Quantification analysis of pleural line movement for the diagnosis of pneumothorax

Abstract

BACKGROUND There is no research on quantitative pleural line movement. In this study, we assume that tissue Doppler and its quantitative technology can quantify the pleural line movement and can be used to diagnose pneumothorax. AIM To evaluate the quantitative assessment of pleural line movement measured by tissue Doppler imaging (TDI) for pneumothorax diagnosis. METHODS Adult patients ( n = 45) diagnosed with unilateral pneumothorax were included in this study. Each patient underwent TDI of both lungs. The pneumothorax side and contralateral normal lung side were compared using several indices obtained from TDI: peak pleural line velocity (PVmax), peak chest wall tissue velocity (CVmax), peak pleural line strain value (PS max ), peak chest wall tissue strain value (CS max ), PV max /CV max and PS max /CS max . The receiver operating characteristic analysis was used to evaluate the performance of these quantitative assessments for pneumothorax diagnosis. RESULTS Various quantitative variables of the pneumothorax side were all lower than that of the non-pneumothorax side and included the PV max (0.36 cm/s vs 0.59 cm/s, P < 0.001), PS max (1.14% vs 1.90%, P = 0.001), PV max /CV max (1.06 vs 4.93, P < 0.001), and PS max /CS max (0.76 vs 1.74, P < 0.001). For the discrimination of pneumothorax, the cut-off values of the PV max , PS max , PV max /CV max , and PS max /CS max were calculated as 0.50 cm/s, 0.94%, 1.96, and 1.12, respectively. Similarly, the sensitivities and specificities of PV max , PS max , PV max /CV max , and PS max /CS max were 96% and 62%, 47% and 91%, 93% and 96%, and 82% and 93%, respectively. The area under the receiver operating characteristic curve were 0.84, 0.72, 0.99, and 0.91, respectively, for PV max , PS max , PV max /CV max , and PS max /CS max . CONCLUSION Quantification analysis of pleural line movement using TDI is a us...

Quantitative assessment of pneumothorax by using Shannon entropy of lung ultrasound M-mode image and diaphragmatic excursion based on automated measurement

“…Recruitment of patients with pneumothorax is the next step of our group. Fourth, although the absence of lung sliding is the most common diagnostic criterion of pneumothorax ( 2 , 8 , 9 ), the presence of some other lung conditions (e.g., chronic obstructive pulmonary disease and large parenchymal tumor) may also have an absent lung sliding and confuse clinicians ( 1 - 3 , 52 ). Differentiating pneumothorax from these conditions based on our proposed method may be challenging, fortunately, using the bedside LUS in emergency (BLUE) protocol ( 53 - 55 ), the detection of other parameters, such as the B-line artifact, consolidation, and lung pulse, can help overcome this limitation.…”

“…Moreover, its portability and real-time assessment capability enable clinicians to detect and monitor pneumothorax at any location—from the operating room to the bedside to outside the hospital. The LUS diagnostic criteria for pneumothorax include the presence of lung point and lung pulse, and the absence of lung sliding and A-line, with the absence of lung sliding being the most common criteria ( 2 , 8 , 9 ). Nevertheless, it is a great challenge to interpret lung sliding compared to identify it since the changes in lung sliding on traditional LUS B-mode images may be subtle from normal to severe pneumothoraces.…”

Determinants of point-of-care ultrasound lung sliding amplitude in mechanically ventilated patients

“…Reduced apical lung sliding amplitude was seen in both B-mode and pulsed wave Doppler. Previous studies examining lung sliding amplitude in mechanically ventilated patients were done using tissue Doppler imaging (TDI) [ 10 ] or pulsed wave Doppler [ 15 ]. By utilizing B-mode, our study best reflects standard use of lung ultrasound in critically ill patients, such as described by the BLUE-protocol (Bilateral Lung Ultrasound in Emergency) [ 2 ].…”

“…Lung sliding amplitude has been evaluated using tissue Doppler [ 10 ] and speckle tracking, particularly for the diagnosis of pneumothorax rather than assessment of regional ventilation [ 19 – 21 ]. Speckle tracking is a technique routinely used in echocardiography whereby tissue deformation is assessed by analysis of speckle pattern movement in a two-dimensional plane.…”

“…As in the aforementioned studies, POCUS lung sliding is typically reported qualitatively as being absent or present, but it can be quantified with greater precision. Lung sliding amplitude expresses the amount of pleural movement seen by ultrasound and has been described both in terms of pleural distance travelled in B-mode (mm) [ 9 ] and maximum pleural velocity measured by Doppler (cm/s) [ 10 ]. However, it has never simultaneously been reported using both B-mode and pulsed wave Doppler in the same study and measurements by these two techniques have never been correlated.…”