Abuzahra Faris, Spöler Felix, Först Michael, Brans Richard, Erdmann Stefan, Merk Hans F, Obrigkeit Daniela Hoeller
Department of Dermatology and Allergology, University clinic, RWTH Aachen University, Aachen, Germany.
Mycoses. 2010 Jul;53(4):334-9. doi: 10.1111/j.1439-0507.2009.01717.x. Epub 2009 Sep 28.
The objective of this study was to compare optical coherence tomography (OCT) with conventional techniques such as KOH-preparation, culture and histology in the identification of the fungal elements in the nail. A total of 18 patients were examined; 10 with clinically evident onychomycosis in toe nails, two with psoriatic nail lesions, one with nail affection caused by lichen planus and five healthy controls. Serial in vivo OCT analyses of onychomycosis was performed prior to KOH-preparation, culture and punch biopsy of the nail plate for consecutive histology. Fungal elements were detected non-invasively in vivo using OCT in all 10 patients with histologically proven onychomycosis. Fungal elements were detectable as highly scattering elongated structures inside the nail plate, in the middle of the areas of homogeneous decrease in signal intensity. KOH-preparations and culture did reveal a positive result in 5/6 out of 10 patients. In patients with psoriasis, lichen planus as well as in the healthy controls, no fungal infection could be detected by either method used. OCT is a reliable, easy to use, non-invasive and non-destructive method to visualise fungal elements in vivo in onychomycosis, even in cases of false negative KOH-preparation and culture. Furthermore, OCT offers the opportunity to screen several areas of the same nail plate and to detect fungal elements during local or systemic therapy.
本研究的目的是比较光学相干断层扫描（OCT）与传统技术（如KOH涂片、培养和组织学检查）在识别指甲中的真菌成分方面的差异。共检查了18例患者，其中10例脚趾甲有临床明显的甲癣，2例有银屑病甲损害，1例有扁平苔藓引起的指甲病变，5例为健康对照。在对甲板进行KOH涂片、培养和连续组织学检查的打孔活检之前，对甲癣进行了连续的体内OCT分析。在所有10例经组织学证实为甲癣的患者中，使用OCT在体内非侵入性地检测到了真菌成分。真菌成分可在甲板内检测为高散射的细长结构，位于信号强度均匀降低区域的中部。KOH涂片和培养在10例患者中的6例中有5例显示阳性结果。在银屑病、扁平苔藓患者以及健康对照中，两种方法均未检测到真菌感染。OCT是一种可靠、易用、非侵入性且非破坏性的方法，可在体内可视化甲癣中的真菌成分，即使在KOH涂片和培养结果为假阴性的情况下也是如此。此外，OCT提供了对同一甲板的多个区域进行筛查以及在局部或全身治疗期间检测真菌成分的机会。
