Wang Liyun, Yan Feng, Yang Yujia, Xiang Xi, Qiu Li
Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China.
Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China; Laboratory of Clinical Ultrasound Imaging Drug, West China Hospital of Sichuan University, Chengdu, China.
Ultrasound Med Biol. 2017 Jul;43(7):1339-1347. doi: 10.1016/j.ultrasmedbio.2017.02.009. Epub 2017 Apr 28.
The purpose of this study was to evaluate the usefulness of ultrasound shear-wave elastography (US-SWE) in characterization of localized scleroderma (LS), as well as in the disease staging. A total of 21 patients with 37 LS lesions were enrolled in this study. The pathologic stage (edema, sclerosis or atrophy) of the lesions was characterized by pathologic examination. The skin elastic modulus (E-values including E, E, E and E) and thickness (h) was evaluated both in LS lesions and site-matched unaffected skin (normal controls) using US-SWE. The relative difference of E-values (E) was calculated between each pair of lesions and its normal control for comparison among different pathologic stages. Of the 37 LS lesions, 2 were in edema, 22 were in sclerosis and 13 were in atrophy. US-SWE results showed a significant increase of skin elastic modulus and thickness in all lesions (p < 0.001 in sclerosis and p < 0.05 in atrophy) compared with the normal controls. The measured skin elastic modulus and thickness were greater in sclerosis than in atrophy. However, once normalized by skin thickness, the atrophic lesions, which were on average thinner, appeared significantly stiffer than those of the sclerosis (normalized E: an increase of 316.3% in atrophy vs. 50.6% in sclerosis compared with the controls, p = 0.007). These findings suggest that US-SWE allows for quantitative evaluation of the skin stiffness of LS lesions in different stages; however, the E-values directly provided by the US-SWE system alone do not distinguish between the stages, and the normalization by skin thickness is necessary. This non-invasive, real-time imaging technique is an ideal tool for assessing and monitoring LS disease severity and progression.
本研究旨在评估超声剪切波弹性成像（US-SWE）在局限性硬皮病（LS）特征描述及疾病分期中的应用价值。本研究共纳入21例患者的37个LS病灶。通过病理检查确定病灶的病理分期（水肿、硬化或萎缩）。使用US-SWE评估LS病灶及其部位匹配的未受累皮肤（正常对照）的皮肤弹性模量（E值，包括E、E、E和E）和厚度（h）。计算每个病灶与其正常对照之间E值的相对差异（E），以比较不同病理分期。在37个LS病灶中，2个处于水肿期，22个处于硬化期，13个处于萎缩期。US-SWE结果显示，与正常对照相比，所有病灶的皮肤弹性模量和厚度均显著增加（硬化期p < 0.001，萎缩期p < 0.05）。测量的皮肤弹性模量和厚度在硬化期大于萎缩期。然而，一旦通过皮肤厚度进行标准化，平均较薄的萎缩性病灶显得比硬化性病灶明显更硬（标准化E：与对照相比，萎缩期增加316.3%，硬化期增加50.6%，p = 0.007）。这些发现表明，US-SWE能够对不同阶段LS病灶的皮肤硬度进行定量评估；然而，仅由US-SWE系统直接提供的E值无法区分各阶段，需要通过皮肤厚度进行标准化。这种非侵入性的实时成像技术是评估和监测LS疾病严重程度及进展的理想工具。
