1.1.1 Ultrasound Features
Echogenicity
Layers of Involvement
Surface
Bottom
Stratum Corneum
Shape
Internal Composition
Special Signs
4.1.1.2 Measurement
Size
Thickness
Regular Shape
Crawling
Irregular Shape
Ill-Defined Boundary
4.1.2 Color Doppler Ultrasound
4.1.3 Pulsed Doppler Ultrasound
4.2 Artifacts
4.2.1 Gray-Scale Ultrasound Artifacts
4.2.1.1 Acoustic Shadowing
4.2.1.2 Reverberation Artifact
4.2.1.3 Side Lobe Artifact
4.2.1.4 Partial Volume Effect
4.2.1.5 Posterior Acoustic Enhancement
4.2.1.6 Mirror Effect
4.2.2 Doppler Ultrasound Artifacts
4.2.2.1 Color Doppler Signal Overflow
4.2.2.2 Color Doppler Twinkling Artifact
4.2.2.3 Flash Artifact
4.2.2.4 Aliasing Artifact
Suggested Reading
5: Skin Tumors
5.1 Benign Skin Tumors
5.1.1 Epidermoid Cyst
5.1.1.1 Clinical Manifestation and Pathology
5.1.1.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.1.1.3 Differential Diagnosis
Trichilemmal Cyst
Dermoid Cyst
5.1.1.4 Diagnosis Clues
5.1.2 Digital Mucous Cyst
5.1.2.1 Clinical Manifestation and Pathology
5.1.2.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.1.2.3 Differential Diagnosis
Epidermoid Cyst
Heberden’s Nodes
5.1.2.4 Diagnosis Clues
5.1.3 Trichilemmal Cyst
5.1.3.1 Clinical Manifestation and Pathology
5.1.3.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.1.3.3 Differential Diagnosis
Epidermoid Cyst
Dermoid Cyst
Pilomatricoma
5.1.3.4 Diagnosis Clues
5.1.4 Steatocystoma
5.1.4.1 Clinical Manifestation and Pathology
5.1.4.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.1.4.3 Differential Diagnosis
Epidermoid Cyst
Trichilemmal Cyst
Dermoid Cyst
5.1.4.4 Diagnosis Clues
5.1.5 Lipoma
5.1.5.1 Clinical Manifestation and Pathology
5.1.5.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.1.5.3 Differential Diagnosis
Liposarcoma
Epidermoid Cyst
5.1.5.4 Diagnosis Clues
5.1.6 Pigmented Nevus
5.1.6.1 Clinical Manifestation and Pathology
5.1.6.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.1.6.3 Differential Diagnosis
Seborrheic Keratosis (SK)
Malignant Melanoma (MM)
5.1.6.4 Diagnosis Clues
5.1.6.5 Clinical Significance
5.1.7 Seborrheic Keratosis
5.1.7.1 Clinical Manifestation and Pathology
5.1.7.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.1.7.3 Differential Diagnosis
Actinic Keratosis (AK)
Basal Cell Carcinoma (BCC)
Bowen’s Disease (BD)
5.1.7.4 Diagnosis Clues
5.1.8 Pilomatricoma
5.1.8.1 Clinical Manifestation and Pathology
5.1.8.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.1.8.3 Differential Diagnosis
Superficial Lymph Node
Epidermoid Cyst
Hemangioma with Calcification
5.1.8.4 Diagnosis Clues
5.1.9 Scar
5.1.9.1 Clinical Manifestation and Pathology
5.1.9.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.1.9.3 Differential Diagnosis
5.1.9.4 Diagnosis Clues
5.1.9.5 Clinical Significance
5.1.10 Keratoacanthoma
5.1.10.1 Clinical Manifestation and Pathology
5.1.10.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.1.10.3 Differential Diagnosis
Squamous Cell Carcinoma (SCC)
Nodular Basal Cell Carcinoma (BCC)
5.1.10.4 Diagnosis Clues
5.1.11 Dermatofibroma
5.1.11.1 Clinical Manifestation and Pathology
5.1.11.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.1.11.3 Differential Diagnosis
