Ultrasound and non-ultrasound imaging techniques in the assessment of diaphragmatic dysfunction

Abstract

Diaphragm muscle dysfunction is increasingly recognized as an important element of several diseases including neuromuscular disease, chronic obstructive pulmonary disease and diaphragm dysfunction in critically ill patients. Functional evaluation of the diaphragm is challenging. Use of volitional maneuvers to test the diaphragm can be limited by patient effort. Non-volitional tests such as those using neuromuscular stimulation are technically complex, since the muscle itself is relatively inaccessible. As such, there is a growing interest in using imaging techniques to characterize diaphragm muscle dysfunction. Selecting the appropriate imaging technique for a given clinical scenario is a critical step in the evaluation of patients suspected of having diaphragm dysfunction. In this review, we aim to present a detailed analysis of evidence for the use of ultrasound and non-ultrasound imaging techniques in the assessment of diaphragm dysfunction. We highlight the utility of the qualitative information gathered by ultrasound imaging as a means to assess integrity, excursion, thickness, and thickening of the diaphragm. In contrast, quantitative ultrasound analysis of the diaphragm is marred by inherent limitations of this technique, and we provide a detailed examination of these limitations. We evaluate non-ultrasound imaging modalities that apply static techniques (chest radiograph, computerized tomography and magnetic resonance imaging), used to assess muscle position, shape and dimension. We also evaluate non-ultrasound imaging modalities that apply dynamic imaging (fluoroscopy and dynamic magnetic resonance imaging) to assess diaphragm motion. Finally, we critically review the application of each of these techniques in the clinical setting when diaphragm dysfunction is suspected.

Characterisation of hemidiaphragm dysfunction using dynamic chest radiography: a pilot study

“…No single imaging or spirometric technique can accurately diagnose diaphragm paralysis, and each has its own advantages and disadvantages. [3] DCR, which combines the visual ease of fluoroscopy with the ability to provide quantifiable measures of hemidiaphragm and chest wall movement, may be of use as an adjunct technique. These metrics may also be of use in disease monitoring and outcome prediction, for example after thoracic surgery and other scenarios where forced respiratory manoeuvres for lung volume measurement are problematic.…”

“…Fluoroscopy, and more recently ultrasound, has been used for this visual confirmation of paradoxical motion; however, both techniques have important limitations in the diagnosis of hemidiaphragm paralysis. [3] A recent technological innovation is dynamic chest radiography (DCR), a low dose cineradiographic imaging system in which sequential frames of the entire thorax are digitally reconstructed to produce a continuous moving image. [4] It occupies the same footprint as a standard chest X-ray module and can also be used to provide plain radiographic imaging.…”

An Overview of Lifestyle in Communities During The Second Wave of Covid-19 Pandemic

“…Solving covid-19 problems, especially social impact, will involve the smallest element of the community, that is, every family that must strive to overcome difficulties, especially lifestyle (Cremasco et al 2021). Solving this covid-19 problem, especially on social impact, will involve the smallest element of the community, that is, every family that must strive to overcome issues, especially lifestyle (Laghi, Saad, and Shaikh 2021); (Basray et al 2021).…”

The Feasibility of Ultrasonographic Diaphragmatic Excursion in Healthy Dogs: Effect of Positioning, Diaphragmatic Location, and Body Weight of Dogs

“…Several modalities, such as thoracic radiography ( 19 – 21 ), US ( 18 , 19 , 22 , 23 ), fluoroscopy ( 19 , 24 ), computed tomography ( 19 , 25 ), and magnetic resonance imaging ( 18 , 19 , 26 , 27 ), have been used to detect DE. Thoracic radiography provides a high sensitivity, but it has a low specificity for detecting diaphragmatic movement ( 20 ).…”

“…In DE evaluation, there are several factors that need to be considered. In humans, US techniques including diaphragmatic location and the angle of the US beam have been reported to influence DE ( 19 , 33 , 35 , 36 ). Moreover, DE differs between diaphragmatic sides, and varies according to the patient's sex, age, and body weight (BW) ( 37 – 39 ).…”