Lung Ultrasound Artifacts Interpreted as Pathology Footprints

Abstract

Background: The original observation that lung ultrasound provides information regarding the physical state of the organ, rather than the anatomical details related to the disease, has reinforced the idea that the observed acoustic signs represent artifacts. However, the definition of artifact does not appear adequate since pulmonary ultrasound signs have shown valuable diagnostic accuracy, which has been usefully exploited by physicians in numerous pathologies. Method: A specific method has been used over the years to analyze lung ultrasound data and to convert artefactual information into anatomical information. Results: A physical explanation of the genesis of the acoustic signs is provided, and the relationship between their visual characteristics and the surface histopathology of the lung is illustrated. Two important sources of potential signal alteration are also highlighted. Conclusions: The acoustic signs are generated by acoustic traps that progressively release previously trapped energy. Consequently, the acoustic signs highlight the presence of acoustic traps and quantitatively describe their distribution on the lung surface; they are not artifacts, but pathology footprints and anatomical information. Moreover, the impact of the dynamic focusing algorithms and the impact of different probes on the visual aspect of the acoustic signs should not be neglected.

Lung ultrasound in a nutshell. Lines, signs, some applications, and misconceptions from a radiologist’s point of view. Part 2

“…Since the time of writing of that paper, an interesting study was published by Demi et al . [ 16 ]. They state that B-line is not an artifact but a pathology footprint and anatomical information.…”

Where Are We? The Past, Present and Future of Thoracic Ultrasound

“…This number is progressively increasing, reaching a huge peak of more than 21, 000 total papers in 2021 and 2022, thanks in part to COVID-19-related research (Figure 1). This literature jungle has evolved from case reports and descriptions of artifacts and signs for lung study protocols and clinical trials, up to physical models to explain the origin of different vertical artifacts [7] and studies on the possible role of artificial intelligence [8].…”

Real-Time Simulation of Wave Phenomena in Lung Ultrasound Imaging

“…B-lines are the consequence of interlobular septal thickening covered by air-filled alveoli, creating a significant acoustic impedance gradient that produces the reverberation artifacts. B-lines are associated with various lung diseases, including pulmonary edema, interstitial lung disease and pneumonia [20][21][22][23].…”