Abstract
Purpose
To evaluate the technical feasibility of real-time elastography (RTE) to assess the stiffness of the skin of the peri-oral region in patients affected by systemic sclerosis (SSc).
Methods
Six female patients affected by SSc (median age = 52 years) presenting with microstomia and six healthy controls matched for age and sex underwent RTE evaluation of the peri-oral region. Two operators with different experience evaluated the stiffness of the peri-oral region placing the probe in four different positions: parasagittal left (PL), parasagittal right (PR), upper axial (UA), lower axial (LA). Color map was converted into a semi-quantitative scale in which blue = 1, green = 2 and red = 3. Thus, each subject had a variable score ranging from 4 (four positions × value = 1) and 12 (four positions × value = 3). Mann–Whitney U and k statistics were used.
Results
RTE demonstrated that the skin of the peri-oral region of patients affected by SSc was stiffer than that of controls, both overall (6;4–6 [median; 25–75th percentile] vs. 11;9–11, p < 0.001) and for each probe position (PL = 1;1–2 vs. 2;2-3, PR = 1;1–2 vs. 2;2–3, UA = 1;1–2 vs. 2;2–3; LA = 1;1–1 vs. 3;3–3, p ≤ 0.011 for all). Interobserver reproducibility was excellent both overall and for each probe position (k = 1).
Conclusion
RTE is a feasible modality to assess peri-oral region skin stiffness with excellent interobserver reproducibility. Further studies on a larger cohort of patients including more clinical data and measures are warranted to confirm our initial results.
Sommario
Obiettivo
Valutare la fattibilità dell’utilizzo dell’elastosonografia per studiare la rigidità della cute della regione periorale in pazienti affetti da sclerosi sistemica.
Metodi
Sei pazienti affette da sclerosi sistemica (età mediana = 52 anni) con microstomia e sei controlli sani appaiati per sesso ed età sono state sottoposte ad elastosonografia della regione periorale. Due operatori con differente esperienza hanno valutato l’elasticità della regione periorale con la sonda in quattro posizioni parasagittale sinistra (SX), parasagittale destra (DX), assiale superiore (AS), assiale inferiore (AI). La mappa colore è stata convertita in una scala semi-quantitativa in cui blu = 1, verde = 2 e rosso = 3. Pertanto, ogni soggetto ha avuto un punteggio totale variabile tra 4 (quattro posizioni × valore = 1) e 12 (quattro posizioni × valore = 3). Sono stati utilizzati i test U di Mann–Whitney e k di Cohen.
Risultati
L’elastosonografia ha dimostrato che la cute della regione periorale delle pazienti affette da sclerodermia è più rigida di quella dei controlli, sia globalmente (6;4–6 [mediana; 25–75th percentile] vs. 11;9–11, p < 0.001) che per ogni singola posizione (SX = 1;1–2 vs. 2;2–3, DX = 1;1–2 vs. 2;2–3, UP = 1;1–2 vs. 2;2–3; DN = 1;1–1 vs. 3;3–3, p ≤ 0.011 per tutti). La riproducibilità interosservatore è stata eccellente sia globamente che per singola posizione (k = 1).
Conclusioni
L’elastosonografia può essere eseguita nella regione periorale per valutare il grado di rigidità della cute, con eccellente riproducibilità interosservatore. Ulteriori studi che includano un campione maggiore di pazienti con dati clinici sono necessari per confermare i nostri risultati preliminari.
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Acknowledgments
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Institutional review board approval and informed patients’ consent were obtained for the present prospective study.
Conflict of interest
The authors (Paola Maria Cannaò, Valeriano Vinci, Fabio Caviggioli, Marco Klinger, Davide Orlandi, Francesco Sardanelli, Giovanni Serafini and Luca Maria Sconfienza) have no conflict of interest to disclose.
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Cannaò, P.M., Vinci, V., Caviggioli, F. et al. Technical feasibility of real-time elastography to assess the peri-oral region in patients affected by systemic sclerosis. J Ultrasound 17, 265–269 (2014). https://doi.org/10.1007/s40477-014-0119-0
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DOI: https://doi.org/10.1007/s40477-014-0119-0