Three-Dimensional Imaging: The Future Of Reflectance Confocal Microscopy

Background: Reflectance confocal microscopy (RCM) is an innovative, noninvasive technology that captures in-vivo images of the skin. The Vivascope 1500 (Caliber ID, Rochester, NY) is used to acquire 2-dimensional block, stack, and live video images to accurately diagnose benign, cancerous, and inflammatory skin conditions. Stack images are taken in 0.5 × 0.5 mm frames, with z-depth slices as thin as 1.5 μm. This presents the opportunity to reconstruct the 2D images into a 3D projection. When a patient presented to our clinic with graft-vs-host disease, RCM was performed for monitoring purposes. Using ImageJ software provided by the National Institutes of Health, we compiled the stack images and isolated a multinucleated, epidermal giant cell. Here, we present our reconstruction of RCM 2D stack images into an interactive 3D model. This model both showcases the entire periphery of the cell, and allows depth visualization into its encased structures. Particularly, 2 nuclei are distinctly shown in this giant cell. Our work holds the potential to influence the future of RCM and dermatopathology, as it demonstrates the advanced imaging capabilities that are possible without invasive procedures.