Andrea Schwarz Doria MD, Presenter: Nothing to Disclose

Ronald Laxer MD, Abstract Co-Author: Nothing to Disclose

Arun Mohanta, Abstract Co-Author: Nothing to Disclose

Paul S. Babyn MD, Abstract Co-Author: Nothing to Disclose

Rahim Moineddin, Abstract Co-Author: Nothing to Disclose

Elena Pope MD, Abstract Co-Author: Nothing to Disclose

Morphea or localized scleroderma is caused by excessive accumulation of collagen in skin and subdermal tissues. Assessing interval changes of morphea lesions during treatment is difficult due to lack of objective and reliable tools. High-resolution ultrasound (HRUS) holds potential as an objective diagnostic tool for morphea. Our purpose was to evaluate the responsiveness of HRUS as compared with clinical measures to interval changes in morphology and vascularity of a priori-determined morphea lesions over 1-year of treatment.

9 morphea patients (age range at onset, 2-14 years; mean, 7 years; age range at study: 5-16 years; mean, 10 years); F:M,8:1were evaluated by HRUS (linear 13 MHz probes) and clinical (visual analogue scale and DIET [Dyspigmentation, Induration, Erythema, Telangiectasis) scores at baseline, and 1, 3, 6, 9 and 12 months after start of Imiquimod 5% topical cream. Gray-scale (dermis and hypodermis thickness, dermis undulation, hypodermis thickness loss, disorganization and thickened bands,”yo-yo” hypodermis appearance) and color Doppler (dermis and hypodermis vascularity) US parameters were scored as 1 (>20% difference from contralateral non-affected body part) or 0 (≤20%) in 4 quadrants of the lesion. The average US scores in the 4 quadrants was used for comparison with clinical scores (range 0, none to 3, severe).

The maximum diameter of lesions ranged from 2 to 16 cm; mean, 6 cm. Lesions were located in the abdomen (n=4), neck (n=1), trunk (n=2), or extremities (n=2). The US parameters that showed interval changes following treatment were hypodermis thickness and hypodermis thickness loss (baseline and months 1, 3, 6, 9, 12, P=0.02 for both). VAS showed response to treatment over time (baseline and months 1, 3, 6, 9, 12, P<0.0001), but DIET scores not (P=0.58). Correlations between clinical scores and hypodermis thickness loss (r=-0.28, P=0.04) and hypodermis thickness (r=-0.25, P=0.07) were poor.

Assessment of hypodermis morphology with HRUS holds potential as a responsiveness tool to morphea treatment. Further evaluation of relationships between clinical and imaging scores as surrogate markers of sensitivity to change to therapy is required.

Accurate diagnostic tools for follow-up of morphea treatment are limited and highly needed. HRUS holds potential as a responsiveness tool to morphea treatment by assessing subcutaneous microstructure.

Doria, A, Laxer, R, Mohanta, A, Babyn, P, Moineddin, R, Pope, E, Responsiveness of Gray Scale and Color Doppler Ultrasound to Imiquimod 5% Topical Cream in Plaque Morphea: Prospective Open Label Study.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034447.html