Ultrasound Elastography Assessment of Skin Involvement in Systemic Sclerosis: Lights and Shadows

Abstract

Objective. To assess skin elasticity in systemic sclerosis (SSc) by using a new imaging modality, ultrasound elastography (UE). Methods. Our study included 18 consecutive patients with SSc and 15 healthy controls. Modified Rodnan skin score, physical examination, and assessment of organ involvement were performed. UE was carried out on the middle forearm and on the fingers of the dominant arm. The echo signals recorded in real time during freehand operations of probe compression and relaxation produced images representing tissue elasticity, consisting of translucent colored bands superimposed on the B-mode ultrasonographic images. The color scale varied within a large band spectrum from red, indicative of soft and highly elastic tissue, to blue, which denoted hard and barely elastic tissue. Results. On the forearm of all patients, UE showed a homogeneous blue area corresponding to the dermis visualized in a B-mode ultrasonographic image; in controls, a blue pattern was never detected and a predominance of green with sporadic areas of pale blue was observed. At sequential evaluations, UE of fingers produced inconstant and changeable colored areas. Conclusion. The imaging pattern observed in the forearm of patients with SSc may represent the reduction of strain in the dermis clue to loss of elasticity. The variable pattern obtained by finger evaluation demonstrated that UE can assess skin involvement in SSc only in those areas where the dermis is known to be thicker and where the bone hyperreflection is minimal. Further studies are needed to confirm our results and determine the validity of this new imaging modality. (First Release June 15 2010; J Rheumatol 2010;37: 1688-91: doi:10.3899/jrheum.090974

Value of Ultrasound Elastography in Assessment of Enlarged Cervical Lymph Nodes

“…Lesions that present score 1 or 2 are classified as probably benign, while score 3 and 4 are indicative of probable malignancy (Furukawa et al, 2007;Iagnocco et al, 2010). Another kind of UE evaluation methods was the SR of neck muscle to cervical lymph node.…”

“…On the elastogram, soft areas usually appear red or yellow and hard areas appear blue. UE has been used on several organs: breast (Itoh et al, 2006;Thomas et al, 2006), thyroid (Lyshchik et al, 2005), prostate (Taylor et al, 2005), liver (Friedrich-Rust et al, 2007;Thomas et al, 2007) and skin (Iagnocco et al, 2010). But on cervical LNs, there were few researches, such as Lyshchik et al (2007), Farzana Alam et al (2008) and Rong Tan et al (2010).…”

Low Frequency Ultrasonography in Plaque-Type Morphea

“…Aynı çalışmada lokalize sklerodermada USG incelemenin duyarlılığı %99, spesifitesi ise %100 olarak bildirilmiştir (6). Son olarak 6 morfealı çocuk olguda USG'nin lezyon takibindeki faydaları öne sürülmüştür (13). Tedaviye yanıtın takibinde kullanılabileceği gibi dermatolojik lezyonlarda preoperatif dönemde lezyon yayılımı, bileşimi, doku perfüzyonu ve ekstralezyonel matriks dokunun özellikleri ile ilgili veriler sağlamaktadır.…”

Skin imaging in systemic sclerosis

“…In patients with SSc, the first investigation of the role of US elastography was reported by Iagnocco and coworkers in 2010 (33). Their study included 18 patients with SSc, with or without clinically detectable skin involvement.…”