Assessment of Sclerodermoid Chronic Graft-versus-host Disease with Colour Doppler Ultrasound

Authors

  • Priscila Giavedoni Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Villarroel 170, ES-08036 Barcelona, Spain
  • Carmen Martinez
  • Sebastian Podlipnik
  • María Suárez-Lleidó
  • Ignasi Martí-Martí
  • Daniel Morgado-Carrasco
  • Montserrat Rovira
  • Fernández-Avilés Fernández-Avilés
  • Gonzalo Gutiérrez
  • Laura Rosiñol
  • Joan Cid
  • Miquel Lozano
  • José Manuel Mascaró Jr.

DOI:

https://doi.org/10.2340/00015555-3747

Keywords:

graft-versus-host disease, Doppler ultrasound, diagnosis, sclerodermoid, inflammation, allogeneic haematopoietic stem cell transplantation

Abstract

Sclerodermoid chronic graft-versus-host disease (scGVHD) is a severe complication of allogeneic haema­- topoietic stem cell transplantation. The aim of this study was to investigate the usefulness of high-frequency ultrasound of the skin in assessing the inflammatory patterns and prognosis of patients with scGVHD. A prospective study was carried out with patients who developed scGVHD in the period June 2016 to April 2018. Clinical and ultrasound examinations were performed on the first visit and at 6-month follow-up. A total of 24 patients were included in the study. A 6-month follow-up high-frequency ultrasound of the skin was performed on 20 of the 24 patients. Abnormal B-mode findings in high-frequency ultrasound of the skin consisted of hypoechogenic dermis, hypoechogenicity of septa and hyperechogenicity of lobules in hypodermis. No differences were observed in these basal parameters between treatment progressive/non-responding and inactive/responding scGVHD groups of patients. Basal Doppler showing increased vascular flow with a systolic peak ≥10 cm/s and a vascular resistance index ≥ 0.70 was observed only in those patients who developed progressive/non-responding scGVHD (62.5% vs 0% p = 0.006). In conclusion, Doppler ultrasound is a useful tool to assess the inflammatory activity and outcome of scGVHD. These findings could enhance patient management and help to guide treatment decisions.

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References

Lee SJ, Flowers MED. Recognizing and managing chronic graft-versus-host disease. Hematol Am Soc Hematol Educ Program 2008; 1: 134-141.

DOI: https://doi.org/10.1182/asheducation-2008.1.134

Cowen EW. Graft-vs-host disease. JAMA Dermatol 2016; 152: 356.

DOI: https://doi.org/10.1001/jamadermatol.2015.5659

Arai S, Jagasia M, Storer B, Chai X, Pidala J, Cutler C, et al. Global and organ-specific chronic graft-versus-host disease severity according to the 2005 NIH Consensus Criteria. Blood 2011; 118: 4242-4249.

DOI: https://doi.org/10.1182/blood-2011-03-344390

Jagasia MH, Greinix HT, Arora M, Williams, K, Wolff D, Cowen E, et al. National Institutes of Health Consensus Development Project on criteria for clinical trials in chronic graft-versus-host disease: I. The 2014 Diagnosis and Staging Working Group report. Biol Blood Marrow Transplant J Am Soc Blood Marrow Transplant 2015; 21: 389-401.e1.

DOI: https://doi.org/10.1016/j.bbmt.2015.05.004

Wortsman X. Ultrasound in dermatology: why, how, and when? Semin Ultrasound CT MR 2013; 34: 177-195.

DOI: https://doi.org/10.1053/j.sult.2012.10.001

Pérez-López I, Garrido-Colmenero C, Ruiz-Villaverde R, Tercedor-Sánchez J. Ultrasound monitoring of childhood linear morphea. Actas Dermosifiliogr 2015; 106: 340-342.

DOI: https://doi.org/10.1016/j.ad.2014.09.012

Bia?ynicki-Birula R, Reszke R, Szepietowski JC. High-frequency ultrasonography (HFUS) as a useful tool in differentiating between plaque morphea and extragenital lichen sclerosus lesions. Postepy Dermatol Alergol 2017; 34: 485-489.

DOI: https://doi.org/10.5114/ada.2017.71118

Liu H, Hou Y, Zhu Q-L, Xu D, Wang L, Li J-C, et al. A preliminary study of skin ultrasound in diffuse cutaneous systemic sclerosis: Does skin echogenicity matter? PloS One 2017; 12: e0174481.

DOI: https://doi.org/10.1371/journal.pone.0174481

Kaloudi O, Bandinelli F, Filippucci E, Conforti M-L, Miniati I, Guiducci S, et al. High frequency ultrasound measurement of digital dermal thickness in systemic sclerosis. Ann Rheum Dis 2010; 69: 1140-1143.

