Research Of Keloid Scars Evaluated By Ultrasound Shear Wave Elastography

Objective: A study of ultrasound shear wave elastography combined with traditional scar assessment scales for accurate keloid assessment.Methods: Part I: 10 keloid lesions requiring surgical excision were selected,and the pathological differences in HE staining and Masson staining were observed at five sites for each lesion: the highest SWV;the lowest SWV;the most pronounced area of the patient’s conscious itching;the least pronounced area,and the keloid adjacent to normal skin.Immunohistochemistry was used to assess CD31,Collagen II and α-SMA expression at each site.High-frequency ultrasound,SWE,and traditional VSS and POSAS scales were performed to assess the above sites.Part II: 20 keloid lesions treated with drug closure injections were included.The relationship between SWE values,scar thickness,VSS and POSAS scale scores before and after treatment were compared.Statistical software SPSS 25.0 was used to obtain basic information about the cases,differences in indicators between groups,and correlations between indicators for statistical analysis.Results:Part I:1.HE staining results: normal skin compared with keloid at the highest SWV,at the lowest SWV,and at the most pronounced and least pronounced areas of the patient’s conscious itching,respectively,all suggesting significant differences with sig values <0.01.2.Masson staining results: there was a significant difference of the percentage of fibrous tissue expression area within the skin tissue between the normal skin and the least obvious place of self-induced itching,and the rest of the two-two paired analysis showed no significant difference(sig > 0.05).3.Immunohistochemical results: compared with the normal skin group,the CD31 protein content of human scar tissue was significantly elevated in the group with the most pronounced self-pruritus,which was statistically significant(P < 0.01).Compared with the normal skin group,the Collagen II protein content of human scar tissue was significantly increased in the group with the most pronounced self-induced itching and the group with the highest shear wave velocity,which was statistically significant(P < 0.01).Compared with the normal skin group,the α-SMA protein content of human keloid tissue was significantly higher in the group with the most pronounced conscious itching and the group with the least pronounced conscious itching,which was statistically significant(P < 0.01).4.There were significant differences between keloid lesion thickness and normal skin thickness,and between lesion SWV and normal skin tissue SWV(Mean＿avg,Min＿avg,Max＿avg).5.Correlation analysis between ultrasound data and Scar core Scales : the correlation coefficients between lesion thickness and shear wave velocity(Mean＿avg,Min＿avg,Max＿avg),VSS(color,thickness,vascular distribution,softness),POSAS observers(color,thickness,roughness),and POSAS patients(pruritus,thickness)of keloids were all positive,reaching 0.01 level of significance.Part II:1.lesions treated with pharmacocontainment injections for 8 weeks compared with pre-injection: the vertical maximum diameter,lesion thickness,SWV(Mean＿avg,Min＿avg,Max＿avg)in keloid ultrasound measurements reached significant levels(P < 0.05)and were significantly different.2.There were significant differences between lesion thickness and normal skin thickness,and between lesion SWV and normal skin tissue SWV(Mean＿avg,Min＿avg,Max＿avg)in keloids treated with drug closure injections.3.Correlation analysis between ultrasound data and rating scales:correlation coefficients between lesion thickness of keloids and SWV(Mean＿avg,Max＿avg),VSS(thickness,vascular distribution),POSAS observers(vascular distribution,thickness,roughness,softness),and POSAS patients(pain,pruritus,hardness)were all positive and reached a significance of 0.01 level.Conclusion:There is a positive correlation between hardness and thickness measured by SWE,high-frequency ultrasound and traditional VSS,POSAS.SWE and high-frequency ultrasound are more accurate than traditional scale assessments.The use of ultrasound SWE for accurate quantification of the different clinical states of keloids is a better assessment method.However,there is a need to introduce more objective evaluation techniques for some keloid-related indicators.The correlation between patients’ conscious pruritic symptoms and keloid hardness was not significant and may be related to vascular abundance.α-SMA correlated more with keloid hardness.