Ultrasound B-lines in the evaluation of interstitial lung disease in patients with systemic sclerosis

Abstract

The aim of this study was to establish the cut-off point of ultrasound (US) B-lines number for detecting the presence of significant interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) (SSc-ILD) in relation to high-resolution computed tomography (HRCT) findings. Consecutive SSc-ILD patients underwent chest HRCT, lung US (LUS), pulmonary function test, and clinical assessment. Exclusion criteria were represented by the presence of a coexisting congestive heart failure and a clinical history suggestive of lung or pleural diseases. HRCT images were scored for the presence of ILD by 2 readers, in accordance with the Warrick scoring system. US assessment was performed by a US skilled rheumatologist, blinded to HRCT results and clinical data, and included the bilateral evaluation of 14 lung intercostal spaces (LIS). In each LIS, the number of B-lines was recorded and summed. To test discriminant validity, we used the receiver operating characteristic (ROC) curve analysis applying a Warrick score of 7 as external criterion for the presence of SSc-ILD. Forty patients completed the study. The US B-lines number and the Warrick score confirmed excellent correlation (Spearman rho: 0.958, P = .0001). The ROC curve analysis revealed that the presence of 10 US B-lines is the cut-off point with the greatest positive likelihood ratio (12.52) for the presence of significant SSc-ILD. The detection of 10 B-lines is highly predictive for the HRCT presence of significant SSc-ILD. In SSc patients, the LUS assessment as first imaging tool may represent an effective model to improve the correct timing of chest HRCT.

Reply to the comments of Dr. Quarato et al.

“…Hence, Ferre et al find an increase of six Delta-B-line as the threshold value to diagnose weaning-induced pulmonary edema, Miglioranza et al, counting B-lines in predicting of heart decompensation, find two threshold points; B-lines number ≥ 30 identified a group at high risk of pulmonary edema and number of B-lines < 15 indicated patients without a risk of pulmonary edema. In last few years, similar results about clinical significance of the B-line counting were found by Enghard et al, Tardella et al and others [3,4].…”

Lung Ultrasound in COVID-19 Pneumonia: Correlations with Chest CT on Hospital admission

“…We must also acknowledge that the ultrasonographic signs of COVID-19 pneumonia can be present in other respiratory and cardiovascular diseases, including pulmonary fibrosis and congestive heart failure [34, 35]. Confluent or nonconfluent B lines with pleural line thickening and subpleural nodules are the key abnormalities associated with idiopathic or secondary pulmonary fibrosis [34, 36]. Diffuse B lines also represent a well-known index of pulmonary congestion usually responding to diuretic treatment [35, 37].…”

Possible Role of Chest Ultrasonography for the Evaluation of Peripheral Fibrotic Pulmonary Changes in Patients Affected by Idiopathic Pulmonary Fibrosis—Pilot Case Series

“…An acoustic map of the peripheral lung is already possible based on these considerations. Echographic scans with a pattern of SIS displaying vertical artifacts prevailing on horizontal phenomena and altered pleural line is in fact indicative of important fibrotic alterations in the peripheral parenchyma [22,23]. Moreover, if, in correspondence of a specific landmark, a LUS pattern 1 changes towards a LUS pattern 3 in a subsequent evaluation over time, this could be indicative of a progression of the diseases in that specific point, and guide the timing of HRCT scan re-evaluation.…”