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Fulvio G, Izzetti R, Aringhieri G, Donati V, Ferro F, Gabbriellini G, Mosca M, Baldini C. UHFUS: A Valuable Tool in Evaluating Exocrine Gland Abnormalities in Sjögren's Disease. Diagnostics (Basel) 2023; 13:2771. [PMID: 37685309 PMCID: PMC10486364 DOI: 10.3390/diagnostics13172771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Sjögren's Disease (SjD) is a chronic autoimmune disorder that affects the salivary and lacrimal glands, leading to xerostomia and xerophthalmia. Ultrasonography of Major Salivary Glands (SGUS) is a well-established tool for the identification of the salivary glands' abnormalities in SjD. Recently, a growing interest has arisen in the assessment of the other exocrine glands with ultrasonography: lacrimal glands (LGUS) and labial salivary glands (LSGUS). The objective of this study is to explore the practical applications of ultra-high frequency ultrasound (UHFUS) in the assessment of lacrimal glands and labial salivary glands. Indeed, UHFUS, with its improved spatial resolution compared to conventional ultrasonography, allows for the evaluation of microscopic structures and has been successfully applied in various medical fields. In lacrimal glands, conventional high-frequency ultrasound (HFUS) can detect characteristic inflammatory changes, atrophic alterations, blood flow patterns, and neoplastic lesions associated with SjD. However, sometimes it is challenging to identify lacrimal glands characteristics, thus making UHFUS a promising tool. Regarding labial salivary glands, limited research is available with conventional HFUS, but UHFUS proves to be a good tool to evaluate glandular inhomogeneity and to guide labial salivary glands biopsy. The comprehensive understanding of organ involvement facilitated by UHFUS may significantly improve the management of SjD patients.
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Affiliation(s)
- Giovanni Fulvio
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Department of Clinical and Translational Science, University of Pisa, 56126 Pisa, Italy
| | - Rossana Izzetti
- Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Giacomo Aringhieri
- Academic Radiology, Department of Clinical and Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Valentina Donati
- Unit of Pathological Anatomy 2, Department of Laboratory Medicine, University of Pisa, 56126 Pisa, Italy
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Giovanna Gabbriellini
- Ophthalmology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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Dini V, Iannone M, Michelucci A, Manzo Margiotta F, Granieri G, Salvia G, Oranges T, Janowska A, Morganti R, Romanelli M. Ultra-High Frequency UltraSound (UHFUS) Assessment of Barrier Function in Moderate-to-Severe Atopic Dermatitis during Dupilumab Treatment. Diagnostics (Basel) 2023; 13:2721. [PMID: 37685259 PMCID: PMC10487092 DOI: 10.3390/diagnostics13172721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 09/10/2023] Open
Abstract
Atopic dermatitis (AD) is a chronic multifactorial inflammatory disease characterized by intense itching and inflammatory eczematous lesions. Biological disease-modifying drugs, such as dupilumab are recommended for patients with moderate-to-severe AD, refractory to systemic immunosuppressive therapies. Disease monitoring is performed by clinical scores. Since 1970, however, the use of ultrasound and particularly high-frequency ultrasound (HFUS), has identified alterations in dermal echogenicity, called the subepidermal low-echogenic band (SLEB), that correlates with disease severity and response to treatment. We enrolled 18 patients with moderate-to-severe AD, divided into two groups: twelve patients in the dupilumab treatment (Group A) and six patients in standard treatment, from February 2019 to November 2019. We performed ultra-high frequency ultrasound (UHFUS) evaluation of lesional and non-lesional skin, focusing on SLEB average thicknesses measurement, epidermal thickness, and vascular signal in correlation with objective disease scores (EASI, IGA), patient's reported scores (Sleep Quality NRS and Itch NRS), and TEWL and corneometry at baseline (T0), after 1 month (T1) and 2 months (T2). The SLEB average thickness measurement, vascular signal, and epidermal thickness showed a statistically significant reduction in lesional skin of the biological treatment group and no significant reduction in non-lesional skin in both groups. In the lesional skin of the standard treatment group, only epidermal thickness showed a statistically significant reduction. Our study demonstrates that SLEB measurement, vascular signals, and epidermal thickness could be used as objective parameters in monitoring the AD treatment response, while the presence of SLEB in non-lesional skin could be used as a marker of subclinical inflammation and could predict development of clinical lesions, suggesting a pro-active therapy. Further follow-up and research are needed to clarify the association of SLEB decrease/disappearance with a reduction of flares/prolongment of the disease remission time.
