皮膚攝影技術(shù)的應(yīng)用現(xiàn)在狀況與展望(4),醫(yī)學(xué)技術(shù)論文近年來(lái)，光聲成像已在乳腺癌診斷[59]、腫瘤血管新生成像[60]、血紅蛋白和血氧濃度成像[61]、心腦血管易損斑塊成像等得到應(yīng)用[62].該技術(shù)對(duì)皮下微血管的三維成像在皮膚病、整形外科等領(lǐng)域有著重要應(yīng)用。但皮下微血管的功能成像仍然面臨挑戰(zhàn)[63].雙波長(zhǎng)〔584nm和764nm〕光源對(duì)黑素瘤小鼠模型完好顯示黑素腫瘤的形態(tài)和周圍的血管[64].7多光子CT7.1多光子CT原理多光子CT是利用近紅外飛秒激光具有亞分子空間分辨率的特點(diǎn)發(fā)展而來(lái)，一個(gè)熒光分子同時(shí)吸收兩個(gè)一樣頻率的飛秒脈沖紅外光光子，到達(dá)高能激發(fā)態(tài)，經(jīng)過(guò)一個(gè)弛豫經(jīng)過(guò)后自發(fā)躍遷，輻射出一個(gè)頻率略小于兩倍入射光頻率的紫外光或可見(jiàn)光熒光分子。除了雙光子激發(fā)熒光外，由組織構(gòu)造的不同而產(chǎn)生二次諧波信號(hào)〔SHG〕可用于不同細(xì)胞構(gòu)造〔細(xì)胞壁、膠原纖維〕成像。具有較清楚明晰分辨不同組織、細(xì)胞構(gòu)造的功能，相對(duì)共聚焦激光成像技術(shù)分辨率更高層次。7.2多光子CT的應(yīng)用多光子CT主要用于黑素瘤診斷，在科研中具有更廣闊的應(yīng)用前景〔化裝品評(píng)價(jià)、皮膚老化研究、藥效評(píng)價(jià)等〕。7.3多光子CT的特點(diǎn)和發(fā)展多光子CT技術(shù)分辨率較高，有望得到更廣泛的應(yīng)用，但制約該技術(shù)應(yīng)用的主要障礙為價(jià)格相對(duì)高昂、穿透深度缺乏，這兩點(diǎn)有待于今后研制生產(chǎn)中逐步解決。8結(jié)束語(yǔ)總體而言，皮膚影像技術(shù)是一種在體、無(wú)創(chuàng)的檢查手段，已經(jīng)在色素性、非色素性皮損及相關(guān)腫瘤診斷中發(fā)揮了重要的作用。今后這一技術(shù)必將更廣泛地用于其他類型皮膚病診斷。對(duì)于詳細(xì)每個(gè)皮膚影像技術(shù)而言，它的發(fā)展方向應(yīng)該是：看的更細(xì)、更深、使用更便捷。由于不同皮膚影像技術(shù)的原理、優(yōu)勢(shì)和局限性有所差異，能夠構(gòu)成優(yōu)勢(shì)互補(bǔ)關(guān)系，不同皮膚影像技術(shù)組合使用，甚至與其他類型皮膚病檢查手段有機(jī)組合，進(jìn)而到達(dá)最好的診斷效果。以下為參考文獻(xiàn)：[1]BinderM,KittlerH,PehambergerH,etal.Possiblehaz-ardtopatientsfromimmersiooilusedforepilumines-cencemiemslopy[J].JournaloftheAmericanAcademyofDermatology,1999,40〔3〕:499.[2]ArgenzianoG,SoyerHP.Dermoscopyofpigmentedskinlesionsavaluabletoolforearlydiagnosisofmelanoma[J].LancetOncol,2001,2〔7〕:443-449.[3]LinJ,HanS,CuiL,etal.Evaluationofdermoscopicalgo-rithmforseborrhoeickeratosis:aprospectivestudyin412patients[J].JEurAcadDermatolVenereol,2020,28〔7〕:957-962.[4]張海紅，王硯寧，胡亞莉，等。皮膚鏡在皮膚腫瘤及非典型皮膚病鑒別診斷中的應(yīng)用進(jìn)展[J].臨床誤診誤治，2020,26〔6〕:99-102.[5]AshfaqAM,RalphPB,AlfredWK.AtlasofDermoscopy[M].London:InformaHealthcare,2005:23-291.[6]TostiA,TortesF.Dermoscopyinthediagnosisofhairandscalpdisorders[J].ActasDermosifiliogr,2018,100〔Suppl1〕:114-119.[7]趙瑩，蔡澤明，鞏毓剛，等。斑禿的皮膚鏡表現(xiàn)及與病理聯(lián)絡(luò)[J].中華皮膚科雜志，2018,44〔1〕:30-34.[8]ZabalosP,AraM,PuigS,etal.Dermoseopyofmollus-cumcontagiosum:ausefultoolforclinicaldiagnosisinadultllnod[J].JEarAeadDermatolVeners,2006,20〔4〕:482-483.