DOI: https://doi.org/10.1136/ard.2009.114843

Li H, Furst DE, Jin H, Sun C, Wang X, Yang L, et al. High-frequency ultrasound of the skin in systemic sclerosis: an exploratory study to examine correlation with disease activity and to define the minimally detectable difference. Arthritis Res Ther 2018; 20: 181.

DOI: https://doi.org/10.1186/s13075-018-1686-9

Lee SY, Cardones AR, Doherty J, Nightingale K, Palmeri M. Preliminary results on the feasibility of using ARFI/SWEI to assess cutaneous sclerotic diseases. Ultrasound Med Biol 2015; 41: 2806-2819.

DOI: https://doi.org/10.1016/j.ultrasmedbio.2015.06.007

Osmola-Ma?kowska A, Silny W, Da?czak-Pazdrowska A, Polanska A, Olek-Hrab K, Sadowska-Przytocka A, et al. Assessment of chronic sclerodermoid graft-versus-host disease patients, using 20 MHz high-frequency ultrasonography and cutometer methods. Skin Res Technol Off J Int Soc Bioeng Skin ISBS Int Soc Digit Imaging Skin ISDIS Int Soc Skin Imaging ISSI 2013; 19: e417-e422.

DOI: https://doi.org/10.1111/j.1600-0846.2012.00659.x

Gottlöber P, Leiter U, Friedrich W, Bunjes D, Schulz A, Kerscher M, et al. Chronic cutaneous sclerodermoid graft-versus-host disease: evaluation by 20-MHz sonography. J Eur Acad Dermatol Venereol 2003; 17: 402-407.

DOI: https://doi.org/10.1046/j.1468-3083.2003.00516.x

Wortsman X. Dermatologic ultrasound with clinical and histologic correlations. Springer Science & Business Media; 2013.

DOI: https://doi.org/10.1007/978-1-4614-7184-4

Wortsman X, Wortsman J. Clinical usefulness of variable-frequency ultrasound in localized lesions of the skin. J Am Acad Dermatol 2010; 62: 247-256.

DOI: https://doi.org/10.1016/j.jaad.2009.06.016

Drakonaki EE, Sudo?-Szopi?ska I, Sinopidis C, Givissis P. High resolution ultrasound for imaging complications of muscle injury: is there an additional role for elastography? J Ultrason 2019; 19: 137-144.

DOI: https://doi.org/10.15557/JoU.2019.0020

Wortsman X, Wortsman J, Sazunic I, Carreño L. Activity assessment in morphea using color Doppler ultrasound. J Am Acad Dermatol 2011; 65: 942-948.

DOI: https://doi.org/10.1016/j.jaad.2010.08.027

Santiago T, Santiago M, Ruaro B, Salvador MJ, Cutolo M, da Silva JP. Ultrasonography for the assessment of skin in systemic sclerosis: a systematic review. Arthritis Care Res 2019; 71: 563-574.

DOI: https://doi.org/10.1002/acr.23597

Caposiena Caro RD, Solivetti FM, Bianchi L. Power Doppler ultrasound assessment of vascularization in hidradenitis suppurativa lesions. J Eur Acad Dermatol Venereol 2018; 32: 1360-1367.

DOI: https://doi.org/10.1111/jdv.14745

Worstman X. Atlas of dermatologic ultrasound. Springer Science & Business Media; 2018.

Hesselstrand R, Carlestam J, Wildt M, Sandqvist G, Andréasson K. High frequency ultrasound of skin involvement in systemic sclerosis - a follow-up study. Arthritis Res Ther 2015; 17: 329.

DOI: https://doi.org/10.1186/s13075-015-0853-5

Jacobsohn DA, Kurland BF, Pidala J, Inamoto Y, Chai X, Palmer JM, et al. Correlation between NIH composite skin score, patient-reported skin score, and outcome: results from the Chronic GVHD Consortium. Blood 2012; 120: 2545-2552; quiz 2774.

DOI: https://doi.org/10.1182/blood-2012-04-424135

Published

2021-02-16

How to Cite

Giavedoni, P., Martinez, C., Podlipnik, S., Suárez-Lleidó, M., Martí-Martí, I., Morgado-Carrasco, D., Rovira, M., Fernández-Avilés, F.-A., Gutiérrez, G., Rosiñol, L., Cid, J., Lozano, M., & Mascaró Jr., J. M. (2021). Assessment of Sclerodermoid Chronic Graft-versus-host Disease with Colour Doppler Ultrasound. Acta Dermato-Venereologica, 101(2), adv00395. https://doi.org/10.2340/00015555-3747