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Affiliation(s)
- Valentina Dini
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (V.D.); (M.I.); (F.M.M.); (G.G.); (G.S.); (A.J.); (M.R.)
| | - Michela Iannone
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (V.D.); (M.I.); (F.M.M.); (G.G.); (G.S.); (A.J.); (M.R.)
| | - Alessandra Michelucci
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (V.D.); (M.I.); (F.M.M.); (G.G.); (G.S.); (A.J.); (M.R.)
| | - Flavia Manzo Margiotta
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (V.D.); (M.I.); (F.M.M.); (G.G.); (G.S.); (A.J.); (M.R.)
| | - Giammarco Granieri
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (V.D.); (M.I.); (F.M.M.); (G.G.); (G.S.); (A.J.); (M.R.)
| | - Giorgia Salvia
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (V.D.); (M.I.); (F.M.M.); (G.G.); (G.S.); (A.J.); (M.R.)
| | - Teresa Oranges
- Unit of Dermatology, Department of Pediatrics, IRCCS Meyer Children’s Hospital, 50139 Florence, Italy;
| | - Agata Janowska
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (V.D.); (M.I.); (F.M.M.); (G.G.); (G.S.); (A.J.); (M.R.)
| | - Riccardo Morganti
- Statistical Support to Clinical Trials Department, University of Pisa, 56126 Pisa, Italy;
| | - Marco Romanelli
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (V.D.); (M.I.); (F.M.M.); (G.G.); (G.S.); (A.J.); (M.R.)
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Evertsson M, Graneli C, Vernersson A, Wiaczek O, Hagelsteen K, Erlöv T, Cinthio M, Stenström P. Design of a Pediatric Rectal Ultrasound Probe Intended for Ultra-High Frequency Ultrasound Diagnostics. Diagnostics (Basel) 2023; 13:diagnostics13101667. [PMID: 37238152 DOI: 10.3390/diagnostics13101667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/28/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
It has been shown that ultra-high frequency (UHF) ultrasound applied to the external bowel wall can delineate the histo-anatomic layers in detail and distinguish normal bowel from aganglionosis. This would potentially reduce or lessen the need for biopsies that are currently mandatory for the diagnosis of Hirschsprung's disease. However, to our knowledge, no suitable rectal probes for such a use are on the market. The aim was to define the specifications of an UHF transrectal ultrasound probe (50 MHz center frequency) suitable for use in infants. Probe requirements according to patient anatomy, clinicians' requests, and biomedical engineering UHF prerequisites were collected within an expert group. Suitable probes on the market and in clinical use were reviewed. The requirements were transferred into the sketching of potential UHF ultrasound transrectal probes followed by their 3D prototype printing. Two prototypes were created and tested by five pediatric surgeons. The larger and straight 8 mm head and shaft probe was preferred as it facilitated stability, ease of anal insertion, and possible UHF technique including 128 piezoelectric elements in a linear array. We hereby present the procedure and considerations behind the development of a proposed new UHF transrectal pediatric probe. Such a device can open new possibilities for the diagnostics of pediatric anorectal conditions.
