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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.

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.

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.

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.

Because of its relatively low cost, lack of ionizing radiation and great versatility, US is considered the imaging modality of choice to evaluate a large variety of pediatric conditions. Imaging of superficial structures and small anatomical parts can be at times limited with standard US. Recent advances in technology yielded ultra-high-frequency US systems that are capable of scanning with frequencies as high as 70 MHz and resolutions of 30 μm. This technology, approved by the United States Food and Drug Administration, has not been widely used in the clinical setting. It has the potential to become a powerful diagnostic tool in clinical practice, especially in the evaluation of infants, given their inherent body habitus. Our main objective is to discuss the use of ultra-high-frequency US at a tertiary care center. This pictorial essay presents a gamut of pediatric pathologies pertaining to imaging of the soft tissues and the superficial and musculoskeletal structures. Our aim in this pictorial essay is to highlight and illustrate the role of ultra-high-frequency US in improving the depiction of common and less common pathologies. We think it also helps to gain a new understanding of the normal anatomy in the pediatric population and to display specific features not shown by standard US and, in certain cases, ones that lead to a change in diagnosis.

Here, we describe the case of a 48-year-old female patient with prurigo nodularis, where B-mode and color-Doppler ultrasound of one nodule was performed; this revealed hypoechoic dermal and hyperechoic epidermal thickening with lesion hypervascularity. To the best of our knowledge, no previous published articles have reported ultra-high-frequency ultrasound images of this disease, so this case can encourage prurigo nodularis studies in order to better assess ultrasound features and their usefulness in supporting clinical diagnosis and in distinguishing prurigo nodularis from other diseases.

Psoriatic onychopathy is one of the clinical presentations of psoriasis and a well-known risk factor for the development of psoriatic arthritis. High-frequency ultrasounds (HFUS > 20 MHz) have recently been used to evaluate the nail apparatus of healthy and psoriatic subjects. The aim of our study was to detect by means of ultra-high-frequency ultrasound (UHFUS 70–100 MHz) alterations of the nail bed and matrix in patients with psoriatic onychopathy and to monitor these parameters during the treatment with monoclonal antibody (mAb). We enrolled 10 patients with psoriatic onychopathy and naive to previous biologic therapies. Patients were evaluated at baseline, after 1 month and after 3 months from the beginning of mAb therapy by a complete clinical assessment and US evaluation. A UHFUS examination with a 70 MHz probe was performed on the thumbnail (I), the index fingernail (II) and the nail with greater clinical impairment (W). The following measurements were analyzed: nail plate thickness (A), nail bed thickness (B), nail insertion length (C), nail matrix length (D) and nail matrix thickness (E). Among the various parameters analyzed, some measures showed a statistically significant decrease with p-value < 0.05 (t0 WA = 0.52 mm vs. t2 WA = 0.42 mm; t0 WB = 2.8 mm vs. t2 WB = 2.4 mm; t0 WE = 0.76 mm vs. t2 WE = 0.64 mm; t0 IIA = 0.49 mm vs. t2 IIA = 0.39 mm). In conclusion, UHFUS could represent a viable imaging technique for the real-time evaluation and monitoring of psoriatic onychopathy, thus supporting the clinical parameters and revealing any subclinical signs of early drug response.

Background: The superficial vessel system in the lower abdomen, including the superficial circumflex iliac artery (SCIA) and superficial inferior epigastric artery (SIEA), is widely used in reconstructive microsurgery. Preoperative ultrasonography, particularly ultra-high-frequency ultrasound (UHFUS), enhances surgical planning by providing high-resolution imaging. This study aimed to utilize UHFUS to examine the SCIA, SCIV, SIEA, and SIEV for reconstructive surgery planning. Methods: This prospective study included 25 patients undergoing free DIEP flap breast reconstruction. Patients with horizontal lower abdominal scars were excluded. Preoperative UHFUS, using a 48 MHz transducer, was performed to map and measure the superficial branch of SCIA (sSCIA), SCIV, SIEA, and SIEV. The vessel location, diameter, depth, and course were documented and analyzed. Results: Twenty-five female patients (50 hemiabdomens) aged 41 to 66 were included. The mean BMI was 21.6 kg/m2 (range: 18.4–30.4 kg/m2). At the ASIS level, the mean diameter of the sSCIA, SIEA, SCIV, and SIEV were 0.76 mm, 0.63 mm, 1.72 mm, and 2.18 mm, respectively. A superior lateral pedicle course was observed in 98% of the sSCIA. All patients had at least one detectable superficial artery, with 96% showing detectable arteries on both sides of the lower abdomen. Conclusions: UHFUS effectively maps superficial vessels in the lower abdomen for reconstructive surgery. The SCIA and SCIV are reliably detectable, while the SIEA is less consistently identified. UHFUS enhances flap design by providing precise vessel localization and sizing, leading to safer and more efficient surgeries.

Sjögren’s Disease (SjD) is a chronic autoimmune disorder that affects the salivary and lacrimal glands, leading to xerostomia and xerophthalmia. Ultrasonography of Major Salivary Glands (SGUS) is a well-established tool for the identification of the salivary glands’ abnormalities in SjD. Recently, a growing interest has arisen in the assessment of the other exocrine glands with ultrasonography: lacrimal glands (LGUS) and labial salivary glands (LSGUS). The objective of this study is to explore the practical applications of ultra-high frequency ultrasound (UHFUS) in the assessment of lacrimal glands and labial salivary glands. Indeed, UHFUS, with its improved spatial resolution compared to conventional ultrasonography, allows for the evaluation of microscopic structures and has been successfully applied in various medical fields. In lacrimal glands, conventional high-frequency ultrasound (HFUS) can detect characteristic inflammatory changes, atrophic alterations, blood flow patterns, and neoplastic lesions associated with SjD. However, sometimes it is challenging to identify lacrimal glands characteristics, thus making UHFUS a promising tool. Regarding labial salivary glands, limited research is available with conventional HFUS, but UHFUS proves to be a good tool to evaluate glandular inhomogeneity and to guide labial salivary glands biopsy. The comprehensive understanding of organ involvement facilitated by UHFUS may significantly improve the management of SjD patients.