Correlation between lung ultrasound and chest CT patterns with estimation of pulmonary burden in COVID-19 patients

Abstract

Purpose The capability of lung ultrasound (LUS) to distinguish the different pulmonary patterns of COVID-19 and quantify the disease burden compared to chest CT is still unclear. Methods PCR-confirmed COVID-19 patients who underwent both LUS and chest CT at the Emergency Department were retrospectively analysed. In both modalities, twelve peripheral lung zones were identified and given a Severity Score basing on main lesion pattern. On CT scans the well-aerated lung volume (%WALV) was visually estimated. Per-patient and per-zone assessments of LUS classification performance taking CT findings as reference were performed, further revisioning the images in case of discordant results. Correlations between number of disease-positive lung zones, Severity Score and %WALV on both LUS and CT were assessed. The area under receiver operating characteristic curve (AUC) was calculated to determine LUS performance in detecting %WALV ≤ 70%. Results The study included 219 COVID-19 patients with abnormal chest CT. LUS correctly identified as positive 217 (99%) patients, but per-zone analysis showed sensitivity = 75% and specificity = 66%. The revision of the 121 (55%) cases with positive LUS and negative CT revealed COVID-compatible lesions in 42 (38%) CT scans. Number of disease-positive zones, Severity Score and %WALV between LUS and CT showed moderate correlations. The AUCs for LUS Severity Score and number of LUS-positive zones did not differ in detecting %WALV ≤ 70%. Conclusion LUS in COVID-19 is valuable for case identification but shows only moderate correlation with CT findings as for lesion patterns and severity quantification. The number of disease-positive lung zones in LUS alone was sufficient to discriminate relevant disease burden.

Prevalence and significance of pulmonary disease on lung ultrasonography in outpatients with SARS-CoV-2 infection

“…As recent studies have confirmed high sensitivity of LUS for COVID-19 pneumonia, this limitation unlikely has significant impact on disease prevalence, although we acknowledge that severity score concordance between CT and LUS vary. 8 This study also has several strengths. This was the first study to investigate the prevalence of pulmonary findings in outpatients with SARS-CoV-2 infection using LUS, and the largest outpatient COVID-19 study of the general population to date.…”

“…3 Given the lack of radiation, ease of use, portability and low cost, 4 ultrasound may be a useful tool in the management of COVID-19. COVID-19 pneumonia is commonly located in a subpleural, peripheral and basilar distribution on CT imaging, [5][6][7][8] which makes it amenable to detection by lung ultrasound (LUS). Protocols targeting the posterior and lateral aspects of lungs allow detection of the disease and maximise provider safety.…”

Advantages of lung ultrasound in triage, diagnosis and monitoring COVID-19 patients: review

“…B-lines are vertical hyperechoic laser-like rays arising from the pleural line and extended to the edge of the screen, which move with respiration (a sign called lungsliding). The B-line pattern is the most characteristic sign in COVID-19 with different varieties (separated B-lines, focal, multifocal, coalescent, "rocket sign", "light beam"), reported by most of the studies, with a predominantly posterior and inferior distribution [19][20][21][22][23][24]. The B-lines can coexist with A-lines, in the context of good aeration, called spared areas.…”

Chemistry of selected drugs for SARS-CoV-2 inhibition: Tested in vitro and approved by the FDA

“…As a domestic way to treat or decrease the hard breathing associated with COVID-19, we recommend breathing the boiled eucalyptus vapor. This practice with drugs could help patients to overcome the disease (Marzano et al, 2021;Núñez-Gil et al, 2021;Repullo, 2021;Rizzetto et al, 2021).…”