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Preoperative identification of functional lymphatic vessels (LVs) and accurate measurement of their internal diameters can facilitate lymphaticovenous anastomosis (LVA). However, current single imaging methods cannot accurately measure LVs internal diameters while locating functional LVs. This study aims to demonstrate the accuracy and effectiveness of combining contrast-enhanced ultrasound (CEUS) with ultra-high-frequency ultrasound (UHFUS) for precisely locating functional LVs and measuring internal diameters. 24 patients with secondary upper or lower extremity lymphedema were included in this retrospective study, who underwent three localization methods respectively: CEUS combined with UHFUS (Group A), CEUS alone (Group B), and UHFUS alone (Group C). 24 patients were all female (mean age, 61.9 ± 7.1 years [SD]). Compared with UHFUS, CEUS can locate more functional LVs more quickly (3.00 (2.00,3.00) number vs. 5.88 ± 1.25 number, P  < 0.001 b , 36.43 ± 8.62 min/each vs. 8.45 ± 4.25 min/each, P  < 0.001 b ). UHFUS can measure internal diameters of LVs more accurately compared to CEUS (0.10(0.10,0.10) mm vs. 0.30(0.20,0.34) mm, P  < 0.001 b ). Compared with CEUS alone, CEUS combined with UHFUS can measure internal diameters of LVs more accurately on the basis of quickly locating functional LVs (0.10 (0.10,0.10) mm vs. 0.30(0.20,0.34) mm P  < 0.001 b ). CEUS combined with UHFUS can locate more functional LVs more quickly compared to UHFUS alone (5.25 ± 0.89 number vs. 3.00 (2.00,3.00) number, P  < 0.001 b , 9.88 ± 4.21 min/each vs. 36.43 ± 8.62 min/each, P  < 0.001 b ). The integrated approach combined the advantages of both CEUS and UHFUS. It can not only rapidly localize functional LVs, but also accurately measure internal diameters, which streamlines LVA and improves efficiency.

Objective methods are needed to quantify digital artery disease in systemic sclerosis (SSc) for clinical trials of vascular therapies. Our primary aim was to examine feasibility of a novel tomographic three-dimensional-(3-D) ultrasound (tUS) with high-frequency ultrasound (HFUS) or ultra-high-frequency ultrasound (UHFUS) to assess the digital arteries in patients with SSc compared to healthy controls. A secondary objective was to compare the total wall volume (TWV) as a measure of intimal/medial thickness. Eighteen patients with a confirmed diagnosis of SSc were studied by tUS HFUS (17.5 MHz, n = 10) or tUS UHFUS (48 and 70 MHz, n = 8) with equal numbers of healthy controls of similar age and gender. The majority of patients had limited cutaneous SSc and were representative of a spectrum of digital vasculopathy, with over half (n = 6 HFUS and n = 5 UHFUS) having previous digital ulceration. Over half were receiving oral vasodilatory therapy. TWV was measured in both digital arteries of the middle finger bilaterally. At least, two digital arteries could be identified at 17.5 MHz in all patients and healthy controls. Whereas, at least two digital arteries could be identified in relatively fewer patients compared to healthy controls using 48 MHz (n = 6 and 10) and especially 70 MHz (n = 4 and 10) UHFUS. The median difference in TWV between patients and healthy controls was -6.49 mm3 using 17.5 MHz, 1.9 mm3 at 48 MHz, and -0.4 mm3 at 70 MHz. tUS using UHFUS is a feasible method to measure TWV of digital arteries in SSc. Transducer frequency plays an important factor in successful digital artery measurement, with 48 MHz being the optimal frequency.

