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Vargas-Ursúa F, Ramos-Hernández C, Pazos-Area LA, Fernández-Granda I, Rodríguez-Otero I, Gómez-Corredoira E, Pintos-Louro M, Fernández-Villar A. Current evidence for lung ultrasound elastography in the field of pneumology: a systematic review. ERJ Open Res 2024; 10:00081-2024. [PMID: 39010887 PMCID: PMC11247369 DOI: 10.1183/23120541.00081-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/04/2024] [Indexed: 07/17/2024] Open
Abstract
Background and objectives Elastography is a technology that has strongly impacted several medical specialties; however, it is not yet applied as part of standard clinical practice in the field of pulmonology. The objective of this systematic review is to analyse the evidence available to date in relation to pleuropulmonary ultrasound elastography, focusing on the three pathologies with the most publications: subpleural consolidations, interstitial lung diseases and pleural effusion. Methods Original in vivo studies published up until 12 August 2023 in the Embase, MEDLINE or Web of Science databases were included. The QUADAS-2 tool was applied to analyse bias. Results We found 613 records in database search. After duplicates removal, we screened 246 records and finally included 18 papers. The average cohort sample size was 109 patients. The elastography modes most frequently used were strain (22.2%), transient elastography (22.2%), point shear-wave elastography (38.9%) and two-dimensional shear-wave elastography (22.2%). The possibility of a meta-analysis was ruled out because of the heterogeneity of the studies included. Discussion The currently available literature indicates that pleuropulmonary ultrasound elastography produces promising and consistent results, although the lack of standardisation in the use of the technique and in the elastography modes employed still impedes its use in daily clinical pneumology practice. The development of a clinical guideline establishing a common nomenclature and standardised techniques for pleuropulmonary elastography will be imperative to generate quality scientific evidence in this field.
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Affiliation(s)
- Fernando Vargas-Ursúa
- Respiratory Department, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
- NeumoVigo I+i Research Group, Southern Galician Institute of Health Research (IISGS), Vigo, Spain
| | - Cristina Ramos-Hernández
- Respiratory Department, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
- NeumoVigo I+i Research Group, Southern Galician Institute of Health Research (IISGS), Vigo, Spain
| | - Luis Alberto Pazos-Area
- Respiratory Department, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
- NeumoVigo I+i Research Group, Southern Galician Institute of Health Research (IISGS), Vigo, Spain
| | | | | | | | - Manuel Pintos-Louro
- Respiratory Department, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | - Alberto Fernández-Villar
- Respiratory Department, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
- NeumoVigo I+i Research Group, Southern Galician Institute of Health Research (IISGS), Vigo, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias), Instituto de Salud Carlos III, Madrid, Spain
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Łyźniak P, Świętoń D, Szurowska E. Lung ultrasound in a nutshell. Lines, signs, some applications, and misconceptions from a radiologist's point of view. Part 2. Pol J Radiol 2024; 89:e211-e224. [PMID: 38783909 PMCID: PMC11112417 DOI: 10.5114/pjr.2024.139286] [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: 02/10/2024] [Accepted: 03/11/2024] [Indexed: 05/25/2024] Open
Abstract
In recent years, lung ultrasound (LUS) has developed rapidly, and it is gaining growing popularity in various scenarios. There are constant attempts to introduce it to new fields. In addition, knowledge regarding lung and LUS has been augmented by the recent COVID-19 pandemics. In the first part of this review we discuss lines, signs and pheno-mena, profiles, some applications, and misconceptions. An aim of the second part of the review is mainly to discuss some advanced applications of LUS, including lung elastography, lung spectroscopy, colour and spectral Doppler, contrast-enhanced ultrasound of lung, speckled tracking of pleura, quantification of pulmonary oedema, predicting success of talc pleurodesis, asthma exacerbations, detecting chest wall invasion by tumours, lung biopsy, estimating pleural effusion volume, and predicting mechanical ventilatory weaning outcome. For this purpose, we reviewed literature concerning LUS.
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Affiliation(s)
- Piotr Łyźniak
- 2 Department of Radiology, University Clinical Centre in Gdańsk, Gdańsk, Poland
| | - Dominik Świętoń
- 2 Department of Radiology, University Clinical Centre in Gdańsk, Gdańsk, Poland
| | - Edyta Szurowska
- 2 Department of Radiology, University Clinical Centre in Gdańsk, Gdańsk, Poland
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3
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Zhang X, Lu Y, Huang K, Pan Q, Jia Y, Cui B, Yin P, Li J, Ju J, Fan X, Tian R. The synergized diagnostic value of VTQ with chemokine CXCL13 in lung tumors. Front Oncol 2023; 13:1115485. [PMID: 37025603 PMCID: PMC10070862 DOI: 10.3389/fonc.2023.1115485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/27/2023] [Indexed: 04/08/2023] Open
Abstract
Virtual Touch Tissue Quantification (VTQ) offers several advantages in the diagnosis of various lung diseases. Chemokine expression levels, such as CXCL13, play a vital role in the occurrence and development of tumors and aid in the diagnosis process. The purpose of this study was to evaluate the combined value of VTQ and changes in CXCL13 expression levels for the diagnosis of lung tumors. A total of 60 patients with thoracic nodules and pleural effusion were included, with 30 of them having malignant pleural effusion (based on pathology) and the remaining 30 having benign thoracic nodules and pleural effusion. The relative expression level of CXCL13 was measured in the collected pleural effusions using Enzyme-Linked Immunosorbent Assay (ELISA). The relationship between CXCL13 expression levels and various clinical features was analyzed. A Receiver Operating Characteristic (ROC) curve analysis was conducted on the VTQ results and relative expression levels of CXCL13, and the areas under the curve, critical values, sensitivity, and specificity were calculated. Multivariate analysis incorporating multiple indicators was performed to determine the accuracy of lung tumor diagnosis. The results showed that the expression levels of CXCL13 and VTQ were significantly higher in the lung cancer group compared to the control group (P < 0.05). In the Non-Small Cell Lung Cancer (NSCLC) group, CXCL13 expression levels increased with later TNM staging and poorer tumor differentiation. The expression level of CXCL13 in adenocarcinoma was higher than that in squamous cell carcinoma. The ROC curve analysis revealed that CXCL13 had an area under the curve (AUC) of 0.74 (0.61, 0.86) with an optimal cut-off value of 777.82 pg/ml for diagnosing lung tumors. The ROC curve analysis of VTQ showed an AUC of 0.67 (0.53, 0.82) with a sensitivity of 60.0% and a specificity of 83.3%, and an optimal diagnostic cut-off of 3.33 m/s. The combination of CXCL13 and VTQ for diagnosing thoracic tumors had an AUC of 0.842 (0.74, 0.94), which was significantly higher than either factor alone. The results of the study demonstrate the strong potential of combining VTQ results with chemokine CXCL13 expression levels for lung tumor diagnosis. Additionally, the findings suggest that elevated relative expression of CXCL13 in cases of malignant pleural effusion caused by non-small cell lung cancer may indicate a poor prognosis. This provides promising potential for using CXCL13 as a screening tool and prognostic indicator for patients with advanced lung cancer complicated by malignant pleural effusion.
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Affiliation(s)
- Xu Zhang
- Department of Ultrasound, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Yejian Lu
- Department of Oncology, Hospital of the People’s Liberation Army: 82nd Group Army, Baoding, China
| | - Kenan Huang
- Department of Oncology, Hospital of the People’s Liberation Army: 82nd Group Army, Baoding, China
| | - Qingfang Pan
- Department of Oncology, Hospital of the People’s Liberation Army: 82nd Group Army, Baoding, China
| | - Youchao Jia
- Department of Oncology, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Baoshuan Cui
- Department of Oncology, Hospital of the People’s Liberation Army: 82nd Group Army, Baoding, China
| | - Peipei Yin
- Department of Oncology, Hospital of the People’s Liberation Army: 82nd Group Army, Baoding, China
| | - Jianhui Li
- Department of Ultrasound, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Junping Ju
- Department of Radiology, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Xiangyu Fan
- Department of Pathology, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Rui Tian
- Department of Oncology, Hospital of the People’s Liberation Army: 82nd Group Army, Baoding, China
- *Correspondence: Rui Tian,
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Alhyari A, Görg C, Dietrich CF, Trenker C, Ludwig M, Safai Zadeh E. Diagnostic Performance of Point Shear Wave Elastography Using Acoustic Radiation Force Impulse Technology in Peripheral Pulmonary Consolidations: A Feasibility Study. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:778-785. [PMID: 35151527 DOI: 10.1016/j.ultrasmedbio.2021.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
The aim of the study described here was to evaluate the diagnostic performance of lung ultrasound point shear wave elastography using acoustic radiation force impulse (ARFI) in peripheral pulmonary consolidations (PPCs). A total of 87 patients with PPCs diagnosed from April to December 2020 were included retrospectively in the study. The inclusion criteria were (i) a PPC >1 cm; (ii) valid ARFI measurements; and (iii) confirmation of the diagnosis of a PPC by histocytological examination and/or clinical and radiological follow-up. The presence of pleural effusions and mean ARFI velocities (MAVs) of PPCs were evaluated. To examine the MAV for potential cutoff values between benign and malignant PPCs, a receiver operating characteristic analysis was implemented. In total, 48 of 87 PPCs (55.2%) were accompanied by pleural effusions. Benign PPCs had significantly lower MAVs than malignant PPCs (1.82 ± 0.97 m/s vs. 3.05 ± 0.73 m/s, p < 0.001). Selecting 2.21 m/s as a cutoff value yielded a sensitivity and specificity of 89.7% and 75.9%, respectively, in diagnosing malignant PPCs (area under the curve = 0.852, 95% confidence interval: 0.773-0.931). In summary, ARFI elastography may be an additional non-invasive tool for differentiating benign from malignant PPCs. Furthermore, the feasibility of using ARFI elastography in PPCs associated with pleural effusions was proved. However, there is some degree of overlap between different disease entities, and diagnosis should always take into account the clinical background.
