Quantification of skin lesions using high-frequency ultrasound and shear wave elastography in port-wine stain patients: a clinical study

Abstract

Background: This study aimed to assess the different types of port-wine stain (PWS) skin lesions quantitatively using high-frequency ultrasound (US) and shear wave elastography (SWE) before and after treatment, and investigate the feasibility and application value of high-frequency US and SWE in PWSs.Methods: A total of 195 PWS patients with 238 skin lesions before treatment and 72 follow-up PWS patients with 90 skin lesions were assessed using high-frequency US and SWE. The skin lesions were divided into four groups: pink-type, purple-type, thickened-type, and nodular-type PWSs. Gray-scale US was used to observe normal skin, observe the skin changes of lesions, and assess the skin thickness. The thickened skin was calculated. Power Doppler (PD) signal grades were used to assess the skin blood signals. SW velocity (in m/s) and Young's elastic modulus (in kPa) were used to assess the stiffness of normal skin and skin lesions.The heightened SWE was also calculated. Results:The dermis hypoechogenicity, thickness of thickened skin, and skin PD signal grades were significantly higher in all PWS-type groups compared with the normal-skin group (all P<0.05). The thickened skin and skin PD signal grades in the nodular-type and thickened-type group were significantly thicker and higher than those in the pink-type and purple-type group (all P<0.05). The PD signal grades in the purple-type was significantly higher than that in the pink-type group (P<0.05). All SWE values of PWS lesions were significantly higher in the transverse section than those in the longitudinal section (all P<0.05). The differences in heightened E mean , E min , C mean , and C min between each PWS group and the normal-skin group were not significant. The heightened E max and C max in the nodular-type PWS group was significantly higher than those in the normal-skin group and pinktype, and purple-type PWS groups (all P<0.05). The heightened E max and C max were significantly higher in the thickened-type PWS group than those in the normal-skin group (all P<0.05). In the evaluation of therapeutic effects, the ratio of dermis hypoechogenicity in pink-type lesions significantly decreased, and thickened skins in all groups were significantly thinned (all P<0.05). The differences of PD signal grades, heightened E max , and C max in all groups between pre-treatment and post-treatment showed no significance.Conclusions: High-frequency US and SWE show feasibility and application values assessing PWS skin lesions. Their features include dermis hypoechogenicity, thicker skin, higher PD signal grades, higher E max , and higher C max . Thicker skin is thus the best feature for assessing therapeutic effect.

Noninvasive diagnostic techniques of port wine stain

“…Studies on PDT therapy for PWS have revealed reduced dermal thickness post-PDT therapy, and also, there was an increase in dermal density as the tissue became more compact. 13,27 However, there were no significant changes in the power Doppler signals pre-and post-treatment. 27 Similar results were observed by Haerdersdal et al when PWS lesions were treated with PDL.…”

“…13,27 However, there were no significant changes in the power Doppler signals pre-and post-treatment. 27 Similar results were observed by Haerdersdal et al when PWS lesions were treated with PDL. Thus, skin thickness can be considered as the best predictor of treatment efficacy.…”

“…Thus, skin thickness can be considered as the best predictor of treatment efficacy. 25,27 Linear hypoechoic signals indicative of significantly dilated vessels responded poorly when treated with HMME-PDT and thus could be an indicator of poor prognosis. 13 (blood perfusion units) to determine the tissue perfusion.…”

Probing elastic anisotropy of human skin in vivo with light using non-contact acoustic micro-tapping OCE and polarization-sensitive OCT

“…Indeed, the thickness of the dermis varies between 0.3 mm and 3 mm, and shear-wave propagation will be guided. Although multiple studies were performed using conventional shear wave elastography in skin [57][58][59] , only a few discussed anisotropy 60 and none (to our knowledge) considered the influence of boundaries. Ignoring these factors can lead to serious errors in moduli reconstruction due to strong frequency dispersion.…”

Probing Elastic Anisotropy of Human Skin in Vivo With Light Using Non-Contact Acoustic Micro-Tapping OCE and Polarization-Sensitive OCT

“…Indeed, the thickness of the dermis varies between 0.3 mm and 3 mm, and shear-wave propagation will be guided. Although multiple studies were performed using conventional shear wave elastography in skin [56][57][58] , only a few discussed anisotropy 59 and none (to our knowledge) considered the influence of boundaries. Ignoring these factors can lead to serious errors in moduli reconstruction due to strong frequency dispersion.…”