Ultrasonography for the Assessment of Skin in Systemic Sclerosis: A Systematic Review

Santiago, Tânia; Santiago, Mariana; Ruaro, Barbara; Salvador, Maria João; Cutolo, Maurizio; Silva, José António Pereira da

doi:10.1002/acr.23597

Cited by 44 publications

(84 citation statements)

References 32 publications

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“…On the whole, these findings support the use of skin ultrasound for SSc patients in clinical practice, and potentially in clinical trials. Despite increasing evidence on ultrasound skin assessment in SSc, standardized methodology has not been established and heterogeneity still exists in terms of which skin layers to be examined [17]. Histologically speaking, not only the dermis but also the epidermis was found to be significantly thickened in clinically involved scleroderma skin [7,18].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound assessment of skin thickness and stiffness: the correlation with histology and clinical score in systemic sclerosis

et al. 2020

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Background: Ultrasound is a useful tool to evaluate and quantify skin lesions. Few studies have assessed the criterion validity of skin ultrasound in systemic sclerosis (SSc). The aims of the study were to investigate skin thickness and stiffness using ultrasound and shear wave elastography (SWE) in SSc and to validate skin ultrasound measurements against histological skin thickness. Methods: A total of 22 patients with diffuse cutaneous SSc (dcSSc), 22 with limited cutaneous SSc (lcSSc), and 22 age-and gender-matched healthy controls were enrolled. Skin thickness and stiffness were measured by B-mode ultrasound with SWE imaging on the bilateral fingers and hands. Additional ultrasound evaluation was carried out in 13 patients (9 dcSSc and 4 lcSSc) on their dorsal forearms, followed by skin biopsy conducted in the same skin areas. Correlations between ultrasound measurements and histological skin thickness and modified Rodnan skin score (mRSS) were investigated using Spearman's correlation. Results: Compared with controls, ultrasound-measured skin thickness and skin stiffness were significantly higher in patients with SSc (p < 0.001) and even higher in those with dcSSc. No clear correlation could be established between ultrasound-determined skin thickness and stiffness at the same site. Ultrasound-measured skin thickness correlated well with histological skin thickness (r = 0.6926, p = 0.009). A weaker association was also observed between histological skin thickness and local mRSS (r = 0.5867, p = 0.050). Conclusions: Ultrasound is a reliable tool for quantifying skin involvement in SSc. Ultrasound-measured skin thickness showed good agreement with histological skin thickness.

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Section: Discussionmentioning

confidence: 99%

Ultrasound assessment of skin thickness and stiffness: the correlation with histology and clinical score in systemic sclerosis

et al. 2020

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“…[19] More recently, SWE per se has received some attention in those conditions where soft tissue stiffness is a key part of the pathology. For example, SWE has been utilised in systemic sclerosis (SSc) where significantly higher SWE values have been noted in the forearm of SSc patients, [20] suggesting a complementary role for SWE in skin evaluation in SSc. In Sjogrens syndrome (SS) SWE has promising utility for the evaluation of salivary glands.…”

Section: Introductionmentioning

confidence: 99%

Differences in Achilles tendon stiffness in people with gout.

Otter

Payne

Jones

et al. 2020

Preprint

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Background Chronic gout is associated with weaker foot/leg muscles, altered gait patterns and on-going foot pain. Inflammation associated with gout may change tissue elasticity and ultrasound imaging (US) utilising shear wave elastography (SWE) offers a non-invasive method of quantifying these changes in tendon stiffness and SWE findings have not previously been reported in individuals with gout. We sought to determine differences in Achilles tendon stiffness in people with chronic gout compared to controls (non-gout). Methods A cross sectional study comparing 24 people with gout and 26 age/sex-matched controls. Clinical and demographic data were collated and US imaging used to determine tendon thickness, presence of gouty tophi and/or aggregates and levels of angiogenesis. Ten shear wave elastography (SWE) measures were taken along a longitudinal section of the mid-point of the Achilles tendon bilaterally. Prior to data collection, intra-observer error was good (0.75). Data were summarised using descriptive statistics and a repeated measures ANCOVA was used to compare SWE measures between the two groups for the left and right foot separately after accounting for Body Mass Index (BMI). Results: A small proportion of those with gout presented with intra-tendon aggregates and/or intra-tendon tophi in one or both tendons. There was no statistically significant difference in tendon thickness between groups. Neo-vascularity was present in a third of gout participants. SWE findings demonstrated significantly reduced tendon stiffness in those with gout compared to controls: right Achilles mdiff =1.04 (95% CI (0.38 to 1.7) p=0.003 and left Achilles mdiff = 0.7 (95% CI 0.09 to 1.32) p=0.025. Conclusion: Subjects with chronic gout show significantly reduced Achilles tendon stiffness compared to non-gout controls. From a clinical standpoint, our findings were similar to SWE measurements in subjects with Achilles tendinopathy and who did not have gout.

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“…With the superior spatial resolution of OCT, optical coherence angiography has promising potential to image microangiopathy severity in SSc patients since SSc also has a substantial vasculopathic component . However, previous work utilizing both OCT‐ and UI/UE‐based modalities lacks criterion validation , which requires correlating measurements with histologically measured DT from skin biopsies .…”

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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Ultrasonography for the Assessment of Skin in Systemic Sclerosis: A Systematic Review

Cited by 44 publications

References 32 publications

Ultrasound assessment of skin thickness and stiffness: the correlation with histology and clinical score in systemic sclerosis

Ultrasound assessment of skin thickness and stiffness: the correlation with histology and clinical score in systemic sclerosis

Differences in Achilles tendon stiffness in people with gout.

Translational optical coherence elastography for assessment of systemic sclerosis

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