Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.

Assessment of Skin Involvement in Systemic Sclerosis (SSc) with Ultrasound Elastography

Iagnocco1,  Annamaria, Perella1,  Chiara, Riccieri1,  Valeria, Kaloudi2,  Olga, Bandinelli2,  Francesca, Porta2,  Francesco, Valesini1,  Guido

Cattedra di Reumatologia, Dip Clinica e Terapia Medica, Sapienza Università di Roma, Roma, Italy,
University of Florence, Italy, Florence, Italy


Excessive dermal deposition of collagen and changes in the architecture of connective tissue components are hallmarks of SSc that is characterised by reduced dermal elasticity due to tissue thickness and fibrosis. A new tool able to correlate tissue US imaging with tissue structure and/or pathology, namely US elastography (UE), has been used to assess skin elasticity in SSc.


18 consecutive SSc patients (mean age 58.8 years) and 15 healthy controls (mean age 29.8 years) were studied. Each UE exam was performed separately by two blinded sonographers who repeated each single exam twice and each evaluation was then repeated, after an interval of 4 weeks, up to calculate intra- and inter- observer reliability. Modified Rodnan skin score, physical examination and assessment of organ involvement were performed. UE was performed on the middle forearm and on the fingers. The echo signals captured in real-time during free-hand operations of probe compression and relaxation produced images representative of tissue elasticity, consisting in translucent coloured bands superimposed on the B-mode images. The colour scale varied within a large band-spectrum from red, indicative of a soft and highly elastic tissue, to blue, which denoted a hard and scarcely elastic one.


On the forearm of all patients, UE showed a homogeneous blue area corresponding to the dermis visualized in B-mode image; in controls, a blue pattern was never detected and a predominance of green with sporadic areas of pale blue was observed. At sequential evaluations UE of fingers produced inconstant and changeable coloured areas, this might be due to the reduced presence of tissue and the prevalent bony component within the elastographic field. The overall inter-observer sonographers agreement and the intra-observer reliability, for patients and controls, resulted always of 100%


The imaging pattern observed in the forearm of SSc patients may represent the reduction of strain in the dermis due to loss of elasticity. The finger evaluation instead was not reliable for the measurement of skin elasticity. UE may evaluate skin involvement in SSc in areas where the dermis is highly expressed and where the bone hyperreflection is minimal. Further studies and in particular, correlations with histopathologic findings, are needed to confirm our results and determine the criterion validity of this new imaging modality.

To cite this abstract, please use the following information:
Iagnocco, Annamaria, Perella, Chiara, Riccieri, Valeria, Kaloudi, Olga, Bandinelli, Francesca, Porta, Francesco, et al; Assessment of Skin Involvement in Systemic Sclerosis (SSc) with Ultrasound Elastography [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1722
DOI: 10.1002/art.26796

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