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Affiliation(s)
- Maria Evertsson
- Department of Clinical Sciences, Lund University, 22185 Lund, Sweden
- Department of Biomedical Engineering, The Faculty of Engineering, Lund University, 22185 Lund, Sweden
| | - Christina Graneli
- Department of Pediatrics, Clinical Sciences, Lund University, 22185 Lund, Sweden
- Department of Pediatric Surgery, Skåne University Hospital Lund, 22185 Lund, Sweden
| | - Alvina Vernersson
- Department of Biomedical Engineering, The Faculty of Engineering, Lund University, 22185 Lund, Sweden
| | - Olivia Wiaczek
- Department of Biomedical Engineering, The Faculty of Engineering, Lund University, 22185 Lund, Sweden
| | - Kristine Hagelsteen
- Department of Pediatrics, Clinical Sciences, Lund University, 22185 Lund, Sweden
- Department of Pediatric Surgery, Skåne University Hospital Lund, 22185 Lund, Sweden
| | - Tobias Erlöv
- Department of Biomedical Engineering, The Faculty of Engineering, Lund University, 22185 Lund, Sweden
| | - Magnus Cinthio
- Department of Biomedical Engineering, The Faculty of Engineering, Lund University, 22185 Lund, Sweden
| | - Pernilla Stenström
- Department of Pediatrics, Clinical Sciences, Lund University, 22185 Lund, Sweden
- Department of Pediatric Surgery, Skåne University Hospital Lund, 22185 Lund, Sweden
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Di Battista M, Barsotti S, Vitali S, Palma M, Granieri G, Oranges T, Aringhieri G, Dini V, Della Rossa A, Neri E, Romanelli M, Mosca M. Multiparametric Skin Assessment in a Monocentric Cohort of Systemic Sclerosis Patients: Is There a Role for Ultra-High Frequency Ultrasound? Diagnostics (Basel) 2023; 13:diagnostics13081495. [PMID: 37189596 DOI: 10.3390/diagnostics13081495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/16/2023] [Accepted: 04/20/2023] [Indexed: 05/17/2023] Open
Abstract
Background: To assess skin involvement in a cohort of patients with systemic sclerosis (SSc) by comparing results obtained from modified Rodnan skin score (mRSS), durometry and ultra-high frequency ultrasound (UHFUS). Methods: SSc patients were enrolled along with healthy controls (HC), assessing disease-specific characteristics. Five regions of interest were investigated in the non-dominant upper limb. Each patient underwent a rheumatological evaluation of the mRSS, dermatological measurement with a durometer, and radiological UHFUS assessment with a 70 MHz probe calculating the mean grayscale value (MGV). Results: Forty-seven SSc patients (87.2% female, mean age 56.4 years) and 15 HC comparable for age and sex were enrolled. Durometry showed a positive correlation with mRSS in most regions of interest (p = 0.025, ρ = 0.34 in mean). When performing UHFUS, SSc patients had a significantly thicker epidermal layer (p < 0.001) and lower epidermal MGV (p = 0.01) than HC in almost all the different regions of interest. Lower values of dermal MGV were found at the distal and intermediate phalanx (p < 0.01). No relationships were found between UHFUS results either with mRSS or durometry. Conclusions: UHFUS is an emergent tool for skin assessment in SSc, showing significant alterations concerning skin thickness and echogenicity when compared with HC. The lack of correlations between UHFUS and both mRSS and durometry suggests that these are not equivalent techniques but may represent complementary methods for a full non-invasive skin evaluation in SSc.
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Affiliation(s)
- Marco Di Battista
- Rheumatology Unit, University of Pisa, 56124 Pisa, Italy
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | | | | | - Marco Palma
- Radiology Unit, University of Pisa, 56124 Pisa, Italy
| | | | | | | | | | | | - Emanuele Neri
- Radiology Unit, University of Pisa, 56124 Pisa, Italy
| | | | - Marta Mosca
- Rheumatology Unit, University of Pisa, 56124 Pisa, Italy
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Hawez T, Graneli C, Erlöv T, Gottberg E, Munoz Mitev R, Hagelsteen K, Evertsson M, Jansson T, Cinthio M, Stenström P. Ultra-High Frequency Ultrasound Imaging of Bowel Wall in Hirschsprung's Disease-Correlation and Agreement Analyses of Histoanatomy. Diagnostics (Basel) 2023; 13:diagnostics13081388. [PMID: 37189490 DOI: 10.3390/diagnostics13081388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023] Open
Abstract
Hirschsprung's disease (HD) is characterized by aganglionosis in the bowel wall, requiring resection. Ultra-high frequency ultrasound (UHFUS) imaging of the bowel wall has been suggested to be an instantaneous method of deciding resection length. The aim of this study was to validate UHFUS imaging of the bowel wall in children with HD by exploring the correlation and systematic differences between UHFUS and histopathology. Resected fresh bowel specimens of children 0-1 years old, operated on for rectosigmoid aganglionosis at a national HD center 2018-2021, were examined ex vivo with UHFUS center frequency 50 MHz. Aganglionosis and ganglionosis were confirmed by histopathological staining and immunohistochemistry. Histoanatomical layers of bowel wall in histopathological and UHFUS images, respectively, were outlined using MATLAB programs. Both histopathological and UHFUS images were available for 19 aganglionic and 18 ganglionic specimens. The thickness of muscularis interna correlated positively between histopathology and UHFUS in both aganglionosis (R = 0.651, p = 0.003) and ganglionosis (R = 0.534, p = 0.023). The muscularis interna was systematically thicker in histopathology than in UHFUS images in both aganglionosis (0.499 vs. 0.309 mm; p < 0.001) and ganglionosis (0.644 versus 0.556 mm; p = 0.003). Significant correlations and systematic differences between histopathological and UHFUS images support the hypothesis that UHFUS reproduces the histoanatomy of the bowel wall in HD accurately.
