Lung ultrasound compared to computed tomography detection and automated quantification of systemic sclerosis-associated interstitial lung disease: preliminary study

Lung Ultrasound for Assessment of Interstitial Lung Disease in Systemic Sclerosis: Relationship With High-Resolution Computed Tomography and Nailfold Capillaroscopy

Background

Lung ultrasound (LUS) has been recently proposed as a convenient and radiation-free imaging modality for the evaluation of systemic sclerosis-related interstitial lung disease.

Objectives

The current study evaluates the relation between LUS and both high-resolution computed tomography (HRCT) and capillaroscopy findings in patients with systemic sclerosis.

Design

This cross-sectional study included 32 patients with systemic sclerosis.

Methods

Besides clinical evaluation, all participants underwent LUS, HRCT, pulmonary function tests (PFT), and nailfold video-capillaroscopy (NVC). All participants' data were compared and correlated.

Results

There is an excellent agreement between number of B-lines and HRCT score (interclass correlation = 0.864, P-value < .001). A significant positive correlation exists between number of B-lines and disease duration (r = 0.459, P-value = .008). Conversely, the number of B-lines is negatively correlated with capillary density (r = -0.687, P-value < .001), forced expiratory volume in the first second (FEV1) (r = -0.886, P-value < .001), and forced vital capacity (FVC) (r = -0.898, P-value < .001). Patients with either neoangiogenesis or previous/current digital ulcers had significantly higher number of B-lines than those without (P-value < .001, .016, respectively).

Conclusion

The number of B-lines parallels the HRCT score and the extent of digital vascular damage as indicated by NVC and clinical digital ulcers. Lung ultrasound has proven to be a reliable radiation-free modality for screening of systemic sclerosis-related interstitial lung disease and detecting its extent.

Practical Use of Ultrasound in Modern Rheumatology-From A to Z

During the past 20 years, the use of ultrasound (US) in rheumatology has increased tremendously, and has become a valuable tool in rheumatologists' hands, not only for assessment of musculoskeletal structures like joints and peri-articular tissues, but also for evaluation of nerves, vessels, lungs, and skin, as well as for increasing the accuracy in a number of US-guided aspirations and injections. The US is currently used as the imaging method of choice for establishing an early diagnosis, assessing disease activity, monitoring treatment efficacy, and assessing the remission state of inflammatory joint diseases. It is also used as a complementary tool for the assessment of patients with degenerative joint diseases like osteoarthritis, and in the detection of crystal deposits for establishing the diagnosis of metabolic arthropathies (gout, calcium pyrophosphate deposition disease). The US has an added value in the diagnostic process of polymyalgia rheumatica and giant-cell arteritis, and is currently included in the classification criteria. A novel use of US in the assessment of the skin and lung involvement in connective tissue diseases has the potential to replace more expensive and risky imaging modalities. This narrative review will take a close look at the most recent evidence-based data regarding the use of US in the big spectrum of rheumatic diseases.