Background: Primary cutaneous lymphoma (PCL) is a rare form of extranodal non-Hodgkin’s lymphoma characterized by malignant lymphocytes confined to the skin. Accurate diagnosis and staging are crucial for optimal management, yet radiological literature on imaging PCL remains limited. This study aims to delineate the imaging characteristics of PCLs using high and ultra-high frequency ultrasound (UHFUS) and proposes a classification system based on ultrasound findings. Methods: A cohort of 88 individuals with suspected PCL underwent high-resolution ultrasound (HRUS) and color Doppler examination of lesions. Lesions were categorized based on sonographic appearance, and subsequent histopathological assessment confirmed the diagnosis. Results: Ultrasound imaging revealed distinct patterns for primary cutaneous T-cell lymphomas (PCTCL) and primary cutaneous B-cell lymphomas (PCBCL), with characteristic features such as hypoechoic nodules, pseudonodular lesions, and dermal infiltration. Histopathological analysis confirmed the ultrasound findings, supporting the proposed classification system. Conclusions: Ultrasonography, particularly UHFUS, offers valuable insights into the imaging characteristics of primary cutaneous lymphomas, aiding the accurate diagnosis and assessment of treatment response. The proposed classification system based on ultrasound findings enhances the diagnostic approach to PCLs, and paves the way for improved patient care and management strategies.

Dermatologic ultrasonography applications are rapidly growing in all skin fields. Thanks to very high spatial resolution, high-frequency and ultra-high-frequency ultrasound can evaluate smaller structures, allowing us to improve diagnosis accuracy and disease activity. Moreover, they can guide treatment, such as drug injection, and assess therapy efficacy and complications. In this narrative review, we evaluated high-frequency ultrasound and ultra-high-frequency ultrasound in infections, inflammatory dermatoses, metabolic and genetic disorders, specific cutaneous structure skin disorders, vascular and external-agent-associated disorders, neoplastic diseases, and aesthetics.

Dermatofibrosarcoma protuberans (DFSP) and dermatofibroma (DF) are cutaneous lesions with overlapping clinical features, often requiring histopathological confirmation. This study aims to evaluate and compare the diagnostic utility of high-frequency ultrasound (HFUS) and ultra-high-frequency ultrasound (UHFUS) in distinguishing these two entities over 15-year period. A retrospective analysis was conducted on 334 patients (127 DFSP, 207 DF) with pathologically confirmed diagnoses. HFUS or UHFUS was used to assess lesion characteristics, including demographics, location, size, morphology, echogenicity, homogeneity, posterior acoustic features, and vascularity. Univariate and multivariate logistic regression analyses were performed to identify significant predictors. DFSP patients were significantly older than DF patients (40.99 years vs 34.00 years; < 0.001). DFSP lesions were predominantly on the trunk, while DF was more common on the extremities ( < 0.001). DFSP lesions were significantly larger (mean 43.02 mm vs 10.34 mm; < 0.001), and exhibited more aggressive sonographic features, including tentacle-like borders, internal hyperechoic areas, peripheral hyperechoic rims, mixed echogenicity, irregular shape, ill-defined margins, internal heterogeneity, and frequent posterior enhancement (all < 0.005). DFSP also showed higher vascularity with random, peripheral, or arborizing patterns and higher Adler grades (all < 0.001). Multivariate analysis identified tumor location (extremities favoring DF), size, ultrasound pattern (tentacle-like border pattern, internal hyperechoic area, peripheral hyperechoic rim, and mixed echogenicity pattern favoring DFSP) as independent predictors. HFUS and UHFUS demonstrates strong diagnostic utility in differentiating DFSP from DF based on key clinical and sonographic features. These findings support the use of HFUS and UHFUS as a valuable non-invasive tool for preoperative diagnosis. Future studies should validate these criteria in multi-center settings and exploring artificial intelligence integration to further enhance diagnostic accuracy and standardization.

