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Gutierrez M, Bertolazzi C, Zozoaga-Velazquez E, Clavijo-Cornejo D. The Value of Ultrasound for Detecting and Following Subclinical Interstitial Lung Disease in Systemic Sclerosis. Tomography 2024; 10:521-532. [PMID: 38668398 PMCID: PMC11054173 DOI: 10.3390/tomography10040041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/14/2024] [Accepted: 03/28/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Interstitial lung disease (ILD) is a complication in patients with systemic sclerosis (SSc). Accurate strategies to identify its presence in early phases are essential. We conducted the study aiming to determine the validity of ultrasound (US) in detecting subclinical ILD in SSc, and to ascertain its potential in determining the disease progression. METHODS 133 patients without respiratory symptoms and 133 healthy controls were included. Borg scale, Rodnan skin score (RSS), auscultation, chest radiographs, and respiratory function tests (RFT) were performed. A rheumatologist performed the lung US. High-resolution CT (HRCT) was also performed. The patients were followed every 12 weeks for 48 weeks. RESULTS A total of 79 of 133 patients (59.4%) showed US signs of ILD in contrast to healthy controls (4.8%) (p = 0.0001). Anti-centromere antibodies (p = 0.005) and RSS (p = 0.004) showed an association with ILD. A positive correlation was demonstrated between the US and HRCT findings (p = 0.001). The sensitivity and specificity of US in detecting ILD were 91.2% and 88.6%, respectively. In the follow-up, a total of 30 patients out of 79 (37.9%) who demonstrated US signs of ILD at baseline, showed changes in the ILD score by US. CONCLUSIONS US showed a high prevalence of subclinical ILD in SSc patients. It proved to be a valid, reliable, and feasible tool to detect ILD in SSc and to monitor disease progression.
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Affiliation(s)
- Marwin Gutierrez
- Center of Excellence in Rheumatic and Musculoskeletal Disorders, Mexico City 03530, Mexico;
| | - Chiara Bertolazzi
- Center of Excellence in Rheumatic and Musculoskeletal Disorders, Mexico City 03530, Mexico;
- Division of Rheumatology, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City 03530, Mexico;
| | | | - Denise Clavijo-Cornejo
- Division of Rheumatology, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City 03530, Mexico;
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Delle Sedie A, Terslev L, Bruyn GAW, Cazenave T, Chrysidis S, Diaz M, Di Carlo M, Frigato M, Gargani L, Gutierrez M, Hocevar A, Iagnocco A, Juche A, Keen H, Mandl P, Naredo E, Mortada M, Pineda C, Karalilova R, Porta F, Ravagnani V, Scirè C, Serban T, Smith K, Stoenoiu MS, Tardella M, Torralba K, Wakefield R, D'Agostino MA. Standardization of interstitial lung disease assessment by ultrasound: results from a Delphi process and web-reliability exercise by the OMERACT ultrasound working group. Semin Arthritis Rheum 2024; 65:152406. [PMID: 38401294 DOI: 10.1016/j.semarthrit.2024.152406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES Over the last years ultrasound has shown to be an important tool for evaluating lung involvement, including interstitial lung disease (ILD) a potentially severe systemic involvement in many rheumatic and musculoskeletal diseases (RMD). Despite the potential sensitivity of the technique the actual use is hampered by the lack of consensual definitions of elementary lesions to be assessed and of the scanning protocol to apply. Within the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group we aimed at developing consensus-based definitions for ultrasound detected ILD findings in RMDs and assessing their reliability in dynamic images. METHODS Based on the results from a systematic literature review, several findings were identified for defining the presence of ILD by ultrasound (i.e., Am-lines, B-lines, pleural cysts and pleural line irregularity). Therefore, a Delphi survey was conducted among 23 experts in sonography to agree on which findings should be included and on their definitions. Subsequently, a web-reliability exercise was performed to test the reliability of the agreed definitions on video-clips, by using kappa statistics. RESULTS After three rounds of Delphi an agreement >75 % was obtained to include and define B-lines and pleural line irregularity as elementary lesions to assess. The reliability in the web-based exercise, consisting of 80 video-clips (30 for pleural line irregularity, 50 for B-lines), showed moderate inter-reader reliability for both B-lines (kappa = 0.51) and pleural line irregularity (kappa = 0.58), while intra-reader reliability was good for both B-lines (kappa = 0.72) and pleural line irregularity (kappa = 0.75). CONCLUSION Consensus-based ultrasound definitions for B-lines and pleural line irregularity were obtained, with moderate to good reliability to detect these lesions using video-clips. The next step will be testing the reliability in patients with ILD linked to RMDs and to propose a consensual and standardized protocol to scan such patients.
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Affiliation(s)
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - George A W Bruyn
- Reumakliniek Lelystad, Lelystad, and Tergooi Hospital, Hilversum, the Netherlands
| | - Tomas Cazenave
- Instituto de Rehabiltacion Psicofisca, Buenos Aires, Argentina
| | - Stavros Chrysidis
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Esbjerg Hospital, Denmark
| | - Mario Diaz
- Fundacion Santa Fe de Bogotá, Bogotà, Colombia
| | - Marco Di Carlo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Jesi, Italy
| | - Marilena Frigato
- S.C. Allergologia, Immunologia e Reumatologia, ASST "Carlo Poma" Mantova, Mantova, Italy
| | - Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | | | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche e Biologiche - AO Mauriziano di Torino, Università di Torino, Turin, Italy
| | - Aaron Juche
- Medical Centre for Rheumatology Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Helen Keen
- Department of Medicine and Pharmacology, University of Western Australia, Murdoch, Perth, WA, Australia
| | - Peter Mandl
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Esperanza Naredo
- Department of Rheumatology and Bone and Joint Research Unit, Fundación Jiménez Díaz, Madrid, Spain
| | - Mohamed Mortada
- Department of Rheumatology Rehabilitation and Physical Medicine, Zagazig University, Zagazig, Egypt
| | - Carlos Pineda
- Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Rositsa Karalilova
- Medical University of Plovdiv, University Hospital "Kaspela", Plovdiv, Bulgaria
| | - Francesco Porta
- Interdisciplinary Pain Medicine Unit, Santa Maria Maddalena Hospital, Rovigo, Italy
| | | | - Carlo Scirè
- School of Medicine, University of Milano Bicocca, Milan, Italy
| | | | - Kate Smith
- NIHR Leeds Biomedical Research Centre and University of Leeds, UK
| | - Maria S Stoenoiu
- Rheumatology Department, Clinique Universitaires Saint Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Marika Tardella
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Jesi, Italy
| | | | | | - Maria Antonietta D'Agostino
- Rheumatology division, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Università Cattolica del Sacro Cuore, Roma, Italy
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3
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Velazquez Guevara BA, Abud Mendoza C, Avilés Ramírez LRDJ, Santillán Guerrero E. Ultrasound for diagnosis of interstitial lung disease in diffuse connective tissue diseases. REUMATOLOGIA CLINICA 2023; 19:455-462. [PMID: 37164882 DOI: 10.1016/j.reumae.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/05/2022] [Indexed: 05/12/2023]
Abstract
Patients with diffuse connective tissue diseases frequently develop interstitial lung disease, which carries a worse prognosis and shortens survival. High-resolution computed tomography is the first-choice test, and is competitive with histopathology, however, the cost and radiation may limit its use, particularly for screening. Lung ultrasound is a rapid, accessible, reproducible, and inexpensive study that is useful for diagnosis of interstitial lung disease. Furthermore, extensive training is not required to identify the alterations associated with these lung diseases. B lines and pleural irregularities compose the ultrasonographic interstitial syndrome, although, it must be kept in mind that it is not specific, and it is necessary to rule out haemodynamic, cardiovascular, and infectious abnormalities. This review highlights the elevated prevalence of this lung condition in the main rheumatological diseases, with emphasis on the usefulness of pulmonary ultrasound.