Dermatofibrosarcoma Protuberans (DFSP)
Cavernous Hemangioma
Verrucous Epidermal Nevus
5.1.11.4 Diagnosis Clues
5.1.12 Neurofibroma (Neurofibromatosis)
5.1.12.1 Clinical Manifestation and Pathology
5.1.12.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.1.12.3 Differential Diagnosis
Schwannoma
Hemangioma
5.1.12.4 Diagnosis Clues
5.1.13 Schwannoma
5.1.13.1 Clinical Manifestation and Pathology
5.1.13.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.1.13.3 Differential Diagnosis
Neurofibroma
Superficial Lymph Node
5.1.13.4 Diagnosis Clues
5.1.14 Angioleiomyoma
5.1.14.1 Clinical Manifestation and Pathology
5.1.14.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.1.14.3 Differential Diagnosis
Glomus Tumor
Epidermoid Cyst
5.1.14.4 Diagnosis Clues
5.1.15 Poroma
5.1.15.1 Clinical Manifestation and Pathology
5.1.15.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.1.15.3 Differential Diagnosis
Porocarcinoma
Nodular Basal Cell Carcinoma (BCC)
Seborrheic Keratosis (SK)
5.1.15.4 Diagnosis Clues
5.1.16 Abdominal Wall Endometriosis
5.1.16.1 Clinical Manifestation and Pathology
5.1.16.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.1.16.3 Differential Diagnosis
Abdominal Incisional Hernia
Scar at Abdominal Incision
Hematoma under Abdominal Incision
5.1.16.4 Diagnosis Clues
5.1.17 Glomus Tumor
5.1.17.1 Clinical Manifestation and Pathology
5.1.17.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.1.17.3 Differential Diagnosis
Nail Papilloma
Nevi of the Nail Matrix
5.1.17.4 Diagnosis Clues
5.2 Precancerous Skin Tumors
5.2.1 Actinic Keratosis
5.2.1.1 Clinical Manifestation and Pathology
5.2.1.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.2.1.3 Differential Diagnosis
SK
BD
Superficial BCC
5.2.1.4 Diagnosis Clues
5.2.1.5 Clinical Significance
5.2.2 Leukoplakia
5.3 Malignant Skin Tumors
5.3.1 Bowen’s Disease
5.3.1.1 Clinical Manifestation and Pathology
5.3.1.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.3.1.3 Differential Diagnosis
Superficial Basal Cell Carcinoma (Superficial BCC)
AK
SK
5.3.1.4 Diagnosis Clues
5.3.1.5 Clinical Significance
5.3.2 Basal Cell Carcinoma
5.3.2.1 Clinical Manifestation and Pathology
5.3.2.2 Ultrasound Manifestation
Nodular BCC
Superficial BCC
Pigmented BCC
Morpheaform BCC
5.3.2.3 Differential Diagnosis
Malignant Melanoma (MM)
Cutaneous Squamous Cell Carcinoma (cSCC)
5.3.2.4 Diagnosis Clues
5.3.2.5 Clinical Significance
5.3.3 Cutaneous Squamous Cell Carcinoma
5.3.3.1 Clinical Manifestation and Pathology
5.3.3.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.3.3.3 Differential Diagnosis
Malignant Melanoma (MM)
BCC
5.3.3.4 Diagnosis Clues
5.3.3.5 Clinical Significance
5.3.4 Malignant Melanoma
5.3.4.1 Clinical Manifestation and Pathology
5.3.4.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.3.4.3 Differential Diagnosis
Melanocytic Nevus
Hemangioma
cSCC
5.3.4.4 Diagnosis Clues
5.3.4.5 Clinical Significance
5.3.5 Extramammary Paget’s Disease
5.3.5.1 Clinical Manifestation and Pathology
5.3.5.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.3.5.3 Differential Diagnosis
BD
MM
5.3.5.4 Diagnosis Clues
5.3.5.5 Clinical Significance
5.3.6 Dermatofibrosarcoma Protuberans
5.3.6.1 Clinical Manifestation and Pathology
