Sobolewski Piotr, Maślińska Maria, Zakrzewski Jakub, Paluch Łukasz, Szymańska Elżbieta, Walecka Irena
Department of Dermatology, Center of Postgraduate Medical Education, Central Clinical Hospital of Ministry of the Interior and Administration, Warsaw, Poland.
Early Arthritis Clinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland.
Rheumatol Int. 2020 May;40(5):737-745. doi: 10.1007/s00296-020-04539-y. Epub 2020 Mar 7.
The assessment of skin fibrosis is vital for the diagnosis and monitoring of treatment in the systemic sclerosis (SSc)-a severe autoimmune disease. The elastography is a technique of skin fibrosis assessment through the evaluation of skin strain. We compared the efficacy of the shear wave elastography (SWE) and commonly used modified Rodnan skin score (RSS) in skin fibrosis assessment in SSc. The study included 40 SSc patients and 28 healthy individuals, with the exclusion of individuals with other skin/autoimmune diseases. Skin thickness using RSS and skin strain using SWE were assessed in the same 20 body localizations. Subjects' informed consent and the bioethics committee approval were obtained. Elastographic skin strain correlated positively with both partial and overall RSS values, with strong positive correlation (r ≥ 0.75) for hands and fingers localizations in particular. In SSc patients with normal RSS values, the elastographic strain was significantly higher than in healthy controls. Elastographic strain of fingers' skin evaluated in SWE is highly accurate for distinguishing SSc patients (sensitivity 0.897-0.923, specificity 0.929-0.964, positive predictive value 0.946-0.973, negative predictive value 0.867-0.900). ESW results are substantially more reproducible than those of RSS examination (intraclass correlation coefficients: 0.987 vs. 0.941). The shear wave elastography is more reproducible and has higher sensitivity than RSS in the evaluation of skin condition in SSc, especially in case of changes non-detectable on physical evaluation, indicating it might become a useful tool in SSc diagnosis.
皮肤纤维化评估对于系统性硬化症（SSc，一种严重的自身免疫性疾病）的诊断和治疗监测至关重要。弹性成像技术是一种通过评估皮肤应变来进行皮肤纤维化评估的技术。我们比较了剪切波弹性成像（SWE）和常用的改良Rodnan皮肤评分（RSS）在SSc皮肤纤维化评估中的效果。该研究纳入了40例SSc患者和28名健康个体，排除了患有其他皮肤/自身免疫性疾病的个体。在相同的20个身体部位评估了使用RSS的皮肤厚度和使用SWE的皮肤应变。获得了受试者的知情同意并得到了生物伦理委员会的批准。弹性成像皮肤应变与部分和整体RSS值均呈正相关，特别是在手和手指部位呈强正相关（r≥0.75）。在RSS值正常的SSc患者中，弹性成像应变显著高于健康对照。通过SWE评估的手指皮肤弹性成像应变在区分SSc患者方面具有很高的准确性（敏感性0.897 - 0.923，特异性0.929 - 0.964，阳性预测值0.946 - 0.973，阴性预测值0.867 - 0.900）。ESW结果的可重复性明显高于RSS检查（组内相关系数：0.987对0.941）。在评估SSc的皮肤状况时，剪切波弹性成像比RSS具有更高的可重复性和敏感性，特别是在体格检查未发现变化的情况下，这表明它可能成为SSc诊断中的一种有用工具。