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Affiliation(s)
- Tebin Hawez
- Department of Pediatric Surgery, Children's Hospital, Skåne University Hospital Lund, Lund University, 221 85 Lund, Sweden
| | - Christina Graneli
- Department of Pediatric Surgery, Children's Hospital, Skåne University Hospital Lund, Lund University, 221 85 Lund, Sweden
| | - Tobias Erlöv
- Department of Biomedical Engineering, The Faculty of Engineering, Lund University, 223 63 Lund, Sweden
| | - Emilia Gottberg
- Department of Clinical Genetics and Pathology, Skåne University Hospital, Lund University, 222 42 Lund, Sweden
| | - Rodrigo Munoz Mitev
- Department of Clinical Genetics and Pathology, Skåne University Hospital, Lund University, 222 42 Lund, Sweden
| | - Kristine Hagelsteen
- Department of Pediatric Surgery, Children's Hospital, Skåne University Hospital Lund, Lund University, 221 85 Lund, Sweden
| | - Maria Evertsson
- Department of Biomedical Engineering, Skåne University Hospital Lund, The Faculty of Engineering, Lund University, 221 00 Lund, Sweden
| | - Tomas Jansson
- Department of Biomedical Engineering, Skåne University Hospital Lund, The Faculty of Engineering, Lund University, 221 00 Lund, Sweden
| | - Magnus Cinthio
- Department of Biomedical Engineering, The Faculty of Engineering, Lund University, 223 63 Lund, Sweden
| | - Pernilla Stenström
- Department of Pediatric Surgery, Children's Hospital, Skåne University Hospital Lund, Lund University, 221 85 Lund, Sweden
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Oranges T, Janowska A, Scatena C, Faita F, Lascio ND, Izzetti R, Fidanzi C, Romanelli M, Dini V. Ultra-High Frequency Ultrasound in Melanoma Management: A New Combined Ultrasonographic-Histopathological Approach. J Ultrasound Med 2023; 42:99-108. [PMID: 36117417 DOI: 10.1002/jum.16096] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 08/10/2022] [Accepted: 08/21/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The main aim of this study is to evaluate the correspondence between the ultrasonographic thickness and the Breslow thickness in melanoma using ultra-high frequency ultrasound and the intra- and inter-operator repeatability in the ultrasonographic measurements of melanoma depth. Moreover, we propose a new protocol based on a combined ultrasonographic-histopathological approach. METHODS We analyzed 27 melanomas in a population consisted of 27 patients (mean age 57.6 years, 51.8% males), who came at the Department of Dermatology (University of Pisa, Pisa, Italy) from April 2016 to March 2018 and had an ultrasonographic examination of a suspected lesion before the surgical removal using ultra-high frequency ultrasound (Vevo®MD, Fujifilm, Visualsonics, Toronto, Canada; 70 MHz probe). B-mode images were analyzed by two skilled and blinded operators, and the maximum depth of the lesions was measured using a dedicated graphical user interface developed in Matlab R2016b (MathWorks Inc., Natick, MA), to obtain repetitive measurements. RESULTS All melanomas appeared as band-like or oval/fusiform shaped hypoechoic inhomogeneous lesions. We observed an excellent agreement between the Breslow thickness of melanomas and the ultrasonographic thickness, as well as a reduced intra- and inter-operator variability in the ultrasonographic measurements of melanoma depth. CONCLUSIONS We propose a ultrasonographic-histopathological protocol which may help clinicians to reduce the diagnostic delay, improve prognosis and survival rates, perform a surgical excision with negative margins, and reduce the variability in the assessment of Breslow thickness.
