The Role of Ultra-High-Frequency Ultrasound in Pyoderma Gangrenosum: New Insights in Pathophysiology and Diagnosis
Pyoderma gangrenosum (PG) is a neutrophilic dermatological disease, whose pathogenesis is still poorly clarified. Because of the lack of validated criteria for diagnosis and response, PG treatment is still challenging and should be differentiated in the inflammatory and non-inflammatory phases. Our...
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MDPI AG
2023-08-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/13/17/2802 |
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| author | Giammarco Granieri Alessandra Michelucci Flavia Manzo Margiotta Bianca Cei Saverio Vitali Marco Romanelli Valentina Dini |
| author_facet | Giammarco Granieri Alessandra Michelucci Flavia Manzo Margiotta Bianca Cei Saverio Vitali Marco Romanelli Valentina Dini |
| author_sort | Giammarco Granieri |
| collection | DOAJ |
| description | Pyoderma gangrenosum (PG) is a neutrophilic dermatological disease, whose pathogenesis is still poorly clarified. Because of the lack of validated criteria for diagnosis and response, PG treatment is still challenging and should be differentiated in the inflammatory and non-inflammatory phases. Our study aimed to provide a new semi-quantitative approach for PG diagnosis and monitoring, identifying ultra-high-frequency ultrasound (UHFUS) early biomarkers associated with the transition between the two phases. We enrolled 13 patients affected by painful PG lesions evaluated during the inflammatory phase (T0) and during the non-inflammatory phase (T1): pain was measured by the Visual Analogue Scale (VAS); clinical features were recorded through digital photography; epidermis and dermis ultrasound (US) characteristics were evaluated by UHFUS examination with a 70 MHz probe (Vevo MD<sup>®</sup> FUJIFILM VisualSonics). In T1 UHFUS examination, the presence of hyperechoic oval structures was lower compared to T0 (<i>p</i> value < 0.05). An hyperechogenic structure within the oval structure, suggestive of a hair tract, was evident in T0 and absent in T1 (<i>p</i> value < 0.05). In T0, blood vessels appear as U-shaped and V-shaped anechoic structures with a predominance of U-shaped vessels (<i>p</i> value < 0.05) compared to the more regular distribution found in T1. Finding early biomarkers of the transition from the inflammatory to the non-inflammatory phase could provide new insight in terms of therapeutic decision making and response monitoring. The differences found by this study suggest a potential use of UHFUS for the development of an objective standardized staging method. Further investigations will be necessary to confirm our preliminary results, thus providing a turning point in PG early detection, differential diagnosis and treatment monitoring. |
| first_indexed | 2024-03-10T23:25:58Z |
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| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-10T23:25:58Z |
| publishDate | 2023-08-01 |
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| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-9e818016cbc24eb88816dce52c23b8062023-11-19T07:59:49ZengMDPI AGDiagnostics2075-44182023-08-011317280210.3390/diagnostics13172802The Role of Ultra-High-Frequency Ultrasound in Pyoderma Gangrenosum: New Insights in Pathophysiology and DiagnosisGiammarco Granieri0Alessandra Michelucci1Flavia Manzo Margiotta2Bianca Cei3Saverio Vitali4Marco Romanelli5Valentina Dini6Department of Dermatology, University of Pisa, 56126 Pisa, ItalyDepartment of Dermatology, University of Pisa, 56126 Pisa, ItalyDepartment of Dermatology, University of Pisa, 56126 Pisa, ItalyDepartment of Dermatology, University of Pisa, 56126 Pisa, ItalyDiagnostic and Interventional Radiology, University Hospital of Pisa, 56126 Pisa, ItalyDepartment of Dermatology, University of Pisa, 56126 Pisa, ItalyDepartment of Dermatology, University of Pisa, 56126 Pisa, ItalyPyoderma gangrenosum (PG) is a neutrophilic dermatological disease, whose pathogenesis is still poorly clarified. Because of the lack of validated criteria for diagnosis and response, PG treatment is still challenging and should be differentiated in the inflammatory and non-inflammatory phases. Our study aimed to provide a new semi-quantitative approach for PG diagnosis and monitoring, identifying ultra-high-frequency ultrasound (UHFUS) early biomarkers associated with the transition between the two phases. We enrolled 13 patients affected by painful PG lesions evaluated during the inflammatory phase (T0) and during the non-inflammatory phase (T1): pain was measured by the Visual Analogue Scale (VAS); clinical features were recorded through digital photography; epidermis and dermis ultrasound (US) characteristics were evaluated by UHFUS examination with a 70 MHz probe (Vevo MD<sup>®</sup> FUJIFILM VisualSonics). In T1 UHFUS examination, the presence of hyperechoic oval structures was lower compared to T0 (<i>p</i> value < 0.05). An hyperechogenic structure within the oval structure, suggestive of a hair tract, was evident in T0 and absent in T1 (<i>p</i> value < 0.05). In T0, blood vessels appear as U-shaped and V-shaped anechoic structures with a predominance of U-shaped vessels (<i>p</i> value < 0.05) compared to the more regular distribution found in T1. Finding early biomarkers of the transition from the inflammatory to the non-inflammatory phase could provide new insight in terms of therapeutic decision making and response monitoring. The differences found by this study suggest a potential use of UHFUS for the development of an objective standardized staging method. Further investigations will be necessary to confirm our preliminary results, thus providing a turning point in PG early detection, differential diagnosis and treatment monitoring.https://www.mdpi.com/2075-4418/13/17/2802pyoderma gangrenosumultra-high-frequency ultrasoundUHFUSPG |
| spellingShingle | Giammarco Granieri Alessandra Michelucci Flavia Manzo Margiotta Bianca Cei Saverio Vitali Marco Romanelli Valentina Dini The Role of Ultra-High-Frequency Ultrasound in Pyoderma Gangrenosum: New Insights in Pathophysiology and Diagnosis Diagnostics pyoderma gangrenosum ultra-high-frequency ultrasound UHFUS PG |
| title | The Role of Ultra-High-Frequency Ultrasound in Pyoderma Gangrenosum: New Insights in Pathophysiology and Diagnosis |
| title_full | The Role of Ultra-High-Frequency Ultrasound in Pyoderma Gangrenosum: New Insights in Pathophysiology and Diagnosis |
| title_fullStr | The Role of Ultra-High-Frequency Ultrasound in Pyoderma Gangrenosum: New Insights in Pathophysiology and Diagnosis |
| title_full_unstemmed | The Role of Ultra-High-Frequency Ultrasound in Pyoderma Gangrenosum: New Insights in Pathophysiology and Diagnosis |
| title_short | The Role of Ultra-High-Frequency Ultrasound in Pyoderma Gangrenosum: New Insights in Pathophysiology and Diagnosis |
| title_sort | role of ultra high frequency ultrasound in pyoderma gangrenosum new insights in pathophysiology and diagnosis |
| topic | pyoderma gangrenosum ultra-high-frequency ultrasound UHFUS PG |
| url | https://www.mdpi.com/2075-4418/13/17/2802 |
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