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Affiliation(s)
- Amjad Alhyari
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, Marburg, Germany; Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstrße Marburg, Germany.
| | - Christian Görg
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, Marburg, Germany; Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstrße Marburg, Germany
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Corinna Trenker
- Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, Marburg, Germany
| | - Michael Ludwig
- Clinic for Internal Medicine, Bundeswehrkrankenhaus Berlin, Berlin, Germany
| | - Ehsan Safai Zadeh
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, Marburg, Germany; Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstrße Marburg, Germany.
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Conformity of Fine Needle Aspiration Biopsy (FNAB) and Core Needle Biopsy (CNB) in peripheral lung tumor patients: A cross-sectional study. Ann Med Surg (Lond) 2022; 75:103423. [PMID: 35386804 PMCID: PMC8977934 DOI: 10.1016/j.amsu.2022.103423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/16/2022] [Accepted: 02/27/2022] [Indexed: 11/24/2022] Open
Abstract
Background The problem of establishing lung tumor diagnostics is a challenge for clinicians, especially pulmonologists, in determining a definitive diagnosis of a lung tumor. Objective Analyzing the conformity of anatomical pathology results between fine-needle aspiration biopsy (FNAB) and core needle biopsy (CNB) materials in peripheral lung tumors. Methods A cross-sectional study was conducted from July 2019 to December 2020 with 66 participants. Participants were examined for CNB and FNAB, in which the results of these examinations were compared for conformity. Statistical analysis used the Kappa test with p < 0.05. Result Most participants' tumor size was >70 mm, with FNAB results showing malignant category (39.5%), non-malignant (40.0%), and undiagnosed (38.9%; p = 0.757). Meanwhile, CNB examination showed a tumor size of >70 mm that was categorized into malignant (40.4%) and non-malignant (33.3%; p = 0.510). Most tumors were located in the right superior lobe that had FNAB results in the malignant (39.5%), non-malignant (30.0%) and undiagnosed (27.8%; p = 0.306) categories. The CNB examination also showed that most tumors were located in the right superior lobe, which had resulted in the category of malignant (34.4%), non-malignant (26.7%), and undiagnosed (75.0%; p = 0.240). Conformity of anatomical pathology results from FNAB and CNB subject such as malignancy category of 35 participants (74.5%), non-malignancy of 7 participants (53.8%) and undiagnosed of 4 participants (16.7%) with an accuracy of 69.69% (Κ = 0.43; p = 0.001). Conclusion There is a conformity between the anatomical pathology results from FNAB and CNB materials for the diagnosis of lung tumors. CNB showed better results in the detection of anatomical malignancy and specimen adequacy. There is a conformity between the results of FNAB and CNB assisted by ultrasound. FNAB and CNB results in lung cancer are similar >70%. The use of FNAB followed by CNB minimizes misdiagnosis.
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Tacconi F, Chegai F, Perretta T, Ambrogi V. Real-Time Pleural Elastography: Potential Usefulness in Nonintubated Video-Assisted Thoracic Surgery. J Chest Surg 2021; 54:433-435. [PMID: 33767023 PMCID: PMC8548183 DOI: 10.5090/jcs.20.121] [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: 09/23/2020] [Revised: 10/22/2020] [Accepted: 11/03/2020] [Indexed: 11/29/2022] Open
Abstract
Pleural adhesions are a major challenge in standard and nonintubated video-assisted thoracic surgery. The currently available imaging techniques help to assess the presence and extent of pleural adhesions, but do not provide information on tissue deformability, which is crucial for intraoperative management. In this report, we describe the utilization of real-time elastography mapping of pleural adhesions. This technique enabled us to detect areas with softer adhesions, and helped establish the surgical plan in a difficult case of a patient scheduled for nonintubated video-assisted thoracic surgery.
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Affiliation(s)
- Federico Tacconi
- Unit of Thoracic Surgery, Interventional Radiology, Molecular Imaging and Radiotherapy, Tor Vergata University Hospital, Rome, Italy
| | - Fabrizio Chegai
- Department of Diagnostic Imaging, Interventional Radiology, Molecular Imaging and Radiotherapy, Tor Vergata University Hospital, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging, Interventional Radiology, Molecular Imaging and Radiotherapy, Tor Vergata University Hospital, Rome, Italy
| | - Vincenzo Ambrogi
- Unit of Thoracic Surgery, Interventional Radiology, Molecular Imaging and Radiotherapy, Tor Vergata University Hospital, Rome, Italy
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Bracciale P, Bellanova S, Cipriani C. Lung Ultrasound in Patients With Dyspnea From Infective Lung Disease. Front Med (Lausanne) 2021; 8:709239. [PMID: 34422865 PMCID: PMC8374238 DOI: 10.3389/fmed.2021.709239] [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: 05/13/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Infective lung disease is a spectrum of pulmonary disorders with high prevalence in clinical practice. In the last decade, many studies focused on the clinical usefulness of lung ultrasound (LUS) in the management of patients presenting with dyspnea from infective lung disease. We report data on the methodological and standardized use of bedside LUS in the differential diagnosis of patients with acute dyspnea from infective lung diseases. We performed a cross-sectional study in 439 patients (160 women and 279 men, mean age 64.2 ± 11.5 years, age range 23-91 years) with infective lung diseases. A bedside LUS with a convex probe and chest X-ray were performed in all subjects. Chest CT was performed in a subgroup of patients, as clinically needed. We observed a statistically significant difference in the percentage of pleural effusion and pulmonary consolidation assessed by LUS, compared to X-ray (52.7 vs. 20%, respectively, p < 0.05; 93.6 vs. 48.2%, p < 0.001). The majority of the consolidations detected by LUS were mixed, hypo- and hyperechoic, lesions, with air bronchogram in 40% of cases. All findings assessed by LUS were confirmed by chest CT, when performed. We describe the actual role of LUS in the assessment of patients with infective lung disease. It has higher sensitivity compared to chest X-ray in the detection of pleural effusion. Consolidations from infective lung disease have mostly mixed echogenicity by LUS.
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Affiliation(s)
- Pierluigi Bracciale
- Pneumology and Respiratory Semi-intensive Care Unit, Covid Center Ostuni Hospital, Brindisi, Italy
| | - Salvatore Bellanova
- Pneumology and Respiratory Semi-intensive Care Unit, Covid Center Ostuni Hospital, Brindisi, Italy
| | - Cristiana Cipriani
- Department of Clinical, Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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Lacedonia D, Quarato CMI, Borelli C, Dimitri L, Graziano P, Foschino Barbaro MP, Scioscia G, Mirijello A, Maggi MM, Rea G, Ferragalli B, De Cosmo S, Sperandeo M. Transthoracic Ultrasound in Infectious Organizing Pneumonia: A Useful Guide for Percutaneous Needle Biopsy. Front Med (Lausanne) 2021; 8:708937. [PMID: 34350202 PMCID: PMC8326407 DOI: 10.3389/fmed.2021.708937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
In patients presenting with classical features of CAP (i.e., new peripheral pulmonary consolidations and symptoms including fever, cough, and dyspnea), a clinical response to the appropriate therapy occurs in few days. When clinical improvement has not occurred and chest imaging findings are unchanged or worse, a more aggressive approach is needed in order to exclude other non-infective lesions (including neoplasms). International guidelines do not currently recommend the use of transthoracic ultrasound (TUS) as an alternative to chest X-ray (CXR) or chest computed tomography (CT) scan for the diagnosis of CAP. However, a fundamental role for TUS has been established as a guide for percutaneous needle biopsy (US-PNB) in pleural and subpleural lesions. In this retrospective study, we included 36 consecutive patients whose final diagnosis, made by a US-guided percutaneous needle biopsy (US-PTNB), was infectious organizing pneumonia (OP). Infective etiology was confirmed by additional information from microbiological and cultural studies or with a clinical follow-up of 6–12 months after a second-line antibiotic therapy plus corticosteroids. All patients have been subjected to a chest CT and a systematic TUS examination before biopsy. This gave us the opportunity to explore TUS performance in assessing CT findings of infective OP. TUS sensitivity and specificity in detecting air bronchogram and necrotic areas were far lower than those of CT scan. Conversely, TUS showed superiority in the detection of pleural effusion. Although ultrasound findings did not allow the characterization of chronic subpleural lesions, TUS confirmed to be a valid diagnostic aid for guiding percutaneous needle biopsy of subpleural consolidations.
