Multimodal ultrasound assessment for monitoring keloid severity and treatment response

The current understanding and a standardized assessment or treatment guidelines for keloids are not fully established, highlighting the need for an objective method to gauge keloid severity and treatment outcomes. This study investigated the clinical utility of multimodal ultrasound, integrating Shear Wave Elastography (SWE) and Angio planewave ultrasensitive imaging (AP), to assess keloid severity and treatment responses in 58 keloids across 31 patients. Keloids were categorized into mild, moderate, and severe based on Vancouver Scar Scale (VSS) scores. The results revealed significant differences in keloid thickness, elasticity parameters, and blood flow levels among severity groups, with the AP technique demonstrated superior sensitivity in detecting keloid microcirculation. Additionally, the study evaluated the therapeutic response to Strontium-90 Yttrium-90 isotope applicator treatment in 28 keloids, categorizing them into 13 good responders and 15 poor responders based on improvements observed in their VSS scores. Good responders demonstrated marked improvements post-treatment, including significant flattening of the keloids, decreased stiffness, and normalization of blood flow levels. In contrast, poor responders exhibited minimal changes in keloid thickness, stiffness, and blood flow signals following treatment. These findings underscore the effectiveness of multimodal ultrasound in evaluating treatment responses in keloid management. In conclusion, multimodal ultrasound, focusing on SWE and AP modalities, offers a promising tool for comprehensive assessment, with potential to enhance keloid evaluation and track treatment responses across varying therapeutic interventions, thereby facilitating optimized clinical management and guiding personalized treatment. The study was successfully registered on ClinicalTrials.gov on 12/09/2023, with the Identifier NCT06034587.