Abstract
sBackgroundUltrasound 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.MethodsA 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.ResultsCompared 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).ConclusionsUltrasound is a reliable tool for quantifying skin involvement in SSc. Ultrasound-measured skin thickness showed good agreement with histological skin thickness.
Highlights
IntroductionFew studies have assessed the criterion validity of skin ultrasound in systemic sclerosis (SSc)
Ultrasound is a useful tool to evaluate and quantify skin lesions
Compared with controls, ultrasound-measured skin thickness and skin stiffness were significantly higher in patients with systemic sclerosis (SSc) (p < 0.001) and even higher in those with diffuse cutaneous SSc (dcSSc)
Summary
Few studies have assessed the criterion validity of skin ultrasound in systemic sclerosis (SSc). Systemic sclerosis (SSc) is an autoimmune disease characterized by progressive fibrosis affecting the skin and internal organs [1]. Skin sclerosis is almost a universal manifestation of SSc, with more than 90% of patients being affected, leading to decreased mobility, flexion contracture, and severe functional impairment [1, 2]. Modified Rodnan skin score (mRSS), which assesses skin thickness based on palpation at 17 body sites, is commonly used to semi-quantify the extent and severity of skin involvement in SSc [6]. The skin score has been proved to be well correlated with the histological extent of skin fibrosis, and being widely adopted in both routine care and clinical trials [7, 8]. Certain defects still exist, including substantial inter-observer variability, relatively low sensitivity to subtle changes, probably poor clinical trial discrimination, and incompetence in distinguishing between thickened, hardened, and tethered skin [9, 10]
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