New developments in fluorescence diagnostics

In the last decade, significant advances have been achieved in the direct viewing of the skin. Non‐invasive analysis of various skin diseases in vivo has become possible by special skin display devices, allowing the physician to view the structure and properties of the skin in greater detail than can be achieved by simple visual examination. We review the last 100 years of fluorescence imaging development from clinical observation to advanced spectral imaging, addressing the role of fluorescence diagnostics (FD) in modern dermatology as well as the detection of autofluorescence.     

Medical imaging and MRI in nail disorders: report of 119 cases and review of the literature

Radiographs remain the golden standard for exploration of the bony structures located beneath the nail plate, but they provide no information on the perionychium. Until a few years ago the nail apparatus was deprived of investigative medical imaging. Glomus tumor was the only condition that was explored using invasive techniques such as angiography or scintigraphy. High-frequency ultrasound rapidly came up against technical limits. High-resolution magnetic resonance imaging (MRI) offers a superior alternative in detection of distal lesions as well as their relationship with the adjacent structures. MRI provides an accurate analysis of the nail apparatus with detection of lesions as small as 1 mm. This noninvasive technique will allow us to better understand, diagnose, and treat pathologies of the distal phalanx.     

玫瑰痤疮的皮肤影像学和无创检测技术相关进展

【摘要】 玫瑰痤疮是一种慢性炎症性疾病，进行诊断和治疗时除主观评估外还需要可定量的客观标准作依据。目前已有一些皮肤影像学及无创检测技术在临床应用，可提供定量或半定量的指标辅助玫瑰痤疮的诊疗。本文综述相关研究进展，为临床规范应用提供证据。     

Imaging the skin

Since the discovery of X-rays, the use of imaging technology has continued to play an important role in medicine. Technological advancements have led to the development of various imaging modalities, most of which have been used to image organs deep within the human body. More recently, attention has focused on the application of imaging technology for evaluation of the skin. A variety of techniques are currently being used to examine the skin and these include specialized photography, surface microscopy, ultrasound, laser Doppler perfusion imaging, confocal microscopy, and magnetic resonance imaging. These modalities can provide information that can assist in the management of skin problems. Although many of these techniques are still undergoing research, they are showing promise as useful clinical tools in dermatology.     

Fluorescence digital photography of acne using a light-emitting diode illuminator

BACKGROUND/PURPOSE: The fluorescence findings of several dermatological diseases, such as erythrasma, tinea versicolor, and acne are helpful for diagnosis and follow-up. However, many experience difficulty taking photographic images of fluorescence. The aim of this study was to develop a 405 nm light-emitting diode (LED) system for fluorescence digital photography of acne and to determine whether such a diode can be used to evaluate acne. METHODS: Eight healthy acne patients were compared with controls by fluorescence digital photography using a digital camera equipped with a 405 nm LED illuminator. Digital photographs were taken by two different ways of exposure, i.e. appropriate exposure level and longer exposure. One side of the nose, cheek, and glabella was compared. The numbers and extents of fluorescence dots were counted and measured. As normal controls, seven individuals with apparent oiliness and no acne were enrolled. RESULTS: Red fluorescent facial dots were observed and photographed digitally using the 405 nm LED illuminator. These were more numerous and extensive on the glabella and cheeks of acne patients. CONCLUSION: Fluorescence digital photography of acne was successfully performed using a 405 nm LED illuminator. This illuminator could be used for acne evaluations.     