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Affiliation(s)
- Teresa Oranges
- Dermatology Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - Agata Janowska
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - Cristian Scatena
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesco Faita
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Nicole Di Lascio
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Rossana Izzetti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | | | - Valentina Dini
- Department of Dermatology, University of Pisa, Pisa, Italy
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Granieri G, Oranges T, Morganti R, Janowska A, Romanelli M, Manni E, Dini V. Ultra-high frequency ultrasound detection of the dermo-epidermal junction: Its potential role in dermatology. Exp Dermatol 2022; 31:1863-1871. [PMID: 36017602 DOI: 10.1111/exd.14664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/02/2022] [Accepted: 08/18/2022] [Indexed: 12/14/2022]
Abstract
Traditional high-frequency ultrasound (HFUS; 20 MHz) is a non-invasive method used to study skin in vivo but is not able to measure skin thickness accurately and to identify the dermal-epidermal junction (DEJ). Ultra-high frequency ultrasound (UHFUS; 70-100 MHz) has sub-millimetre resolution comparable to histology. The aim of this study was to identify, by UHFUS, the DEJ and to describe skin differences in healthy individuals by providing a measure of skin thickness, based on age and gender. We also described the bullous pemphigoid lesion. We enrolled 42 patients divided into 2 groups: A and B. Group A included 32 healthy volunteers aged 22-74 years. Group B consisted of 10 patients with bullous pemphigoid. For each patient in group A, 8 ultrasound (US) clips by 70 MHz probe were performed at forehead, cheek, nose, forearm, abdomen, chest, back and leg. For each patient in group B, 5 US images were acquired at blisters roofs and edges. In each US image, we measured thickness of stratum corneum (α-β), epidermis (α-γ) and epidermis plus dermis (α-δ). In both groups, we found the presence of 4 lines delimiting: the stratum corneum (the layer between α-line and β-line), the epidermis (distance between α- and γ-line), and the boundary between dermis and subcutis (δ-line). The γ-line corresponds to the point of detachment of the bullae. The abdominal α-β layer was thicker in males (p = 0.019) and α-δ thickness at cheeks (p < 0.001), chest (p = 0.007), back (p = 0.025) and forearm (p < 0.001). In females, α-γ thickness of the back was greater (p = 0.005). In old people compared to young, we noticed an increase of α-β layer at forehead and chest (p = 0.014), an increase of α-γ layer at forearm (p = 0.001), back (p = 0.024) and leg (p = 0.010) and an increase of α-δ layer at forehead (p = 0.001) and nose (p = 0.049). UHFUS is an advanced imaging technique that can detect both the DEJ and the boundary between dermis and subcutaneous tissue so that epidermal and dermal thickness can be measured with good accuracy. Regarding gender and age, skin differences obtained with UHFUS were comparable to other non-invasive methods.
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Affiliation(s)
| | - Teresa Oranges
- Department of Pediatrics, Meyer Childern's University Hospital, Florence, Italy
| | | | - Agata Janowska
- Department of Dermatology, University of Pisa, Pisa, Italy
| | | | | | - Valentina Dini
- Department of Dermatology, University of Pisa, Pisa, Italy
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Sundholm JKM, Litwin L, Rönö K, Koivusalo SB, Eriksson JG, Sarkola T. Ultra-high frequency ultrasound delineated changes in carotid and muscular artery intima-media and adventitia thickness in obese early middle-aged women. Diab Vasc Dis Res 2022; 19:14791641221094321. [PMID: 35637577 PMCID: PMC9160911 DOI: 10.1177/14791641221094321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Obesity is linked to increased arterial size, carotid intima-media thickness and arterial stiffness. The effects of obesity and body composition on muscular artery intima-media and adventitia thickness has previously not been established. The aim of this study was to explore associations between carotid and muscular artery wall layer thickness with body composition and cardiovascular risk factors in early middle-aged women. This is a cross-sectional study including 199 women aged 40±4 years. Arterial lumen (LD), intima-media (IMT) and adventitia thickness (AT) were measured from carotid, brachial and radial arteries using ultra-high frequency ultrasound (22-71 MHz). Women with obesity had increased IMT in carotid (0.47 vs 0.45 mm), brachial (0.19 vs 0.17 mm) and radial arteries (0.16 vs 0.15 mm) and increased brachial AT (0.14 vs 0.13 mm). In multiple regression models all arterial LD (β-range 0.02-0.03 mm/kg/m2), IMT (β-range 0.91-3.37 µm/kg/m2), AT (β-range 0.73-1.38 µm/kg/m2) were significantly associated with BMI. The IMT of all arteries were significantly associated with systolic blood pressure (β-range 0.36-0.85 µm/mmHg), attenuating the association between IMT and BMI (β-range 0.18-2.24 µm/kg/m2). Obese early middle-aged women have increased arterial intima media thickness and brachial artery adventitia thickness compared to non-obese counterparts. The association between BMI and intima-media thickness is partly mediated through blood pressure levels.