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Affiliation(s)
| | - Carlos Abud Mendoza
- Hospital Central Dr. Ignacio Morones Prieto, Universidad Autónoma de San Luís Potosí, San Luis Potosí, Mexico.
| | | | - Eva Santillán Guerrero
- Hospital Central Dr. Ignacio Morones Prieto, Universidad Autónoma de San Luís Potosí, San Luis Potosí, Mexico
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Huang S, Guo R, Yuan X, Tang X, Liu T, Xie Q, Qiu L. Evaluation of connective tissue disease-related interstitial lung disease using ultrasound elastography: a preliminary study. Quant Imaging Med Surg 2022; 12:3778-3791. [PMID: 35782243 PMCID: PMC9246744 DOI: 10.21037/qims-21-1205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/14/2022] [Indexed: 11/25/2023]
Abstract
BACKGROUND Interstitial lung disease (ILD) is a common pulmonary complication of connective tissue disease (CTD), which can lead to shortened survival. This article explores the ability of shear wave elastography (SWE) to assess lung surface elastic properties and to distinguish healthy lungs from diseased lungs with connective tissue disease-related interstitial lung disease (CTD-ILD). We aimed to determine whether SWE can be used to assess the severity of CTD-ILD. METHODS A total of 65 CTD-ILD patients and 60 healthy volunteers were included for the case group and the control group, respectively. All participants underwent lung ultrasound (count of B-line and measurement of pleural line thickness) and SWE [measurement of Young's modulus (Emean) and shear wave velocity (SMV) (Cmean)] examinations at 50 lung sites. All participants also underwent an examination with high-resolution computed tomography (HRCT) and a pulmonary function test (PFT). For SWE assessment, the Q-box was set to its minimum size (1 mm) and manually placed on the pleural line, rather than inside the lung, to measure the stiffness of the lung surface. The intra- and inter-reliability of SWE measurements of healthy controls (HC), the receiver operating characteristic (ROC) curve for SWE for CTD-ILD, and correlations between different assessment methods were analyzed. RESULTS Excellent intra- and inter-reliability of SWE measurements on the mid-anterior lung site of HCs (correlation coefficient >0.97; P<0.01) were found. The results of the lung ultrasound of case group participants were significantly higher than those of HCs at each site (P<0.001). The SWE results revealed a significant increase in both Emean and Cmean in CTD-ILD patients (P<0.001) compared with HCs at certain sites (P<0.001). The areas under the curve (AUC) of Emean and Cmean for CTD-ILD were 0.646 and 0.647 (P<0.05), respectively, and the cutoff values for Emean and Cmean to distinguish CTD-ILD from healthy lungs were 15.81 kPa and 2.31 m/s, respectively. There was no significant correlation between the SWE measured values and the number of B-lines, or the HRCT and PFT results, respectively (P>0.05). CONCLUSIONS As a noninvasive ultrasound elastography (UE) technique, SWE may provide a novel method to differentiate CTD-ILD-affected lungs and healthy lungs. It is a reliable way to measure the stiffness of a healthy lung surface in the supine position. However, the ability of SWE to evaluate the severity of CTD-ILD may be limited.
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Affiliation(s)
- Songya Huang
- Department of Medical Ultrasound and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Ruiqian Guo
- Department of Medical Ultrasound and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Xinhui Yuan
- Department of Medical Ultrasound, The People’s Hospital of Leshan, Leshan, China
| | - Xinyi Tang
- Department of Medical Ultrasound and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Tao Liu
- Department of Rheumatology and Immunology, West China Hospital of Sichuan University, Chengdu, China
| | - Qibing Xie
- Department of Rheumatology and Immunology, West China Hospital of Sichuan University, Chengdu, China
| | - Li Qiu
- Department of Medical Ultrasound and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
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5
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[Value of CT and transthoracic lung ultrasound in patients with systemic sclerosis : Joint statement of the ÖRG/ÖGP/ÖGR/ÖGUM]. Z Rheumatol 2022; 81:610-618. [PMID: 35513537 PMCID: PMC9468076 DOI: 10.1007/s00393-022-01206-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/12/2022]
Abstract
Die Lungenbeteiligung ist die häufigste Todesursache bei Patienten mit systemischer Sklerose (SSc). Da eine Lungenbeteiligung häufig asymptomatisch ist, wird derzeit empfohlen, bei allen Patienten mit einer neu diagnostizierten SSc eine Thorax-CT durchzuführen. Uneinigkeit herrscht derzeit darüber, wie SSc-Patienten, bei denen zum Diagnosezeitpunkt keine Lungenbeteiligung gefunden wurde, weiterverfolgt werden sollen. Basierend auf einem Konsensus österreichischer Rheumatologen, Pneumologen und Radiologen, wird empfohlen, bei asymptomatischen PatientInnen mit einer negativen CT zum Zeitpunkt der Erstdiagnose jährlich transthorakale Ultraschalluntersuchungen sowie Lungenfunktionsuntersuchungen alle 6 bis 12 Monate durchzuführen. Bei Vorliegen eines positiven Lungenultraschallbefundes wird eine ergänzende CT zur weiterführenden Abklärung empfohlen. Aufgrund der Datenlage werden bei PatientInnen mit einem höheren Risiko, definiert durch entsprechende Risikofaktoren, jährliche CT-Verlaufskontrollen empfohlen.
