title: Technical feasibility of real-time elastography to assess the peri-oral region in patients affected by systemic sclerosis.
abstract: OBJECTIVE
  To evaluate the technical feasibility of real-time elastography (RTE) to assess the stiffness of the skin of the peri-oral region in patients affected by systemic sclerosis (SSc).
  
  
  METHODS
  Six female patients affected by SSc (median age = 52 years) presenting with microstomia and six healthy controls matched for age and sex underwent RTE evaluation of the peri-oral region. Two operators with different experience evaluated the stiffness of the peri-oral region placing the probe in four different positions: parasagittal left (PL), parasagittal right (PR), upper axial (UA), lower axial (LA). Color map was converted into a semi-quantitative scale in which blue = 1, green = 2 and red = 3. Thus, each subject had a variable score ranging from 4 (four positions × value = 1) and 12 (four positions × value = 3). Mann-Whitney U and k statistics were used.
  
  
  RESULTS
  RTE demonstrated that the skin of the peri-oral region of patients affected by SSc was stiffer than that of controls, both overall (6;4-6 [median; 25-75th percentile] vs. 11;9-11, p < 0.001) and for each probe position (PL = 1;1-2 vs. 2;2-3, PR = 1;1-2 vs. 2;2-3, UA = 1;1-2 vs. 2;2-3; LA = 1;1-1 vs. 3;3-3, p ≤ 0.011 for all). Interobserver reproducibility was excellent both overall and for each probe position (k = 1).
  
  
  CONCLUSIONS
  RTE is a feasible modality to assess peri-oral region skin stiffness with excellent interobserver reproducibility. Further studies on a larger cohort of patients including more clinical data and measures are warranted to confirm our initial results.
authors.affiliation: Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20100 Milano, Italy.
authors.forename: Paola Maria
authors.initials: PM
authors.lastname: Cannaò
authors.affiliation: Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milano, Via Manzoni 56, Rozzano, 20098 Milan, Italy.
authors.forename: Valeriano
authors.initials: V
authors.lastname: Vinci
authors.affiliation: Reconstructive and Aesthetic Plastic Surgery School, Plastic Surgery Unit, IRCCS MultiMedica, Via Milanese 300, Sesto San Giovanni, 20099 Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Caviggioli
authors.affiliation: Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milano, Via Manzoni 56, Rozzano, 20098 Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Klinger
authors.affiliation: Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Genova, Via Alberti 4, 16132 Genoa, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Orlandi
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Piazza Malan 1, 20097 San Donato Milanese, Italy ; Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 1, San Donato Milanese, 20097 Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sardanelli
authors.affiliation: Dipartimento di Radiologia, Ospedale Santa Corona, ASL 2 Savonese-Via XXV Aprile 38, 17027 Pietra Ligure (SV), Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Serafini
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Piazza Malan 1, 20097 San Donato Milanese, Italy ; Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 1, San Donato Milanese, 20097 Milan, Italy.
authors.forename: Luca Maria
authors.initials: LM
authors.lastname: Sconfienza
keywords: Microstomia; Real-time elastography; Skin; Systemic sclerosis; Ultrasonography