Morphological and functional evaluation of chronic kidney disease using magnetic resonance imaging

X-ray computed tomography(CT),ultrasonography(US)and radionuclide scanning are important clinical methods for evaluating morphology of the kidney.These modalities are also applicable for estimating kidney function with time lapse analysis using proper contrastmedia as may be necessary.In the case of US,it can estimate kidney function based on the measurement of blood flow using the Doppler effect.Formerly,magnetic resonance imaging(MRI)was an inappropriate diagnostic imaging technique for abdominal organs because of their respiratory displacements.However,MRI is now actively used for kidney as well as liver or other parenchymal organs,in tandem with the technological advances.Unlike unenhanced X-ray CT,"conventional"MRI can distinguish the border between cortex and medulla in T1 or T2 weighted images.It was known that the border blurred with decreasing kidney function.Moreover,several other particular imaging methods were introduced in recent years,and these could be called"functional"MRI.In this review,the following are discussed:functional MRI for chronic kidney disease,which include blood oxygenation level-dependent MRI for evaluation of hypoxia,diffusion-weighted imagingfor evaluation of fibrosis,diffusion tensor imaging for evaluation of microstructure,and arterial spin labeling to evaluate the amount of organ perfusion,accompanied with several related articles.The ultimate goal of functional MRI is to provide useful in vivo information repeatedly for daily medical treatment non-invasively.     

Dermatoscopy for melanoma and pigmented lesions

This article presents an overview of the history and development of dermatoscopy over the last 2 decades. The common dermatoscopic diagnostic algorithms are discussed, including classic pattern analysis, the ABCD rule (asymmetry, border, color, and dermatoscopic structures), 7-point checklist, and Menzies method, as well as a new method by the authors (ASAP: a simple and practical approach). In addition, evidence on the clinical impact and challenges of dermatoscopy for the diagnosis and management of pigmented lesions and the importance of training are reviewed.     

Quantitative evaluation of healthy epidermis by means of multiphoton microscopy and fluorescence lifetime imaging microscopy

Background/purpose: Multiphoton microscopy (MPM) enables the assessment of unstained living biological tissue with submicron resolution, whereas fluorescence lifetime imaging microscopy (FLIM) generates image contrast between different states of tissue characterized by various fluorescence decay rates. The aim of this study was to compare the healthy skin of young individuals with that of older subjects, as well as to assess the skin at different body sites, by means of MPM and FLIM. Methods: Nineteen elderly patients were examined on the outer side of the forearm, whereas 30 young individuals were assessed on the dorsal and volar sides of the forearm and on the thigh. Results: Cell and nucleus diameters, cell density and FLIM vary according to the epidermal cell depth and the skin site. In elderly subjects, epidermal cells show morphologic alterations in shape and size, with smaller cell and nucleus diameters; the number of basal cells is decreased, whereas the mean fluorescence lifetimes at both the upper and the lower layers increase. Conclusion: This study provides quantitative and qualitative data on normal epidermis at different skin sites at different ages and represents a reference for the clinician attempting to understand the effectiveness of MPM and FLIM in discriminating diseased states of the skin from normal ones.     

高频超声在部分损容性皮肤病中的应用价值

【摘要】 损容性皮肤病是一类不同程度影响患者外貌和心理健康的皮肤疾病，患者对治疗效果通常抱有较高期望，迫切需要便捷且精确的无创辅助评估工具，以更好地进行诊治。越来越多的皮肤疾病包括损容性皮肤病在高频超声下得到客观而准确的评估。本文总结了高频超声在部分损容性皮肤病诊疗中的研究进展。     

Subungual glomus tumor diagnosis based on imaging

A 50-year-old woman had had tenderness of the nail bed of the right thumb for more than 20 years. For the previous 5 or 6 years, she had also had attacks of pain with exposure to cold, and deformity of the right thumb nail plate began to appear. There was red discoloration on the proximal aspect of the nail bed, and a longitudinal fissure on the distal aspect of the nail plate. Ultrasonography showed a well-circumscribed hypoechoic area under the proximal aspect of the nail plate and the nail matrix. Color Doppler ultrasonography showed subtle flow signals within the hypoechoic area. Magnetic resonance imaging showed a well-circumscribed mass in the same place that the ultrasonography indicated. It was isointense to the dermis of the nail bed on the T1-weighted image and hyperintense on the T2-weighted image. Radiography showed subtle dorsal bone erosion in the distal phalanx. Surgery was performed. Histologically, the diagnosis of a subungual glomus tumor was made. We diagnosed the exact location and size of the subungual glomus tumor by preoperative imaging and completely removed it easily and safely. Imaging is very useful for diagnosing tumors of the nail unit.     