[9]KimSH,SeoSH,KoHC,etal.Theuseofdermatoscopytodifferentiatevestibularpapilae,anormalvariantofthefemaleexternalgenitalia,fromcondylomaacuminata[J].JAmAcadDermatol,2018,60〔2〕:353-355.[10]OisoN,KawaraS,YanoY,etal.Diagnosticeffective-nessofdermoscopyfortickbite[J].JEarAcadDer-matolVenere,2018,24〔2〕:231-232.[11]CabreraIT,DazaF.Dermoscopyinthediagnosisoftungiasis[J].BrJDermatol,2018,160〔5〕:1136-1137.[12]李蕓，劉潔，孫秋寧。黃褐斑的皮膚鏡學(xué)特征[J].中國(guó)醫(yī)學(xué)科學(xué)院學(xué)報(bào)，2021,37〔2〕:226-229.[13]歐陽(yáng)恒，楊志波，朱明芳。白癜風(fēng)診斷與治療[M].北京：人民軍醫(yī)出版社，2007:22,69.[14]ChullAA,ZawarV.Demonstrationofresidualperifollicu-larpigmentationinlocalizedvitiligo-areverseandno-velapplicationofdigitalepiluminesceneedermoscopy[J].ComputModImagingGraph,2004,28〔4〕:213-217.[15]EinollahiB,Baradaran-RafiA,Rezaei-KanaviM,etal.Mechanicalversusalcohol-assistedepithelialdebride-mentduringphotorefractivekeratectomy:aconfoealmicroscopicclinicaltrial[J].JRefractSurg,2018,27:887-893.[16]孫兆偉，徐麗敏。傳染性軟疣的共聚焦顯微鏡特征[J].臨床皮膚科雜志，2018,39〔4〕:223-224.[17]GonzalezS,TannousZ.Invivoconfocalreflectancemi-croscopyofbasalcelcarcinoma[J].JAmAcadDer-matol,2002,47:869-874.[18]SiegelR,WardE,BrawleyO,etal.Cancerstatistics,2018:theimpactofeliminatingsocioeconomicandra-cialdisparitiesonprematurecancerdeaths[J].CACancerJClin,2018,61〔4〕:212-236.[19]GuiteraP,PelacaniG,CrottyKA,etal.Theimpactofinvivoreflectanceconfocalmicroscopyonthediagnosticaccuracyoflentigomalignaandequivocalpigmentedandnonpigmentedmaculesoftheface[J].JInvestDermatol,2018,130〔8〕:2080-2091.[20]LosiA,LongoC,CesinaroAM,etal.Hyporeflectivepagetoidcels:Anewclueforamelanoticmelanomadi-agnosisbyreflectanceconfocalmicroscopy[J].BrJDermatol,2020,171〔1〕:48-54.[21]SalerniG,LovattoL,CarreraC,etal.Correlationamongdermoscopy,confocalreflectancemicroscopy,andhis-tologicfeaturesofmelanomaandbasalcelcarcinomacollisiontumor[J].DermatolSurg,2018,37〔2〕:275-279.[22]吳冬梅，李青，戴耕武。反射式共聚焦顯微鏡在皮膚惡性黑素瘤中的應(yīng)用進(jìn)展[J].實(shí)用皮膚病學(xué)雜志，2021,8〔2〕:122-125.[23]劉華緒，林燕。白癜風(fēng)及其他色素減退性皮膚病的RCM圖像特點(diǎn)[J].中國(guó)麻風(fēng)皮膚病雜志，2020,28〔3〕:192-196.[24]PanZY,YanF,ZhangZH,etal.Invivoreflectancecon-focalmi-croscopyforthedifferentialdiagnosisbe-tweenvitiligoandnevusdepigmentosus[J].IntJDer-matol2018,50〔6〕:740-745.[25]LaiLG,XuAE.Invivoreflectanceconfocalmicroscopyimagingofvitiligo,nevusdepigmentosusandnevusanemicus[J].SkinResTechnol,2018,17〔4〕:404-410.