Initial evaluation of an ultrasound measure for assessing the activity of skin lesions in juvenile localized scleroderma

Li, S. C.; Liebling, Melissa S.; Haines, Kathleen A.; Weiss, Jessika; Prann, A.

doi:10.1002/acr.20407

Cited by 75 publications

(55 citation statements)

References 23 publications

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“…Elastografi geleneksel B-Mod görüntüleme ile doku elastisitesi ve sertliğinin renkli grafik temsilinden ibaret yeni bir yardımcı gerçek zamanlı USG görüntüleme tekniğidir (14). Elastografi USG probunun yarattığı eksternal güç uygulaması altında dokunun distorsiyon derecesini ölçerek tahmini doku sertliğini veren yeni bir dinamik USG yöntemidir.…”

Section: Discussionunclassified

“…Vaskülarite ve ekojenite parametrelerinin morfea aktivitesini belirlemede en sensitif ve spesifik parametreler olduğu daha önceden rapor edilmiş ise de çalışmamızda deri kalınlığı ve elastisitede normal deriye oranla farklılıklar saptanmıştır (12). Günümüzde 14-MHz (düşük frekanslı) USG tekniği dokuda Önceki çalışmalarda karaciğer ve tiroid gibi birçok dokuda uygulanan elastografik değerlendirme deri lezyonlarında da birkaç çalışmada uygulanmıştır (14,16). Önceki çalışmalarda kalitatif değerler elde edilmiş olup incelenen dokulardaki gerginlik, yumuşak dokular kırmızı, sert dokular mavi olacak şekilde renk haritaları çıkarılarak değerlendirilmiştir (14,16).…”

Section: Discussionunclassified

“…Günümüzde 14-MHz (düşük frekanslı) USG tekniği dokuda Önceki çalışmalarda karaciğer ve tiroid gibi birçok dokuda uygulanan elastografik değerlendirme deri lezyonlarında da birkaç çalışmada uygulanmıştır (14,16). Önceki çalışmalarda kalitatif değerler elde edilmiş olup incelenen dokulardaki gerginlik, yumuşak dokular kırmızı, sert dokular mavi olacak şekilde renk haritaları çıkarılarak değerlendirilmiştir (14,16). Biz ilk defa germe elastografi ile lezyon ve karşılaştırılan normal dokulardaki elastisite indekslerini ve elastisite oranlarını semi-kantitatif olarak değerlendirdik.…”

Section: Discussionunclassified

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Low Frequency Ultrasonography in Plaque-Type Morphea

Balevi¹,

Eren²,

Üstüner³

et al. 2017

tdd

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Amaç: Düşük frekanslı ultrasonografik incelemenin lokalize sklerodermada deri tabakalarını ve dokuların perfüzyon paternlerini belirleyen başarılı bir yardımcı teknik olduğu düşünülmektedir. Histopatolojik olarak morfea tanısı olan olgularda lezyonlu derinin kalınlığı, elastisitesi, ekojenitesi ve vaskülaritesi gibi temel parametrelere bakılarak düşük frekanslı ultrason tekniğinin klinik takipteki rolünün belirlenmesi amaçlanmıştır. Objective: Low frequency ultrasonographic examination is thought to be a successful adjuvant technique for determination of skin layers and tissue perfusion patterns in localized scleroderma. We aimed to identify the role of this technique in the clinical follow-up via investigation of basic parameters such as skin thickness, elasticity, echogenicity and vascularity in patients diagnosed with morphea by histopathology. Methods: Thirty-five plaque lesions of nineteen patients with morphea and symmetric, uninvolved cutaneous areas were compared by ultrasound in terms of mean skin thickness, elasticity index and elasticity ratio. The associations between the skin thickness and thickness score, elasticity score and elasticity index, echogenicity score and vascularity score were investigated in all tissue levels. Results: Of the morphea lesions, while the mean dermal skin thickness and dermal elasticity ratio were decreased compared to normal skin, the dermal vascularity was solely increased with an increase of the tissue thickness. Only the mean skin thickness was found to be significantly lower compared to the normal skin areas in the hypodermis of the morphea plaque lesions. Conclusion: Low frequency ultrasound can be used as an effective, adjuvant technique in the clinical follow-up of morphea plaque lesions in the levels of dermis and hypodermis.

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Section: Discussionunclassified

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Low Frequency Ultrasonography in Plaque-Type Morphea

Balevi¹,

Eren²,

Üstüner³

et al. 2017

tdd

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“…Monitoring dermal thickness has been used as an outcome measure in several treatment trials and the decrease in dermal thickness has usually occurred together with clinical improvement [71], even though another study has not found correlation between skin thickness and lesion activity [72]. Some authors suggest that deeper LS lesions may be better evaluated with lower frequency US (variable frequency array transducers), which can show proper thinning of the hypodermis and/or muscle layers.…”

Section: Sclerodermamentioning

confidence: 98%

“…This must be useful to recognize active morphea lesions, which seem to show increased blood flow and increased subcutaneous echogenicity [72,78]. Studies comparing sonographic findings with the recently developed modified localized scleroderma skin severity index (mLoSSI) [79] are still lacking, even though this new index has not been compared with histology yet.…”

Section: Sclerodermamentioning

confidence: 99%

Ultrasound and dermatology: basic principles and main applications in dermatologic research