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Affiliation(s)
- Johnny KM Sundholm
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
- Johnny KM Sundholm, Children’s Hospital, Helsinki University Hospital, Stenbäckinkatu 9, POB 281, FIN-00029, Helsinki 00029, Finland.
| | - Linda Litwin
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
- Department of Congenital Heart Defects and Pediatric Cardiology, SMDZ in Zabrze, SUM, Katowice, Poland
| | - Kristiina Rönö
- Women’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Saila B Koivusalo
- Women’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Gynecology and Obstetrics, University of Turku and Turku University Hospital, Turku Finland
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Agency for Science, Technology and Research, Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - Taisto Sarkola
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
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Izzetti R, Fulvio G, Nisi M, Gennai S, Graziani F. Reliability of OMERACT Scoring System in Ultra-High Frequency Ultrasonography of Minor Salivary Glands: Inter-Rater Agreement Study. J Imaging 2022; 8:jimaging8040111. [PMID: 35448238 PMCID: PMC9026431 DOI: 10.3390/jimaging8040111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/03/2022] [Accepted: 04/12/2022] [Indexed: 12/10/2022] Open
Abstract
Minor salivary gland ultra-high frequency ultrasonography (UHFUS) has recently been introduced for the evaluation of patients with suspected primary Sjögren’s Syndrome (pSS). At present, ultrasonographic assessment of major salivary glands is performed using the Outcome Measures in Rheumatology (OMERACT) scoring system. Previous reports have explored the possibility of applying the OMERACT scoring system to minor salivary glands UHFUS, with promising results. The aim of this study was to test the inter-reader concordance in the assignment of the OMERACT score to minor salivary gland UHFUS. The study was conducted on 170 minor salivary glands UHFUS scans of patients with suspected pSS. Three independent readers performed UHFUS image evaluation. Intraclass correlation coefficient (ICC) was employed to assess inter-reader reliability. Bland and Altman analysis was employed to test the agreement with a gold standard examiner. ICC values > 0.9 were found for scores 0 and 1, while score 2 and score 3 presented ICCs of 0.873 and 0.785, respectively. The measurements performed by the three examiners were in agreement with the gold standard examiner. According to these results, UHFUS interpretation showed good inter-observer reliability, suggesting that OMERACT score can be effectively used for the evaluation of glandular alterations, even for minor salivary glands.
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Affiliation(s)
- Rossana Izzetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (M.N.); (S.G.); (F.G.)
- Unit of Dentistry and Oral Surgery, University Hospital of Pisa, 56126 Pisa, Italy
- Correspondence:
| | - Giovanni Fulvio
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
- Unit of Rheumatology, University Hospital of Pisa, 56126 Pisa, Italy
| | - Marco Nisi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (M.N.); (S.G.); (F.G.)
- Unit of Dentistry and Oral Surgery, University Hospital of Pisa, 56126 Pisa, Italy
| | - Stefano Gennai
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (M.N.); (S.G.); (F.G.)
- Unit of Dentistry and Oral Surgery, University Hospital of Pisa, 56126 Pisa, Italy
| | - Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (M.N.); (S.G.); (F.G.)