[26]KangHY,leDuffF,PasseronT,etal.Anoninvasivetechnique,reflectanceconfocalmicroscopy,forthecharacterizationofmelanocytelossinuntreatedandtreatedvitiligolesions[J].JAmAcadDermatol,2018,63〔5〕:97-100.[27]KangHY,BahadoranP,OrtonneJP.reflectanceconfo-calmicroscopyforpigmentanrydisorders[J].ExpDer-matol,2018,19〔3〕:233-239.[28]ArdigoM,MalizewskyI,DellannaML,etal.Preliminaryevaluationofvitiligousinginvivoreflectanceconfocalmicroscopy[J].JEurAcadDermatolVenereol,2007,21〔10〕:1344-1140.[29]KangHY,leDuffF,PasseronT,etal.Anoninvasivetechnique,reflectanceconfocalmicroscopy,forthecharacterizationofmelanocytelossinuntreatedandtreatedvitiligolesions[J].JAmAcadDermatol,2018,63〔5〕:97-100.[30]KangHY,BahadoranP,OrtonneJP.reflectanceconfo-calmicroscopyforpigmentanrydisorders[J].ExpDer-matol,2018,19〔3〕:233-239.[31]SwindellsK,BurnettN,Rius-DiazF,etal.Reflectanceconfocalmicroscopymaydifferentiateacutealergicandirritantcontactdermatitisinvivo[J].JAmAcadDermatol,2004,50:220-228.[32]劉峰，郭海霞。皮膚CT在皮膚病學(xué)的研究進(jìn)展[J].中國(guó)中西醫(yī)結(jié)合皮膚性病學(xué)雜志，2020,13〔3〕:189-191.[33]劉華緒，林燕。皮膚CT在皮膚病學(xué)的研究進(jìn)展[J].中國(guó)麻風(fēng)皮膚病雜志，2018,27〔7〕:488-491.[34]CoronE,MosnierJF,AhluwaliaA,etal.Colonicmucosalbiopsiesobtainedduringconfocalendomicroscopyareprestainedwithfluoresceininvivoandaresuitableforhistologicevaluation[J].Endoscopy,2020,44:148-153.[35]TierneyE,PetersenJ,HankeCW,etal.Photodynamicdiagnosisoftumormarginsusingmethylaminolevuli-natebeforeMohsmicrographicsurgery[J].OrvHetil,2020,153:1334-1340.[36]MontazerabadiAR,SazgarniaA,Bahreyni-ToosiMH,etal.Theeffectsofcombinedtreatmentwithionizingra-diationandindocyaninegreen-mediatedphotodynam-ictherapyonbreastcancercels[J].JPhotochemPhotobiolB,2020,109:42-49.[37]柯宜均,黃海艷，王芳，等，色素減退性皮膚病的無(wú)創(chuàng)檢測(cè)研究進(jìn)展[J].中國(guó)皮膚性病學(xué)雜志，2020,27〔12〕:1286-1288.[38]CammarotaT,PintorF,MagliaroA,etal.CurrentusesofdiagnostichighfrequencyUSindermatology[J].EurJRadiol,1998,27〔Suppl2〕:S2215.[39]BessoudB,LassauN,KoscielnyS,etal.High-frequencysonographyandcolorDopplerinthemanagementofpigmentedskinlesions[J].UltrasounMedBiol,2003,29〔6〕:875.[40]Timar-BanuO,BeauregardH,TousignantJ,etal.Devel-opmentofnoninvasiveandquantitativemethodologiesfortheassessmentofchroniculcersandscarsinhumans[J].WoundRepairRegen,2001,9〔2〕:123.