Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. 3-dimensional (3D) stereophotogrammetry identified craniofacial morphea (CM) progression in patients with clinically reported disease activity.

2. 3D stereophotogrammetry identified the occult progression of CM that was not identified in clinical assessment alone.

Evidence Rating Level: 1 (Excellent)

Study Rundown:

Craniofacial morphea (CM) is an autoimmune disorder causing skin and soft tissue inflammation leading to atrophy. It primarily affects children but can occur in adults. Detecting the progression of CM is challenging as current methods need more sensitivity. One emerging tool for quantifying CM is 3-dimensional (3D) stereophotogrammetry, a non-invasive, radiation-free imaging method. Therefore, this prospective study evaluated the utility of 3-dimensional (3D) stereophotogrammetry in detecting CM progression over time. Blinded assessment of sequential 3D stereophotogrammetry images supported clinical assessment and also detected occult progression of facial asymmetry that was not found on clinical examination. This study is limited by its small sample size and lack of CM diagnoses criterion. Furthermore, the results of a flip-registration procedure may not reflect the use in patients presenting with midline or symmetric facial defects.

In-Depth [prospective cohort]:

This prospective cohort consisted of 27 consecutive patients seen at Boston’s Children’s Hospital and Brigham & Women’s Hospital outpatient rheumatology-dermatology clinics between April 1, 2019, and March 1, 2023. Each patient had expert-diagnosed CM (biopsy optional) and had 3D facial photographs taken using a flip-registration procedure, with the unaffected half of their face being reflected onto the affected half to allow for volumetric differences to be identified through a topographical heat map. The information retrieved from health records included demographic characteristics, clinical features, treatment data, and disease recurrence or progression. A blinded plastic surgeon and dermatologist independently reviewed the 3D images to assess for progressive facial asymmetry. The assessments were performed at 2-12 month intervals and were qualitatively rated as demonstrating no progression or definitive progression. Of 27 patients (19 female; median age, 14 [range, 5-40] years) with images obtained at a minimum of 2 separate time points (median, 4 [range, 2-10] images; median, 3 [range, 2-12] months apart), 10 were found to have disease progression. The interrater reliability (κ) was 0.80 [95% CI, 0.61-0.99]). A review of the 3D images also detected occult progression of asymmetry that was not noted on clinical examination in 3 patients. Overall, 3D stereophotogrammetry may be a beneficial adjunct outcome measurement for CM.

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