Tang Yuanjiao, Cheng Shan, Tang Xue, Guo Ruiqian, Zhang Lingyan, Qiu Li
Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China.
Department of Ultrasound, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China.
Ann Transl Med. 2019 Dec;7(24):803. doi: 10.21037/atm.2019.12.57.
This study aimed to assess the different types of port-wine stain (PWS) skin lesions quantitatively using high-frequency ultrasound (US) and shear wave elastography (SWE) before and after treatment, and investigate the feasibility and application value of high-frequency US and SWE in PWSs.
A total of 195 PWS patients with 238 skin lesions before treatment and 72 follow-up PWS patients with 90 skin lesions were assessed using high-frequency US and SWE. The skin lesions were divided into four groups: pink-type, purple-type, thickened-type, and nodular-type PWSs. Gray-scale US was used to observe normal skin, observe the skin changes of lesions, and assess the skin thickness. The thickened skin was calculated. Power Doppler (PD) signal grades were used to assess the skin blood signals. SW velocity (in m/s) and Young's elastic modulus (in kPa) were used to assess the stiffness of normal skin and skin lesions. The heightened SWE was also calculated.
The dermis hypoechogenicity, thickness of thickened skin, and skin PD signal grades were significantly higher in all PWS-type groups compared with the normal-skin group (all P<0.05). The thickened skin and skin PD signal grades in the nodular-type and thickened-type group were significantly thicker and higher than those in the pink-type and purple-type group (all P<0.05). The PD signal grades in the purple-type was significantly higher than that in the pink-type group (P<0.05). All SWE values of PWS lesions were significantly higher in the transverse section than those in the longitudinal section (all P<0.05). The differences in heightened E, E, C, and C between each PWS group and the normal-skin group were not significant. The heightened E and C in the nodular-type PWS group was significantly higher than those in the normal-skin group and pink-type, and purple-type PWS groups (all P<0.05). The heightened E and C were significantly higher in the thickened-type PWS group than those in the normal-skin group (all P<0.05). In the evaluation of therapeutic effects, the ratio of dermis hypoechogenicity in pink-type lesions significantly decreased, and thickened skins in all groups were significantly thinned (all P<0.05). The differences of PD signal grades, heightened E, and C in all groups between pre-treatment and post-treatment showed no significance.
High-frequency US and SWE show feasibility and application values assessing PWS skin lesions. Their features include dermis hypoechogenicity, thicker skin, higher PD signal grades, higher E, and higher C. Thicker skin is thus the best feature for assessing therapeutic effect.
本研究旨在利用高频超声（US）和剪切波弹性成像（SWE）在治疗前后对不同类型的葡萄酒色斑（PWS）皮肤病变进行定量评估，并探讨高频US和SWE在PWS中的可行性及应用价值。
共对195例治疗前有238处皮肤病变的PWS患者以及72例随访的有90处皮肤病变的PWS患者进行高频US和SWE评估。皮肤病变分为四组：粉色型、紫色型、增厚型和结节型PWS。灰阶US用于观察正常皮肤、观察病变的皮肤变化并评估皮肤厚度，计算增厚皮肤的厚度。采用功率多普勒（PD）信号分级评估皮肤血供信号。用SW速度（单位：m/s）和杨氏弹性模量（单位：kPa）评估正常皮肤和皮肤病变的硬度，计算增强的SWE。
与正常皮肤组相比，所有PWS类型组的真皮低回声性、增厚皮肤厚度和皮肤PD信号分级均显著更高（均P<0.05）。结节型和增厚型组的增厚皮肤和皮肤PD信号分级显著厚于和高于粉色型和紫色型组（均P<0.05）。紫色型的PD信号分级显著高于粉色型组（P<0.05）。PWS病变的所有SWE值在横切面上均显著高于纵切面（均P<0.05）。各PWS组与正常皮肤组之间增强的E、E、C和C的差异不显著。结节型PWS组的增强E和C显著高于正常皮肤组以及粉色型和紫色型PWS组（均P<0.05）。增厚型PWS组的增强E和C显著高于正常皮肤组（均P<0.05）。在治疗效果评估中，粉色型病变的真皮低回声性比例显著降低，所有组的增厚皮肤均显著变薄（均P<0.05）。所有组治疗前和治疗后PD信号分级、增强的E和C的差异均无统计学意义。
高频US和SWE在评估PWS皮肤病变方面显示出可行性和应用价值。其特征包括真皮低回声性、皮肤增厚、PD信号分级更高、E更高和C更高。因此，皮肤增厚是评估治疗效果的最佳特征。