5.3.6.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.3.6.3 Differential Diagnosis
Lipoma
Keloid
Nodular Panniculitis
5.3.6.4 Diagnosis Clues
5.3.7 Porocarcinoma
5.3.7.1 Clinical Manifestation and Pathology
5.3.7.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.3.7.3 Differential Diagnosis
Eccrine Poroma
cSCC
5.3.7.4 Diagnosis Clues
5.3.8 Sebaceous Gland Carcinoma
5.3.8.1 Clinical Manifestation and Pathology
5.3.8.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.3.8.3 Differential Diagnosis
Nodular BCC
cSCC
Nevus Sebaceus
5.3.8.4 Diagnosis Clues
5.3.8.5 Clinical Significance
5.3.9 Trichilemmal Carcinoma
5.3.9.1 Clinical Manifestation and Pathology
5.3.9.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.3.9.3 Differential Diagnosis
cSCC
KA
5.3.9.4 Diagnosis Clues
5.3.10 Mycosis Fungoides
5.3.10.1 Clinical Manifestation and Pathology
5.3.10.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.3.10.3 Differential Diagnosis
Eczema
Psoriasis
5.3.10.4 Diagnosis Clues
5.3.10.5 Clinical Significance
5.3.11 Cutaneous Metastatic Carcinoma
5.3.11.1 Clinical Manifestation and Pathology
5.3.11.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.3.11.3 Differential Diagnosis
Herpes Zoster
Hemangioma
5.3.11.4 Diagnosis Clues
5.3.12 Lymph Node Metastasis
5.3.12.1 Clinical Manifestation and Pathology
5.3.12.2 Ultrasound Manifestation (Fig. 5.78)
5.3.12.3 Differential Diagnosis
Normal Lymph Nodes (Fig. 5.79)
Malignant Lymphoma
Reactive Lymph Node Hyperplasia
5.3.12.4 Diagnosis Clues
5.4 Hemangioma and Congenital Vascular Malformation
5.4.1 Hemangioma
5.4.1.1 Clinical Manifestation and Pathology
5.4.1.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.4.1.3 Differential Diagnosis
Giant Cell Tumor of Tendon Sheath
Schwannoma
Epidermoid Cyst
5.4.1.4 Diagnosis Clues
5.4.2 Port Wine Stains
5.4.2.1 Clinical Manifestation and Pathology
5.4.2.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
5.4.2.3 Differential Diagnosis
Infantile Hemangioma
5.4.2.4 Diagnosis Clues
5.5 Summary
5.5.1 Summary of Benign Skin Tumors
5.5.2 Summary of Malignant Skin Tumors
5.5.3 Diagnostic Clues of Common Skin Tumors
Suggested Reading
6: Non-tumorous Skin Lesions
6.1 Inflammatory Skin Diseases
6.1.1 Cutaneous Edema
6.1.1.1 Clinical Manifestation and Pathology
6.1.1.2 Ultrasound Manifestation
Gray-Scale Ultrasound
6.1.1.3 Differential Diagnosis
Lymphangitis and Erysipelas
Etiological Identification
6.1.1.4 Diagnosis Clues
6.1.2 Panniculitis
6.1.2.1 Clinical Manifestation and Pathology
6.1.2.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
6.1.2.3 Differential Diagnosis
Superficial Lipoma
Nodular Fasciitis
6.1.2.4 Diagnosis Clues
6.1.3 Folliculitis
6.1.3.1 Clinical Manifestation and Pathology
6.1.3.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
6.1.3.3 Differential Diagnosis
Cellulitis
6.1.3.4 Diagnosis Clues
6.1.4 Cellulitis
6.1.4.1 Clinical Manifestation and Pathology
6.1.4.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
6.1.4.3 Differential Diagnosis
6.1.4.4 Diagnosis Clues
6.1.5 Wart
6.1.5.1 Clinical Manifestation and Pathology
6.1.5.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
6.1.5.3 Differential Diagnosis
AK
SK
6.1.5.4 Diagnosis Clues