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Affiliation(s)
- Donato Lacedonia
- Institute of Respiratory Diseases, Policlinico Universitario "Riuniti" di Foggia, Foggia, Italy.,Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Carla Maria Irene Quarato
- Institute of Respiratory Diseases, Policlinico Universitario "Riuniti" di Foggia, Foggia, Italy.,Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Cristina Borelli
- Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Lucia Dimitri
- Unit of Patology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Paolo Graziano
- Unit of Patology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Maria Pia Foschino Barbaro
- Institute of Respiratory Diseases, Policlinico Universitario "Riuniti" di Foggia, Foggia, Italy.,Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giulia Scioscia
- Institute of Respiratory Diseases, Policlinico Universitario "Riuniti" di Foggia, Foggia, Italy.,Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonio Mirijello
- Department of Internal of Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Michele Maria Maggi
- Department of Emergency Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Gaetano Rea
- Department of Radiology, "Vincenzo Monaldi" Hospital-Association of periOperative Registered Nurses (AORN) Ospedale Dei Colli, Naples, Italy
| | - Beatrice Ferragalli
- Department of Radiology, "SS. Annunziata" Hospital, University of Chieti, Chieti, Italy
| | - Salvatore De Cosmo
- Department of Internal of Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Marco Sperandeo
- Unit of Interventional and Diagnostic Ultrasound of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
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Liu Y, Zhen Y, Zhang X, Gao F, Lu X. Application of Transthoracic Shear Wave Elastography in Evaluating Subpleural Pulmonary Lesions. Eur J Radiol Open 2021; 8:100364. [PMID: 34195303 PMCID: PMC8233193 DOI: 10.1016/j.ejro.2021.100364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 01/10/2023] Open
Abstract
AIM The objective of this research was to investigate the feasibility of transthoracic shear wave elastography in the differentiation of subpleural masses. METHODS Between December 2019 and November 2020,82 consecutive patients with radiographic evidence (including chest X ray and thoracic computed tomography CT) of single subpleural lesion enrolled in this research. The Young's modulus E (including Emean and Emax) of each lesion was detected, and the Young's modulus E of malignant lesions were compared with those of benign ones. We made diagnoses according to the results of pathology or standard clinical course for at least 3 months. Receiver operating characteristic (ROC) analysis was plotted to determine the cut-off point by maximizing the Youden index. RESULTS The Emean and Emax of the benign and malignant group was 34.68 ± 12.12 kPa vs. 53.82 ± 11.95 kPa (p < 0.001), 57.77 ± 14.45 kPa vs. 76.62 ± 17.04 kPa (p < 0.001). The ROC of Emean showed that when the cut-off point was 43.8 kPa, the Youden index (0.53) for distinguishing benign and malignant tumors was the largest (sensitivity 80.4 %, specificity 72.2 %, AUC = 0.848, p < 0.0001). When the cut-off point recommended by Emax ROC was 73.5 kPa, the Youden index (0.44) for distinguishing benign and malignant tumors was the largest (sensitivity 76.1 %, specificity 66.7 %, AUC = 0.780, p < 0.0001). CONCLUSIONS This study demonstrated that we can employ transthoracic shear wave elastography as a valuable instrument in differentiating benign subpleural lesions from malign ones.
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Affiliation(s)
| | | | | | | | - Xuefeng Lu
- Corresponding author at: The Second Affiliated Hospital of Zhengzhou University Department of Ultrasonography, 2 Jing 8th Road, ZhengZhou 450000, China.
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10
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UNLU EN, ALTINSOY HB, GÜLEÇ BALBAY E, SUNGUR MA, BORAN M, ÖNAL B. Shear Wave Ultrasound Elastography And Dıffusıon-Weıghted Magnetıc Resonance Imagıng Fındıngs Of Pleural-Based Masses Wıth Hıstopathologıc Correlatıon. KONURALP TIP DERGISI 2021. [DOI: 10.18521/ktd.880329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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11
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Li W, Shen M, Zhang Y, Cong Y, Zu H, Chen H, Wang Y. A Model for Predicting Malignant Sub-pleural Solid Masses Using Grayscale Ultrasound and Ultrasound Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1212-1218. [PMID: 33573845 DOI: 10.1016/j.ultrasmedbio.2021.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 06/12/2023]
Abstract
This article aimed to establish a prediction model of grayscale sonography and ultrasound elastography for malignant sub-pleural solid masses and evaluate its diagnostic value. The study included 153 patients, including 89 patients with malignant tumors and 64 patients with benign diseases. Statistical differences between the malignant and benign groups were found in the factors of age, air bronchogram, borderline, shape and elasticity score (p < 0.05). Age, elasticity score and borderline were effective factors for predicting malignant sub-pleural solid masses, offering an area under the receiver operating characteristic curve (AUROC) value of 0.72 (95% confidence interval [CI] 0.64-0.80), 0.73 (95% CI 0.65-0.79) and 0.70 (95% CI 0.62-0.77), respectively. The AUROC value of the prediction model for malignant sub-pleural solid masses was 0.88 (95% CI 0.81-0.92), which indicates that the prediction model was able to improve the diagnostic accuracy and that it may prove a useful auxiliary diagnostic tool for malignant sub-pleural solid masses, especially in primary health care institutions in developing countries.
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Affiliation(s)
- Wanbin Li
- Department of Ultrasonography, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China; Department of Intervention Radiology, Shanghai Fengxian District Central Hospital, Shanghai, China
| | - Mengjun Shen
- Department of Ultrasonography, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yi Zhang
- Department of Ultrasonography, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Cong
- Department of Ultrasonography, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huiming Zu
- Department of Ultrasonography, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hongwei Chen
- Department of Ultrasonography, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yin Wang
- Department of Ultrasonography, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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12
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López González FJ, García Alfonso L, Cascón Hernández J, Ariza Prota M, Herrero Huertas J, Hermida Valverde T, Ruíz Álvarez I, Torres Rivas HE, Fernández Fernández LM, Enríquez Rodríguez AI, García Clemente MM, Gallo González V. Biopsy of Intrapulmonary Lesions in Lungs with Atelectasis and Pleural Effusion. Arch Bronconeumol 2021; 57:438-439. [PMID: 34088403 DOI: 10.1016/j.arbr.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Lucía García Alfonso
- Área de Gestión Clínica del Pulmón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Juan Cascón Hernández
- Área de Gestión Clínica del Pulmón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Miguel Ariza Prota
- Área de Gestión Clínica del Pulmón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Julia Herrero Huertas
- Área de Gestión Clínica del Pulmón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Tamara Hermida Valverde
- Área de Gestión Clínica del Pulmón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Inés Ruíz Álvarez
- Sección de Neumología, Hospital Alvarez-Buylla, Mieres, Asturias, Spain
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13
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Quarato CMI, Venuti M, Dimitri L, Lacedonia D, Simeone A, Mirijello A, Cosmo SD, Maiello E, Taurchini M, Scioscia G, Barbaro MPF, Copetti M, Sperandeo M. Transthoracic ultrasound shear wave elastography for the study of subpleural lung lesions. Ultrasonography 2021; 41:93-105. [PMID: 34218607 PMCID: PMC8696150 DOI: 10.14366/usg.21021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/15/2021] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The aim of this study was to assess whether new-generation shear wave elastography (SWE) is suitable for the characterization of lung subpleural lesions. METHODS In total, 190 consecutive patients with subpleural lung lesions received ultrasonography and SWE. Patients with suspected malignancy underwent ultrasound-guided transthoracic needle biopsy. Final diagnoses were made on the basis of patients' clinical course, microbiological studies, and histological results. SWE was also performed in 25 healthy volunteers. RESULTS We found no statistically significant differences in stiffness between lung carcinomas, lung metastases, and pneumonia (P=0.296) or between different histological types of lung cancer (P=0.393). Necrosis was associated with reduced stiffness in pneumonia. Excluding necrotic lesions, pneumonia showed higher stiffness than lung carcinomas (2.95±0.68 m/s vs. 2.60±0.54 m/s, P=0.006). Chronic pneumonia showed increased stiffness (3.03±0.63 m/s), probably due to the presence of fibrotic tissue on histology. Pleural effusion was associated with a statistically significant reduction in stiffness, both in lung carcinomas (P=0.004) and lung metastases (P=0.002). The presence of air in healthy lung tissue may lead to incorrect speed estimates due to shear wave reflection (very high values, 14.64±2.19 m/s). CONCLUSION Transthoracic SWE could not distinguish lung malignancy from pneumonia, or between different histological types of lung carcinomas. In particular, SWE seems unable to resolve the clinical dilemma of chronic subpleural consolidations.