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Ruaro B, Baratella E, Confalonieri P, Confalonieri M, Vassallo FG, Wade B, Geri P, Pozzan R, Caforio G, Marrocchio C, Cova MA, Salton F. High-Resolution Computed Tomography and Lung Ultrasound in Patients with Systemic Sclerosis: Which One to Choose? Diagnostics (Basel) 2021; 11:2293. [PMID: 34943531 PMCID: PMC8700001 DOI: 10.3390/diagnostics11122293] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 02/07/2023] Open
Abstract
Imaging plays a pivotal role in systemic sclerosis for both diagnosis management of pulmonary complications, and high-resolution computed tomography (HRCT) is the most sensitive technique for the evaluation of systemic sclerosis-associated interstitial lung disease (SSc-ILD). Indeed, several studies have demonstrated that HRCT helps radiologists and clinicians to make a correct diagnosis on the basis of recognised typical patterns for SSc-ILD. Most SSc patients affected by ILD have a non-specific interstitial pneumonia pattern (NISP) on HRCT scan, whilst a minority of cases fulfil the criteria for usual interstitial pneumonia (UIP). Moreover, several recent studies have demonstrated that lung ultrasound (LUS) is an emergent tool in SSc diagnosis and follow-up, although its role is still to be confirmed. Therefore, this article aims at evaluating the role of LUS in SSc screening, aimed at limiting the use of CT to selected cases.
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Affiliation(s)
- Barbara Ruaro
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Paola Confalonieri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Marco Confalonieri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Fabio Giuseppe Vassallo
- Department of Pulmonology, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34149 Trieste, Italy;
| | - Barbara Wade
- AOU City of Health and Science of Turin, Department of Science of Public Health and Pediatrics, University of Torino, 10124 Torino, Italy;
| | - Pietro Geri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Riccardo Pozzan
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Gaetano Caforio
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Cristina Marrocchio
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Maria Assunta Cova
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Francesco Salton
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
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7
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Vicente-Rabaneda EF, Bong DA, Castañeda S, Möller I. Use of ultrasound to diagnose and monitor interstitial lung disease in rheumatic diseases. Clin Rheumatol 2021; 40:3547-3564. [PMID: 34159494 DOI: 10.1007/s10067-021-05761-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 12/13/2022]
Abstract
Interstitial lung disease (ILD) is one of the most relevant extra-articular manifestations of rheumatic diseases resulting in a substantial increase in morbidity and mortality. Early diagnosis and close monitoring to identify patients at high risk of progression are crucial to establish the need for targeted treatment with immunomodulatory and antifibrotic drugs, with potential ability to change the course of the disease. However, there are unmet needs in this field as pulmonary auscultation, chest radiography, or pulmonary function studies do not allow identification of the most incipient stages of the disease. High-resolution computed tomography (HRCT), which is the current gold standard for diagnosis and evolutionary control, is problematic owing to ionizing radiation, cost, and accessibility. In this context, lung ultrasound (LUS) is an attractive tool in a growing research and validation process. The identification of vertical artifacts, such as B lines, and alterations of the pleural line present a good correlation with the presence of ILD by HRCT and have a good concordance with the extent and severity of the disease, with sensitivity and negative predictive values of up to 100%. Regarding the monitoring of the evolution, the validation process of LUS is in a more preliminary phase but data is encouraging. All this, together with its safety, accessibility, low cost, and good patient acceptance, postulate LUS as a useful tool for the screening of ILD and for the optimization of the indications of HRCT. Key Points • The good sensitivity and negative predictive values of LUS postulate this technique as a useful tool for the screening of ILD and for the optimization of the indications of HRCT in rheumatic diseases.
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Affiliation(s)
- Esther F Vicente-Rabaneda
- Rheumatology Department, Hospital Universitario de La Princesa, IIS-Princesa. C/ Diego de León 62, 28006, Madrid, Spain.
| | - David A Bong
- Faculty of Medicine, University of Barcelona-Bellvitge Campus, Barcelona, Spain.,Instituto Poal de Reumatología, Barcelona, Spain
| | - Santos Castañeda
- Rheumatology Department, Hospital Universitario de La Princesa, IIS-Princesa. C/ Diego de León 62, 28006, Madrid, Spain.,Cátedra UAM-Roche EPID-Future, Autonomous University of Madrid (UAM), Madrid, Spain
| | - Ingrid Möller
- Instituto Poal de Reumatología Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Castanyer 15, Sarrià-Sant Gervasi 08022, Barcelona, Barcelona, Spain
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8
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Hughes M, Bruni C, Cuomo G, Delle Sedie A, Gargani L, Gutierrez M, Lepri G, Ruaro B, Santiago T, Suliman Y, Watanabe S, Iagnocco A, Furst D, Bellando-Randone S. The role of ultrasound in systemic sclerosis: On the cutting edge to foster clinical and research advancement. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2021; 6:123-132. [PMID: 35386740 PMCID: PMC8892934 DOI: 10.1177/2397198320970394] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/05/2020] [Indexed: 09/29/2023]
Abstract
Ultrasound has been widely explored in systemic sclerosis in the clinical and research settings. Ultrasound allows a non-invasive and ionising radiation-free 'window' into this complex disease and is well-suited to repeated examinations. Ultrasound provides novel insights into the pathogenesis and measurement of disease in systemic sclerosis, including early (preclinical) internal organ involvement. The purpose of this review is to describe the role of ultrasound to foster clinical and research advancements in systemic sclerosis relating to (1) musculoskeletal, (2) digital ulcer, (3) lung disease and (4) skin disease. We also highlight unmet needs which much be addressed for ultrasound to assume a central role in systemic sclerosis clinical care and research.