[41]HuD,PhanTT,CherryGW,etal.Dermaloedemaas-sessedbyhighfrequencyultrasoundinvenouslegul-cers[J].BrJDermatol,1998,138〔5〕:815.[42]GottloberP,KerscherMJ,KortingHC,etal.SonographicdeterminationofcutaneousandsubcutaneousfibrosisafteraccidentalexposuretoionisingradiationinthecourseoftheChernobylnuclearpowerplantaccident[J].UltrasoundMedBiol,1997,23〔1〕:9.[43]SaterPG,SchmidtJB,HonigsmannH.Objectiveassess-mentofphotoageingeffectsusinghigh-frequencyul-trasoundinPUVA-treatedpsoriasispatients[J].BrJDermatol,2002,147〔2〕:291.[44]張淼，康春松。高頻超聲在皮膚疾病研究中的應(yīng)用[J].中國(guó)醫(yī)學(xué)影像學(xué)雜志，2004,12〔3〕:221-222.[45]HuangD,SwansonEA,LinCP,etal.Opticalcoherencetomography[J].Science,1991,254〔5035〕:1178-1181.[46]NanNan,BuPeng,GuoXin,etal.Three-dimensionalfull-rangecomplexFourierdomainopticalcoherencetomographysystemforvivoimagingofhumanskin[J].ChineseJLasers,2020,39〔7〕:0204001-0204006.[47]NelsonJS,KelyKM,ZhaoY,etal.Imagingbloodflowinhumanport-winesstaininsituandinrealtimeusingopticalDopplertomography[J].ArchDermatol,2001,137:741-744.[48]楊昆，趙國(guó)忠，梁承森，等。脈沖太赫茲波成像與連續(xù)波太赫茲成像特性的比擬[J].中國(guó)激光，2018,36〔11〕:2853-2858.[49]何明霞，陳濤。太赫茲成像技術(shù)在腫瘤診斷方面的應(yīng)用[J].腫瘤，2020,32〔12〕:1039-1042.[50]WoodwardRM,ColeBE,WalaceVP,etal.Terahertzpulseimaginginreflectiongeometryofhumanskincancerandskintissue[J].PhysicsinMedicineandBi-ology,2002,47:3853.[51]PickwelE,ColeBEfitzgeraldAJ,etal.Invivostudyofhumanskinusingpulsedterahertzradiation[J].PhysMedBiol,2004,49:1595.[52]WoodwardRM,WalaceVP.Terahertzpulseimagingofexvivobasalcelcarcinoma[J].JournalofInvestigDermatol,2003,120:72-78.[53]WoodwardRM,ColeB,WalaceVP,etal.Terahertzpulseimagingofin-vitrobasalcelcarcinomasamples[J].LasersandElectro-Optics,2001:329-330.[54]WalaceVP,FitzgeraldAJ,ShankarS,etal.Terahertzpulsedimagingofbasalcelcarcinomaexvivoandinvivo[J].BritishJournalofDermatology,2004,151〔2〕:424-432.[55]BrownER,TaylorZD,TewariP,etal.THzimagingofskintissue-Exploitingthestrongreflectivityofliquidwa-ter[J].InfraredMilimeterandTerahertzWaves,201835thInternationalConferenceon,2018:1-2.[56]何明霞，陳濤。太赫茲科學(xué)技術(shù)在生物醫(yī)學(xué)中的應(yīng)用研究[J].電子測(cè)量與儀器學(xué)報(bào)，2020,26〔6〕:471-483.[57]SunT,DieboldGJ.Generationofultrasonicwavesfromalayeredphotoacousticsource[J].Nature,1992.355〔6363〕:806-808.[58]張建英，謝文明，曾志平，等。光聲成像技術(shù)的最新進(jìn)展[J].中國(guó)光學(xué)，2018,4〔2〕: