Dupuytren Hastalığında Kontraktür Gelişiminin Görüntüleme Yöntemleriyle Öngörülmesi: Multimodal Ultrasonografik Değerlendirme

Abstract

Amaç: Bu çalışmada Dupuytren hastalığında ultrasonografi (US), renkli Doppler US (RDUS) ve strain elastografi (SEL) bulgularının değerlendirilmesi ve bu bulguların klinik bulgular ve lezyon morfolojisiyle ilişkilerinin araştırılması amaçlandı. Yöntemler: Toplam 226 hasta (153 erkek, 73 kadın; ortalama yaş: 61,5 ± 9,9 yıl) ve 226 lezyon retrospektif olarak analiz edildi. Lezyonlar, B-mod US, RDUS ve SEL ile ekojenite, morfoloji, boyutlar, vaskülarite, sertlik ve anatomik komşuluk açısından değerlendirildi. Fleksiyon deformitesi ve fleksör tendon ve/veya musküler yapılara uzanım kaydedildi. Karşılaştırmalarda ki-kare testi, Mann-Whitney U testi ve Spearman korelasyon analizi kullanıldı. Bulgular: Lezyonlar en sık 3. (%74,3) ve 4. (%23,9) parmaklar düzeyinde lokalizeydi. Morfolojik olarak lezyonların %62,8'i kord şeklindeydi ve %83,6'sı hipoekoikti. Fleksiyon deformitesi vakaların %42,9'unda saptandı ve tendon ve/veya musküler yapılara uzanımı olan lezyonlarda belirgin olarak daha sık görüldü (%81,3 vs. %0; p < 0,001). Ayrıca, deformite kord morfolojisine sahip lezyonlarda (%66,2) nodüler olanlara (%3,6) kıyasla daha yaygındı (p < 0,001). İzo-hiperekoik lezyonlarda deformite görülme oranı hipoekoik lezyonlara göre anlamlı derecede fazlaydı (%59,5 vs. %39,7; p = 0,026). SEL ile yapılan değerlendirmede lezyonların %52,7'si sert, %41,2'si orta sertlikte, %6,2'si yumuşak olarak sınıflandırıldı. Deformitesi olan lezyonların anterior-posterior (AP) çapları daha genişti (p = 0,001). Transvers ve AP çaplar arasında orta düzeyde korelasyon saptandı (ρ = 0,631, p < 0,001). Sonuç: Dupuytren hastalığında fleksiyon deformitesi, özellikle tendon veya nörovasküler yapılara uzanımı olan ve kord morfolojisine sahip lezyonlarla yakından ilişkilidir. Ultrasonografi ve elastografi bulguları, hastalığın ciddiyetini öngörmede ve tedavi planlamasında değerli bilgiler sunabilir.

Keywords

• Dupuytren hastalığı
• ultrasonografi
• elastografi
• fleksiyon deformitesi

Imaging Predictors of Contracture in Dupuytren’s Disease: Multimodal Ultrasonographic Perspective

Abstract

Objective: To investigate ultrasonographic (US), color Doppler ultrasonographic (CDUS), and strain elastography (SEL) characteristics of Dupuytren's disease (DD) and assess their relationship with clinical findings and lesion morphology. Methods: A total of 226 patients (153 males, 73 females; mean age: 61.5 ± 9.9 years) and 226 lesions were retrospectively analyzed. Lesions were evaluated using B-mode US, CDUS, and SEL for echogenicity, morphology, dimensions, vascularity, stiffness, and anatomical relationships. Flexion deformity and extension of flexor tendons and/or muscular structures were recorded. Statistical comparisons were performed using chi-square, Mann-Whitney U, and Spearman correlation tests. Results: Lesions were most frequently located in the 4th (74.3%) and 5th (23.9%) finger. Cord-like morphology was observed in 62.8%, and 83.6% were hypoechoic. Flexion deformity was detected in 42.9% of cases and was significantly more frequent in lesions with tendon and/or muscular extension (81.3% vs. 0%; p < 0.001). The deformity was also more common in cord-like than nodular lesions (66.2% vs. 3.6%, p < 0.001). Iso-hyperechoic lesions were more likely to be associated with deformity compared to hypoechoic ones (59.5% vs. 39.7%, p = 0.026). In SEL, 52.7% of lesions were stiff, 41.2% moderate, and 6.2% soft. Lesions with deformity had significantly greater anterior-posterior (AP) diameter (p = 0.001). A moderate correlation existed between transverse and AP size (ρ = 0.631, p < 0.001). Conclusion: Flexion deformity in DD is strongly associated with tendon/muscular extension and lesion morphology. US and SEL parameters offer significant value in clinical evaluation, enabling early identification of severe disease and aiding therapeutic planning.