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Affiliation(s)
- Michael Hughes
- Department of Rheumatology, Royal
Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust,
Sheffield, UK
| | - Cosimo Bruni
- Department of Experimental and
Clinical Medicine, University of Florence, Florence, Italy
| | - Giovanna Cuomo
- Department of Medicine of
Precision, University of Naples L. Vanvitelli, Naples, Italy
| | - Andrea Delle Sedie
- Rheumatology Unit, Department of
Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luna Gargani
- Institute of Clinical Physiology,
National Research Council, Pisa, Italy
| | - Marwin Gutierrez
- Division of Musculoskeletal and
Rheumatic Diseases, National Institute of Rehabilitation, Mexico City,
Mexico
- Rheumatology Center of Excellence,
Mexico City, Mexico
| | - Gemma Lepri
- Department of Experimental and
Clinical Medicine, University of Florence, Florence, Italy
| | - Barbara Ruaro
- Pulmonology Department, University
Hospital of Cattinara, Trieste, Italy
| | - Tania Santiago
- Rheumatology Department, Centro
Hospitalar e Universitáro de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University
of Coimbra, Portugal
| | - Yossra Suliman
- Rheumatology and Rehabilitation
Department, Assiut University Hospital, Assiut, Egypt
| | - Shinji Watanabe
- Department of Allergy and
Rheumatology, Nippon Medical School, Tokyo, Japan
| | - Annamaria Iagnocco
- Academic Rheumatology Centre,
Università degli Studi di Torino, Turin, Italy
| | - Daniel Furst
- Department of Experimental and
Clinical Medicine, University of Florence, Florence, Italy
- Department of Medicine, Division
of Rheumatology, University of California Los Angeles, Los Angeles, CA,
USA
- University of Washington,
Seattle, WA, USA
| | - Silvia Bellando-Randone
- Department of Experimental and
Clinical Medicine, University of Florence, Florence, Italy
- Department of Geriatric
Medicine, Division of Rheumatology, Careggi University Hospital, Florence,
Italy
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9
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Vicente-Rabaneda EF, Acebes C, Castañeda S. Usefulness of extra-articular ultrasound applied to systemic inflammatory diseases in clinical practice. ACTA ACUST UNITED AC 2020; 17:229-236. [PMID: 32471711 DOI: 10.1016/j.reuma.2020.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/06/2020] [Accepted: 04/01/2020] [Indexed: 02/09/2023]
Abstract
Ultrasound is a non-invasive, innocuous, reproducible, cost-efficient imaging technique that provides immediate information, as it can be performed in our consultations. The good profile of ultrasound and the technological advances that have taken place in recent years, which have allowed a substantial improvement in the resolution of the image to make it almost anatomical, have promoted research on its application in the comprehensive study of systemic inflammatory diseases. At present, the threshold of using ultrasound to exclusively investigate musculoskeletal manifestations has been crossed, to also apply it to the study of extra-articular manifestations and comorbidities associated with rheumatic diseases. In this review we will revise its usefulness for the diagnosis of glandular involvement in Sjögren's syndrome, interstitial lung disease or giant cell arteritis and for stratification of cardiovascular risk in patients with chronic inflammatory rheumatic diseases.
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Affiliation(s)
| | - Carlos Acebes
- Servicio de Reumatología del Hospital General de Villalba, Madrid, España
| | - Santos Castañeda
- Servicio de Reumatología, Hospital Universitario de la Princesa, IIS-Princesa, Madrid , España; Cátedra ROCHE-UAM, EPID-Futuro, Universidad Autónoma de Madrid, Madrid, España
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10
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Gargani L, Bruni C, Romei C, Frumento P, Moreo A, Agoston G, Guiducci S, Bellando-Randone S, Lepri G, Belloli L, Della Rossa A, Delle Sedie A, Stagnaro C, De Nes M, Salvadori S, Mosca M, Falaschi F, Epis O, Picano E, Matucci-Cerinic M. Prognostic Value of Lung Ultrasound B-Lines in Systemic Sclerosis. Chest 2020; 158:1515-1525. [PMID: 32360727 DOI: 10.1016/j.chest.2020.03.075] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 03/26/2020] [Accepted: 03/29/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A high percentage of systemic sclerosis (SSc) patients experience interstitial lung disease (ILD) during the disease course. Recent data have shown that lung ultrasound (LUS) can assess ILD by the evaluation of B-lines, the sonographic sign of pulmonary interstitial involvement. RESEARCH QUESTION To establish the prognostic value of B-lines in a large number of patients with SSc. STUDY DESIGN AND METHODS A total of 396 consecutive patients with SSc, who were enrolled at three Rheumatology Departments, underwent a comprehensive LUS examination on the anterolateral and posterior chest for a total of 58 scanning sites. All available clinical, imaging, and functional data were recorded. Patients were followed after enrolment to establish the prognostic role of LUS. RESULTS The median number of B-lines was higher in patients with the diffuse cutaneous subset (44 vs 17 B-lines; P < .0001), topoisomerase I autoantibodies (39 vs 16 B-lines; P < .0001), and the presence of ILD at chest high-resolution CT (45 vs 9 B-lines; P < .0001). At multivariable analysis, the number of posterior B-lines ≥5 was associated with new development or worsening ILD (hazard ratio, 3.378; 95% CI, 1.137-9.994; P = .028), with additional value over topoisomerase I positivity. The prognostic value was further confirmed in the subgroup of patients with known ILD at baseline (hazard ratio, 1.010; 95% CI, 1.003-1.018; P = .008). INTERPRETATION Lung ultrasound B-lines are associated with worsening or development of pulmonary deterioration. In the near future, LUS might become part of the diagnostic and prognostic armamentarium in patients with SSc, which would allow a more sustainable and user-friendly approach to this very fragile population.
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Affiliation(s)
- Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy.
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Chiara Romei
- 2nd Radiology Unit, Azienda Ospedaliero Universitaria Pisa, Italy
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Antonella Moreo
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Gergely Agoston
- Cardiology and Rheumatology Department, Niguarda Hospital, Milan, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Laura Belloli
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Alessandra Della Rossa
- Department of Family Medicine, University of Szeged, Szeged, Hungary and Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Andrea Delle Sedie
- Department of Family Medicine, University of Szeged, Szeged, Hungary and Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Chiara Stagnaro
- Department of Family Medicine, University of Szeged, Szeged, Hungary and Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Michele De Nes
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Stefano Salvadori
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Marta Mosca
- Department of Family Medicine, University of Szeged, Szeged, Hungary and Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Fabio Falaschi
- 2nd Radiology Unit, Azienda Ospedaliero Universitaria Pisa, Italy
| | - Oscar Epis
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Eugenio Picano
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
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11
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Subclinical Interstitial Lung Disease in Patients with Systemic Sclerosis. A Pilot Study on the Role of Ultrasound. ACTA ACUST UNITED AC 2019; 17:144-149. [PMID: 31400981 DOI: 10.1016/j.reuma.2019.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/16/2019] [Accepted: 05/06/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Interstitial lung disease (ILD) is a common comorbidity present in patients with systemic sclerosis (SSc). Employment of high-resolution computed tomography (HRCT) is very limited and lung ultrasound (LUS) can be an alternative tool for the early evaluation of ILD. OBJECTIVE To determine the validity of LUS in the early detection of ILD in patients with SSc. METHODS Sixty-eight patients with SSc ≥18 years without respiratory symptoms were included. A rheumatologist rated the subclinical respiratory condition, another rheumatologist blinded to the clinical assessment performed the LUS. To determine validity HRCT was performed as well. RESULTS Prevalence of ILD in SSc patients was 41.2% in contrast to the 4.8% healthy controls (P=.0001). Variables associated with LUS and HRCT findings were anti-centromere antibodies (P=.005) and the Rodnan skin score (P=.004). A positive correlation was present between the findings of HRCT and LUS (P=.001). Sensitivity and specificity were 91.2% and 88.6% respectively. Good reliability in the LUS findings was found between observers (k=.72). CONCLUSIONS By proving to be a valid, trustworthy and feasible alternative tool, we consider that LUS can be implemented for the early detection of ILD in SSc.