6.1.6 Nodular Fasciitis
6.1.6.1 Clinical Manifestation and Pathology
6.1.6.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
6.1.6.3 Differential Diagnosis
Superficial Lipoma
Epidermoid Cyst
Panniculitis
6.1.6.4 Diagnosis Clues
6.1.7 Scleroderma
6.1.7.1 Clinical Manifestation and Pathology
6.1.7.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
SWE
6.1.7.3 Differential Diagnosis
Eosinophilic Fasciitis
Scleredema Adultorum of Buschke
6.1.7.4 Diagnosis Clues
6.1.8 Cutaneous Lupus Erythematosus
6.1.8.1 Clinical Manifestation and Pathology
6.1.8.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
6.1.8.3 Differential Diagnosis
Psoriasis Vulgaris
Dermatomyositis
6.1.8.4 Diagnosis Clues
6.1.9 Dermatomyositis
6.1.9.1 Clinical Manifestation and Pathology
6.1.9.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
6.1.9.3 Differential Diagnosis
CLE
Solar Dermatitis
6.1.9.4 Diagnosis Clues
6.1.10 Radiodermatitis
6.1.10.1 Clinical Manifestation and Pathology
6.1.10.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
6.1.10.3 Differential Diagnosis
Paget’s Disease of the Breast
6.1.10.4 Diagnosis Clues
6.1.11 Odontogenic Cutaneous Fistula
6.1.11.1 Clinical Manifestation and Pathology
6.1.11.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
6.1.11.3 Differential Diagnosis
Epidermoid Cyst
Skin Abscess
6.1.11.4 Diagnosis Clues
6.1.11.5 Clinical Significance
6.1.12 Pseudocyst of the Auricle
6.1.12.1 Clinical Manifestation and Pathology
6.1.12.2 Ultrasound Manifestation
Gray-Scale Ultrasound
Color Doppler Ultrasound
6.1.12.3 Differential Diagnosis
Epidermoid Cyst
Gouty Tophi
6.1.12.4 Diagnosis Clues
6.2 Foreign Bodies
6.2.1 Clinical Manifestation and Pathology
6.2.2 Ultrasound Manifestation
6.2.2.1 Gray-Scale Ultrasound
6.2.2.2 Color Doppler Ultrasound
6.2.3 Differential Diagnosis
6.2.3.1 Skin Tumor
6.2.3.2 Erysipelas
6.2.4 Diagnosis Clues
6.3 Psoriasis and Psoriatic Arthritis
6.3.1 Clinical Manifestation and Pathology
6.3.1.1 Psoriasis Vulgaris
6.3.1.2 Psoriasis Pustular
6.3.1.3 Erythrodermic Psoriasis
6.3.1.4 Arthropathic Psoriasis
6.3.2 Ultrasound Manifestation
6.3.2.1 Psoriasis Vulgaris
6.3.3 Pustular Psoriasis and Erythrodermic Psoriasis
6.3.3.1 Psoriatic Arthropathy (PsA)
6.3.4 Differential Diagnosis
6.3.4.1 Seborrheic Dermatitis
6.3.4.2 Gouty Arthritis
6.3.4.3 Rheumatoid Arthritis (RA)
6.3.5 Diagnosis Clues
6.4 Gouty Arthritis
6.4.1 Clinical Manifestation and Pathology
6.4.2 High-Frequency Ultrasound
6.4.2.1 Gray-Scale Ultrasound
6.4.2.2 Color Doppler Ultrasound
6.4.3 Differential Diagnosis
6.4.3.1 RA
6.4.3.2 Osteoarthritis
6.4.4 Diagnosis Clues
6.4.5 Clinical Significance
6.5 Summary
Suggested Reading
7: Skin Aging and Plastic Surgery
7.1 Skin Aging
7.2 Plastic Surgery
Suggested Reading
8: Future Development
8.1 New Diagnosis and Treatment Mode
8.2 Future Prospects
8.2.1 I. Ultrafast Ultrasound Localization Microscopy for Deep Super-Resolution Imaging
8.2.2 II. Stretchable Ultrasound Transducer
8.2.3 III. Automatic Scanning with the Aid of AI
8.2.4 IV. Progress of Skin Photoacoustic Imaging
Suggested Reading
Appendix
Appendix A: Template of Reports for Skin Ultrasound
Appendix B: Template of Application Form for Skin Ultrasound