Keywords

• Dupuytren
• ultrasound
• elastography
• flexion deformity

References

1. 1. Dutta A, Jayasinghe G, Deore S, Wahed K, Bhan K, Bakti N, et al. Dupuytren’s contracture–current concepts. J Clin Orthop Trauma. 2020;11(4):590-6.
2. 2. Lanting R, Broekstra DC, Werker PM, van den Heuvel ER. A systematic review and meta-analysis on the prevalence of Dupuytren disease in the general population of Western countries. Plast Reconstr Surg. 2014;133(3):593-603.
3. 3. Grazina R, Teixeira S, Ramos R, Sousa H, Ferreira A, Lemos R. Dupuytren's disease: where do we stand? EFORT Open Rev. 2019;4(2):63-9.
4. 4. Alser OH, Kuo RY, Furniss D. Nongenetic factors associated with Dupuytren’s disease: a systematic review. Plast Reconstr Surg. 2020;146(4):799-807.
5. 5. Broekstra DC, Groen H, Molenkamp S, Werker PM, van den Heuvel ER. A systematic review and meta-analysis on the strength and consistency of the associations between Dupuytren disease and diabetes mellitus, liver disease, and epilepsy. Plast Reconstr Surg. 2018;141(3):367e-79e.
6. 6. Sayadi LR, Alhunayan D, Sarantopoulos N, Kong C, Condamoor S, Sayadi J, et al. The molecular pathogenesis of Dupuytren disease: review of the literature and suggested new approaches to treatment. Ann Plast Surg. 2019;83(5):594-600.
7. 7. Rayan GM. Dupuytren disease: anatomy, pathology, presentation, and treatment. JBJS. 2007;89(1):189-98.
8. 8. Morris G, Jacobson JA, Kalume Brigido M, Gaetke‐Udager K, Yablon CM, Dong Q. Ultrasound features of palmar fibromatosis or Dupuytren contracture. J Ultrasound Med. 2019;38(2):387-92.

9. 9. Molenkamp S, van Straalen RJ, Werker PM, Broekstra DC. Imaging for Dupuytren disease: a systematic review of the literature. BMC Musculoskelet Disord. 2019;20(1):224.
10. 10. Botar Jid C, Vasilescu D, Damian L, Dumitriu D, Ciurea A, Dudea SM. Musculoskeletal sonoelastography. pictorial essay. Med Ultrason. 2012;14(3):239-45.
11. 11. Murphey MD, Ruble CM, Tyszko SM, Zbojniewicz AM, Potter BK, Miettinen M. Musculoskeletal fibromatoses: radiologic-pathologic correlation. Radiography. 2009;29(7):2143-83.
12. 12. van den Berge BA, Werker PM, Broekstra DC. Limited progression of subclinical Dupuytren’s disease: results from a prospective cohort study. Bone Joint J. 2021;103(4):704-10.
13. 13. Anthony SG, Lozano-Calderon SA, Simmons BP, Jupiter JB. Gender ratio of Dupuytren's disease in the modern US population. Hand. 2008;3(2):87-90.
14. 14. Walthall J, Anand P, Rehman U. Dupuytren Contracture. [Updated 2023 Feb 26]. StatPearls [Internet] Treasure Island (FL): StatPearlsPublishing. 2024.
15. 15. Sarkar M, Kashyap N, Madabhavi I. Dupuytren’s disease: a review. Chin J Plast Reconstr Surg. 2024;6:142-8.
16. 16. Stahl S, Calif E. Dupuytren's palmar contracture in women. Isr Med Assoc J. 2008;10(6):445.
17. 17. Vanek P, Strömberg J, Fridén J, Aurell Y. Morphological patterns of the pretendinous cord in Dupuytren’s disease: a predictor of clinical outcome? J Plast Surg Hand Surg. 2018;52(4):240-4.
18. 18. Lambi AG, Morrell NT, Popoff SN, Benhaim P, Barbe MF. Let’s focus on the fibrosis in Dupuytren Disease: cell communication network factor 2 as a novel target. J Hand Surg Glob Online. 2023;5(5):682-8.
19. 19. Crowley B, Tonkin MA. The proximal interphalangeal joint in Dupuytren's disease. Hand clinics. 1999;15:137-48.
20. 20. Lanting R, Nooraee N, Werker PM, van den Heuvel ER. Patterns of Dupuytren disease in fingers: studying correlations with a multivariate ordinal logit model. Plast Reconstr Surg. 2014;134(3):483-90.
21. 21. Ulusoy A, Tikiz C, Örgüç Ş. Dupuytren’s contracture with rare bilateral thumb and little finger involvement demonstrated by ultrasound elastography. Arch Rheumatol. 2015;30(4):357-60.
22. 22. Molenkamp S, Song W, Bloembergen M, Broekstra DC, Werker PM. Echogenicity of Dupuytren’s nodules is correlated to myofibroblast load and nodule hardness. J Hand Surg (European Volume). 2022;47(3):280-7.
23. 23. Rehman S, Goodacre R, Day PJ, Bayat A, Westerhoff HV. Dupuytren's: a systems biology disease. Arthritis Res Ther. 2011;13(5):238.