title: Color Doppler Ultrasound Assessment of Activity in Keloids.
abstract: BACKGROUND
  The assessment of activity in keloids may be critical for defining their management. There is a lack of clinical scorings designed for the evaluation of keloids and biopsies may be contraindicated.
  
  
  OBJECTIVE
  To assess the sonographic activity of keloids in comparison with clinical scoring.
  
  
  METHODS
  A retrospective study of the clinical and color Doppler ultrasound (CDU) images of patients medically derived to CDU with the diagnosis of keloid was performed. Activity was evaluated clinically (modified Seattle Scar Scale) and CDU. Keloids were considered active when CDU detected vascularity within the lesion. Statistical analysis was performed (Wilcoxon-Mann-Whitney, Student t-test, and interobserver agreement).
  
  
  RESULTS
  Thirty-five patients with 42 keloids were evaluated. Color Doppler ultrasound provided the diameters, including depth, and vascularity. On CDU, 76% were active and 24% inactive. Clinically, Observer 1 found 55% and Observer 2 found 88% of active keloids. Interobserver agreement between clinical observers was moderate (k = 0.42). Subclinical fistulous tracts, involvement of the hypodermis, muscle, and calcifications were also found on CDU.
  
  
  CONCLUSIONS
  Color Doppler ultrasound can support the assessment of activity in keloids. Clinical evaluation alone can underestimate the activity in keloids. Relevant anatomical and subclinical features can be detected by CDU.
authors.affiliation: *Department of Dermatology, Hospital Clínico Universidad de Chile, Faculty of Medicine, University of Chile, Santiago, Chile; †Departments of Radiology and Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Clinica Servet, Faculty of Medicine, University of Chile, Santiago, Chile.
authors.forename: Nelson
authors.initials: N
authors.lastname: Lobos
authors.forename: Ximena
authors.initials: X
authors.lastname: Wortsman
authors.forename: Fernando
authors.initials: F
authors.lastname: Valenzuela
authors.forename: Faustino
authors.initials: F
authors.lastname: Alonso
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007627:Keloid / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D012189:Retrospective Studies; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult