The validity and reliability of using ultrasound elastography to measure cutaneous stiffness, a systematic review

Ultrasound elastography is an imaging technology which can objectively and non-invasively assess tissue stiffness. It is emerging as a useful marker for disease diagnosis, progression and treatment efficacy.

To examine current, published research evaluating the use of ultrasound elastography for the measurement of cutaneous or subcutaneous stiffness and to determine the level of validity and reliability, recommended methodologies and limitations.

MEDLINE, Web of science and Scopus were systematically searched in August 2016 to identify original articles evaluating the use of ultrasound elastography to assess cutaneous stiffness. Relevant studies were then quality evaluated using the Quality Assessment of Diagnostic Accuracy Studies v 2 (QUADAS-2) tool and the Quality Appraisal of Reliability Studies (QAREL).

From a total of 688 articles, 14 met the inclusion criteria for full review. Within the 14 studies, elastography was used to evaluate tumors, systemic sclerosis, lymphedema, abscess, and post-radiation neck fibrosis. Only three robust studies demonstrated good interrater reliability, whereas all validity studies had low sample sizes and demonstrated risks of bias.

Robust evidence supporting the use of ultrasound elastography as a diagnostic tool in cutaneous conditions is low, however, initial indicators support further research to establish the utility of ultrasound elastography in dermatology.