Utility of a simplified ultrasound assessment to assess interstitial pulmonary fibrosis in connective tissue disorders - Preliminary results.
IntroductionInterstitial pulmonary fibrosis (IPF) is a frequent manifestation in patients with connective tissue disorders (CTD). Recently the ultrasound (US) criterion validity for its assessment has been proposed, however the US scoring systems adopted include the study of several lung intercostal spaces (LIS) which could be time consuming in daily clinical practice.
The aim of this study was to investigate the utility of a simplified US B-lines scoring system compared with both the US comprehensive assessment and the HRCT findings of IPF in CTD patients.
Thirty-six patients with diagnosis of CTD were enrolled. Each patient underwent chest HRCT and lung US by experienced radiologist and rheumatologist respectively.
Both comprehensive and simplified US B-lines assessments were scanned. The comprehensive US assessment was performed at 50 LIS level, whereas the simplified US assessment included bilaterally 14 LIS: for the anterior chest: 2nd LIS along the para-sternal lines, 4th LIS along the mid-clavear, anterior axillary and mid-axillary lines.
For the posterior chest: 8th LIS along the paravertebral, sub-scapular and posterior axillary lines.For criterion validity, HRCT was considered the gold standard. Feasibility, inter and intra-observer reliability was also investigated.
A highly significant correlation between comprehensive and simplified US assessment was found (p=0.0001).
A significant correlation was also found between the simplified US assessment and HRCT findings (p=0.0006). Kappa values for the inter-observer simplified US assessment were in a range from 0.769 to 0.885 whereas the concordance correlation coefficient values for the intra-observer were from 0.856 to 0.955.
There was a relevant difference in time spent on comprehensive (mean 23,3 +/- SD 4.5 minutes) with respect to simplified US assessment (mean 8.6 +/- SD 1.4) (p= <0.00001).
Our results provide a new working hypothesis in favour of the utility of a simplified US B-lines assessment as an adjunct method to assess IPF in patients with CTD.
Published on: 2011-08-18