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Affiliation(s)
- Carla Maria Irene Quarato
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Mariapia Venuti
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Lucia Dimitri
- Unit of Pathology, Department of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Anna Simeone
- Department of Radiology, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Antonio Mirijello
- Department of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Salvatore De Cosmo
- Department of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Evaristo Maiello
- Unit of Oncology, Department of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Marco Taurchini
- Unit of Thoracic Surgery, Department of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Maria Pia Foschino Barbaro
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, Department of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Marco Sperandeo
- Unit of Interventional and Diagnostic Ultrasound, Department of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
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14
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Laursen CB, Clive A, Hallifax R, Pietersen PI, Asciak R, Davidsen JR, Bhatnagar R, Bedawi EO, Jacobsen N, Coleman C, Edey A, Via G, Volpicelli G, Massard G, Raimondi F, Evison M, Konge L, Annema J, Rahman NM, Maskell N. European Respiratory Society statement on thoracic ultrasound. Eur Respir J 2021; 57:13993003.01519-2020. [PMID: 33033148 DOI: 10.1183/13993003.01519-2020] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/20/2020] [Indexed: 12/19/2022]
Abstract
Thoracic ultrasound is increasingly considered to be an essential tool for the pulmonologist. It is used in diverse clinical scenarios, including as an adjunct to clinical decision making for diagnosis, a real-time guide to procedures and a predictor or measurement of treatment response. The aim of this European Respiratory Society task force was to produce a statement on thoracic ultrasound for pulmonologists using thoracic ultrasound within the field of respiratory medicine. The multidisciplinary panel performed a review of the literature, addressing major areas of thoracic ultrasound practice and application. The selected major areas include equipment and technique, assessment of the chest wall, parietal pleura, pleural effusion, pneumothorax, interstitial syndrome, lung consolidation, diaphragm assessment, intervention guidance, training and the patient perspective. Despite the growing evidence supporting the use of thoracic ultrasound, the published literature still contains a paucity of data in some important fields. Key research questions for each of the major areas were identified, which serve to facilitate future multicentre collaborations and research to further consolidate an evidence-based use of thoracic ultrasound, for the benefit of the many patients being exposed to clinicians using thoracic ultrasound.
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Affiliation(s)
- Christian B Laursen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark .,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Amelia Clive
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Rob Hallifax
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Pia Iben Pietersen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Regional Center for Technical Simulation, Odense University Hospital, Odense, Denmark
| | - Rachelle Asciak
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Jesper Rømhild Davidsen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,South Danish Center for Interstitial Lung Diseases (SCILS), Odense University Hospital, Odense, Denmark
| | - Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Eihab O Bedawi
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Niels Jacobsen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Regional Center for Technical Simulation, Odense University Hospital, Odense, Denmark
| | | | - Anthony Edey
- Dept of Radiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Gabriele Via
- Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
| | | | - Gilbert Massard
- Faculty of Science, Technology and Medicine, University of Luxembourg, Grand-Duchy of Luxembourg
| | - Francesco Raimondi
- Division of Neonatology, Section of Pediatrics, Dept of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy
| | - Matthew Evison
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Centre for HR, University of Copenhagen, Copenhagen, Denmark
| | - Jouke Annema
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,Laboratory of Pleural and Lung Cancer Translational Research, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,National Institute for Health Research, Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.,Joint last authors
| | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,Joint last authors
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15
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Boccatonda A, Susca V, Primomo GL, Cocco G, Cinalli S, Di Resta V, Martino L, Mucilli F, Marinari S, Cipollone F, Schiavone C. Role of shear-wave and strain elastography to differentiate malignant vs benign subpleural lung lesions. Medicine (Baltimore) 2021; 100:e24123. [PMID: 33429785 PMCID: PMC7793371 DOI: 10.1097/md.0000000000024123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/09/2020] [Indexed: 11/26/2022] Open
Abstract
Elastosonography is a non-invasive diagnostic method to evaluate tissue stiffness. The aim of our study was to demonstrate the applicability and efficacy of elastosonography to differentiate benign vs malignant subpleural lung lesions compared to clinical, radiological and histological findings.We performed both strain and shear wave velocity (SWV) elastosonography on subpleural lung lesions. Moreover, we elaborated a composite score called "elasto index".Fourteen patients, 10 males and 4 females were recruited. On strain elastography, 9 lesions showed a hard pattern (type 3), 3 lesions showed an intermediate pattern (type 2), and 2 lesions a soft pattern (type 1). All lesions showed a mean SWV value of 4.46 ± 2.37 m/second. The mean SWV for malignant lesions (n = 6) was 5.92 ± 2.8 m/second. The mean SWV for benign lesions (n = 8) was 3.36 ± 1.20 m/second. SWV shows an area under the curve (AUC) of 0.792, and the Youden index shows a value of 3.6 m/second. The ROC curve elaborated for the diagnosis of malignancy by strain elastography showed an AUC of 0.688. ROC curve for the diagnosis of malignancy by elasto index demonstrated an AUC of 0.802.SWV values obtained by ARFI elastosonographic method are higher in malignant lung lesions (mean SWV: 5.92 m/second) than in benign ones (mean SWV: 3.36); a composite score (elasto index) is characterized by better statistical significance for the differentiation of the lesions.
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Affiliation(s)
- Andrea Boccatonda
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, “G. d’Annunzio” University
| | - Valentina Susca
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, “G. d’Annunzio” University
| | | | - Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, “G. d’Annunzio” University
| | | | - Velia Di Resta
- Department of General and Thoracic Surgery, University Hospital “SS. Annunziata”
| | - Laura Martino
- Pneumology Department, SS Annunziata Hospital, Chieti
| | - Felice Mucilli
- Department of General and Thoracic Surgery, University Hospital “SS. Annunziata”
| | | | - Francesco Cipollone
- Department of Medicine and Aging, Center of Aging Science and Translational Medicine (CESI-Met), Via Luigi Polacchi, Chieti, Italy
| | - Cosima Schiavone
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, “G. d’Annunzio” University
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16
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Weiling CMD, Bei XMD, Lan WMD, Lixue YMD. Recommendations for Operation, Measurement, Reporting and Application of Pediatric Lung Ultrasound: Chinese Experts Consensus. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2021. [DOI: 10.37015/audt.2021.200056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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17
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Zhi X, Chen J, Xie F, Sun J, Herth FJF. Diagnostic value of endobronchial ultrasound image features: A specialized review. Endosc Ultrasound 2021; 10:3-18. [PMID: 32719201 PMCID: PMC7980684 DOI: 10.4103/eus.eus_43_20] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) technology is important in the diagnosis of intrathoracic benign and malignant lymph nodes (LNs). With the development of EBUS imaging technology, its role in noninvasive diagnosis, as a supplement to pathology diagnosis, has been given increasing attention in recent years. Many studies have explored qualitative and quantitative methods for the three EBUS modes, as well as a variety of multimodal analysis methods, to find the optimal method for the noninvasive diagnosis using EBUS for LNs. Here, we review and comment on the research methods and predictive diagnostic value, discuss the existing problems, and look ahead to the future application of EBUS imaging.
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Affiliation(s)
- Xinxin Zhi
- Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Junxiang Chen
- Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Fangfang Xie
- Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
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18
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Fusco P, DI Carlo S, Petroni GM, Scimia P, Sepolvere G, Ciaschi W, Marinangeli F. Lung elastosonography for diagnosis and management of COVID-19 pneumonia. Minerva Anestesiol 2020; 87:374-376. [PMID: 33319954 DOI: 10.23736/s0375-9393.20.15075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Pierfrancesco Fusco
- Unit of Anesthesia and Intensive Care, San Salvatore Hospital, L'Aquila, Italy
| | - Stefano DI Carlo
- Department of Anesthesia, Postoperative Medicine and Intensive Care Therapy, Filippo Del Ponte Women and Children's Hospital, ASST dei Sette Laghi, Varese, Italy
| | - Gian M Petroni
- Department of Clinical Medicine, Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy -
| | - Paolo Scimia
- Intensive Care Unit, Department of Anesthesia, G. Mazzini Hospital, Teramo, Italy
| | - Giuseppe Sepolvere
- Intensive Care Unit, Department of Anesthesia and Cardiac Surgery, San Michele Hospital, Maddaloni, Caserta, Italy
| | - Walter Ciaschi
- Department of Anesthesia, Intensive Care and Pain Medicine, F. Spaziani Hospital, Frosinone, Italy
| | - Franco Marinangeli
- Department of Clinical Medicine, Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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19
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Zhou B, Yang X, Zhang X, Curran WJ, Liu T. Ultrasound Elastography for Lung Disease Assessment. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:2249-2257. [PMID: 32970595 PMCID: PMC8544928 DOI: 10.1109/tuffc.2020.3026536] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/20/2020] [Indexed: 06/11/2023]
Abstract
Ultrasound elastography (US-E) is a noninvasive, safe, cost-effective and reliable technique to assess the mechanical properties of soft tissue and provide imaging biomarkers for pathological processes. Many lung diseases such as acute respiratory distress syndrome, chronic obstructive pulmonary disease, and interstitial lung disease are associated with dramatic changes in mechanical properties of lung tissues. Nevertheless, US-E is rarely used to image the lung because it is filled with air. The large difference in acoustic impedance between air and lung tissue results in the reflection of the ultrasound wave at the lung surface and, consequently, the loss of most ultrasound energy. In recent years, there has been an increasing interest in US-E applications in evaluating lung diseases. This article provides a comprehensive review of the technological advances of US-E research on lung disease diagnosis. We introduce the basic principles and major techniques of US-E and provide information on various applications in lung disease assessment. Finally, the potential applications of US-E to the diagnosis of COVID-19 pneumonia is discussed.
