Vertical Artifacts in Lung Ultrasonography: Some Common Clinician Questions and the Related Engineer Answers

Demi, M.; Buda, Natalia; Soldati, Gino

doi:10.3390/diagnostics12010215

Cited by 17 publications

(24 citation statements)

References 23 publications

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“…In agreement with recent evidence that connects the vertical artifacts to acoustic traps that can capture acoustic energy and restore it over time, and white lung with a relatively random scattered distribution, a relationship between CT and US features can be speculated [ 53 ]; for example, between septal enlargement and vertical artifacts, or between ground glass opacity in CT and white lung. Equally probable is a deteriorating progression, in terms of ventilation, from less dense vertical artifacts to white lung and consolidations.…”

Section: Discussionsupporting

confidence: 82%

The Role of Lung Ultrasound in SARS-CoV-19 Pneumonia Management

Lugarà¹,

Tamburrini²,

Coppola³

et al. 2022

Diagnostics

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Purpose: We aimed to assess the role of lung ultrasound (LUS) in the diagnosis and prognosis of SARS-CoV-2 pneumonia, by comparing it with High Resolution Computed Tomography (HRCT). Patients and methods: All consecutive patients with laboratory-confirmed SARS-CoV-2 infection and hospitalized in COVID Centers were enrolled. LUS and HRCT were carried out on all patients by expert operators within 48–72 h of admission. A four-level scoring system computed in 12 regions of the chest was used to categorize the ultrasound imaging, from 0 (absence of visible alterations with ultrasound) to 3 (large consolidation and cobbled pleural line). Likewise, a semi-quantitative scoring system was used for HRCT to estimate pulmonary involvement, from 0 (no involvement) to 5 (>75% involvement for each lobe). The total CT score was the sum of the individual lobar scores and ranged from 0 to 25. LUS scans were evaluated according to a dedicated scoring system. CT scans were assessed for typical findings of COVID-19 pneumonia (bilateral, multi-lobar lung infiltration, posterior peripheral ground glass opacities). Oxygen requirement and mortality were also recorded. Results: Ninety-nine patients were included in the study (male 68.7%, median age 71). 40.4% of patients required a Venturi mask and 25.3% required non-invasive ventilation (C-PAP/Bi-level). The overall mortality rate was 21.2% (median hospitalization 30 days). The median ultrasound thoracic score was 28 (IQR 20–36). For the CT evaluation, the mean score was 12.63 (SD 5.72), with most of the patients having LUS scores of 2 (59.6%). The bivariate correlation analysis displayed statistically significant and high positive correlations between both the CT and composite LUS scores and ventilation, lactates, COVID-19 phenotype, tachycardia, dyspnea, and mortality. Moreover, the most relevant and clinically important inverse proportionality in terms of P/F, i.e., a decrease in P/F levels, was indicative of higher LUS/CT scores. Inverse proportionality P/F levels and LUS and TC scores were evaluated by univariate analysis, with a P/F–TC score correlation coefficient of −0.762, p < 0.001, and a P/F–LUS score correlation coefficient of −0.689, p < 0.001. Conclusions: LUS and HRCT show a synergistic role in the diagnosis and disease severity evaluation of COVID-19.

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Section: Discussionsupporting

confidence: 82%

The Role of Lung Ultrasound in SARS-CoV-19 Pneumonia Management

Lugarà¹,

Tamburrini²,

Coppola³

et al. 2022

Diagnostics

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“…Although classifications of ultrasound signs of bronchiolitis in previous studies exist [ 13 , 14 , 15 , 16 , 17 , 22 ], there is no accepted consensus establishing their use for scoring. Consequently, we attributed value to what has been published in the clinical literature supported by recent technical studies [ 31 , 32 , 33 , 34 , 35 , 36 ] on the genesis and significance of the common ultrasound signs visible in bronchiolitis, especially in terms of lung tissue aeration, and on the possibility of these signs to semi-quantify the density of the peripheral lung. Further concepts will be explored in the discussion.…”

Section: Methodsmentioning

confidence: 92%

“…Fourth, only one subject needed intensive care unit hospitalization. Fifth, the severity score used is not consensus based, but it is supported by recent theoretical hypothesis and experimental models [ 34 , 35 , 36 , 48 , 50 ]. Sixth, due to the emergency scenario related with COVID-19 pandemic and its impact on the circulation of respiratory viruses, the study ended earlier than planned in February 2020, possibly limiting the number of patients with severe bronchiolitis enrolled.…”

Section: Discussionmentioning

confidence: 99%

“… A-lines: Horizontal reverbs of pleural line, normal ultrasound finding (Score 0 for the quantitative analysis, negative for the dycotomous analyses). Short vertical artifacts (SVA, artifacts that do not reach the bottom of the screen, using a depth setting of 3 cm) According to a recent hypothesis [ 34 ], short artifacts may be produced by small channel or by acoustic traps which allows a quick release of the trapped acoustic energy [ 33 ]. Acoustic traps of this type are compatible with simple geometries such as those caused by minimal superficial alveolar collapses.…”

Section: Methodsmentioning

confidence: 99%

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Prognostic Role of Lung Ultrasound in Children with Bronchiolitis: Multicentric Prospective Study

Gori¹,

Amendolea²,

Buonsenso

et al. 2022

JCM

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There is increasing recognition of the role of lung ultrasound (LUS) to assess bronchiolitis severity in children. However, available studies are limited to small, single-center cohorts. We aimed to assess a qualitative and quantitative LUS protocol to evaluate the course of bronchiolitis at diagnosis and during follow-up. This is a prospective, multicenter study. Children with bronchiolitis were stratified according to clinical severity and underwent four LUS evaluations at set intervals. LUS was classified according to four models: (1) positive/negative; (2) main LUS pattern (normal/interstitial/consolidative/mixed) (3) LUS score; (4) LUS score with cutoff. Two hundred and thirty-three children were enrolled. The baseline LUS was significantly associated with bronchiolitis severity, using both the qualitative (positive/negative LUS p < 0.001; consolidated/normal LUS pattern or mixed/normal LUS p < 0.001) and quantitative models (cutoff score > 9 p < 0.001; LUS mean score p < 0.001). During follow-up, all LUS results according to all LUS models improved (p < 0.001). Better cut off value was declared at a value of >9 points. Conclusions: Our study supports the role of a comprehensive qualitative and quantitative LUS protocol for the identification of severe cases of bronchiolitis and provides data on the evolution of lung aeration during follow-up.

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“…Our interest in lung US as a team began in 2010, and just after a few months, we adopted a precise method of analysis which, in the subsequent years, provided significant results: the four-step method [ 13 , 14 , 16 ], which is illustrated in Figure 1 .…”

Section: Methodsmentioning

confidence: 99%

Lung Ultrasound Artifacts Interpreted as Pathology Footprints

Demi

Soldati²,

Ramalli

2023

Diagnostics

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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.

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Vertical Artifacts in Lung Ultrasonography: Some Common Clinician Questions and the Related Engineer Answers

Cited by 17 publications

References 23 publications

The Role of Lung Ultrasound in SARS-CoV-19 Pneumonia Management

The Role of Lung Ultrasound in SARS-CoV-19 Pneumonia Management

Prognostic Role of Lung Ultrasound in Children with Bronchiolitis: Multicentric Prospective Study

Lung Ultrasound Artifacts Interpreted as Pathology Footprints

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