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12
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Gutierrez M, Tardella M, Rodriguez L, Mendoza J, Clavijo-Cornejo D, García A, Bertolazzi C. Ultrasound as a potential tool for the assessment of interstitial lung disease in rheumatic patients. Where are we now? LA RADIOLOGIA MEDICA 2019; 124:989-999. [PMID: 31267321 DOI: 10.1007/s11547-019-01053-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/18/2019] [Indexed: 11/26/2022]
Abstract
Lung ultrasound (LUS) achieved an intriguing role in the management of pulmonary involvement in patients affected by connective tissues diseases (CTDs). Few studies have been performed to support its usefulness in the evaluation of the presence and the severity of interstitial lung disease (ILD), relating it to the information obtained with chest high-resolution computed tomography (HRCT). These results open up new fields of research in order to demonstrate the utility of LUS as screening tool to evaluate ILD in CTD. The aim of this review is to provide the "state of the art" of the role of LUS in the management of ILD associated with CTD.
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Affiliation(s)
- Marwin Gutierrez
- Instituto Nacional de Rehabilitación, Mexico City, Mexico
- Rheumatology Section, Center of Excellence of Rheumatology, Mexico City, Mexico
| | - Marika Tardella
- Clinica Reumatologica, Università Politecnica delle Marche, Ospedale "Carlo Urbani", Via Aldo Moro 25, 60035, Jesi, AN, Italy.
| | - Luis Rodriguez
- Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Jaime Mendoza
- Instituto Nacional de Rehabilitación, Mexico City, Mexico
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13
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Gutierrez M, Soto-Fajardo C, Pineda C, Alfaro-Rodriguez A, Terslev L, Bruyn G, Iagnocco A, Bertolazzi C, D'Agostino MA, Delle Sedie A. Ultrasound in the Assessment of Interstitial Lung Disease in Systemic Sclerosis: A Systematic Literature Review by the OMERACT Ultrasound Group. J Rheumatol 2019; 47:991-1000. [PMID: 31263075 DOI: 10.3899/jrheum.180940] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To provide an overview of the role of lung ultrasound (LUS) in the assessment of interstitial lung disease (ILD) in systemic sclerosis (SSc) and to discuss the state of validation supporting its clinical relevance and application in daily clinical practice. METHODS Original articles published between January 1997 and October 2017 were included. To identify all available studies, a detailed search pertaining to the topic of review was conducted according to guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). A systematic search was performed in PubMed and EMBASE. The quality assessment of retrieved articles was performed according to the Oxford Center for Evidence-based Medicine. The methodological quality of the studies was assessed using the Cochrane Handbook for Systematic Reviews and the Quality Assessment of Diagnostic Accuracy Studies-2 tool. RESULTS From 300 papers identified, 12 were included for the analysis. LUS passed the filter of face, content validity, and feasibility. However, there is insufficient evidence to support criterion validity, reliability, and sensitivity to change. CONCLUSION Despite a great deal of work supporting the potential role of LUS for the assessment of ILD-SSc, much remains to be done before validating its use as an outcome measure in ILD-SSc.
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Affiliation(s)
- Marwin Gutierrez
- From the Division of Musculoskeletal and Rheumatic Disorders, and the Division of Neurosciences, Instituto Nacional de Rehabilitacion, Mexico City; Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana, Iztapalapa, México City, Mexico; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy; Université Versailles Saint-Quentin en Yvelines, Paris, France; Rheumatology Unit, University of Pisa, Pisa, Italy. .,M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, and Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana; C. Soto-Fajardo, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; C. Pineda, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; A. Alfaro-Rodriguez, MD, Division of Neurosciences, Instituto Nacional de Rehabilitacion; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet; G. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; A. Iagnocco, MD, PhD, Academic Rheumatology Center, Università degli Studi di Torino; C. Bertolazzi, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; M.A. D'Agostino, MD, PhD, Université Versailles Saint-Quentin en Yvelines; A. Delle Sedie, MD, PhD, Rheumatology Unit, University of Pisa.
