基于pBCC的皮肤镜特征及在RCM图像三维可视化中的早期响应

Research on features of pBCC by dermoscopy and its early response to RCM images in three-dimensional visualization

目的探索色素型基底细胞癌(pigmented basal cell carcinoma,pBCC)的皮肤镜诊断指征和反射式共聚焦激光扫描显微镜(Reflectanceconfocal miscroscopy,RCM)的图像特征,并经三维可视化重构与建模后进行比对,验证两种影像学技术之间关系,为pBCC的皮肤镜诊断提供理论依据。方法选取来自我院就诊经皮肤镜和RCM诊断为pBCC后经病理验证的皮损样本。选择pBCC皮肤镜诊断指征典型图像,在同一靶目标区进行RCM检查,实时获取X、Y、Z三个方向连续扫描图像存储备查。采用三维可视化图像处理软件,先对RCM靶目标图像进行特征提取及无关组织透明化,使靶目标图像更加清晰,后将其连续扫描系列图像进行三维可视化重构与建模,观察靶目标图像的立体与空间信息、矢状面信息,肿瘤组织影像学形态与周围组织的关系,及对pBCC皮肤镜图像与RCM图像比对。结果皮肤镜和RCM分别同时确诊pBCC 37例;取得pBCC的皮肤镜诊断指征典型图像,包括:蓝灰色卵圆形巢、叶状结构、多发性蓝灰色小球、轮辐射状结构、溃疡和树枝状血管与RCM图像的三维可视化重构与建模结果。结论取得pBCC皮肤镜与RCM图像三维可视化重构与数据库建模后的满意结果,明确pBCC皮肤镜诊断指征与RCM图像之间的密切与对应关系,为pBCC皮肤镜诊断提供理论依据和提高其诊断符合率奠定扎实基础。

Objective To explore the diagnostic indications of pBCC by Dermoscopy as well as its image features by RCM and verify the relationship between the two imaging technologies after reconstructing the images in three-dimensional visualization and modeling,and to provide the theoretical evidence for the diagnosis of pBCC by Dermoscopy. Methods We selected the cases diagnosed as pBCC by Dermoscopy and RCM,and then confirmed them by histopathology. We chose the typical images of pBCC by Dermoscopy,and examined them by RCM in the same target area,real-timely obtained and restored the images by continuous scanning in three directions of X,Y and Z axes. We adopted the three-dimensional visual image processing software to extract the image features in target area by RCM and unrelated organization transparency was performed to make the images more clear. Then we reconstructed the continuously scanned images in three-dimensional visualization,built models,observed the stereo and spatial information,sagittal information and the relationship between tumor morphology and peripheral tissue,and then compared these images obtained by the two technologies. Results 37 cases were respectively diagnosed by Dermoscopy or by RCM. We obtained the typical images as diagnostic indications of pBCC by Dermoscopy,including blue-gray ovoid nests,leaf-like structures,multiple blue-gray globules,spoke-wheel-like structures,ulcer and arborizing blood vessels,as well as the results of reconstructing images in three-dimensional visualization and modeling by RCM. Conclusion By acquiring the satisfactory results after reconstructing the images of pBCC in three-dimensional visualization and modeling by Dermoscopy and RCM,the close correspondence between the diagnostic indications of pBCC by Dermoscopy and the image technology of RCM can be revealed,in order to provide the theoretical evidence for the diagnosis of pBCC by Dermoscopy and lay the solid foundation for the further development in the diagnostic accordance rate.