A novel ultraviolet photography technique for assessing photodamage

Photography is critical to accurately capturing clinical results in cosmetic dermatology.  However, this shift from film to digital photography has made the capture of true ultraviolet (UV) images more difficult. Film cameras were developed that used special lighting and film to create true UV images, but this technology has not translated into the digital realm. At present, commercial digital photography systems use computer processing to generate UV-like images from visible light photography. This research developed a technique to obtain UV images with a UV pass glass filter placed in front of the camera lens. The UV filter was opaque to visible light (400–750 nm) with a peak transmission at 360 nm. In addition, a glass infrared (IR) block filter was also placed in front of the UV filter during photography. This research resulted in the development of an affordable digital camera system that was able to capture true UV light photographs.  This technique can be used by research and clinical dermatologists to obtain photographs demonstrating changes in photodamage as a result of therapeutic intervention.     

Depilatory chemical thioglycolate affects hair cuticle and cortex,degrades epidermal cornified envelopes and induces proliferation and differentiation responses in keratinocytes

Thioglycolate is a potent depilatory agent. In addition, it has been proposed to be useful as a penetration enhancer for transepidermal drug delivery. However, the effects on hair structure and stress responses it elicits in epidermal keratinocytes have not been fully characterised. We have used label‐free confocal and fluorescence lifetime imaging supported by electron microscopy to demonstrate how thioglycolate damages hair cuticle cells by generating breakages along the endocuticle and leading to swelling of cortex cells. Maleimide staining of free SH‐groups and a decrease in the average fluorescence lifetime of endogenous fluorophores demonstrate a specific change in protein structure in both hair cuticle and cortex. We found that the thioglycolate damages cornified envelopes isolated from the stratum corneum of the epidermis. However, thioglycolate‐treated epidermal equivalent cultures recover within 48 hours, which highlights the reversibility of the damage. HaCaT keratinocytes respond to thioglycolate by increased proliferation, onset of differentiation and expression of the chaperone protein Hsp 70, but not Hsp 27. Up‐regulation of involucrin can be blocked by an application of c‐Jun N–terminal kinase (JNK) inhibitor, but the up‐regulation of Hsp 70 takes place regardless of the presence of the JNK inhibitor.     

Role of magnetic resonance imaging in the diagnostic work up of clinical localized prostate cancer: A review

Imaging plays an increasingly important role in the work up of prostate cancer(PCa) and magnetic resonance imaging(MRI) is generally accepted as the most accurate and promising imaging modality in the local staging of PCa due to its high spatial resolution and excellent soft tissue contrast. The quality and performance of MRI of the prostate has improved dramatically during the last decade. Mainly, the combination of morphological information and functional information on cell density, tissue perfusion or metabolism as provided in multi-parametric prostate MRI(mp MRI) has led to a substantial increase in lesion detection and characterization. The correlation between functional parameters as provided by MRI and the aggressiveness of PCa as determined by the Gleason Score may help in differentiating clinically signifi cant from indolent PCa non-invasively. Besides these pros, radiologists are confronted with an immense amount of information and standardized acquisition, interpretation and reporting of mp MRI is not yet a reality. Furthermore, prostate MRI availability is still limited to high volume centers in many countries; hence, it is not yet a routine tool in common daily practice. Hence, development of guidelines for standardized acquisition, interpretation andreporting of prostate MRI exams is urgently needed in order to provide useful information for treating clinicians. Preferably, multi-centric clinical studies comparing MRI fi ndings to step-section histological specimens are mandatory during the coming years. Furthermore, simplification of the acquisition must be achieved in order to make this imaging modality applicable for daily use in common uro-radiological practice.