Superb microvascular imaging for assessing keloids and short-term changes after intralesional triamcinolone acetonide injection: a preliminary study

To investigate the value of combining high-frequency ultrasound with superb microvascular imaging (SMI) for assessing keloids and the short-term therapeutic change of triamcinolone acetonide (TA) injection. This prospective study included 21 patients (60 keloids). Of the 60 keloids, 23 lesions from 9 patients received a single intralesional TA injection and were reassessed one month later. Skin thicknesses at the keloids and healthy contralateral skin sites were evaluated using high-frequency ultrasound, whereas SMI was used to detect microvascular blood flow in the skin and measure the vascular index (VI). Lesion-level changes in thickness and VI were analyzed, supplemented by patient-level sensitivity analyses. Skin thickness (3.37 ± 1.34 mm and 1.57 ± 0.30 mm) and VI values (7.34 (4.94, 14.78) % and 0.70 (0.51, 1.44) %) between the 60 keloids and the healthy contralateral skin sites showed significant differences ( P < 0.05). Further, TA injection at the 23 keloids reduced skin thickness (before: 3.70 (2.10, 4.20) mm; after: 2.90 (2.10, 3.70) mm), VI values (before: 7.60 (4.60, 12.60) %; after: 5.70 (1.20, 10.00) %) and mVSS score (before: 10 (9, 11); after: 8 (7, 10)) ( P < 0.05). Patient-level analyses demonstrated a significant mean thickness reduction (− 0.56 mm, P < 0.05), whereas the mean VI change (− 2.47%) was not statistically significant ( P = 0.203). High‑frequency ultrasound combined with SMI can quantify keloid thickness and microvascular characteristics. Short‑term VI changes observed at the lesion level were not corroborated by patient‑level analyses. Given its exploratory nature, findings should be interpreted cautiously. This convenient, non‑invasive imaging approach holds promise for monitoring treatment response.