- Unit of Dentistry and Oral Surgery, University Hospital of Pisa, 56126 Pisa, Italy
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10
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Izzetti R, Ferro F, Vitali S, Nisi M, Fonzetti S, Oranges T, Donati V, Caramella D, Baldini C, Gabriele M. Ultra-high frequency ultrasonography (UHFUS)-guided minor salivary gland biopsy: A promising procedure to optimize labial salivary gland biopsy in Sjögren's syndrome. J Oral Pathol Med 2021; 50:485-491. [PMID: 33501696 DOI: 10.1111/jop.13162] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/05/2020] [Accepted: 01/21/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Sjögren's syndrome (SS) is an autoimmune disease characterized by an inflammatory infiltrate of exocrine salivary and lachrymal glands. Diagnosis is complex, and minor salivary gland biopsy and subsequent focus score (FS) calculation appear of extreme importance in the diagnostic work-up of the disease. Ultra-high frequency ultrasonography (UHFUS) is a recently introduced diagnostic technique, which is gaining an increasingly important role in intraoral imaging. This study aims at exploring the usefulness of UHFUS for obtaining valuable labial salivary gland samples to assess the histopathological features of SS patients. METHODS Patients with clinical suspect of SS and eligible for minor salivary gland biopsy were enrolled. UHFUS scan of the lower lip was performed. Glandular echostructure was classified according to Outcome Measures in Rheumatology (OMERACT) scoring system. The glands to be sampled were selected on the basis of UHFUS evaluation and biopsied. The areas of the samples were recorded and compared with those obtained without UHFUS guidance. The correlation between UHFUS grade and labial gland FS was also assessed. RESULTS The areas of the samples obtained with UHFUS guidance were significantly higher (7.25 ± 3.98 mm2 ) than those obtained by conventional procedures (5.79 ± 3.49 mm2 , P = .02). UHFUS correlated significantly with the salivary gland FS (r = .532, P = .001). CONCLUSION UHFUS seems a promising tool in SS diagnostic algorithm, being able to provide a valuable support to the biopsy procedure. Further studies are mandatory to confirm the role of UHFUS in SS.
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Affiliation(s)
- Rossana Izzetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Unit of Dentistry and Oral Surgery, University of Pisa, Pisa, Italy
| | - Francesco Ferro
- Department of Clinical and Experimental Medicine, Unit of Rheumatology, University of Pisa, Pisa, Italy
| | - Saverio Vitali
- Department of Translational Research and of New Technologies in Medicine and Surgery, Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Marco Nisi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Unit of Dentistry and Oral Surgery, University of Pisa, Pisa, Italy
| | - Silvia Fonzetti
- Department of Clinical and Experimental Medicine, Unit of Rheumatology, University of Pisa, Pisa, Italy
| | - Teresa Oranges
- Department of Clinical and Experimental Medicine, Unit of Dermatology, University of Pisa, Pisa, Italy
| | - Valentina Donati
- Unit of Anatomic Pathology II, University Hospital of Pisa, Pisa, Italy
| | - Davide Caramella
- Department of Translational Research and of New Technologies in Medicine and Surgery, Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Chiara Baldini
- Department of Clinical and Experimental Medicine, Unit of Rheumatology, University of Pisa, Pisa, Italy
| | - Mario Gabriele
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Unit of Dentistry and Oral Surgery, University of Pisa, Pisa, Italy
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11
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Izzetti R, Nisi M, Aringhieri G, Vitali S, Oranges T, Romanelli M, Caramella D, Graziani F, Gabriele M. Ultra-high frequency ultrasound in the differential diagnosis of oral pemphigus and pemphigoid: An explorative study. Skin Res Technol 2021; 27:682-691. [PMID: 33405267 DOI: 10.1111/srt.13000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/05/2020] [Accepted: 12/05/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Intraoral ultra-high frequency ultrasound (UHFUS) is an emerging technique in oral medicine, due to its possibility to provide submillimeter resolution imaging of superficial mucosal structures. In this study, the potential role of UHFUS in the diagnosis of oral pemphigus vulgaris (PV) and mucous membrane pemphigoid (MMP) is assessed. MATERIALS AND METHODS Consecutive patients with suspected oral PV or MMP were enrolled. All patients underwent clinical examination, laboratory tests, intraoral UHFUS scan, and biopsy. Histology and direct immunofluorescence were set as benchmark for diagnosis confirmation. The sensitivity and specificity of UHFUS compared to histology were assessed. Mann-Whitney test was performed to evaluate the presence of differences in the echogenicity of PV and MMP. P-value was set at P < 0.05. RESULTS Twenty-five patients were included. Thirteen patients were diagnosed with PV, and twelve with MMP. The UHFUS features of PV and MMP lesions were described. Image analysis showed statistically significant differences between the echogenicity of PV and MMP lesions (P < 0.05). Good concordance between UHFUS and histology was found. UHFUS showed 75% sensitivity in the diagnosis of PV and 66.7% in the diagnosis of MMP. CONCLUSIONS UHFUS appears a valuable tool in the diagnosis of PV and MMP. Although histology and immunofluorescence remain the gold standard, UHFUS role in the diagnostic algorithm of PV and MMP seems promising as a chair-side tool consistently enhancing clinical evaluation of oral bullous lesions.