| | - Carina Soto-Fajardo
- From the Division of Musculoskeletal and Rheumatic Disorders, and the Division of Neurosciences, Instituto Nacional de Rehabilitacion, Mexico City; Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana, Iztapalapa, México City, Mexico; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy; Université Versailles Saint-Quentin en Yvelines, Paris, France; Rheumatology Unit, University of Pisa, Pisa, Italy.,M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, and Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana; C. Soto-Fajardo, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; C. Pineda, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; A. Alfaro-Rodriguez, MD, Division of Neurosciences, Instituto Nacional de Rehabilitacion; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet; G. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; A. Iagnocco, MD, PhD, Academic Rheumatology Center, Università degli Studi di Torino; C. Bertolazzi, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; M.A. D'Agostino, MD, PhD, Université Versailles Saint-Quentin en Yvelines; A. Delle Sedie, MD, PhD, Rheumatology Unit, University of Pisa
| | - Carlos Pineda
- From the Division of Musculoskeletal and Rheumatic Disorders, and the Division of Neurosciences, Instituto Nacional de Rehabilitacion, Mexico City; Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana, Iztapalapa, México City, Mexico; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy; Université Versailles Saint-Quentin en Yvelines, Paris, France; Rheumatology Unit, University of Pisa, Pisa, Italy.,M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, and Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana; C. Soto-Fajardo, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; C. Pineda, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; A. Alfaro-Rodriguez, MD, Division of Neurosciences, Instituto Nacional de Rehabilitacion; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet; G. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; A. Iagnocco, MD, PhD, Academic Rheumatology Center, Università degli Studi di Torino; C. Bertolazzi, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; M.A. D'Agostino, MD, PhD, Université Versailles Saint-Quentin en Yvelines; A. Delle Sedie, MD, PhD, Rheumatology Unit, University of Pisa
| | - Alfonso Alfaro-Rodriguez
- From the Division of Musculoskeletal and Rheumatic Disorders, and the Division of Neurosciences, Instituto Nacional de Rehabilitacion, Mexico City; Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana, Iztapalapa, México City, Mexico; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy; Université Versailles Saint-Quentin en Yvelines, Paris, France; Rheumatology Unit, University of Pisa, Pisa, Italy.,M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, and Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana; C. Soto-Fajardo, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; C. Pineda, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; A. Alfaro-Rodriguez, MD, Division of Neurosciences, Instituto Nacional de Rehabilitacion; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet; G. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; A. Iagnocco, MD, PhD, Academic Rheumatology Center, Università degli Studi di Torino; C. Bertolazzi, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; M.A. D'Agostino, MD, PhD, Université Versailles Saint-Quentin en Yvelines; A. Delle Sedie, MD, PhD, Rheumatology Unit, University of Pisa
| | - Lene Terslev
- From the Division of Musculoskeletal and Rheumatic Disorders, and the Division of Neurosciences, Instituto Nacional de Rehabilitacion, Mexico City; Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana, Iztapalapa, México City, Mexico; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy; Université Versailles Saint-Quentin en Yvelines, Paris, France; Rheumatology Unit, University of Pisa, Pisa, Italy.,M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, and Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana; C. Soto-Fajardo, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; C. Pineda, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; A. Alfaro-Rodriguez, MD, Division of Neurosciences, Instituto Nacional de Rehabilitacion; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet; G. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; A. Iagnocco, MD, PhD, Academic Rheumatology Center, Università degli Studi di Torino; C. Bertolazzi, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; M.A. D'Agostino, MD, PhD, Université Versailles Saint-Quentin en Yvelines; A. Delle Sedie, MD, PhD, Rheumatology Unit, University of Pisa
| | - George Bruyn
- From the Division of Musculoskeletal and Rheumatic Disorders, and the Division of Neurosciences, Instituto Nacional de Rehabilitacion, Mexico City; Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana, Iztapalapa, México City, Mexico; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy; Université Versailles Saint-Quentin en Yvelines, Paris, France; Rheumatology Unit, University of Pisa, Pisa, Italy.,M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, and Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana; C. Soto-Fajardo, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; C. Pineda, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; A. Alfaro-Rodriguez, MD, Division of Neurosciences, Instituto Nacional de Rehabilitacion; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet; G. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; A. Iagnocco, MD, PhD, Academic Rheumatology Center, Università degli Studi di Torino; C. Bertolazzi, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; M.A. D'Agostino, MD, PhD, Université Versailles Saint-Quentin en Yvelines; A. Delle Sedie, MD, PhD, Rheumatology Unit, University of Pisa
| | - Annamaria Iagnocco
- From the Division of Musculoskeletal and Rheumatic Disorders, and the Division of Neurosciences, Instituto Nacional de Rehabilitacion, Mexico City; Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana, Iztapalapa, México City, Mexico; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy; Université Versailles Saint-Quentin en Yvelines, Paris, France; Rheumatology Unit, University of Pisa, Pisa, Italy.,M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, and Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana; C. Soto-Fajardo, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; C. Pineda, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; A. Alfaro-Rodriguez, MD, Division of Neurosciences, Instituto Nacional de Rehabilitacion; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet; G. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; A. Iagnocco, MD, PhD, Academic Rheumatology Center, Università degli Studi di Torino; C. Bertolazzi, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; M.A. D'Agostino, MD, PhD, Université Versailles Saint-Quentin en Yvelines; A. Delle Sedie, MD, PhD, Rheumatology Unit, University of Pisa
| | - Chiara Bertolazzi
- From the Division of Musculoskeletal and Rheumatic Disorders, and the Division of Neurosciences, Instituto Nacional de Rehabilitacion, Mexico City; Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana, Iztapalapa, México City, Mexico; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy; Université Versailles Saint-Quentin en Yvelines, Paris, France; Rheumatology Unit, University of Pisa, Pisa, Italy.,M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, and Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana; C. Soto-Fajardo, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; C. Pineda, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; A. Alfaro-Rodriguez, MD, Division of Neurosciences, Instituto Nacional de Rehabilitacion; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet; G. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; A. Iagnocco, MD, PhD, Academic Rheumatology Center, Università degli Studi di Torino; C. Bertolazzi, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; M.A. D'Agostino, MD, PhD, Université Versailles Saint-Quentin en Yvelines; A. Delle Sedie, MD, PhD, Rheumatology Unit, University of Pisa
| | - Maria Antonietta D'Agostino
