title: Activity assessment in morphea using color Doppler ultrasound.
abstract: BACKGROUND
  Morphea (circumcripted cutaneous scleroderma) can be difficult to assess for lesion activity. Because variable-frequency ultrasound with color Doppler provides details of skin morphology and function, it may help in the categorization of morphea.
  
  
  OBJECTIVE
  We sought to evaluate color Doppler ultrasound as a probing tool for assessing activity in morphea lesions.
  
  
  METHODS
  Consecutive patients with cutaneous morphea referred by dermatologists were studied with color Doppler ultrasound, and the assessment of lesion activity was compared with histologic findings. Normal skin controls were obtained by performing ultrasound scans of healthy subjects or of unaffected areas of the patients themselves. Measurements included cutaneous layer thickness, relative echogenicity, and blood flow with peak systolic velocity. Ultrasound sensitivity and specificity were determined for each phase of morphea activity and the results correlated with histology.
  
  
  RESULTS
  Fifty-one patients had a total of 104 morphea lesions. Of the lesions, 20% were active, 22% were atrophic, and 58% were inactive. Five of the patients had the Parry-Romberg syndrome with ipsilateral parotid gland inflammatory involvement, and one had an asymptomatic but sonographically active morphea lesion. Sensitivity and specificity for ultrasound diagnosis were 100% and 98.8%, respectively. The most accurate sonographic signs of lesion activity were increased subcutaneous tissue echogenicity and increased cutaneous blood flow (sensitivity and specificity 100% and 100% for each one).
  
  
  CONCLUSIONS
  Ultrasound cannot define lesions less than 0.1-mm deep.
  
  
  CONCLUSIONS
  The morphologic and functional data obtained noninvasively and in real time with color Doppler ultrasound provide new insight into the pathogenesis of morphea. The technique represents a useful counterpart to histologic examination for the assessment of lesion activity.
authors.affiliation: Department of Radiology, Clinica Servet, Faculty of Medicine, University of Chile, Santiago, Chile. xwo@tie.cl
authors.forename: Ximena
authors.initials: X
authors.lastname: Wortsman
authors.forename: Jacobo
authors.initials: J
authors.lastname: Wortsman
authors.forename: Ivo
authors.initials: I
authors.lastname: Sazunic
authors.forename: Laura
authors.initials: L
authors.lastname: Carreño
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001284:Atrophy; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D005150:Facial Hemiatrophy / Q000150:complications / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012469:Salivary Glands / Q000473:pathology; D012594:Scleroderma, Localized / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D012680:Sensitivity and Specificity; D012867:Skin / Q000098:blood supply; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult