A simplified lung ultrasound for the diagnosis of interstitial lung disease in connective tissue disease: a meta-analysis

Abstract

Background Interstitial lung disease (ILD) is a common complication of connective tissue disease (CTD) and a leading cause of morbidity and mortality. There are various lung ultrasound (LUS) scoring systems with different lung intercostal spaces (LIS). The purpose of this meta-analysis was to find a simplified LUS method for the assessment of CTD-ILD. Methods We systematically retrieved lung ultrasound diagnostic studies on CTD-ILD in PubMed, Embase, and Web of Science databases. Summary diagnostic accuracy, including sensitivity, specificity, and area under the curve (AUC), was analyzed. Subgroup analysis was conducted according to different LIS and diseases. Results The 11 studies included in this meta-analysis comprised a total of 487 patients with CTD. The pooled sensitivity and specificity of the LUS were 0.859 (95% confidence interval (CI) 0.812–0.898) and 0.839 (95% CI 0.782–0.886), respectively, illustrating its great value for CTD-ILD diagnosis. In addition, there were six methods to evaluate LIS, including 72, 65, 50, 14, 10, and all LIS. The pooled sensitivity and specificity of 14 LIS were 0.982 (95% CI 0.904–1.000) and 0.875 (95% CI 0.710–0.965), respectively. The pooled positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odd ratio (DOR) of 14 LIS were 7.297 (95% CI 6.050–17.45), 0.029 (95% CI 0.006–0.147), and 292.30 (95% CI 35.53–2403.8), respectively. Moreover, the AUC for systemic sclerosis (SSc) and rheumatoid arthritis (RA) was 0.929 and 0.981, respectively; the DOR for SSc and RA was 42.93 (95% CI 17.75–103.79) and 80.24 (95% CI 8.107–796.09), respectively. Conclusions We found a modified and simplified method of LUS, by scanning 14 LIS in a short time, which had a very high sensitivity and specificity.

Anti-carbamylated proteins antibody repertoire in rheumatoid arthritis: evidence of a new autoantibody linked to interstitial lung disease

“…Various novel candidates have been proposed for RA-ILD screening, including imaging techniques such as positron emission tomography and pulmonary ultrasound,22 23 or serum biomarkers such as the matrix metalloproteinases 7, surfactant protein D and Krebsvon del Lungen-6 4 5. RA-ILD has been associated with different antimodified protein antibodies (AMPAs) based on citrulline24 25 and more recently, malondialdehyde–acetaldehyde adducts 26.…”

Lung Ultrasound vs. Chest X-Ray Study for the Radiographic Diagnosis of COVID-19 Pneumonia in a High-Prevalence Population

“…We defined any CXR finding of infiltrate or atelectasis as possibly showing the radiographic changes of viral/atypical pneumonia. Similarly, we defined the presence of three or more B-lines or the presence of a single confluent B-line encompassing a third or more of the visualized distal intercostal space as positive for viral/atypical pneumonia even though these findings are often found in other pulmonary conditions, such as CHF and ILD (28)(29)(30)(35)(36)(37)(38). B-lines are vertical, hyperechoic artifacts arising from the visceral pleura or alveoli extending to the bottom of the screen and are well-described artifacts of LUS (15).…”

“…Patients with ILD and CHF exacerbations present a unique challenge given that these individuals have Blines present on LUS at baseline (15,16,(35)(36)(37). Fortunately, ILD is an uncommon condition.…”

Lung ultrasound in patients with rheumatoid arthritis and the definition of significant interstitial lung disease

“…Intuitively, a LUS study conducted on more LIS will provide a higher number of B-lines in the presence of significant RA-ILD. However, the method proposed on 14 LIS has demonstrated a high sensitivity and specificity [21]. Investigating more spaces, some works have studied up to 72 LIS [22], could be excessively time-consuming and difficult to apply in daily clinical practice.…”