- From the Division of Musculoskeletal and Rheumatic Disorders, and the Division of Neurosciences, Instituto Nacional de Rehabilitacion, Mexico City; Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana, Iztapalapa, México City, Mexico; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy; Université Versailles Saint-Quentin en Yvelines, Paris, France; Rheumatology Unit, University of Pisa, Pisa, Italy.,M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, and Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana; C. Soto-Fajardo, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; C. Pineda, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; A. Alfaro-Rodriguez, MD, Division of Neurosciences, Instituto Nacional de Rehabilitacion; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet; G. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; A. Iagnocco, MD, PhD, Academic Rheumatology Center, Università degli Studi di Torino; C. Bertolazzi, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; M.A. D'Agostino, MD, PhD, Université Versailles Saint-Quentin en Yvelines; A. Delle Sedie, MD, PhD, Rheumatology Unit, University of Pisa
| | - Andrea Delle Sedie
- From the Division of Musculoskeletal and Rheumatic Disorders, and the Division of Neurosciences, Instituto Nacional de Rehabilitacion, Mexico City; Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana, Iztapalapa, México City, Mexico; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy; Université Versailles Saint-Quentin en Yvelines, Paris, France; Rheumatology Unit, University of Pisa, Pisa, Italy.,M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, and Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana; C. Soto-Fajardo, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; C. Pineda, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; A. Alfaro-Rodriguez, MD, Division of Neurosciences, Instituto Nacional de Rehabilitacion; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet; G. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; A. Iagnocco, MD, PhD, Academic Rheumatology Center, Università degli Studi di Torino; C. Bertolazzi, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; M.A. D'Agostino, MD, PhD, Université Versailles Saint-Quentin en Yvelines; A. Delle Sedie, MD, PhD, Rheumatology Unit, University of Pisa
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14
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Xie HQ, Zhang WW, Sun DS, Chen XM, Yuan SF, Gong ZH, Liu L. A simplified lung ultrasound for the diagnosis of interstitial lung disease in connective tissue disease: a meta-analysis. Arthritis Res Ther 2019; 21:93. [PMID: 30975190 PMCID: PMC6460810 DOI: 10.1186/s13075-019-1888-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/02/2019] [Indexed: 12/27/2022] Open
Abstract
Background Interstitial lung disease (ILD) is a common complication of connective tissue disease (CTD) and a leading cause of morbidity and mortality. There are various lung ultrasound (LUS) scoring systems with different lung intercostal spaces (LIS). The purpose of this meta-analysis was to find a simplified LUS method for the assessment of CTD-ILD. Methods We systematically retrieved lung ultrasound diagnostic studies on CTD-ILD in PubMed, Embase, and Web of Science databases. Summary diagnostic accuracy, including sensitivity, specificity, and area under the curve (AUC), was analyzed. Subgroup analysis was conducted according to different LIS and diseases. Results The 11 studies included in this meta-analysis comprised a total of 487 patients with CTD. The pooled sensitivity and specificity of the LUS were 0.859 (95% confidence interval (CI) 0.812–0.898) and 0.839 (95% CI 0.782–0.886), respectively, illustrating its great value for CTD-ILD diagnosis. In addition, there were six methods to evaluate LIS, including 72, 65, 50, 14, 10, and all LIS. The pooled sensitivity and specificity of 14 LIS were 0.982 (95% CI 0.904–1.000) and 0.875 (95% CI 0.710–0.965), respectively. The pooled positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odd ratio (DOR) of 14 LIS were 7.297 (95% CI 6.050–17.45), 0.029 (95% CI 0.006–0.147), and 292.30 (95% CI 35.53–2403.8), respectively. Moreover, the AUC for systemic sclerosis (SSc) and rheumatoid arthritis (RA) was 0.929 and 0.981, respectively; the DOR for SSc and RA was 42.93 (95% CI 17.75–103.79) and 80.24 (95% CI 8.107–796.09), respectively. Conclusions We found a modified and simplified method of LUS, by scanning 14 LIS in a short time, which had a very high sensitivity and specificity.
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Affiliation(s)
- Hai Qin Xie
- Department of Ultrasound, Peking University Shenzhen Hospital, Lianhua Road 1120, FuTian District, Shenzhen, 518036, Guangdong, China
| | - Wei Wei Zhang
- Department of Ultrasound, Peking University Shenzhen Hospital, Lianhua Road 1120, FuTian District, Shenzhen, 518036, Guangdong, China
| | - De Sheng Sun
- Department of Ultrasound, Peking University Shenzhen Hospital, Lianhua Road 1120, FuTian District, Shenzhen, 518036, Guangdong, China
| | - Xiang Mei Chen
- Department of Ultrasound, Peking University Shenzhen Hospital, Lianhua Road 1120, FuTian District, Shenzhen, 518036, Guangdong, China
| | - Shu Fang Yuan
- Department of Ultrasound, Peking University Shenzhen Hospital, Lianhua Road 1120, FuTian District, Shenzhen, 518036, Guangdong, China
| | - Zheng Hua Gong
- Department of Ultrasound, Peking University Shenzhen Hospital, Lianhua Road 1120, FuTian District, Shenzhen, 518036, Guangdong, China.
| | - Li Liu
- Department of Ultrasound, Peking University Shenzhen Hospital, Lianhua Road 1120, FuTian District, Shenzhen, 518036, Guangdong, China.
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Zoneff ER, Baker K, Sweeny A, Keijzers G, Sanderson J, Watkins S. The prevalence of lung surface abnormalities in a healthy population as detected by a screening lung ultrasound protocol: Comparison between young and older volunteers. Australas J Ultrasound Med 2019; 22:129-137. [DOI: 10.1002/ajum.12124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Elissa Raya Zoneff
- Gold Coast Hospital and Health Service Southport Queensland Australia
- Australian Institute of Ultrasound Broadbeach Waters Queensland Australia
| | - Kylie Baker
- Australian Institute of Ultrasound Broadbeach Waters Queensland Australia
- Ipswich Hospital Ipswich Queensland Australia
| | - Amy Sweeny
- Gold Coast Hospital and Health Service Southport Queensland Australia
- Emergency Medicine Foundation Milton Queensland Australia
| | - Gerben Keijzers
- Gold Coast Hospital and Health Service Southport Queensland Australia
- Bond University School of Medicine Robina Queensland Australia
- Griffith University School of Medicine Southport Queensland Australia
| | - Jenni Sanderson
- Australian Institute of Ultrasound Broadbeach Waters Queensland Australia
| | - Stuart Watkins
- Gold Coast Hospital and Health Service Southport Queensland Australia
- Australian Institute of Ultrasound Broadbeach Waters Queensland Australia
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Wang Y, Gargani L, Barskova T, Furst DE, Cerinic MM. Usefulness of lung ultrasound B-lines in connective tissue disease-associated interstitial lung disease: a literature review. Arthritis Res Ther 2017; 19:206. [PMID: 28923086 PMCID: PMC5604136 DOI: 10.1186/s13075-017-1409-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Interstitial lung disease (ILD) is a major pulmonary manifestation of connective tissue disease (CTD), leading to significant morbidity and mortality. Chest high-resolution computed tomography (HRCT) is presently considered the diagnostic gold standard for pulmonary fibrosis diagnosis and quantification in the clinical arena. However, not negligible doses of ionizing radiation limit the use of HRCT, especially for serial follow-up in younger female patients. In the past decade, lung ultrasound (LUS) has been proposed to assess ILD by detecting and quantifying sonographic B-lines. Previous studies demonstrate that B-lines have a good diagnostic accuracy, especially high sensitivity, and correlate well with HRCT findings, suggesting LUS as a novel, non-invasive, and non-ionizing imaging method to be used in patients with CTD-ILD. Although preliminary data are promising, challenges and controversies still remain. For example, the mechanisms of B-line generation are not fully understood; the diagnostic accuracy and performance characteristics of LUS partially depend on the scanning scheme and scoring system used; and up-to-date B-lines cannot discriminate the early cellular inflammation from the chronic fibrotic phase in CTD-ILD. Therefore it is important for clinicians to understand the strengths and limitations of LUS in CTD-ILD patients, to maximize its value.