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Affiliation(s)
- Boran Zhou
- Department of Radiation OncologyEmory UniversityAtlantaGA30322USA
- Winship Cancer Institute, Emory UniversityAtlantaGA30322USA
| | - Xiaofeng Yang
- Department of Radiation OncologyEmory UniversityAtlantaGA30322USA
- Winship Cancer Institute, Emory UniversityAtlantaGA30322USA
| | | | - Walter J. Curran
- Department of Radiation OncologyEmory UniversityAtlantaGA30322USA
- Winship Cancer Institute, Emory UniversityAtlantaGA30322USA
| | - Tian Liu
- Department of Radiation OncologyEmory UniversityAtlantaGA30322USA
- Winship Cancer Institute, Emory UniversityAtlantaGA30322USA
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20
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López González FJ, García Alfonso L, Cascón Hernández J, Ariza Prota M, Herrero Huertas J, Hermida Valverde T, Ruíz Álvarez I, Torres Rivas HE, Fernández Fernández LM, Enríquez Rodríguez AI, García Clemente MM, Gallo González V. Biopsy of Intrapulmonary Lesions in Lungs with Atelectasis. Arch Bronconeumol 2020. [PMID: 33127202 DOI: 10.1016/j.arbres.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Lucía García Alfonso
- Área de Gestión Clínica del Pulmón, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Juan Cascón Hernández
- Área de Gestión Clínica del Pulmón, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Miguel Ariza Prota
- Área de Gestión Clínica del Pulmón, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Julia Herrero Huertas
- Área de Gestión Clínica del Pulmón, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Tamara Hermida Valverde
- Área de Gestión Clínica del Pulmón, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Inés Ruíz Álvarez
- Sección de Neumología, Hospital Alvarez-Buylla, Mieres, Asturias, España
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21
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Cozzolino I, Ronchi A, Messina G, Montella M, Morgillo F, Vicidomini G, Tirino V, Grimaldi A, Marino FZ, Santini M, Cappabianca S, Franco R. Adequacy of Cytologic Samples by Ultrasound-Guided Percutaneous Transthoracic Fine-Needle Aspiration Cytology of Peripheral Pulmonary Nodules for Morphologic Diagnosis and Molecular Evaluations: Comparison With Computed Tomography–Guided Percutaneous Transthoracic Fine-Needle Aspiration Cytology. Arch Pathol Lab Med 2020; 144:361-369. [DOI: 10.5858/arpa.2018-0346-oa] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Context.—
Fine-needle aspiration cytology (FNAC) of pulmonary nodules is usually guided by computed tomography (CT), whereas ultrasonography (US) is generally considered not applicable for such purposes.
Objective.—
To evaluate the clinical applicability and diagnostic utility of US-guided transthoracic FNAC of peripheral pulmonary nodules.
Design.—
Ultrasonography-guided transthoracic FNAC was obtained from 40 selected patients with peripheral, subpleural, and paravertebral pulmonary nodules. Air-dried and Diff-Quik–stained smears were used for rapid on-site evaluation; additional smears were alcohol fixed for Papanicolaou staining. Cell blocks were set up for immunocytochemical and molecular studies; in 2 cases, a flow cytometry evaluation was also performed. The series was compared to 40 CT-guided pulmonary FNAC samples from patients with pleural, peripheral, and paravertebral pulmonary nodules, to evaluate differences in terms of diagnostic rate, time of execution, safety, and cost.
Results.—
The US-guided FNAC samples had results that were adequate and representative in 95% of cases. No significant differences were observed between the 2 groups in terms of diagnostic rate, number of passes, and cellularity of both smears and cell blocks. The mean time needed for the execution of US-guided FNAC was 13.1 minutes, whereas the mean time for CT-guided FNAC was 23.6 minutes. Thus, US-guided FNAC was significantly more rapid than CT-guided pulmonary FNAC. Because pneumothorax occurred in 1 individual who underwent US-guided FNAC and in 9 who underwent CT-guided FNAC, we might conclude that US-guided FNAC is a significantly safer procedure. Finally, comparing the costs of both procedures, US-guided FNAC is less expensive.
Conclusions.—
Our experience showed an elevated clinical applicability and diagnostic utility of US-guided transthoracic FNAC for selected pulmonary nodules.
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Affiliation(s)
- Immacolata Cozzolino
- From the Pathology Unit, Department of Mental and Physical Health and Preventive Medicine (Drs Cozzolino, Ronchi, Montella, Zito Marino, and Franco), the Thoracic Surgery Unit, Department of Cardiac, Thoracic and Respiratory Sciences (Drs Messina, Vicidomini, and Santini), the Medical Oncology Unit, Department of Clinical and Experimental Medicine “F. Magrassi-A. Lanzara” (Dr Morgillo), the Biote
| | - Andrea Ronchi
- From the Pathology Unit, Department of Mental and Physical Health and Preventive Medicine (Drs Cozzolino, Ronchi, Montella, Zito Marino, and Franco), the Thoracic Surgery Unit, Department of Cardiac, Thoracic and Respiratory Sciences (Drs Messina, Vicidomini, and Santini), the Medical Oncology Unit, Department of Clinical and Experimental Medicine “F. Magrassi-A. Lanzara” (Dr Morgillo), the Biote
| | - Gaetana Messina
- From the Pathology Unit, Department of Mental and Physical Health and Preventive Medicine (Drs Cozzolino, Ronchi, Montella, Zito Marino, and Franco), the Thoracic Surgery Unit, Department of Cardiac, Thoracic and Respiratory Sciences (Drs Messina, Vicidomini, and Santini), the Medical Oncology Unit, Department of Clinical and Experimental Medicine “F. Magrassi-A. Lanzara” (Dr Morgillo), the Biote
| | - Marco Montella
- From the Pathology Unit, Department of Mental and Physical Health and Preventive Medicine (Drs Cozzolino, Ronchi, Montella, Zito Marino, and Franco), the Thoracic Surgery Unit, Department of Cardiac, Thoracic and Respiratory Sciences (Drs Messina, Vicidomini, and Santini), the Medical Oncology Unit, Department of Clinical and Experimental Medicine “F. Magrassi-A. Lanzara” (Dr Morgillo), the Biote
| | - Floriana Morgillo
- From the Pathology Unit, Department of Mental and Physical Health and Preventive Medicine (Drs Cozzolino, Ronchi, Montella, Zito Marino, and Franco), the Thoracic Surgery Unit, Department of Cardiac, Thoracic and Respiratory Sciences (Drs Messina, Vicidomini, and Santini), the Medical Oncology Unit, Department of Clinical and Experimental Medicine “F. Magrassi-A. Lanzara” (Dr Morgillo), the Biote
| | - Giovanni Vicidomini
- From the Pathology Unit, Department of Mental and Physical Health and Preventive Medicine (Drs Cozzolino, Ronchi, Montella, Zito Marino, and Franco), the Thoracic Surgery Unit, Department of Cardiac, Thoracic and Respiratory Sciences (Drs Messina, Vicidomini, and Santini), the Medical Oncology Unit, Department of Clinical and Experimental Medicine “F. Magrassi-A. Lanzara” (Dr Morgillo), the Biote
| | - Virginia Tirino
- From the Pathology Unit, Department of Mental and Physical Health and Preventive Medicine (Drs Cozzolino, Ronchi, Montella, Zito Marino, and Franco), the Thoracic Surgery Unit, Department of Cardiac, Thoracic and Respiratory Sciences (Drs Messina, Vicidomini, and Santini), the Medical Oncology Unit, Department of Clinical and Experimental Medicine “F. Magrassi-A. Lanzara” (Dr Morgillo), the Biote
| | - Anna Grimaldi
- From the Pathology Unit, Department of Mental and Physical Health and Preventive Medicine (Drs Cozzolino, Ronchi, Montella, Zito Marino, and Franco), the Thoracic Surgery Unit, Department of Cardiac, Thoracic and Respiratory Sciences (Drs Messina, Vicidomini, and Santini), the Medical Oncology Unit, Department of Clinical and Experimental Medicine “F. Magrassi-A. Lanzara” (Dr Morgillo), the Biote
| | - Federica Zito Marino
- From the Pathology Unit, Department of Mental and Physical Health and Preventive Medicine (Drs Cozzolino, Ronchi, Montella, Zito Marino, and Franco), the Thoracic Surgery Unit, Department of Cardiac, Thoracic and Respiratory Sciences (Drs Messina, Vicidomini, and Santini), the Medical Oncology Unit, Department of Clinical and Experimental Medicine “F. Magrassi-A. Lanzara” (Dr Morgillo), the Biote
| | - Mario Santini
- From the Pathology Unit, Department of Mental and Physical Health and Preventive Medicine (Drs Cozzolino, Ronchi, Montella, Zito Marino, and Franco), the Thoracic Surgery Unit, Department of Cardiac, Thoracic and Respiratory Sciences (Drs Messina, Vicidomini, and Santini), the Medical Oncology Unit, Department of Clinical and Experimental Medicine “F. Magrassi-A. Lanzara” (Dr Morgillo), the Biote
| | - Salvatore Cappabianca
- From the Pathology Unit, Department of Mental and Physical Health and Preventive Medicine (Drs Cozzolino, Ronchi, Montella, Zito Marino, and Franco), the Thoracic Surgery Unit, Department of Cardiac, Thoracic and Respiratory Sciences (Drs Messina, Vicidomini, and Santini), the Medical Oncology Unit, Department of Clinical and Experimental Medicine “F. Magrassi-A. Lanzara” (Dr Morgillo), the Biote
| | - Renato Franco
- From the Pathology Unit, Department of Mental and Physical Health and Preventive Medicine (Drs Cozzolino, Ronchi, Montella, Zito Marino, and Franco), the Thoracic Surgery Unit, Department of Cardiac, Thoracic and Respiratory Sciences (Drs Messina, Vicidomini, and Santini), the Medical Oncology Unit, Department of Clinical and Experimental Medicine “F. Magrassi-A. Lanzara” (Dr Morgillo), the Biote
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The role of endobronchial ultrasonography elastography for predicting malignancy. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:158-165. [PMID: 32175157 DOI: 10.5606/tgkdc.dergisi.2020.18508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/05/2019] [Indexed: 12/25/2022]
Abstract
Background This study aims to investigate the role of endobronchial ultrasonography elastography in predicting malignancy. Methods Between January 2016 and December 2016, a total of 221 lymph nodes were biopsied using the endobronchial ultrasonography-guided transbronchial needle aspiration from 119 consecutive patients (69 males, 50 females; mean age 63.2±12.4 years; range, 16 to 86 years) were included. Lymph nodes were scored by elastography according to their colors in four categories before the procedure. The strain ratio was calculated based on the region of interest after three measurements. Results Of the patients, 93 were diagnosed with a malignancy through endobronchial ultrasonography-guided transbronchial needle aspiration biopsy. The mean lymph node score of benign versus malignant lesions was 2.2±1.0 and 3.2±1, respectively (p<0.001). There was a positive correlation between the lymph node scores and lymph node diameter, strain ratio, ≥3 of lymph node scoring, the sensitivity for malignancy was 79% and specificity was 60%. The mean strain ratio for malignant and benign lymph nodes was 22.2±30.1 and 5.2±1.7, respectively (p<0.001). With a cut-off value of ≥2.47 of strain ratio, the sensitivity for malignancy was 75% and specificity was 65%. The combined use of positron emission tomography and lymph node score or strain ratio yielded 80.4% and 61.2% sensitivity and 80% and 70.3% specificity for malignancy, respectively. Conclusion Endobronchial ultrasonography elastography is useful in predicting malignancy of the lymph nodes. When combined with positron emission tomography, specificity and positive predictive value for malignancy increase.
