Validity and Reliability of Shear-wave Elastography to Evaluate Burn Scar Stiffness

Ms Helen Dejong1,2,3, Mr Steven Abbott5, Ms Marilyn Zelesco5, Dr Brendan Kennedy3,4, Dr Lisa Martin6, Prof  Melanie Ziman2, Prof Fiona Wood6,7

1Perth Scar And Pain Clinic , Mt Pleasant, Australia, 2Edith Cowan University, Joondalup, Australia, 3BRITElab, Harry Perkins Institute of Medical Research, Nedlands, Australia, 4Department of Electrical, Electronic & Computer Engineering, School of Engineering,The University of Western Australia, Crawley, Australia, 5Department of Medical Imaging, Fiona Stanley Hospital, Murdoch, Australia, 6Fiona Wood Foundation, Murdoch, Australia, 7State Burn Service of Western Australia, Murdoch, Australia


Shear-wave elastography (SWE) is an emerging imaging technology that provides quantitative assessment of tissue stiffness in-vivo. Based on ultrasound, SWE has been used to quantify stiffness associated with disease in the liver, breast, prostate and thyroid. This research aims to evaluate the validity and reliability of using SWE to objectively evaluate the stiffness of skin, burn scars and the associated non-injured subcutaneous tissues.

This prospective, cross sectional study evaluated adult burn patients with a healed partial thickness burn, at least 6 weeks post injury. Each participant had up to three scar sites of varying stiffness, and three matched, contralateral non-injured skin sites assessed with SWE, B-mode ultrasound and the POSAS.

Preliminary results (n=31 scars) indicate that SWE can quantify both the degree and extent of scar stiffness. Scar tissue demonstrated a higher average shear wave speed compared to non-injured skin. A novel trend was found indicating that increasing scar stiffness is also associated with a greater depth of stiffness. This stiffness extends into the non-injured subcutaneous adipose tissue, and in some cases to the peri-muscular fascia. Tests of validity and reliability were also performed.

Our results show that SWE provides a novel method with which to quantify both the degree and extent of increased tissue stiffness associated with a burn scar. Imaging both the scar and the surrounding non-injured subcutaneous tissues provides novel information regarding changes in mechanical properties of tissues associated with a burn.


Helen has been a clinical occupational therapist for over 20 years, working in Burns, upper limb trauma, neurology and chronic pain. She is currently doing her PhD titled the Mechanobiology of Scarring, and runs a private practice called the Perth Scar and Pain Clinic.

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