Ultrasound is a versatile and well-established technique using sound waves with frequencies higher than the upper limit of human hearing. Typically, therapeutic and diagnosis ultrasound operate in the frequency range of 500 kHz to 15 MHz with greater depth of penetration into the body. However, to achieve improved spatial resolution, high-frequency ultrasound (>15 MHz) was recently introduced and has shown promise in various fields such as high-resolution imaging for the morphological features of the eye and skin as well as small animal imaging for drug and gene therapy. In addition, high-frequency ultrasound microbeam stimulation has been demonstrated to manipulate single cells or microparticles for the elucidation of physical and functional characteristics of cells with minimal effect on normal cell physiology and activity. Furthermore, integrating machine learning with high-frequency ultrasound enhances diagnostics, including cell classification, cell deformability estimation, and the diagnosis of diabetes and dysnatremia using convolutional neural networks (CNNs). In this paper, current efforts in the use of high-frequency ultrasound from imaging to stimulation as well as the integration of deep learning are reviewed, and potential biomedical and cellular applications are discussed.

Background The diagnosis of basal cell carcinoma (BCC) is based on clinical and dermoscopical features. In uncertain cases, innovative imaging techniques, such as reflectance confocal microscopy (RCM) and optical coherence tomography (OCT), have been used. The main limitation of these techniques is the inability to study deep margins. HFUS (high‐frequency ultrasound) and the most recent UHFUS (ultra‐high‐frequency ultrasound) have been used in various applications in dermatology, but they are not yet routinely used in the diagnosis of BCC. A key point in clinical practice is to find an imaging technique that can help to reduce post‐surgical recurrences with a careful presurgical assessment of the lesional margins. This technique should show high sensitivity, specificity, reproducibility and simplicity of execution. This concept is very important for the optimal management of patients who are often elderly and have many comorbidities. The aim of the paper is to analyse the characteristics of current imaging techniques and the studies in the literature on this topic. Materials and methods The authors independently searched the MEDLINE, PubMed, Embase, Scopus, ScienceDirect and Cochrane Library databases for studies looking for non‐invasive imaging techniques for the presurgical margin assessment of BCC. Results Preoperative study of the BCC subtype can help to obtain a complete excision with free margins. Different non‐invasive imaging techniques have been studied for in vivo evaluation of tumour margins, comparing the histologic evaluation with a radical surgery. The possibility to study the lateral and deep margins would allow a reduction of recurrences and sparing of healthy tissue. Conclusion HFUS and UHFUS represent the most promising, non‐invasive techniques for the pre‐operative study of BCC facilitating the characterization of vascularization, deep lateral margins and high‐risk subtypes, although they are limited by insufficient literature unlike RCM and OCT.

Background Skin neoplasms, particularly basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are prevalent forms of skin malignancies. To enhance accurate diagnosis, non‐invasive techniques including high‐frequency ultrasound (HFUS) are crucial. HFUS offers deeper penetration compared to reflectance confocal microscopy (RCM), and optical coherence tomography (OCT), making it valuable for examining skin structures. The aim of this study was to investigate and diagnose localized manifestation of BCC and SCC with HFUS and compare it with pathology results in patients referred to Razi Hospital, Tehran, Iran. Method and materials This study included patients diagnosed with BCC and SCC, with clinical and pathological confirmation, attending the oncology clinic of Razi Hospital, Tehran, Iran, from 2022 to 2023. Exclusion criteria comprised metastatic and recurrent cases, patients who underwent treatment or surgery, and tumors located in anatomically challenging areas. HFUS with a 20 MHz probe and Doppler ultrasound were employed to examine the skin. Tumors were subsequently excised, fixed in formalin, and sent for pathological assessment. Ultrasound findings were compared with pathology results. Results The study assessed 40 patients, with half diagnosed with SCC and the other half with BCC. The majority of SCC patients were male (80%), while BCC patients were relatively evenly divided between males (65%) and females (35%). The mean age was 59.15 ± 11.9 years for SCC and 63.4 ± 8.9 years for BCC. Cheeks (20%) and lips (35%) were the most common sampling sites for BCC and SCC, respectively. The correlation coefficients for tumor size and depth between ultrasound and pathology were 0.981 and 0.912, respectively, indicating a high level of agreement between the two methods. Conclusion In BCC patients, there was complete agreement between sonographic loco‐regional extension and pathology findings. However, some discordance (30%) was observed in SCC cases. The study demonstrated a strong correlation between ultrasound and pathology in accurately detecting the depth and extent of the tumor. However, due to the inclusion of only patients with positive pathology, it is not appropriate to evaluate the diagnostic test values and compare them with pathology results. Therefore, it is highly recommended to carry out additional studies with larger sample sizes to further validate these findings.

