激惹型脂溢性角化病的高频超声及剪切波弹性成像表现

目的总结激惹型脂溢性角化病的高频超声及剪切波弹性成像表现。方法收集在我院经手术病理证实的ISK患者32例，均为单发病灶，其中男18例，女14例，年龄47~81岁（59.7±9.4岁），使用高频探头观察肿物的位置、累及层次、形态、大小、边界、内部回声，切换至剪切波弹性成像模式，测量肿物杨氏模量平均值、肿物与临近正常真皮组织之间的弹性应变比。结果32例患者均为单发，最常见于头面部（n=30，93.8%)；29例（90.6%）肿物近期明显增大，21例（65.6%）肿物处有痛、痒症状，9例（28.1%）肿物有表面出血。25例肿物被检查者判定累及真皮层。病变以椭圆形为主（n=23，71.9%），肿物厚径的增加主要体现为表皮层厚度的增加。肿物内部以低回声为主，部分病例内见点状强回声（n=12，37.5%），32例肿物内部血流均为Ⅱ、Ⅲ级血流。杨氏模量平均值21.1±3.6 kPa，与周围正常真皮弹性应变比为1.73±0.64。结论激惹型脂溢性角化病多位于头面部，超声特征表现为外生性的椭圆形低回声结节，多与真皮分界不清，部分病变内部见点状强回声，内部血流以Ⅱ、Ⅲ级血流为主，结合以杨氏模量值30.5 kPa，及肿物与周围正常真皮的弹性应变比值4.00为界值，可与皮肤常见恶性肿瘤相鉴别。

High-frequency ultrasound and shear wave elastograhpy findings of irritated seborrheic keratosis

ObjectiveTo summarize the high-frequency ultrasound and shear wave elastograhpy findings of irritated seborrheic keratosis.Methods32 cases of ISK confirmed by surgery and pathology in our hospital were collected. All of them were single lesions, including 18 males and 14 females, aged from 47 to 81 years old, with an average age of 59.7 ± 9.4 years old. The position, involvement level, shape, size, boundary and internal echo of the tumor were observed with a high-frequency probe, and the mode of shear wave elastography was switched to, the mean young's modulus of the tumor and the Ratio of elastic strain between the tumor and adjacent normal dermal tissue were measured.ResultsAll the 32 patients were single lesions, and the lesions were most common in the head and face (30 cases, accounting for 93.8%). In 29 cases (accounting for 90.6%), the tumor increased significantly recently. 21 cases (accounting for 65.6%) had pain and itching at the tumor site and 9 cases (accounting for 28.1%) had superficial bleeding. The 25 cases' tumor was detected to involve dermis. The lesions were mainly elliptic (23 cases, accounting for 71.9%), and the increase in the thickness of the mass was mainly reflected by the increase in the thickness of the epidermis. The interior of the tumor was mainly hypoechoic, with point-like strong echoes in some cases (12 cases, accounting for 37.5%), and the internal blood flow in 32 cases was grade Ⅱ and Ⅲ. The mean young's modulus was 21.1±3.6 kPa, with a mean elastic strain ratio of 1.73±0.64 to the surrounding normal dermis.ConclusionIrritated seborrheic keratosis is mostly located in the head and face. The ultrasonic features are exophytic oval hypoechoic nodules, which are not clearly demarcated with dermis. In some lesions, there are point-like strong echoes. The internal blood flow is mainly grade Ⅱ and Ⅲ, combined with the value of 30.5 kPa of young's modulus, and the elastic strain ratio of the tumor to the surrounding normal dermis of 4.00 as the threshold, which could be differentiated from common malignant tumors of the skin.