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Zimna K, Sobiecka M, Wakuliński J, Wyrostkiewicz D, Jankowska E, Szturmowicz M, Tomkowski WZ. Lung Ultrasonography in the Evaluation of Late Sequelae of COVID-19 Pneumonia-A Comparison with Chest Computed Tomography: A Prospective Study. Viruses 2024; 16:905. [PMID: 38932196 PMCID: PMC11209275 DOI: 10.3390/v16060905] [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: 03/25/2024] [Revised: 05/22/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
The onset of the COVID-19 pandemic allowed physicians to gain experience in lung ultrasound (LUS) during the acute phase of the disease. However, limited data are available on LUS findings during the recovery phase. The aim of this study was to evaluate the utility of LUS to assess lung involvement in patients with post-COVID-19 syndrome. This study prospectively enrolled 72 patients who underwent paired LUS and chest CT scans (112 pairs including follow-up). The most frequent CT findings were ground glass opacities (83.3%), subpleural lines (72.2%), traction bronchiectasis (37.5%), and consolidations (31.9%). LUS revealed irregular pleural lines as a common abnormality initially (56.9%), along with subpleural consolidation >2.5 mm ≤10 mm (26.5%) and B-lines (26.5%). A strong correlation was found between LUS score, calculated by artificial intelligence percentage involvement in ground glass opacities described in CT (r = 0.702, p < 0.05). LUS score was significantly higher in the group with fibrotic changes compared to the non-fibrotic group with a mean value of 19.4 ± 5.7 to 11 ± 6.6, respectively (p < 0.0001). LUS might be considered valuable for examining patients with persistent symptoms after recovering from COVID-19 pneumonia. Abnormalities identified through LUS align with CT scan findings; thus, LUS might potentially reduce the need for frequent chest CT examinations.
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Affiliation(s)
- Katarzyna Zimna
- I Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Małgorzata Sobiecka
- I Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Jacek Wakuliński
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Dorota Wyrostkiewicz
- I Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Ewa Jankowska
- I Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Monika Szturmowicz
- I Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Witold Z. Tomkowski
- I Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
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Han S, Ji Z, Liu Y. Screening value of lung ultrasound and pleural shear wave elastography in connective tissue disease-related interstitial lung disease: a preliminary study. Clin Rheumatol 2024; 43:2117-2123. [PMID: 38700662 DOI: 10.1007/s10067-024-06983-8] [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: 01/08/2024] [Revised: 04/19/2024] [Accepted: 04/25/2024] [Indexed: 05/24/2024]
Abstract
OBJECTIVE To explore the diagnostic value of lung ultrasound (LUS) and pleural shear wave elastography (SWE) for connective tissue disease-interstitial lung disease (CTD-ILD). METHODS We selected 104 patients diagnosed with connective tissue disease (CTD) at our hospital. All patients underwent LUS, SWE, and high-resolution computed tomography (HRCT). With HRCT as the imaging gold standard for diagnosis, patients were categorized into CTD-ILD and CTD-non-ILD groups. We employed paired chi-square tests to compare the diagnostic differences between HRCT and LUS for ILD. Receiver operating characteristic (ROC) curves were used to assess the diagnostic value of pleural SWE for ILD. Correlation analysis was performed between pleural elasticity values and lung ultrasound scores. RESULTS The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of LUS for diagnosing CTD-ILD were 93.3%, 86.2%, 6.761, and 0.078, respectively. There was no statistically significant difference in the results between HRCT and LUS (P = 1.000), with a kappa value of 0.720 (P < 0.001). There was a statistically significant difference in the pleural elasticity in the bilateral lower back region between the case and control groups (P < 0.001). The area under the receiver operating characteristic (ROC) curve (AUC) for pleural SWE in diagnosing CTD-ILD was 0.685. In CTD-ILD patients, there was no significant correlation between pleural elasticity values and LUS scores (P > 0.05). CONCLUSION The LUS can serve as an important imaging method for screening for CTD-ILD and assessing the severity of the disease. However, pleural SWE has been shown to demonstrate lower diagnostic efficacy for CTD-ILD, and its ability to assess disease severity is limited.
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Affiliation(s)
- Shiyao Han
- Department of Ultrasound, The First Hospital of China Medical University, 155 Nanjingbei Street, Heping District, Shenyang, Shenyang, 110004, Liaoning, China
| | - Ziyao Ji
- Department of Ultrasound, The First Hospital of China Medical University, 155 Nanjingbei Street, Heping District, Shenyang, Shenyang, 110004, Liaoning, China
| | - Yanjun Liu
- Department of Ultrasound, The First Hospital of China Medical University, 155 Nanjingbei Street, Heping District, Shenyang, Shenyang, 110004, Liaoning, China.