Background To date, there are no accepted outcome measures to monitor morphea, and consensus on specific monitoring criteria for morphea remains elusive. A few studies have assessed the criterion validity of skin ultrasound in morphea. So, in this study, we approach ultrasound findings in morphea lesions. Material and methods This was a retrospective‐analytical study conducted between December 2021 and May 2023. Patients were clinically evaluated at a dermatology outpatient clinic and then referred for high‐frequency ultrasound (HF‐US) evaluation and were selected to be included in this study. The lesions were confirmed by histopathology as well. Sonographic evaluations were performed on the lesion site and the symmetrical uninvolved other side. Dermal thickness and dermal echogenicities were recorded. Statistical analysis of group differences was performed by using the 2‐tailed Student t‐test. A p‐value of less than 0.05 was considered statistically significant. Results Forty‐one morphea lesions in the inflammatory phase of 27 patients were included in the study. The mean dermal thickness of morphea lesions was 1107.97 ± 414.3 and the mean dermal thickness of the control side was 1094.65 ± 331.06, The difference between these two variables was not statistically significant. The mean dermal density of lesions was 49.13 ± 18.97 and the mean dermal density of the control side was 52.22 ± 25.33. The difference between these two variables was not statistically significant. Conclusion This study shows that HF‐US indicated increasing dermal thickness and reducing the dermal density of the morphea lesions in the inflammatory phase confirmed with the histopathology.

Background Facial skin photoaging manifests as wrinkles, laxity, roughness, enlarged pores, telangiectasia, pigmentation, and dermal structural changes. Histologically, dermal collagen degradation and dermal‐epidermal junction disruption form the subepidermal low‐echogenic band (SLEB) on ultrasound. Platelet‐rich plasma (PRP) injection promotes skin regeneration but lacks objective imaging biomarkers. Objective To objectively evaluate the structural efficacy of PRP for facial photoaging by quantifying SLEB width and dermal thickness changes via high‐frequency ultrasound (HFUS), alongside skin analyzer assessments. Methods This retrospective case series included 10 patients (Glogau I–III) receiving three monthly PRP injections. The treatment utilized a standardized dual‐step protocol: manual precision injection targeting the deep dermis, followed by mechanical mesogun injection for uniform superficial coverage. SLEB width and dermal thickness were measured at four facial sites using HFUS before and 1 month after treatment. A skin analyzer assessed skin parameters. A comprehensive clinical evaluation was conducted using the Glogau classification and Global Aesthetic Improvement Scale (GAIS) for efficacy and patient satisfaction assessment. Results Post‐treatment, HFUS revealed significant reductions in SLEB width (average decrease 29%–47%, all p < 0.001) and increases in dermal thickness (average increase 24%–51%, all p ≤ 0.003). Skin analyzer showed significant improvements in Pores, Wrinkles, Brown Spots, and Red Areas (all p < 0.05). Clinical evaluations confirmed significant improvement in Glogau classification (p < 0.01) and high patient satisfaction (100% reported improvement on GAIS). No serious adverse events were observed; only transient erythema/edema and mild pain were reported. Conclusion HFUS is a reliable, non‐invasive tool for assessing PRP efficacy. SLEB width reduction serves as a sensitive, objective imaging biomarker, providing structural evidence for PRP's ability to improve photoaging damage.