3D stereophotogrammetry may have utility in evaluating craniofacial morphea

Assessment of craniofacial morphea using 3D stereophotogrammetry correlated highly with assessments made using clinical evaluation, according to study findings.

“Objectively determining tissue loss in craniofacial morphea is challenging,” Laila F. Abbas, MD, of the department of dermatology at the University of Texas Southwestern Medical Center, and colleagues wrote.

They suggested that 3D stereophotogrammetry — a radiation-free imaging modality used to treat several craniofacial disorders — may have utility as a noninvasive modality for assessing tissue loss in craniofacial morphea.

The prospective study included 23 patients with craniofacial morphea. They underwent clinical, 3D stereophotogrammetry and quality of life (QOL) evaluation.

Pathologic asymmetry was observed in at least one region of the face in 20 patients. The most commonly reported region of asymmetry was seen in the forehead, which was observed in 14 patients. Thirteen patients had pathologic asymmetry in the cheek, three in the nose and six in the mouth.

Two experts and two nonexperts reviewed traditional photographs and 3D stereophotogrammetry images to determine if the condition was mild, moderate or severe.

The researchers then calculated inter-rater and intra-rater reliability.

Results showed that 3D stereophotogrammetry images were able to detect pathologic symmetry in 20.6% of the cohort.

When the reviewing panel assessed the images, they rated 19% of 3D stereophotogrammetry images as severe disease but 0% of traditional photographs as severe (P = .004).

The inter-rater reliability among the two expert reviewers was strong for both 3D stereophotogrammetry (kappa coefficient = 0.727) and traditional photographs (kappa coefficient = 0.824). The intra-rater reliability between the two experts “ranged from moderate to almost perfect” for both image assessment types.

For the nonexperts, the inter-rater reliability was “near perfect” for 3D stereophotogrammetry (kappa coefficient = 0.812) and “fair” for traditional photographs (kappa coefficient = 0.333). Regarding intra-rater reliability for nonexperts, the range was from “moderate to substantial” for the two image types.

Further findings showed correlations between Physician Global Assessment of Damage (PGA-D) scores and a number of relevant outcomes, including mouth asymmetry (P = .0021) and cheek asymmetry (P = .04).

Importantly, the PGA-D also correlated with ratings assigned by 3D stereophotogrammetry ratings (median and mild, 27.5 vs. moderate, 46.5 vs. severe, 64; P = .0152).

Other findings showed an association between lower face asymmetry correlated with worse QOL scores (P = .013).

The findings may be limited by the sample size and the cross-sectional design, according to the researchers.

“3D stereophotogrammetry can reliably detect and quantify asymmetry in craniofacial morphea with greater sensitivity than traditional assessment alone,” the researchers concluded. “3D-stereophotogrammetry maybe a useful adjunct to clinical examination.”