Lung Ultrasound as a Screening Method for Interstitial Lung Disease in Patients With Systemic Sclerosis

Abstract

Lung ultrasound may be a method to detect abnormal lung findings in a noninvasive manner in patients with SSc. Because of its high sensitivity, a low score almost rules out the need for an HRCT.

The role of ultrasound in systemic sclerosis: On the cutting edge to foster clinical and research advancement

“…Therefore, as an effort to fulfil this gap, many authors have proposed LUS as an imaging technique that is able to assess SSc-ILD, 43–60 even in the earliest stages. 49,51…”

“…During this phase, an efficient screening tool should be extensively used to early detect lung abnormalities, which may be confirmed by HRCT, to start early a target treatment. Despite many technical differences (convex/linear and 2.5–10 MHz probes; scanning protocols considering 72–10 intercostal spaces; scoring systems; pathological B-lines cut-off), 43–50,53–60 LUS provides significant positive correlations between B-lines and HRCT findings and, less commonly, between B-lines and vascular damage (capillaroscopic pattern and number of digital ulcers). 45,50 Literature data also describe a similar correlation between pleural line alterations (‘US’ thickness > 3 mm or irregularities) and HRCT, probably allowing a better discrimination than B-lines in ILD detection.…”

“…LUS has both of these required prerequisites, in particular, B-lines show a sensitivity between 59% and 100% and NPV between 51.7% and 100%, while pleural line alterations have a sensitivity between 74% and 85%. 46,49,55–57 Furthermore, B-lines have been reported to have a high specificity and positive predictive value of 59%–99% and 90.6%–95.1%, respectively, as well as pleural lines abnormalities which have almost perfect specificity (99%–100%). 46,48,49,55–57,60 These wide ranges are possibly explained by the differences in the probes used (cardiac, convex or linear, with different frequencies) and number of scanned areas (10, 14 or 72).…”

“…42 Our current approach to the assessment of SSc-ILD, which includes plain chest radiography, pulmonary auscultation and pulmonary function tests (PFT), is insensitive to detect early ILD. Therefore, as an effort to fulfil this gap, many authors have proposed Adapted from Hughes et al 32 LUS as an imaging technique that is able to assess SSc-ILD, [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] even in the earliest stages. 49,51 Preliminary studies have demonstrated reasonable correlation between LUS and HRCT findings in the detection of ILD in established patients with SSc.…”

Lung Ultrasound Examination in Patients with SARS-CoV-2 Infection: Multicenter Study

“…Lung ultrasound (LUS) appears to be a particularly promising tool in this respect. The significance of this modality in detecting interstitial pneumonia of various etiologies has increased recently, and since the onset of the COVID-19 pandemic, LUS has been more often employed for the evaluation of lung involvement also in this group of patients [ 3 , 4 , 5 ]. Considering the often dynamic nature of hospitalization of a patient with COVID-19, it can be assumed that LUS in many cases could be a valuable alternative to HRCT.…”