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Miller DL, Dong Z, Dou C, Patterson B, Raghavendran K. Pulmonary Capillary Hemorrhage Induced by Super Sonic Shear Wave Elastography in Rats. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2993-3004. [PMID: 31412979 PMCID: PMC6768750 DOI: 10.1016/j.ultrasmedbio.2019.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/20/2019] [Accepted: 07/06/2019] [Indexed: 05/05/2023]
Abstract
The occurrence of the pulmonary capillary hemorrhage (PCH) bioeffect of diagnostic ultrasound in rats was investigated for a SuperSonic Imagine shear wave elastography system (Aixplorer, Supersonic Imagine, Aix-en-Provence, France). The elastography imaging repeated at 1 Hz and consisted of widely spaced B-mode image pulses, supersonic push (SSP) pulses and shear wave imaging (SWI) pulses. Groups of rats anesthetized with ketamine and xylazine, or with ketamine only, were imaged on their right side in a warm water bath for one frame, 30 s and 300 s. The image focus and region of interest were adjusted to give exposure only with the background B-mode imaging, or primarily with the SSP and SWI pulses. A sham group had only low power aiming scans. The lungs were removed 5 min after exposure and evaluated for PCH area and volume. The B mode was notably ineffective and produced significant PCH only at the maximum 0 dB output. The SSP pulses together with the SWI pulses produced significant PCH for 300 s, 30 s and even single image exposures. Peak rarefactional pressure amplitude PCH thresholds for 300 s exposure were the same with or without the B-mode pulses at 1.5 MPa (in situ mechanical index, MIIS = 0.67). A 30 s duration resulted in a slightly increased threshold of 1.7 MPa (MIIS = 0.76). The omission of xylazine from the anesthetic, which reduces the sensitivity of rat lung to PCH occurrence, resulted in an increased threshold of 2.1 MPa (MIIS = 0.94). The unique SSP pulses were much more effective than the B mode, but thresholds were comparable to previous results with other diagnostic ultrasound modes on other systems.
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Affiliation(s)
- Douglas L Miller
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
| | - Zhihong Dong
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Chunyan Dou
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Brandon Patterson
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
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24
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Sperandeo M, Del Colle A, Frongillo E, Rea G, Dimitri L, Cipriani C, Lacedonia D. Safety maximization of percutaneous transthoracic needle biopsy with ultrasound guide in subpleural lesions in the evaluation of pulmonary consolidation. Respir Res 2019; 20:68. [PMID: 30953529 PMCID: PMC6451297 DOI: 10.1186/s12931-019-1031-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 03/25/2019] [Indexed: 12/16/2022] Open
Abstract
The study by Kiranantawat et al. "Clinical role, safety and diagnostic accuracy of percutaneous transthoracic needle biopsy in the evaluation of pulmonary consolidation" highlights how "pulmonary consolidation can be safely evaluated with CT-guided percutaneous needle biopsy". Even if we agree about the role of CT guidance, we would like to point out how Thoracic Ultrasound could be better than CT for biopsy of subpleural lesions that could easily be detected and reached with this "real-time" and quicker technique.
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Affiliation(s)
- Marco Sperandeo
- Unit of Interventional and Diagnostic Ultrasound of Internal Medicine IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Anna Del Colle
- Department of Medical and Surgical Sciences, Institute of Respiratory Disease, University of Foggia, Viale degli Aviatori, 2, 71122, Foggia, FG, Italy.
| | - Elisabettamaria Frongillo
- Unit of Thoracic Surgery IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Gaetano Rea
- Department of Radiology, Ultrasound Diagnostic Unit, Monaldi Hospital, dei Colli, Naples, AO, Italy
| | - Lucia Dimitri
- Unit of Pathology IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Cristiana Cipriani
- Department of Internal Medicine and Medical Discipline, Sapienza University of Rome, Rome, Italy
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, Institute of Respiratory Disease, University of Foggia, Viale degli Aviatori, 2, 71122, Foggia, FG, Italy
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25
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Usability of Transthoracic Shear Wave Elastography in Differentiation of Subpleural Solid Masses. Ultrasound Q 2018; 34:233-237. [DOI: 10.1097/ruq.0000000000000374] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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26
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Wei H, Lu Y, Ji Q, Zhou H, Zhou X. The application of conventional us and transthoracic ultrasound elastography in evaluating peripheral pulmonary lesions. Exp Ther Med 2018; 16:1203-1208. [PMID: 30116370 PMCID: PMC6090271 DOI: 10.3892/etm.2018.6335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 06/06/2018] [Indexed: 12/11/2022] Open
Abstract
The aim of the present study was to evaluate the diagnostic value of ultrasound (US) elastography in differentiating between benign and malignant peripheral lung lesions (PLLs). This retrospective study included 91 consecutive patients with 91 PLLs. Conventional US, strain elastography (SE), acoustic radiation force impulse imaging (ARFIimaging) and point share wave elastography (p-SWE) were performed. All of the pathological results were confirmed by US-guided biopsies or surgeries. There were 36 benign PLLs and 55 malignant PLLs on pathology. For conventional US, a lesion diameter ≥5 cm, irregular contour, presence of air bronchogram and non-abundant vascularity were predictive factors of malignancy (P<0.05). SE scores were observed to be invalid in differentiating between malignant and benign PLLs (P=0.542). For ARFIimaging scores, an elasticity score of 3 or greater was predictive of malignancy, with a sensitivity of 83.6% (46/55) and a specificity of 52.8% (19/36). For p-SWE, the share wave velocity of malignant PLLs was higher than benign ones (2.47±0.92 vs. 1.85±0.92 m/sec; P=0.0022). When 1.951 m/sec was selected as the cut-off value, a sensitivity of 70.9% (39/55) and a specificity of 69.4% (25/36) were obtained. Thus, US, particularly US elastography, is helpful in distinguishing malignant PLLs from benign PLLs.