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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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Fox TH, Chansangavej S, Kirby K, Cho D, Rodriguez R, Gare G, Collins G, Galeotti J, Krishnan A, deBoisblanc BP. Effects of Lung Ultrasound Technique and Pleural Line Depth on In Vitro and In Vivo Measurements of Pleural Line Thickness. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:165-169. [PMID: 37821245 DOI: 10.1016/j.ultrasmedbio.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE The aim of the work described here was to determine the effects of imaging protocol, technique and pleural line depth on measured pleural line thickness (PLT). METHODS Sonograms were performed on a phantom and healthy volunteers. In vitro, pleural line depth, transducer type (5-1 MHz phased array vs. 13-6 MHz linear array), angle of the pleural line relative to the transducer and distance between the pleural line and focal length were explicitly modified. PLT was measured using electronic calipers. Regression equations described the effects of independent variables on PLT. Factors influencing PLT in vitro were tested in vivo. RESULTS In vitro (n = 250 sonograms), PLT was 3.8 (standard error: ±0.24) mm greater when using the phased array compared with the linear transducer (p < 0.001). For every additional centimeter of pleural line depth, PLT increased by 0.96 (±0.081) mm for the phased array (p < 0.001) and 0.26 (±0.019) mm for the linear transducer (p < 0.001). Neither pleural angle nor focal length altered PLT. In vivo (n = 160 sonograms), PLT was 2.56 (±0.06) mm greater when using the phased array (p < 0.001) compared with the linear transducer. PLT increased by 0.67 (±0.060) mm with the phased array (p < 0.001) and 0.25 mm (±0.019) with the linear transducer (p < 0.001) for every additional centimeter between the transducer and the pleura. Together the variables explained 93% of PLT variance in vivo (p < 0.001). CONCLUSION PLT measurements are affected by transducer type and pleural line depth. Future studies evaluating PLT as a disease marker should account for confounding by these variables.
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Affiliation(s)
- Thomas H Fox
- Section of Internal/Emergency Medicine, LSU School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
| | | | - Krystal Kirby
- Mary Bird Perkins Cancer Center, Baton Rouge, LA, USA
| | - Daniel Cho
- LSU School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | | | - Gautam Gare
- Carnegie Mellon Robotics Institute, Pittsburgh, PA, USA
| | - Garrett Collins
- Section of Pulmonary/Critical Care and Allergy/Immunology, LSU School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - John Galeotti
- Carnegie Mellon Robotics Institute, Pittsburgh, PA, USA
| | - Amita Krishnan
- Section of Pulmonary/Critical Care and Allergy/Immunology, LSU School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Bennett P deBoisblanc
- Section of Pulmonary/Critical Care and Allergy/Immunology, LSU School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Jeon H, Nam BD, Yoon CH, Kim HS. Radiologic approach and progressive exploration of connective tissue disease-related interstitial lung disease: meeting the curiosity of rheumatologists. JOURNAL OF RHEUMATIC DISEASES 2024; 31:3-14. [PMID: 38130961 PMCID: PMC10730800 DOI: 10.4078/jrd.2023.0042] [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] [Received: 07/28/2023] [Revised: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 12/23/2023]
Abstract
Interstitial lung disease (ILD) is often observed in connective tissue diseases (CTDs), frequently in rheumatoid arthritis, systemic sclerosis, primary Sjögren's syndrome, and inflammatory myositis. Early detection of ILDs secondary to rheumatic diseases is important as timely initiation of proper management affects the prognosis. Among many imaging modalities, high-resuloution computed tomography (HRCT) serves the gold standard for finding early lung inflammatory and fibrotic changes as well as monitoring afterwards because of its superior spatial resolution. Additionally, lung ultrasound (LUS) and magnetic resonance imaging (MRI) are the rising free-radiation imaging tools that can get images of lungs of CTD-ILD. In this review article, we present the subtypes of ILD images found in each CTD acquired by HRCT as well as some images taken by LUS and MRI with comparative HRCT scans. It is expected that this discussion would be helpful in discussing recent advances in imaging modalities for CTD-ILD and raising critical points for diagnosis and tracing of the images from the perspective of rheumatologists.
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Affiliation(s)
- Hyeji Jeon
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Bo Da Nam
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Chong-Hyeon Yoon
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun-Sook Kim
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Rai S, Schulert GS, Towe C. New developments related to lung complications in pediatric rheumatic disease. Curr Opin Rheumatol 2023:00002281-990000000-00058. [PMID: 37144679 DOI: 10.1097/bor.0000000000000947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW While substantial progress has been made understanding lung disease in adult patients with rheumatic disease, pediatric lung disease has not been well addressed. Several recent studies provide new insights into diagnosis, management and treatment of lung disease in children with rheumatic disease. RECENT FINDINGS Building on previous research, newly diagnosed patients may have abnormalities in pulmonary function tests and chest computed tomography imaging even when asymptomatic. New guidelines for screening for rheumatic-associated lung disease provide important recommendations for clinicians. New theories have been proposed about immunologic shifts leading to the development of lung disease in children with systemic juvenile idiopathic arthritis. Additionally, there are new antifibrotic agents that are being explored as treatments in pediatric patients with fibrotic lung diseases. SUMMARY Patients appear to have frequent lung function abnormalities while being clinically asymptomatic, emphasizing importance for rheumatologists to refer for pulmonary function tests and imaging at diagnosis. New advances are helping define optimal approaches to treatment of lung disease, including use of biologic agents and antifibrotic medicines for pediatric patients with rheumatologic diseases.
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Affiliation(s)
| | - Grant S Schulert
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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