Bagatin

Caetano

Soares

2013

Expert Review of Dermatology

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Ultrasound imaging has been increasingly used in dermatologic research over the past four decades. This paper aims to review its use as a disease severity and treatment efficacy assessment tool, with emphasis on the past five years. Quantitative parameters such as skin thickness, overall echogenicity, echogenicity distribution, dermal-subcutaneous interface length or area are used. The authors review skin aging, cellulite, striae, fillers, scleroderma, hypertrophic scar, wounds and psoriasis studies, and discuss correlation between sonographic findings and clinical assessment and/or validated scores. Data are still insufficient to support ultrasound imaging use as an unique efficacy assessment method in a trial, but favor that it is a valuable adjuvant assessment tool that brings objectiveness to subjective clinical assessment. Further studies and technology improvement will expand its applications in dermatology. KEYWORDS: dermatology • lipodystrophy • localized scleroderma • psoriasis • scars • skin aging • systemic scleroderma • ultrasonography • ultrasound biomicroscopy • wound healingUltrasonography has been used in medicine for more than 50 years and is one of the most frequently applied diagnostic tools. It is a noninvasive and non-ionizing method with a relatively low cost when compared with computed tomography and scintigraphic scanning techniques [1]. Alexander and Miller were the pioneers in the use of ultrasound (US) in dermatology since 1979 [2]. They demonstrated a15 MHz one-dimensional (A-scan) US equipment that measured the skin thickness with similar accuracy to the radiological techniquethe most accurate non-invasive method so far. Three years later its reproducibility and validation was shown, although the skin thickness determined in vitro was found to be greater than when in vivo determinations were made, probably due to the release of in vivo tension within the dermis [3].The 20 MHz bidimensional (B-scan) US units were first available in the 1980s, thanks to the emergence of mechanical transducers that enabled the cross-sectional imaging of the skin [4]. From then on, studies have evaluated its application in a range of skin conditions with different aims: disease severity and treatment response evaluation, adjunct diagnostic tool, tumor dimensions assessment and other uses. This paper reviews the state of art of US imaging in dermatologic research, focusing on its role as a disease severity and/or treatment efficacy assessment tool, with emphasis on the most frequently reported applications over the past five years. The use of US as a diagnostic tool or for tumor dimension assessment is not discussed here. ConceptsUS is a mechanically propagated wave with frequency above 20 kHz -the upper frequency limit of human hearing [5]. US transducers are made out of piezoelectric materials that generate acoustic energy when a voltage is applied to them. The US beam is transferred as a pulse from the transducer to the adjacent fluid or tissue and propagates as a wave, which can be reflected or refract...

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Responsiveness to Change of the Morphea Activity Measure in Pediatric Patients

García-Romero,

Brandling-Bennett,

Pope

et al. 2024

JAMA Dermatol

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ImportanceDetecting activity of morphea can be complex but is crucial for adequate treatment and outcome assessment. The Morphea Activity Measure (MAM) was recently validated, but its responsiveness to change in disease activity has not been studied.ObjectiveTo evaluate the internal and external responsiveness of MAM to changes in disease activity in pediatric patients.Design, Setting, and ParticipantsThis multicenter prospective, longitudinal prognostic study was performed from October 2021 to January 2023 at 4 pediatric referral centers in North America. Consecutive pediatric patients with morphea who were available for data collection at baseline and at a follow-up visit at least 3 months later were studied.ExposurePatient demographics, clinical characteristics, and measurements of disease activity collected at baseline and the subsequent visit.Main Outcome and MeasuresResponsiveness of MAM to disease activity according to the modified Localized Scleroderma Severity Index (mLoSSI), the Physician Global Assessment (PGA), and a patient and parent global assessment (PtGA) was analyzed using mean and percentage change, standardized effect size, and standardized response mean (SRM) from baseline to follow-up 3 or more months later. Differences between patients whose activity improved vs did not improve were evaluated using the Mann-Whitney U test. The correlation between percentage change in MAM score and mLoSSI, the PGA, and the PtGA was calculated using Spearman rank correlation.ResultsA total of 43 patients (mean [SD] age at onset, 7.11 [3.18] years; 26 [60.5%] female) were included. The mean change and percentage change in MAM score were significantly larger in those whose disease activity improved by the PGA (mean: −18.75 [95% CI, −31.92 to −5.57] vs 2.73 [95% CI, −1.97 to 7.45]; percentage: −108.08% [95% CI, −155.21% to −60.95%] vs −24.11% [95% CI, −81.22% to 32.99%]) and by mLoSSI (mean: −24.15 [95% CI, −41.89 to −6.41] vs −1.30 [95% CI, −8.50 to 5.70]; percentage: −172.06% [95% CI, −263.68% to −80.45%] vs −21.57% [95% CI, −48.13% to 4.97%]) than in those whose activity did not change. The SRM of MAM was significantly different between groups for both measures; the responsiveness was large in those whose activity decreased by the PGA (−0.75 [95% CI, −1.29 to −0.22]) and mLoSSI (−0.97 [95% CI, −1.69 to −0.25]) and none to small in those whose activity did not change by the PGA (0.11 [95% CI, −0.08 to 0.30]) or mLoSSI (−0.05 [95% CI, −0.34 to 0.23]). Percentage change in MAM score correlated strongly and significantly with change in mLoSSI (ρ = 0.69; P &lt; .001) and PGA (ρ = 0.65; P &lt; .001), but there was no correlation with change in the PtGA (ρ = 0.26; P = .09).Conclusions and RelevanceIn this prognostic study, MAM was found to be internally and externally responsive to changes in disease activity. Further evaluation in mixed cohorts of all ages and specialties is needed.

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Initial evaluation of an ultrasound measure for assessing the activity of skin lesions in juvenile localized scleroderma

Cited by 75 publications

References 23 publications

Low Frequency Ultrasonography in Plaque-Type Morphea

Low Frequency Ultrasonography in Plaque-Type Morphea

Ultrasound and dermatology: basic principles and main applications in dermatologic research

Responsiveness to Change of the Morphea Activity Measure in Pediatric Patients

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