Artifacts and Signs in Lung Ultrasound: The Need for a Revised Classification

Zanforlin, Alessandro; Smargiassi, Andrea; Perrone, Tiziano; Inchingolo, Riccardo; Torri, Elena; Limoli, Giuseppe; Buonsenso, Danilo; Mariani, Alberto; Mossolani, Elisa Eleonora; Tursi, Francesco; Soldati, Gino

doi:10.1002/jum.15956

Cited by 4 publications

(2 citation statements)

References 3 publications

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“…Setting aside the well‐known role to manage pleural effusion, 7 ultrasound (US) has been widely used to explore different pleuro‐pulmonary conditions, such as cardiogenic and non‐cardiogenic pulmonary edema, pneumonia, pneumothorax (PNX), and acute respiratory distress syndrome 8–12 . Furthermore, it has been demonstrated that US can be very useful to study diaphragmatic inspiratory excursion and contractility 8–12 …”

Section: Normal Lungmentioning

confidence: 99%

Lung Ultrasound Signs

Inchingolo,

Zanforlin,

Buonsenso

et al. 2024

J of Ultrasound Medicine

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Over the last 20 years, scientific literature and interest on chest/lung ultrasound (LUS) have exponentially increased. Interpreting mixed—anatomical and artifactual—pictures determined the need of a proposal of a new nomenclature of artifacts and signs to simplify learning, spread, and implementation of this technique. The aim of this review is to collect and analyze different signs and artifacts reported in the history of chest ultrasound regarding normal lung, pleural pathologies, and lung consolidations. By reviewing the possible physical and anatomical interpretation of these artifacts and signs reported in the literature, this work aims to present the AdET (Accademia di Ecografia Toracica) proposal of nomenclature and to bring order between published studies.

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Section: Normal Lungmentioning

confidence: 99%

Lung Ultrasound Signs

Inchingolo,

Zanforlin,

Buonsenso

et al. 2024

J of Ultrasound Medicine

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“…lung ultrasound (LUS), a noninvasive imaging technique, is crucial for assessing various pulmonary conditions 10 . Although LUS is widely employed in critically ill patients 1,11 , several studies have reported that by monitoring different lung ultrasonographic signs [12][13][14][15][16] , there are diagnostic differences between cardiogenic and noncardiogenic lung edema, particularly regarding subpleural consolidations [17][18][19] . Some related research has focused on diagnosing the primary disease 20,21 ; other studies have reported the clinical diagnostic value of lung ultrasonography for pneumonia and solitary obstructive atelectasis when combined with relevant clinical indicators to construct a diagnostic decision tree 22,23 .There is a lack of comprehensive and systematic studies of LUS phenotypes based on real clinical data and assessments of their clinical value.…”

Section: Introductionmentioning

confidence: 99%

Establishment of seven lung ultrasound phenotypes: a retrospective observational study

Wang,

Zou,

Zeng

et al. 2024

Preprint

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Background Lung phenotypes have been extensively utilized to assess lung injury and guide precise treatment. However, current phenotypic evaluation methods rely on CT scans and other techniques. Although lung ultrasound (LUS) is widely employed in critically ill patients, there is a lack of comprehensive and systematic identification of LUS phenotypes based on clinical data and assessment of their clinical value. Methods Our study was based on a retrospective database. A total of 821 patients were included from September 2019 to October 2020. 1902 LUS examinations were performed in this period. Using a dataset of 55 LUS examinations focused on lung injuries, a group of experts developed an algorithm for classifying LUS phenotypes based on clinical practice, expert experience, and lecture review. This algorithm was subsequently validated and refined using images from an additional 140 LUS examinations. Finally, machine learning was used to apply the validated algorithm to 1902 LUS phenotypes. After sampling 30% of LUS phenotypes, experts substantiated the efficacy of the machine learning algorithm through meticulous manual verification. By utilizing K-means cluster analysis and expert selection of images from a total of 1902 LUS examinations, we established seven distinct LUS phenotypes. To further explore the diagnostic value of these phenotypes for clinical diagnosis, we investigated their auxiliary diagnostic capabilities. Results A total of 1902 LUS phenotypes were tested by randomly selecting 30% to verify the phenotypic accuracy. With the 1902 LUS phenotypes, seven lung ultrasound phenotypes were established through statistical K-means cluster analysis and expert screening. The acute respiratory distress syndrome (ARDS) exhibited gravity-dependent phenotypes, while the cardiogenic pulmonary edema exhibited nongravity phenotypes. The baseline characteristics of the 821 patients included age (66.14 ± 11.76), sex (560/321), heart rate (96.99 ± 23.75), mean arterial pressure (86.5 ± 13.57), Acute Physiology and Chronic Health Evaluation II( APACHE II )score (20.49 ± 8.60), and duration of ICU stay (24.50 ± 26.22); among the 821 patients, 78.8% were cured. In severe pneumonia patients, the gravity-dependent phenotype accounted for 42% of the cases, whereas the nongravity-dependent phenotype constituted 58%. These findings highlight the value of applying different LUS phenotypes in various diagnoses. Conclusions Seven sets of LUS phenotypes were established through machine learning analysis of retrospective data; these phenotypes could represent the typical characteristics of patients with different types of critical illness.

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Vertical Artifacts as Lung Ultrasound Signs: Trick or Trap? Part 2‐ An Accademia di Ecografia Toracica Position Paper on B‐Lines and Sonographic Interstitial Syndrome

Smargiassi

Zanforlin

Perrone

et al. 2022

J of Ultrasound Medicine

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Although during the last few years the lung ultrasound (LUS) technique has progressed substantially, several artifacts, which are currently observed in clinical practice, still need a solid explanation of the physical phenomena involved in their origin. This is particularly true for vertical artifacts, conventionally known as B-lines, and for their use in clinical practice. A wider consensus and a deeper understanding of the nature of these artifactual phenomena will lead to a better classification and a shared nomenclature, and, ultimately, result in a more objective correlation between anatomo-pathological data and clinical scenarios. The objective of this review is to collect and document the different signs and artifacts described in the history of chest ultrasound, with a particular focus on vertical artifacts (B-lines) and sonographic interstitial syndrome (SIS). By reviewing the possible physical and anatomical interpretation of the signs and artifacts proposed in the literature, this work also aims to bring order to the available studies and to present the AdET (Accademia di Ecografia Toracica) viewpoint in terms of nomenclature and clinical approach to the SIS.

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Artifacts and Signs in Lung Ultrasound: The Need for a Revised Classification

Cited by 4 publications

References 3 publications

Lung Ultrasound Signs

Lung Ultrasound Signs

Establishment of seven lung ultrasound phenotypes: a retrospective observational study

Vertical Artifacts as Lung Ultrasound Signs: Trick or Trap? Part 2‐ An Accademia di Ecografia Toracica Position Paper on B‐Lines and Sonographic Interstitial Syndrome

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