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Affiliation(s)
- Hong Wei
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Yuchan Lu
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Qiao Ji
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Hang Zhou
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Xianli Zhou
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
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27
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Frongillo E, Tinti MG, Dimitri L, Sperandeo M. Safety and accuracy of transthoracic ultrasound-guided fine-needle aspiration biopsy. Ann Thorac Med 2018; 13:122-123. [PMID: 29675065 PMCID: PMC5892088 DOI: 10.4103/atm.atm_343_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Elisabettamaria Frongillo
- Department of Internal Medicine, Interventional Ultrasound Section, Unit of Internal Medicine, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy E-mail:
| | - Maria Giulia Tinti
- Department of Internal Medicine, Unit of Pathology, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Lucia Dimitri
- Department of Pathology, Unit of Pathology, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Marco Sperandeo
- Department of Internal Medicine, Interventional Ultrasound Section, Unit of Internal Medicine, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy E-mail:
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28
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Hasse K, O'Connell D, Min Y, Neylon J, Low DA, Santhanam A. Estimation and validation of patient‐specific high‐resolution lung elasticity derived from 4DCT. Med Phys 2017; 45:666-677. [DOI: 10.1002/mp.12697] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/16/2017] [Accepted: 11/16/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Katelyn Hasse
- Department of Radiation Oncology University of California Los Angeles CA USA
| | - Dylan O'Connell
- Department of Radiation Oncology University of California Los Angeles CA USA
| | - Yugang Min
- Department of Radiation Oncology University of California Los Angeles CA USA
| | - John Neylon
- Department of Radiation Oncology University of California Los Angeles CA USA
| | - Daniel A. Low
- Department of Radiation Oncology University of California Los Angeles CA USA
| | - Anand Santhanam
- Department of Radiation Oncology University of California Los Angeles CA USA
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He HY, Chen JL, Ma H, Zhu J, Wu DD, Lv XD. Value of Endobronchial Ultrasound Elastography in Diagnosis of Central Lung Lesions. Med Sci Monit 2017; 23:3269-3275. [PMID: 28678769 PMCID: PMC5508876 DOI: 10.12659/msm.901808] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Ultrasound elastography is an imaging modality used to show tissue stiffness in tumor pathophysiological processes that promote the formation of stiffer tissues. Endobronchial ultrasound (EBUS) elastography is an ultrasound elastography-based technique for measuring tissue stiffness during EBUS-guided transbronchial needle aspiration (EBUS-TBNA). The diagnostic value of EBUS elastography in central lung lesions remains largely unknown. MATERIAL AND METHODS A total of 57 patients with central lung lesions underwent ultrasonic bronchoscope examination. EBUS with standard B mode evaluation and elastography with grading score measurement were performed before EBUS-guided transbronchial needle aspiration (EBUS-TBNA). Comparison of the diagnosis accuracy in malignant lung lesions between elastography and standard EBUS was made. RESULTS Our data showed that the hypoechoic lesions, uneven echo, distinct boundary, and no air bronchogram were significant indicators of standard EBUS in diagnosis of malignant lung lesions (P<0.01). The differences in elastosonography grading scores between the benign and malignant lung lesions were statistically significance (P<0.01), and the elastography grading score was more sensitive and specific than the standard EBUS criteria in diagnosing malignant lung lesions. The area under the receiver operating characteristic curve (ROC) for the elastography grading score was 0.793. The best cut-off point of the elastography grading score for distinguishing malignant from benign lung lesions was 2.5. The elastography grading score had a sensitivity of 72.2%, specificity of 76.2%, positive predictive value of 83.4%, and negative predictive value of 61.5% for distinguishing malignant from benign lung lesions. The overall accuracy of elastography grading score was 73.7%. CONCLUSIONS BUS elastography can effectively diagnose central lung lesions. The diagnostic accuracy of elastography in malignant lung lesions is higher than that of standard EBUS criteria.
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Affiliation(s)
- Hai-Yan He
- Department of Respiratory Medicine, First People's Hospital of Nantong, Nantong, Jiangsu, China (mainland)
| | - Jin-Liang Chen
- Department of Respiratory Medicine, First People's Hospital of Nantong, Nantong, Jiangsu, China (mainland)
| | - Hang Ma
- Department of Respiratory Medicine, First People's Hospital of Nantong, Nantong, Jiangsu, China (mainland)
| | - Jie Zhu
- Department of Respiratory Medicine, First People's Hospital of Nantong, Nantong, Jiangsu, China (mainland)
| | - Dan-Dan Wu
- Department of Respiratory Medicine, First People's Hospital of Nantong, Nantong, Jiangsu, China (mainland)
| | - Xue-Dong Lv
- Department of Respiratory Medicine, First People's Hospital of Nantong, Nantong, Jiangsu, China (mainland)
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30
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Corcoran JP, Tazi-Mezalek R, Maldonado F, Yarmus LB, Annema JT, Koegelenberg CFN, St Noble V, Rahman NM. State of the art thoracic ultrasound: intervention and therapeutics. Thorax 2017; 72:840-849. [PMID: 28411248 DOI: 10.1136/thoraxjnl-2016-209340] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 03/14/2017] [Accepted: 03/23/2017] [Indexed: 12/25/2022]
Abstract
The use of thoracic ultrasound outside the radiology department and in everyday clinical practice is becoming increasingly common, having been incorporated into standards of care for many specialties. For the majority of practitioners, their experience of, and exposure to, thoracic ultrasound will be in its use as an adjunct to pleural and thoracic interventions, owing to the widely recognised benefits for patient safety and risk reduction. However, as clinicians become increasingly familiar with the capabilities of thoracic ultrasound, new directions for its use are being sought which might enhance practice and patient care. This article reviews the ways in which the advent of thoracic ultrasound is changing the approach to the investigation and treatment of respiratory disease from an interventional perspective. This will include the impact of thoracic ultrasound on areas including patient safety, diagnostic and therapeutic procedures, and outcome prediction; and will also consider potential future research and clinical directions.
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Affiliation(s)
- John P Corcoran
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK
| | - Rachid Tazi-Mezalek
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Lonny B Yarmus
- Division of Pulmonary and Critical Care Medicine, John Hopkins University, Baltimore, Maryland, USA
| | - Jouke T Annema
- Department of Pulmonology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Coenraad F N Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University, Cape Town, South Africa.,Tygerberg Academic Hospital, Cape Town, South Africa
| | - Victoria St Noble
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
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31
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Ultrasound-guided Lung Biopsy in the Hands of Respiratory Physicians: Diagnostic Yield and Complications in 215 Consecutive Patients in 3 Centers. J Bronchology Interv Pulmonol 2017; 23:220-8. [PMID: 27454475 DOI: 10.1097/lbr.0000000000000297] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of the study was to determine the diagnostic yield and prevalence of complications of ultrasound-guided transthoracic needle aspiration biopsies (US-TTNAB) performed by respiratory physicians after implementation of the procedure in an everyday clinical setting at 3 different centers. METHODS Patients were included if they during the period from January 2012 to August 2014 had a registered US-TTNAB procedure code or if a US biopsy registration form had been filled out at either of the participating centers. Histology or cytology results were used as a reference test for diagnoses that could be made based on these results. Reference test for the remaining diagnoses was clinical follow-up. The diagnostic yield of US-TTNAB was defined as the proportion of patients in which the result of the US-TTNAB was consistent with the reference test. RESULTS A total of 215 patients in which a primary US-TTNAB had been performed were identified. The most common biopsy sites were lungs and pleurae with a total of 164 (76.3%) patients and 31 patients (14.4%), respectively. US-TTNAB diagnostic yield was 76.9% (95% CI, 70.3%-83.4%) for malignant diagnoses and 47.6% (95% CI, 31.9%-63.4%) for nonmalignant diagnoses. The most common complications of US-TTNAB were pneumothorax (2.5%; 95% CI, 0.03%-4.6%) and pain at the biopsy site (2%; 95% CI, 0.04%-3.9%). No fatalities related to US-TTNAB were observed. CONCLUSION US-TTNAB performed by respiratory physicians is a safe procedure with a low risk of complications and the diagnostic yield to establish a malignant diagnosis is acceptable.
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32
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Interrigi MC, Trovato FM, Catalano D, Trovato GM. Emergency thoracic ultrasound and clinical risk management. Ther Clin Risk Manag 2017; 13:151-160. [PMID: 28223817 PMCID: PMC5308587 DOI: 10.2147/tcrm.s126770] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Thoracic ultrasound (TUS) has been proposed as an easy-option replacement for chest X-ray (CXR) in emergency diagnosis of pneumonia, pleural effusion, and pneumothorax. We investigated CXR unforeseen diagnosis, subsequently investigated by TUS, considering its usefulness in clinical risk assessment and management and also assessing the sustainability of telementoring. PATIENTS AND METHODS This observational report includes a period of 6 months with proactive concurrent adjunctive TUS diagnosis telementoring, which was done using freely available smartphone applications for transfer of images and movies. RESULTS Three hundred and seventy emergency TUS scans (excluding trauma patients) were performed and telementored. In 310 cases, no significant chest pathology was detected either by CXR, TUS, or the subsequent work-up; in 24 patients, there was full concordance between TUS and CXR (ten isolated pleural effusion; eleven pleural effusion with lung consolidations; and three lung consolidation without pleural effusion); in ten patients with lung consolidations, abnormalities identified by CXR were not detected by TUS. In 26 patients, only TUS diagnosis criteria of disease were present: in 19 patients, CXR was not diagnostic, ie, substantially negative, but TUS detected these conditions correctly, and these were later confirmed by computed tomography (CT). In seven patients, even if chest disease was identified by CXR, such diagnoses were significantly modified by ultrasound, and CT confirmed that TUS was more appropriate. The overall respective individual performances of CXR and TUS for the diagnosis of a pleural-pulmonary disease in emergency are good, with accuracy >95%. CONCLUSION About 20% of pneumonia cases were detectable only by CXR and 20% only by TUS and not by CXR; ie, about 40% of patients may have been misdiagnosed if, by chance, only one of the two tools had been used. The concurrent use of TUS and CXR increases the overall sensitivity and specificity. The contribution of expert telementoring and final reappraisal is a valuable and sustainable element for emergency physicians' training and performance, contributing reasonably to mitigation of clinical risks.
