Scleroderma calcinosis cutis score (SC2S): an imaging metric to quantify SSc-calcinosis cutis

OBJECTIVES: Calcinosis cutis (CC) is disabling for SSc patients, and quantitative outcomes and treatments are needed. We performed computer-assisted mapping of CC lesions on CT exams and quantified CC during sodium thiosulphate (STS) treatment. METHODS: In a pilot study, SSc-CC patients underwent CT imaging of a painful lesion followed by 6-12 month 25% STS, intradermal monthly injections or twice daily cream, treatment. Post-treatment CT exams were obtained, and three assessors used open-source software (BioImageSuite/BIS Web) to map and quantify CC volume, termed scleroderma calcinosis cutis score (SC2S). Results were compared with the Scleroderma Clinical Trials Consortium Radiologic Scoring System for Hand Calcinosis as appropriate. RESULTS: Five women with SSc-CC involving the arm, ischial tuberosities, hands (two patients) and patellae, received topical (n = 2) or intradermal (n = 3) STS. Lesion mapping with BIS Web showed high inter-rater agreement between independent assessors (intraclass correlation coefficient = 0.93). SC2S revealed 75% and 10% reductions in left and right buttock, respectively; 28% reduction in arm; 18% increase in left forefinger; 27% increase in right hand and 12% reduction in left, and 4% increase in right, patellae, respectively. CC volume differences on repeated measures 1-week apart were ≤3%. Mapping time ranged from <30 min for arm and buttock to >4 h for finger/hand and patellae. CONCLUSION: SC2S may be a highly reproducible, broadly applicable, quantitative outcome that is sensitive to CC change. SC2S highlights the variable response of SSc-CC to STS treatment. Future work to automate CC mapping will reduce lesion mapping time.