A preliminary study of skin ultrasound in diffuse cutaneous systemic sclerosis: Does skin echogenicity matter?

Abstract

ObjectiveTo evaluate the usefulness of skin ultrasound and acoustic radiation force impulse (ARFI) quantification in diffuse cutaneous systemic sclerosis (dcSSc).Patients and methods28 patients with dcSSc, and 15 age gender matched normal controls were recruited. Skin echogenicity, thickness, and ARFI quantification were measured by ultrasound at 17 sites corresponding to the modified Rodnan skin score (mRSS) in each participant. Compared with controls, skin echogenicity of dcSSc patients was classified into isoechoic, hypoechoic, and hyperechoic. The skin thickness, ARFI quantification and mRSS were compared between isoechoic, hypoechoic, hyperechoic and controls.ResultsIn patients with dcSSc, the skin thickness increased as the echogenicity changed on the order of isoechoic, hypoechoic and hyperechoic. ARFI quantification was significantly higher in hyperechoic than isoechoic (p<0.001). The mRSS were significantly higher in hyperechoic and/or hypoechoic than isoechoic. For isoechoic patients and healthy controls, the skin echogenicity or thickness was no significant different, however, the ARFI quantification was significantly higher in isoechoic than controls.ConclusionSkin ultrasound is feasible for assessing the skin involvement in dcSSc. Skin echogenicity correlates with skin thickness, stiffness, and mRSS. ARFI quantification may be more sensitive to detect skin changes, compared with skin echogenicity and thickness.

How much of skin improvement over time in systemic sclerosis is due to normal ageing? A prospective study with shear-wave elastography

“…In recent years, shear-wave elastography (SWE) has been investigated as a quantitative and operatorindependent tool to evaluate skin stiffness [7][8][9]. Shearwave velocity (SWV) values reflect tissue stiffness: the stiffer the tissue, the faster the shear-waves propagate.…”

How much of skin improvement over time in systemic sclerosis is due to normal ageing? A prospective study with shear-wave elastography.

“…All participants were recruited from a cross-sectional evaluation previously described elsewhere. 9 In this longitudinal study we included 21 of the original 26 patients (3 died and 2 were lost to follow-up) and, 15 of the 17 initial healthy controls (1 died, and 1 was lost to follow-up). The healthy controls were recruited among hospital staff and patient's family members, using as exclusion criteria, any diagnosis of other skin disorder (e.g.…”

How much of skin improvement over time in systemic sclerosis is due to normal ageing? A prospective study with shear-wave elastography.

“…All participants were recruited from a cross-sectional evaluation previously described elsewhere. 9 In this longitudinal study we included 21 of the original 26 patients (3 died and 2 were lost to follow-up) and, 15 of the 17 initial healthy controls (1 died, and 1 was lost to follow-up). All participants were submitted to a clinical and ultrasound evaluation at baseline and at follow-up, a median of 4.9 (0.4) years later.…”

“…In recent years, shear-wave elastography (SWE) has been investigated as a quantitative and operator-independent tool to evaluate skin stiffness. [7][8][9] Shear-wave velocity (SWV) values reflect tissue stiffness: the stiffer the tissue, the faster the shear-waves propagate. SWE may, therefore, provide a novel opportunity to objectively assess fibrosis -a crucial feature in the complex process of skin involvement in SSc.…”

“…10,11 Cross sectional studies have shown that SWV values are significantly higher in SSc patients than in controls, in almost all of the Rodnan sites. [7][8][9] Interestingly, clinically unaffected skin of patients with SSc could also be differentiated from the skin of healthy comparators. 7,8 Two previous studies have shown excellent reproducibility for SWV measurements, with inter-rater intraclass correlation coefficients (ICCs) ranging from 0.48 (phalanx) to 0.91 (upper arm).…”