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Affiliation(s)
| | - Francesca M Trovato
- Accident and Emergency Department, Ospedale Civile, Ragusa
- Department of Clinical and Experimental Medicine, The School of Medicine, University of Catania
| | - Daniela Catalano
- Department of Clinical and Experimental Medicine, The School of Medicine, University of Catania
- Postgraduate School of Clinical Ultrasound, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Policlinico, University of Catania
| | - Guglielmo M Trovato
- Department of Clinical and Experimental Medicine, The School of Medicine, University of Catania
- Postgraduate School of e-Learning and ICT in Health Sciences, The School of Medicine, University of Catania, Catania, Italy
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33
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Williamson JP, Grainge C, Parameswaran A, Twaddell SH. Thoracic Ultrasound: What Non-radiologists Need to Know. CURRENT PULMONOLOGY REPORTS 2017; 6:39-47. [PMID: 28435782 PMCID: PMC5381550 DOI: 10.1007/s13665-017-0164-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose of review The aim of this review is to provide the theoretical and practical
knowledge essential for non-radiologists to develop the skills necessary to apply
thoracic ultrasound as an extension of clinical assessment and
intervention. Recent findings Issues relating to training and competence are discussed and a
library of thoracic ultrasound videos is provided to illustrate artefacts,
pleural, parenchymal and pneumothorax pathology as well as important pitfalls to
consider. Novel and future diagnostic applications of thoracic ultrasound in the
setting of acute cardiorespiratory pathology including consolidation, acute
interstitial syndromes and pulmonary embolism are explored. Summary Thoracic ultrasound requires an understanding of imaging artefact
specific to lung and pleura and a working knowledge of machine knobology for image
optimisation and interpretation. Ultrasound is a valuable tool for the practicing
chest clinician providing diagnostic information for the assessment of pleural and
parenchymal disease and increased safety and cost effectiveness of thoracic
interventions. Electronic supplementary material The online version of this article (doi:10.1007/s13665-017-0164-1) contains supplementary material, which is available to authorized
users.
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Affiliation(s)
- Jonathan P Williamson
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, Australia.,Respiratory, Sleep and Environmental Health Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia.,Macquarie University Hospital, Sydney, Australia
| | - Chris Grainge
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW Australia
| | - Ahilan Parameswaran
- Department of Emergency Medicine, Royal Prince Alfred Hospital, Camperdown, NSW Australia
| | - Scott H Twaddell
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW Australia
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34
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Lim CK, Chung CL, Lin YT, Chang CH, Lai YC, Wang HC, Yu CJ. Transthoracic Ultrasound Elastography in Pulmonary Lesions and Diseases. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:145-152. [PMID: 27743728 DOI: 10.1016/j.ultrasmedbio.2016.08.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 08/08/2016] [Accepted: 08/29/2016] [Indexed: 06/06/2023]
Abstract
Ultrasound elastography has shown promising result in the diagnosis of various diseases; however, its application for pulmonary diseases has yet to be clarified. This study aimed to assess the application and feasibility of ultrasound elastography in various pulmonary lesions and diseases. We enrolled 45 patients with radiographic evidence of pneumonia, tumors or obstructive pneumonitis, and 70 ultrasonic lesions were identified (eight necrosis, 17 atelectasis, seven consolidation and 38 tumors). Ultrasound elastography was performed and the strain ratio, which is the ratio of strain of the reference tissue to an equally measuring region of interest of a lesion, was measured. The strain ratio was significantly different among lesions with different ultrasound morphologies (1.03 ± 0.71 [necrosis] vs. 2.51 ± 1.14 [atelectasis] vs. 19.98 ± 15.59 [consolidation] vs. 36.19 ± 20.18 [tumor]; p < 0.05). The strain ratio of primary lung cancer was also significantly different from pneumonia (p = 0.023) and metastatic lung cancer (p = 0.015). In conclusion, transthoracic ultrasound elastography can differentiate pulmonary lesions with different ultrasound morphologies. ClinicalTrials.gov Identifier: NCT02636985.
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Affiliation(s)
- Chor-Kuan Lim
- Department of Internal Medicine, Division of Chest Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Che-Liang Chung
- Department of Internal Medicine, Division of Chest Medicine, National Taiwan University Hospital, Douliou City, Taiwan
| | - Yen-Ting Lin
- Department of Internal Medicine, Division of Chest Medicine, National Taiwan University Hospital, Douliou City, Taiwan
| | - Chia-Hao Chang
- Department of Internal Medicine, Division of Chest Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Yi-Chun Lai
- Department of Internal Medicine, Division of Chest Medicine, National Yang Ming University Hospital, Yilan City, Taiwan
| | - Hao-Chien Wang
- Department of Internal Medicine, Division of Chest Medicine, National Taiwan University Hospital, Taipei City, Taiwan; Department of Internal Medicine, School of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Chong-Jen Yu
- Department of Internal Medicine, Division of Chest Medicine, National Taiwan University Hospital, Taipei City, Taiwan; Department of Internal Medicine, School of Medicine, National Taiwan University, Taipei, Taiwan
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Trovato GM. Thoracic ultrasound: A complementary diagnostic tool in cardiology. World J Cardiol 2016; 8:566-574. [PMID: 27847557 PMCID: PMC5088362 DOI: 10.4330/wjc.v8.i10.566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/20/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Clinical assessment and workup of patients referred to cardiologists may need an extension to chest disease. This requires more in-depth examination of respiratory co-morbidities due to uncertainty or severity of the clinical presentation. The filter and integration of ecg and echocardiographic information, addressing to the clues of right ventricular impairment, pulmonary embolism and pulmonary hypertension, and other less frequent conditions, such as congenital, inherited and systemic disease, usually allow more timely diagnosis and therapeutic choice. The concurrent use of thoracic ultrasound (TUS) is important, because, despite the evidence of the strict links between cardiac and respiratory medicine, heart and chest US imaging approaches are still separated. Actually, available expertise, knowledge, skills and training and equipment’s suitability are not equally fitting for heart or lung examination and not always already accessible in the same room or facility. Echocardiography is useful for study and monitoring of several respiratory conditions and even detection, so that this is nowadays an established functional complementary tool in pulmonary fibrosis and diffuse interstitial disease diagnosis and monitoring. Extending the approach of the cardiologist to lung and pleura will allow the achievement of information on pleural effusion, even minimal, lung consolidation and pneumothorax. Electrocardiography, pulse oximetry and US equipment are the friendly extension of the physical examination, if their use relies on adequate knowledge and training and on appropriate setting of efficient and working machines. Lacking these premises, overshadowing or misleading artefacts may impair the usefulness of TUS as an imaging procedure.
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Sperandeo M, Rea G, Grimaldi MA, Trovato F, Dimitri LMC, Carnevale V. Contrast-enhanced ultrasound does not discriminate between community acquired pneumonia and lung cancer. Thorax 2016; 72:178-180. [DOI: 10.1136/thoraxjnl-2016-208913] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 08/18/2016] [Accepted: 09/20/2016] [Indexed: 12/20/2022]
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Trovato FM, Catalano D, Trovato GM. Thoracic ultrasound: An adjunctive and valuable imaging tool in emergency, resource-limited settings and for a sustainable monitoring of patients. World J Radiol 2016; 8:775-784. [PMID: 27721940 PMCID: PMC5039673 DOI: 10.4329/wjr.v8.i9.775] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/11/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Imaging workup of patients referred for elective assessment of chest disease requires an articulated approach: Imaging is asked for achieving timely diagnosis. The concurrent or subsequent use of thoracic ultrasound (TUS) with conventional (chest X-rays-) and more advanced imaging procedures (computed tomography and magnetic resonance imaging) implies advantages, limitations and actual problems. Indeed, despite TUS may provide useful imaging of pleura, lung and heart disease, emergency scenarios are currently the most warranted field of application of TUS: Pleural effusion, pneumothorax, lung consolidation. This stems from its role in limited resources subsets; actually, ultrasound is an excellent risk reducing tool, which acts by: (1) increasing diagnostic certainty; (2) shortening time to definitive therapy; and (3) decreasing problems from blind procedures that carry an inherent level of complications. In addition, paediatric and newborn disease are particularly suitable for TUS investigation, aimed at the detection of congenital or acquired chest disease avoiding, limiting or postponing radiological exposure. TUS improves the effectiveness of elective medical practice, in resource-limited settings, in small point of care facilities and particularly in poorer countries. Quality and information provided by the procedure are increased avoiding whenever possible artefacts that can prevent or mislead the achievement of the correct diagnosis. Reliable monitoring of patients is possible, taking into consideration that appropriate expertise, knowledge, skills, training, and even adequate equipment’s suitability are not always and everywhere affordable or accessible. TUS is complementary imaging procedure for the radiologist and an excellent basic diagnostic tool suitable to be shared with pneumologists, cardiologists and emergency physicians.
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