Should We Scan Hidradenitis Suppurativa Patients? A Systematic Review of Radiologic Findings

Abstract

OBJECTIVE To bring awareness and close gaps between dermatologists and radiologists about the contribution of imaging techniques for diagnosis, treatment, and follow-up of hidradenitis suppurativa (HS). DATA SOURCES Investigators searched the PubMed database for articles on HS and radiology techniques. STUDY SELECTION Databases were searched up to December 2018. The query retrieved 257 publications, of which 103 were unique; of these, 7 were inaccessible. From the remaining 96, 33 were irrelevant (did not discuss HS lesion features). After applying the inclusion criteria, 63 studies were relevant to this study. DATA EXTRACTION A standardized form was constructed to extract data from eligible studies by two independent authors. DATA SYNTHESIS Imaging techniques are significant and useful tools in HS management. Imaging should be carried out to evaluate disease severity, subclinical features, treatment success, and intraoperative patient assessment. Providers should consider nonconventional radiology techniques, which are underused in clinical management of HS. Further, dermatology and radiology require a shared terminology of disease features to better understand patient status. CONCLUSIONS Publications on HS lesion imaging have increased over the years. Imaging techniques have proven useful for determining HS severity and treatment effectiveness, as well as intraoperative patient assessment. These authors strongly recommend the use of these techniques in routine clinical practice for patients with HS.

A Pilot Real-World Study of Ultrasonography Findings of Hidradenitis Suppurativa in Indian Patients and Its Diagnostic and Therapeutic Implications

“…Its major limitation of USG in HS is its inability to visualize lesions less than 0.1 mm 32 and the difficulty in differentiating between acne, pilonidal sinus, and folliculitis lesions. 13,33 This seems consistent with our series in which a patient diagnosed with folliculitis and acne vulgaris showed features identical to HS on USG. Other limitations include impediments in imagining extrasphincteric and suprasphincteric extensions attributable to poor beam penetration.…”

“…Other limitations include impediments in imagining extrasphincteric and suprasphincteric extensions attributable to poor beam penetration. 13 We encountered this limitation while evaluating perianal lesion in a suspect HS patient, although we could rule out HS using USG. Extensive fibrosis has also been shown to reduce the utility of USG, even intraoperatively.…”

“…A multimodal etiology including genetic (mutations in the Notch and γsecretase pathways and the inflammasome), dysfunctional cutaneous microbiome and environmental factors like diet, smoking, obesity, hormonal factors, and mechanical stress have been postulated to play a role in disease development. [6][7][8][9][10][11][12] The first attempt at radiological imaging of HS was via mammography in 1990, 13 while the use of ultrasonography (USG) in HS has been more recent. USG evaluation of the skin was first used by Alexander in 1979 to measure cutaneous thickness.…”

The Role of FDG-PET in the Evaluation of Hidradenitis Suppurativa: A Systematic Review

“…The last two articles comprised comprehensive reviews on the usefulness of various radiological techniques in diagnosing and managing HS. The first review determined that CT imaging was considered inferior to PET imaging for HS; however, PET had limitations in visualizing anatomic localization and lesion extensions [37]. The second review concluded that there was no apparent advantage in imaging HS lesions with FDG-PET/CT scans, as these scans can result in false positives when attempting to identify metastatic cancer [38].…”

“…However, no standardized method currently exists for identifying subclinical lesions. The evidence powering this review comprises 63 studies discussing HS and various radiologic imaging techniques, and includes randomized controlled trials, systematic reviews, books, observational studies, case reports, and case series [37].…”