Dupuytren Hastalığında Kontraktür Gelişiminin Görüntüleme Yöntemleriyle Öngörülmesi: Multimodal Ultrasonografik Değerlendirme

Öz

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.

Anahtar Kelimeler

• Dupuytren hastalığı
• ultrasonografi
• elastografi
• fleksiyon deformitesi

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

Öz

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.

Anahtar Kelimeler

• Dupuytren
• ultrasound
• elastography
• flexion deformity

Kaynakça

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