Effectiveness of Thoracic Ultrasonography in the Evaluation of the Severity of Pulmonary Involvement in Patients With Systemic Sclerosis

Abstract

Objectives: This study aims to investigate the effectiveness of thoracic ultrasonography (USG) in a single session in the evaluation of the severity of pulmonary involvement in systemic sclerosis. Patients and methods: A total of 48 consecutive systemic sclerosis patients (2 males, 46 females; mean age 50.8±11.9 years; range 21 to 76 years) followed-up in our center were included. A thoracic USG using a linear probe was performed for each patient to evaluate the parenchymal involvement by two pulmonary disease specialists. The number of B-lines (B-lines described USG sign of interstitial lung fibrosis) was recorded. Systolic pulmonary artery pressure was measured by means of using a phase probe to evaluate pulmonary hypertension in the same sequence. The same day, pulmonary function tests were conducted. Warrick score was calculated according high resolution computed tomography (HRCT) images which were evaluated independently from each other by a radiologist and a pulmonary disease specialist. Medsger severity scale was calculated for each patient according to the results of HRCT findings, pulmonary function test, and systolic pulmonary artery pressure. Results: The number of B-lines detected on thoracic USG was correlated with the Warrick score (r=0.89; p=0.0001) and Medsger disease scale (r=0.55; p=0.0001) and negatively correlated with diffusing capacity of carbon monoxide (r= -0.56; p=0.0001) and forced vital capacity (r= -0.46; p=0.001). When HRCT was accepted as the gold standard; the sensitivity, specificity, positive predicted value, and negative predicted value for thoracic USG were 100%, 84.2%, 90.6%, and 100%, respectively. If thoracic USG was used instead of HRCT for the evaluation of Medsger scale, the results changed in only one of the 48 patients. Conclusion: Thoracic USG showed good correlation with HRCT findings for the evaluation of pulmonary parenchymal involvement in systemic sclerosis. Therefore, USG might be a noninvasive and useful tool for the long-term follow-up of systemic sclerosis patients after initial examination with USG and HRCT.

Correlation between Transthoracic Lung Ultrasound Score and HRCT Features in Patients with Interstitial Lung Diseases

“…Cakir et al also reported B-lines negatively correlated with DLCO (r = −0.56; p = 0.0001) and FVC (r = 0.46; p = 0.001) [39]. In another study, Tardella et al, after evaluating 14 lung intercostal spaces in patients with SSc, detected that a cutoff = 10 B-lines was predictive for HRCT presence in significant SSc-ILD patients, and they confirmed correlations with HRCT (rho = 0.819; p < 0.001), DLCO (rho = 0.600; p < 0.001), and with health-related quality of life variables (rho = 0.560; p < 0.001) [32].…”

A simplified lung ultrasound for the diagnosis of interstitial lung disease in connective tissue disease: a meta-analysis

“…For the posterior chest, they selected the eighth LIS on three lines, namely the paravertebral, the subscapular, and the posterior axillary lines. Among the reasons for choosing these LIS were the demonstrated higher prevalence rate of B-lines in these fields and the ease of evaluation by LUS [14, 29]. To the best of our knowledge, there is no meta-analysis about which LIS should be evaluated in a modified LUS for diagnosis of CTD-ILD.…”

The role of ultrasound in systemic sclerosis: On the cutting edge to foster clinical and research advancement

“…42 Our current approach to the assessment of SSc-ILD, which includes plain chest radiography, pulmonary auscultation and pulmonary function tests (PFT), is insensitive to detect early ILD. Therefore, as an effort to fulfil this gap, many authors have proposed LUS as an imaging technique that is able to assess SSc-ILD, 43–60 even in the earliest stages. 49,51…”

“…During this phase, an efficient screening tool should be extensively used to early detect lung abnormalities, which may be confirmed by HRCT, to start early a target treatment. Despite many technical differences (convex/linear and 2.5–10 MHz probes; scanning protocols considering 72–10 intercostal spaces; scoring systems; pathological B-lines cut-off), 43–50,53–60 LUS provides significant positive correlations between B-lines and HRCT findings and, less commonly, between B-lines and vascular damage (capillaroscopic pattern and number of digital ulcers). 45,50 Literature data also describe a similar correlation between pleural line alterations (‘US’ thickness > 3 mm or irregularities) and HRCT, probably allowing a better discrimination than B-lines in ILD detection.…”

“…47,54,58–60 Therefore, a negative correlation has been demonstrated between B-lines and PFT (DLCO and forced vital capacity). 43,45,46,48 The potential prognostic utility was explored by Gasparini et al, 50 who showed that basal B-lines predict DLCO change after 12 months and by Gargani et al, 52 who demonstrated that a higher number of B-lines is associated with worsening or development of pulmonary involvement.…”