[1] Harland, C.C.,, Bamber, J.C., Gusterson, B.A. and Mortimer, P.S. (1993) High Frequency, high resolution B-scan ultrasound in the assessment of skin tumours. British Journal of Dermatology, 128, 525-532.

SUMMARY: Sixteen skin tumours and one BCG vaccination granuloma were examined by 20-MHz B-scan ultrasound. Images were compared with closely matched histological sections of excised lesions. The correlation between histology and ultrasound was excellent for maximum tumour depth measurements (r = 0.96, P <0.0001), but less good for maximum width (r = 0.84, P <0.0001), because of the elastic contraction of tissue at excision. Architectural detail of lesions on histological sections corresponded well with that on ultrasound images. There was a good correlation for heterogeneity (collagen distribution vs. echo pattern (r =0.86, P<0.0001), and between collagen content and echogenicity of lesions (r = 0.69, P <0.003). Strong correlations were also obtained for echogenicity vs. spacing of collagen bundles (r = 0.65, P <0.0005), echogenicity vs. collagen bundle size (r = 0.58, P <0.02), and echogenicity vs. cellularity (r = -0.68, P <0.003). Results for dermatolfibroma were atypical, due to paradoxical low internal echogenicity and increased echo absorption. B-scanning is a reliable non-invasive method for assessing tumour dimensions, and has potential for the study of tumour characteristics for diagnostic purposes.

[2] Application of high-frequency ultrasound to the objective assessment of healing. WOUNDS: Proceedings of the 2nd Conference on Advances in Wound Management. Macmillan Press, London, pp.26-29.
Whiston, R.J., Young, S.R., Lunch, J.A., Harding, K.G. and Dyson, M. (1992)
SUMMARY: A collaborative programme of research has been set up between the Wound Healing Research Unit at the University of Wales College of Medicine and the Tissue Repair Research Unit at UMDS, Guy's Hospital, to establish a rapid, sensitive, repeatable and quantitative non-invasive method of imaging tissue both in and adjacent to wound sites. In this pilot study patients were scanned using high frequency diagnostic ultrasound (Supra Scanner, Supra Medical Corp). B-mode ultrasound images yielded detailed echo profiles of the scanned tissues. Using computerised image analysis techniques it is possible to interpret more fully these echo images and to establish mathematically the difference between intact, uninjured tissue and the tissue occupying the wound site. This information was used to measure quantitatively the changes which occur within the wound tissue with time. It may also be used to compare the effectiveness of therapeutic measures in improving the outcome of the healing process. The results of this pilot study suggest that this method of wound assessment will have considerable clinical value.

[3] Young, S.R., Lynch, J.A., Liepins, P.J. and Dyson, M. (1992) Ultrasound imaging: a non-invasive method of wound assessment. Proceedings of the 2nd Conference on Advances in Wound Management. Macmillan Press, London, pp. 29-31.
SUMMARY: Wound repair rate and quality can be studied using a number of techniques. However, the techniques which tend to yield the most informative quantitative data, e.g. histology, tend to be the most traumatic to the patient, involving the biopsy of delicate healing sites. There are some non-invasive methods currently in use, e.g. wound area measurements taken from either tracings or photographs, and there have also been attempts to correlate wound colour with the healing status. The value of these methods is limited since they only yield information about the surface characteristics of the wound.
Work has begun at the Tissue Repair Research Unit at UMDS to test the effectiveness of a diagnostic ultrasound machine, the Supra Scanner (Supra Medical Corp), as a means of obtaining quantitative data about the nature of tissue at and adjacent to the wound site. The machine gives very high resolution images (approximately 65 microns) of this tissue up to a depth of 37mm. The images can be obtained in both A and B scan modes which together provide detailed information about the echogenicity of the scanned tissue. Examination of the echo profiles from a pilot study using computerised image analysis indicates that this method of wound assessment is sensitive, reproducible and quantitative, and should prove to be useful in evaluating the effectiveness of various therapeutic modalities.

[4] International Journal of Aesthetic and Restorative Surgery
Volume 4, Number 2, 1996, Pages 1-5
High Frequency Diagnostic Ultrasound: A non-invasive, Quantitative Aid for Testing the Efficacy of Moisturizers
STEVE R. YOUNG, PhD, A. Erian, MD and M.Dyson
ABSTRACT: The effect of moisturizing the skin was examined ultrasonically in 60 volunteers with a mean age of 53 years. The volunteers used either a twice daily application of a moisturizer or a twice daily massage to the side of their face in the region superficial to the zygomatic arch. The skin was assessed ultrasonically by using a 20 MHz B scan device. Assessments were conducted pre-treatment and on days 1, 3, 7, 14 and 21 after the start of treatment. In addition to epidermal and dermal thickness measurements, changes in dermal echogenicity were assessed by using fractal analysis on the ultrasound scans. The results showed that the mean epidermal and dermal thickness did not change in response to massage only. However, the moisturized skin showed a mean increase in epidermal thickness of 26%. The mean dermal thickness did not change. The fractal nature of the ultrasound scans did not change during the test period, indicating that the dermal component of the skin remained stable and had not changed structurally. The benefits of using high frequency ultrasound to assess the efficacy of moisturizing products has been demonstrated in this study. By using this technique it was possible to noninvasively assess the skin before, during, and after treatment and to target specifically where in the skin the treatments have had their effect.

[5] British Journal of Dermatology 1998: 138: 815-820
Dermal oedema assessed by high frequency ultrasound in venous leg ulcers
H.Hu, T.T.Phan, G.w.Cherry and T.J. Ryan
SUMMARY: Oedema is considered a key pathogenic factor in the development of venous leg ulcers. The purpose of this study was to determine the localization of oedema in legs with ulcers. Twelve patients with 13 venous leg ulcers (one bilateral), with a duration of 7-18 months, were examined by high-frequency B-mode ultrasound scanner. This was performed at three sites in the leg (low, middle and upper sites of the lower leg). In the same group of patients, the legs without ulcers were used as controls. The echogenicity and the thickness of the whole dermis were quantified by digital image analysis: the echogenicities of the upper (papillary) and lower portions of the dermis were measured. In the upper site no significant difference was found between the legs with ulcers and controls. In the middle and low sites of legs with ulcers, the dermal echogenicities were 34% and 64% (P<0.01) less than those in controls, and the dermal thicknesses were 0.4 mm and 0.8 mm (P<0.01) thicker than those in controls, respectively. This indicated intradermal oedema existing in the lower part (gaiter area) of the legs with ulcers. The ratios of low echogenic pixels in the upper and lower portions of the dermis, in the middle and low sites of legs with ulcers, were 0.5 and 0.9 (P <0.05 and P < 0.1) respectively higher than those in controls, suggesting the papillary dermis as a preferential site of oedema formation. The present study demonstrates that in the low sites of legs with ulcers, a marked increase in oedema was seen in the papillary dermis. This may add to the understanding of the origin of leg ulcer in the gaiter area of the leg.