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Affiliation(s)
- YuKai Wang
- 0000 0004 1757 2304grid.8404.8Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- 0000 0004 1757 2304grid.8404.8Department of Geriatric Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
- grid.452734.3Department of Rheumatology and Immunology, Shantou Central Hospital, No 114 Waima Road, Shantou, 515041 Guangdong China
| | - Luna Gargani
- 0000 0004 1756 390Xgrid.418529.3Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy
| | - Tatiana Barskova
- 0000 0004 1757 2304grid.8404.8Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- 0000 0004 1757 2304grid.8404.8Department of Geriatric Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Dan E. Furst
- 0000 0004 1757 2304grid.8404.8Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- 0000 0004 1757 2304grid.8404.8Department of Geriatric Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
- 0000 0000 9632 6718grid.19006.3eDivision of Rheumatology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA USA
| | - Marco Matucci Cerinic
- 0000 0004 1757 2304grid.8404.8Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- 0000 0004 1757 2304grid.8404.8Department of Geriatric Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
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Álvarez-Barreneche MF, Velásquez-Franco CJ, Mesa-Navas MA. Enfermedad pulmonar intersticial en pacientes con esclerosis sistémica. Revisión narrativa de la literatura. IATREIA 2017. [DOI: 10.17533/udea.iatreia.v30n3a03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Gutierrez M, Gomez-Quiroz LE, Clavijo-Cornejo D, Lozada CA, Lozada-Navarro AC, Labra RUM, Fernandez-Torres J, Sanchez-Bringas G, Salaffi F, Bertolazzi C, Pineda C. Ultrasound in the interstitial pulmonary fibrosis. Can it facilitate a best routine assessment in rheumatic disorders? Clin Rheumatol 2016; 35:2387-95. [PMID: 27325229 DOI: 10.1007/s10067-016-3329-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/01/2016] [Accepted: 06/09/2016] [Indexed: 11/27/2022]
Abstract
Ultrasound (US) is increasing its potential in the assessment of several rheumatic disorders. Recently, different applications of this imaging technique have emerged. Interesting data supporting its utility and validity in the assessment of the lung to detect and quantify interstitial pulmonary fibrosis in rheumatic diseases, even in subclinical phases, have been reported. The main purpose of this review is to provide an overview of the role of US in the assessment of interstitial pulmonary fibrosis in rheumatic disorders and to discuss the current evidence supporting its clinical relevance in daily clinical practice.
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Affiliation(s)
- Marwin Gutierrez
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, Mexico City, Mexico. .,Doctorado en Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Iztapalapa, Mexico City, Mexico.
| | - Luis Enrique Gomez-Quiroz
- Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana, Iztapalapa, Mexico City, Mexico
| | - Denise Clavijo-Cornejo
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Carlos A Lozada
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Ana C Lozada-Navarro
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Roxana U Miranda Labra
- Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana, Iztapalapa, Mexico City, Mexico
| | - Javier Fernandez-Torres
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Guadalupe Sanchez-Bringas
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Fausto Salaffi
- Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Chiara Bertolazzi
- Division of Neuroscience, Instituto Nacional de Rehabilitación , Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
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Kristensen MS, Teoh WH, Graumann O, Laursen CB. Ultrasonography for clinical decision-making and intervention in airway management: from the mouth to the lungs and pleurae. Insights Imaging 2014; 5:253-79. [PMID: 24519789 PMCID: PMC3999368 DOI: 10.1007/s13244-014-0309-5] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/20/2013] [Accepted: 01/10/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To create a state-of-the-art overview of the new and expanding role of ultrasonography in clinical decision-making, intervention and management of the upper and lower airways, that is clinically relevant, up-to-date and practically useful for clinicians. METHODS This is a narrative review combined with a structured Medline literature search. RESULTS Ultrasonography can be utilised to predict airway difficulty during induction of anaesthesia, evaluate if the stomach is empty or possesses gastric content that poses an aspiration risk, localise the essential cricothyroid membrane prior to difficult airway management, perform nerve blocks for awake intubation, confirm tracheal or oesophageal intubation and facilitate localisation of tracheal rings for tracheostomy. Ultrasonography is an excellent diagnostic tool in intraoperative and emergency diagnosis of pneumothorax. It also enables diagnosis and treatment of interstitial syndrome, lung consolidation, atelectasis, pleural effusion and differentiates causes of acute breathlessness during pregnancy. Patient safety can be enhanced by performing procedures under ultrasound guidance, e.g. thoracocentesis, vascular line access and help guide timing of removal of chest tubes by quantification of residual pneumothorax size. CONCLUSIONS Ultrasonography used in conjunction with hands-on management of the upper and lower airways has multiple advantages. There is a rapidly growing body of evidence showing its benefits. TEACHING POINTS • Ultrasonography is becoming essential in management of the upper and lower airways. • The tracheal structures can be identified by ultrasonography, even when unidentifiable by palpation. • Ultrasonography is the primary diagnostic approach in suspicion of intraoperative pneumothorax. • Point-of-care ultrasonography of the airways has a steep learning curve. • Lung ultrasonography allows treatment of interstitial syndrome, consolidation, atelectasis and effusion.
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Affiliation(s)
- Michael S Kristensen
- Department of Anaesthesia, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Denmark,
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Sperandeo M, Trovato GM, Catalano D. Quantifying B-lines on lung sonography: insufficient evidence as an objective, constructive, and educational tool. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:362-365. [PMID: 24449744 DOI: 10.7863/ultra.33.2.362] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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21
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Reissig A, Copetti R. Lung ultrasound in community-acquired pneumonia and in interstitial lung diseases. ACTA ACUST UNITED AC 2014; 87:179-89. [PMID: 24481027 DOI: 10.1159/000357449] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Lung ultrasound (LUS) is an accurate tool for the diagnosis and follow-up of pneumonia in adults as well as in children. LUS is at least as accurate as chest radiography in diagnosing pneumonia. The most important parenchymal criterion is the positive air bronchogram within an echopoor area. Among pleural criteria, basal effusion was most often detected. The presence of multiple diffuse bilateral B-lines on lung examination indicates the interstitial syndrome (IS). For further differential diagnosis, an integrated consideration of history, clinical examination, LUS and echocardiography should be performed. LUS is an excellent tool for IS screening. Repeated LUS control examinations may reflect the dynamics of IS under therapy and so LUS may serve as a therapy guide. .
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Affiliation(s)
- Angelika Reissig
- Department of Internal Medicine I, Pneumology and Allergology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
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Acute heart failure diagnosis by ultrasound: new achievements and persisting limitations. Am J Emerg Med 2013; 32:384-5. [PMID: 24462395 DOI: 10.1016/j.ajem.2013.12.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 12/11/2013] [Indexed: 12/27/2022] Open
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