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Affiliation(s)
- Rossana Izzetti
- Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Marco Nisi
- Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Giacomo Aringhieri
- Diagnostic and Interventional Radiology, Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Saverio Vitali
- Diagnostic and Interventional Radiology, Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Teresa Oranges
- Unit of Dermatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Romanelli
- Unit of Dermatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Davide Caramella
- Diagnostic and Interventional Radiology, Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Filippo Graziani
- Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Mario Gabriele
- Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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12
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Izzetti R, Vitali S, Aringhieri G, Nisi M, Oranges T, Dini V, Ferro F, Baldini C, Romanelli M, Caramella D, Gabriele M. Ultra-High Frequency Ultrasound, A Promising Diagnostic Technique: Review of the Literature and Single-Center Experience. Can Assoc Radiol J 2020; 72:418-431. [PMID: 32721173 DOI: 10.1177/0846537120940684] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Ultra-high frequency ultrasonography (UHFUS) is a recently introduced diagnostic technique which finds several applications in diverse clinical fields. The range of frequencies between 30 and 100 MHz allows for high spatial resolution imaging of superficial structures, making this technique suitable for the imaging of skin, blood vessels, musculoskeletal anatomy, oral mucosa, and small parts. However, the current clinical applications of UHFUS have never been analyzed in a consistent multidisciplinary manner. The aim of this study is to revise and discuss the current applications of UHFUS in different aspects of research and clinical practice, as well as to provide some examples of the current work-in-progress carried out in our center. MATERIALS AND METHODS A literature search was performed in order to retrieve articles reporting the applications of UHFUS both in research and in clinical settings. Inclusion criteria were the use of frequencies above 30 MHz and study design conducted in vivo on human subjects. RESULTS In total 66 articles were retrieved. The majority of the articles focused on dermatological and vascular applications, although musculoskeletal and intraoral applications are emerging fields of use. We also describe our experience in the use of UHFUS as a valuable diagnostic support in the fields of dermatology, rheumatology, oral medicine, and musculoskeletal anatomy. CONCLUSION Ultra-high frequency ultrasonography application involves an increasing number of medical fields. The high spatial resolution and the superb image quality achievable allow to foresee a wider use of this novel technique, which has the potential to bring innovation in diagnostic imaging.
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Affiliation(s)
- Rossana Izzetti
- Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, 9310University of Pisa, Pisa, Italy
| | - Saverio Vitali
- Diagnostic and Interventional Radiology, Department of Translational Research and of New Technologies in Medicine and Surgery, 9310University of Pisa, Pisa, Italy
| | - Giacomo Aringhieri
- Diagnostic and Interventional Radiology, Department of Translational Research and of New Technologies in Medicine and Surgery, 9310University of Pisa, Pisa, Italy
| | - Marco Nisi
- Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, 9310University of Pisa, Pisa, Italy
| | - Teresa Oranges
- Unit of Dermatology, Department of Clinical and Experimental Medicine, 9310University of Pisa, Pisa, Italy
| | - Valentina Dini
- Unit of Dermatology, Department of Clinical and Experimental Medicine, 9310University of Pisa, Pisa, Italy
| | - Francesco Ferro
- Unit of Rheumatology, Department of Clinical and Experimental Medicine, 9310University of Pisa, Pisa, Italy
| | - Chiara Baldini
- Unit of Rheumatology, Department of Clinical and Experimental Medicine, 9310University of Pisa, Pisa, Italy
| | - Marco Romanelli
- Unit of Dermatology, Department of Clinical and Experimental Medicine, 9310University of Pisa, Pisa, Italy
| | - Davide Caramella
- Diagnostic and Interventional Radiology, Department of Translational Research and of New Technologies in Medicine and Surgery, 9310University of Pisa, Pisa, Italy
| | - Mario Gabriele
- Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, 9310University of Pisa, Pisa, Italy
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