Warszawski A, Röttinger E M, Vogel R, Warszawski N
Department of Radiotherapy, University of Ulm, Germany.
Radiother Oncol. 1998 Jun;47(3):241-7. doi: 10.1016/s0167-8140(97)00201-6.
In dermatology high resolution ultrasonic systems proved to be valuable in following up genuine and experimental inflammatory dermatoses. The opportunities of 20 MHz ultrasonic imaging for quantitative assessment of early and late postradiation skin reactions are investigated.
Between April and November 1996, 96 high resolution ultrasound examinations of the skin in 29 patients treated for breast cancer at the University of Ulm were analyzed. Total doses between 46 and 60 Gy were applied. The time interval between the completion of radiotherapy and ultrasonic examination was < or =3 months in 18 patients and 6-135 months in 11 patients. For examinations we used a digital high resolution ultrasonic system with a ceramic 20 MHz transducer. Irradiated and non-irradiated skin were compared.
A change of thickness and texture of the dermis depending on the time interval between the completion of radiotherapy and ultrasonic examination and on the administered radiation dose was found. There were significant differences between irradiated and non-irradiated skin regarding the dermal thickness in early (P < 0.001) as well as in late (P = 0.0018) reactions. Echogenicity of the upper and lower corium of irradiated skin decreased in early and late reaction. In upper corium the greatest reduction of signal intensity occurred in early reactions (P = 0.0001). Early reactions of the lower corium differed significantly from late changes (P = 0.001). Discrepancies between visible skin reactions described by examining physicians and ultrasonically proven changes were obvious mainly in late reactions.
There are specific textures of early and late postradiation skin reactions in comparison to non-irradiated skin. High resolution digital 20 MHz ultrasound is non-invasive and quantitative, and in contrast to physical examination, an easy reproducible method for assessing and documenting early and late skin reaction during and after radiation therapy treatment.
在皮肤病学中，高分辨率超声系统已被证明在跟踪真性和实验性炎症性皮肤病方面具有重要价值。本研究旨在探讨20MHz超声成像在定量评估放疗后早期和晚期皮肤反应方面的应用机会。
1996年4月至11月期间，对乌尔姆大学29例接受乳腺癌治疗患者的96次皮肤高分辨率超声检查进行了分析。总剂量为46至60Gy。放疗结束至超声检查的时间间隔在18例患者中≤3个月，在11例患者中为6至135个月。检查时使用配备20MHz陶瓷换能器的数字高分辨率超声系统，对受照射皮肤和未受照射皮肤进行比较。
发现真皮厚度和质地的变化取决于放疗结束至超声检查的时间间隔以及所给予的辐射剂量。在早期（P<0.001）和晚期（P = 0.0018）反应中，受照射皮肤和未受照射皮肤在真皮厚度方面存在显著差异。受照射皮肤的上、下真皮层在早期和晚期反应中回声均降低。在上真皮层，信号强度在早期反应中下降最为明显（P = 0.0001）。下真皮层的早期反应与晚期变化有显著差异（P = 0.001）。检查医生描述的可见皮肤反应与超声证实的变化之间的差异主要在晚期反应中较为明显。
与未受照射皮肤相比，放疗后早期和晚期皮肤反应具有特定的纹理特征。高分辨率数字20MHz超声是非侵入性且定量的，与体格检查相比，是一种在放疗期间及放疗后评估和记录早期及晚期皮肤反应的易于重复的方法。
