Skin imaging in systemic sclerosis

Kang, Tae Goo; Abignano, Giuseppina; Lettieri, Giovanni; Wakefield, Richard J.; Emery, Paul; Galdo, Francesco Del

doi:10.5152/eurjrheumatol.2014.036

Cited by 19 publications

(18 citation statements)

References 34 publications

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“…With a progress in diagnostic imaging, researchers focused their interest on the applicability of ultrasonography for the evaluation of the severity and extent of skin fibrosis in SSc [13,14]. The ultrasound elastography is an ultrasonographic technique suitable for the quantification of skin fibrosis, indicating not the thickening of the skin, but its strain-a parameter, which can be considered as a more detailed marker of a change of the skin structure [15].…”

Section: Introductionmentioning

confidence: 99%

Applicability of shear wave elastography for the evaluation of skin strain in systemic sclerosis

Sobolewski

Maślińska

Zakrzewski³

et al. 2020

Rheumatol Int

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The assessment of skin fibrosis is vital for the diagnosis and monitoring of treatment in the systemic sclerosis (SSc)-a severe autoimmune disease. The elastography is a technique of skin fibrosis assessment through the evaluation of skin strain. We compared the efficacy of the shear wave elastography (SWE) and commonly used modified Rodnan skin score (RSS) in skin fibrosis assessment in SSc. The study included 40 SSc patients and 28 healthy individuals, with the exclusion of individuals with other skin/autoimmune diseases. Skin thickness using RSS and skin strain using SWE were assessed in the same 20 body localizations. Subjects' informed consent and the bioethics committee approval were obtained. Elastographic skin strain correlated positively with both partial and overall RSS values, with strong positive correlation (r ≥ 0.75) for hands and fingers localizations in particular. In SSc patients with normal RSS values, the elastographic strain was significantly higher than in healthy controls. Elastographic strain of fingers' skin evaluated in SWE is highly accurate for distinguishing SSc patients (sensitivity 0.897-0.923, specificity 0.929-0.964, positive predictive value 0.946-0.973, negative predictive value 0.867-0.900). ESW results are substantially more reproducible than those of RSS examination (intraclass correlation coefficients: 0.987 vs. 0.941). The shear wave elastography is more reproducible and has higher sensitivity than RSS in the evaluation of skin condition in SSc, especially in case of changes non-detectable on physical evaluation, indicating it might become a useful tool in SSc diagnosis.

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Section: Introductionmentioning

confidence: 99%

Applicability of shear wave elastography for the evaluation of skin strain in systemic sclerosis

Sobolewski

Maślińska

Zakrzewski³

et al. 2020

Rheumatol Int

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“…Suliman et al (2018) recently characterized skin ulcers by means of the ultrasound technique (grayscale and Doppler study) [21]. Studies have shown reliable results with good inter-/intra-observer variability of this imaging method [22]. While the current study investigated a number of biomechanical indices in patients with scleroderma and made comparisons with age-and BMI-matched healthy subjects, it has some limitations.…”

Section: Discussionmentioning

confidence: 97%

Biomechanical properties of heel-pad and metatarsal head soft tissue and foot ulcers in patients with systemic sclerosis – a case control study

et al. 2019

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Systemic sclerosis is a chronic connective tissue disease accompanied with skin and inner organ fibrosis and increased risk of foot ulcers. Biomechanical indexes (soft tissue thickness and compressibility) could affect the risk of this phenomenon. This study aimed to assess the heel pad and first metatarsal head soft-tissue thickness and compressibility index in scleroderma patients with and without foot ulcers and compare them with those of healthy individuals. Heel pad thickness in standing (loaded) and lying (unloaded) positions was measured in 40 scleroderma patients (diagnosed based on American College of Rheumatology classification criteria) by means of lateral foot radiography. The compressibility index was measured as the ratio of loaded to unloaded thickness. Also, soft-tissue thickness of the first metatarsal head was measured with ultrasound. Results were compared with 40 healthy controls of matched age and body mass index. Among 40 scleroderma patients (36 females, 4 males) with a mean age of 45 (±12) years, a mean body mass index of 25.5 (±4), and a mean disease duration of 10 years (±9.6), 8 (20%) patients had foot ulcers. Heel pad thickness (P value= 0.03) and the compressibility index (P value= 0.005) in the dominant side and the metatarsal head soft-tissue thickness on both sides (P value<0.0001) had significant differences with the control group. When comparing patients with and without foot ulcers, the soft-tissue thickness in both heels was significantly different (P value 0.01 for the right side and 0.007 for the left side). Thicknesses were negatively related to, but no relationship between the compressibility index and disease duration was observed. Plantar soft-tissue thickness decreases in scleroderma patients and could be a risk factor for foot ulcers.

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“…Ultrasound imaging (UI) has been used to assess the dermal thickness (DT) and echogenicity in SSc patients, which has been validated with the site‐specific mRSS (SMRSS) performed by an experienced dermatologist . Hesselstrand et al reported moderate correlations of UI‐assessed skin thickness and an SMRSS of 0.37, 0.72 and 0.65 for the finger, hand and forearm, respectively.…”

Section: Introductionmentioning

confidence: 99%

Translational optical coherence elastography for assessment of systemic sclerosis

Liu

Assassi

Theodore

et al. 2019

Journal of Biophotonics

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Systemic sclerosis (SSc‐scleroderma) is an autoimmune disorder with high mortality rate that results in excessive accumulation of collagen in the skin and internal organs. Currently, the modified Rodnan Skin Score (mRSS) is the gold standard for evaluating the dermal thickening due to SSc. However, mRSS has noticeable inter‐ and intra‐observer variabilities as quantified by the interclass correlation coefficient (ICC: 0.6‐0.75). In this work, optical coherence elastography (OCE) combined with structural optical coherence tomography (OCT) image analysis was used to assess skin thickness in 12 SSc patients and healthy volunteers. Inter‐ (ICC: 0.62‐0.99) and intra‐observer (ICC > 0.90) assessment of OCT/OCE showed excellent reliability. Clinical assessments, including histologically assessed dermal thickness (DT), mRSS, and site‐specific mRSS (SMRSS) were also performed for further validation. The OCE and OCT results from the forearm demonstrated the highest correlation (OCE: 0.78, OCT: 0.65) with SMRSS. Importantly, OCE and OCT had stronger correlations with the histological DT (OCT: r = .78 and OCE: r = .74) than SMRSS (r = .57), indicating the OCT/OCE could outperform semi‐quantitative clinical assessments such as SMRSS. Overall, these results demonstrate that OCT/OCE could be useful for rapid, noninvasive and objective assessments of SSc onset and monitoring skin disease progression and treatment response.

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Skin imaging in systemic sclerosis

Cited by 19 publications

References 34 publications

Applicability of shear wave elastography for the evaluation of skin strain in systemic sclerosis

Applicability of shear wave elastography for the evaluation of skin strain in systemic sclerosis

Biomechanical properties of heel-pad and metatarsal head soft tissue and foot ulcers in patients with systemic sclerosis – a case control study

Translational optical coherence elastography for assessment of systemic sclerosis

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