Technical feasibility of real-time elastography to assess the peri-oral region in patients affected by systemic sclerosis

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). Conclusion 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.