Bahar Dasgeb MD, Presenter: Nothing to Disclose

Eliot Lawrence Siegel MD, Abstract Co-Author: Research grant, General Electric Company Research grant, Siemens AG Speakers Bureau, TeraRecon, Inc Advisory Board, Mercury Computer Systems, Inc Board of Directors, Carestream Health, Inc Research grant, XYBIX Systems, Inc Research grant, Steelcase, Inc Research grant, Anthro Corp Research grant, RedRick Technologies Inc Research grant, Evolved Technologies Corporation Research grant, Barco nv Research grant, Intel Corporation Research grant, Herman Miller, Inc Research grant, Anatomical Travelogue, Inc Advisory Board, Fovia, Inc

The purpose of this study was to investigate the use of ultra-high frequency sonography and quantitative ultrasound elastography for a variety of malignant and non-malignant skin lesions.

Forty patients with proliferative malignant neoplasms or benign skin lesions were imaged utilizing an ultra-high frequency sonography system. Elastographic properties of these lesions were also assessed. Malignant tumors included squamous cell carcinoma, basal cell carcinoma, and melanoma. Benign lesions included benign cephalic histiocytosis, dermatofibroma, lipoma, intradermal nevus, angioma, trichoepithelioma, and others. Diagnosis was confirmed histopathologically. The physical interaction of the tissue with ultrasonic waves in the 14 to 16 MHz range was quantified using a color coding schema to reflect its physical elasticity. The ratio of elasticity between adjacent normal skin and each skin lesion was calculated. Histopathological findings including the size, extent, and depth of the lesions were recorded.

Cystic lesions demonstrated high levels of elasticity while malignant lesions were relatively “hard” with a very low level of elasticity. The ratio of normal skin to the various skin lesions ranged from 0.04 to 0.3 for cystic skin lesions, 0.4 to 5.0 for benign proliferative lesions such as intradermal nevi or benign histiocytosis, and a ratio above 10.0 was characteristically seen in malignant lesions.

High frequency ultrasound imaging and elastographic analysis visualized and quantified the elasticity of the skin and superficial soft tissue lesions. Malignant lesions were significantly less elastic (harder physically) than benign ones. We believe that this may be related to a higher density of DNA in the proliferative and compact S phase for these lesions but other characteristics, such as vascularity and compromised integrity of interstitial fibrous tissue in the chemo-immune environment of malignant skin lesions may also play a substantial role in determining their elastographic characteristics.  In addition, the ratio of elasticity of the lesions to surrounding tissues was found to strongly correlate with the proliferative state of the tumor based on histopathology.  

High frequency ultrasound with ultrasound elastography successfully delineated the extent of and was able to provide quantitative differentiation among a variety of benign and malignant lesions.

Dasgeb, B, Siegel, E, Elastographic Ultrasound Quantitative Analysis Combined with High Frequency Imaging for Characterization of Benign and Malignant Skin Lesions.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8009893.html