A Novel, Reliable Protocol to Objectively Assess Scar Stiffness Using Shear Wave Elastography

Helen DeJong; Steven Abbott; Marilyn Zelesco; Katrina Spilsbury; Lisa Martin; Rowan Sanderson; Melanie Ziman; Brendan F Kennedy; Fiona M Wood

doi:10.1016/j.ultrasmedbio.2020.03.003

A Novel, Reliable Protocol to Objectively Assess Scar Stiffness Using Shear Wave Elastography

Ultrasound Med Biol. 2020 Jul;46(7):1614-1629. doi: 10.1016/j.ultrasmedbio.2020.03.003. Epub 2020 May 5.

Authors

Helen DeJong¹, Steven Abbott², Marilyn Zelesco², Katrina Spilsbury³, Lisa Martin⁴, Rowan Sanderson⁵, Melanie Ziman⁶, Brendan F Kennedy⁵, Fiona M Wood⁷

Affiliations

¹ Perth Scar and Pain Clinic, Fremantle, Western Australia 6160, Australia; School of Medical and Health Science, Edith Cowan University, Joondalup, Western Australia 6027, Australia; BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre Nedlands and Centre for Medical Research, University of Western Australia, Crawley, Western Australia 6009, Australia; Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia. Electronic address: info@perthspc.com.au.
² Department of Medical Imaging, Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia.
³ Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia 6959, Australia.
⁴ Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, Western Australia 6009, Australia.
⁵ BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre Nedlands and Centre for Medical Research, University of Western Australia, Crawley, Western Australia 6009, Australia; Department of Electrical, Electronic and Computer Engineering, School of Engineering, University of Western Australia, Crawley 6009, Western Australia.
⁶ School of Medical and Health Science, Edith Cowan University, Joondalup, Western Australia 6027, Australia; School of Biomedical Science, University of Western Australia, Crawley, Western Australia 6009, Australia.
⁷ Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, Western Australia 6009, Australia; Burn Service of Western Australia, Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia.

PMID: 32386847
DOI: 10.1016/j.ultrasmedbio.2020.03.003

Abstract

The aim of this research was to investigate the use of shear wave elastography as a novel tool to quantify and visualize scar stiffness after a burn. Increased scar stiffness is indicative of pathologic scarring which is associated with persistent pain, chronic itch and restricted range of movement. Fifty-five participants with a total of 96 scars and 69 contralateral normal skin sites were evaluated. A unique protocol was developed to enable imaging of the raised and uneven burn scars. Intra-rater and inter-rater reliability was excellent (intra-class correlation coefficient >0.97), and test-retest reliability was good (intra-class correlation coefficient >0.85). Shear wave elastography was able to differentiate between normal skin, pathologic scars and non-pathologic scars, with preliminary cutoff values identified. Significant correlations were found between shear wave velocity and subjective clinical scar assessment (r = 0.66). Shear wave elastography was able to provide unique information associated with pathologic scarring and shows promise as a clinical assessment and research tool.

Keywords: 2-D shear wave elastography; Burn; Elastography; Objective scar assessment; Reliability; Scar pliability; Shear wave elastography.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Case-Control Studies
Cicatrix / diagnostic imaging*
Cicatrix / pathology
Elasticity Imaging Techniques / methods*
Female
Humans
Male
Middle Aged
Reproducibility of Results
Skin / diagnostic imaging
Skin / pathology
Young Adult