Lung ultrasound for the screening of interstitial lung disease in very early systemic sclerosis

Barskova, Tatiana; Gargani, Luna; Guiducci, Serena; Randone, Silvia Bellando; Bruni, Cosimo; Carnesecchi, Giulia; Conforti, Maria Letizia; Porta, Francesco; Pignone, Alberto Moggi; Caramella, Davide; Picaño, Eugenio; Cerinic, Marco Matucci

doi:10.1136/annrheumdis-2011-201072

Cited by 153 publications

(142 citation statements)

References 30 publications

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“…Even though it did not show any findings in HRCT in the early stages of the disease, USG was considered to be useful. 12 Similar to our study, USG sensitivity, specificity, negative predicted value, and positive predicted value were 100%, 55%, 100%, and 78%, respectively. Another recent study compared HRCT and USG through 10 intercostal spaces in SSc.…”

Section: Discussionsupporting

confidence: 70%

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Effectiveness of Thoracic Ultrasonography in the Evaluation of the Severity of Pulmonary Involvement in Patients With Systemic Sclerosis

et al. 2016

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Objectives: This study aims to investigate the effectiveness of thoracic ultrasonography (USG) in a single session in the evaluation of the severity of pulmonary involvement in systemic sclerosis. Patients and methods: A total of 48 consecutive systemic sclerosis patients (2 males, 46 females; mean age 50.8±11.9 years; range 21 to 76 years) followed-up in our center were included. A thoracic USG using a linear probe was performed for each patient to evaluate the parenchymal involvement by two pulmonary disease specialists. The number of B-lines (B-lines described USG sign of interstitial lung fibrosis) was recorded. Systolic pulmonary artery pressure was measured by means of using a phase probe to evaluate pulmonary hypertension in the same sequence. The same day, pulmonary function tests were conducted. Warrick score was calculated according high resolution computed tomography (HRCT) images which were evaluated independently from each other by a radiologist and a pulmonary disease specialist. Medsger severity scale was calculated for each patient according to the results of HRCT findings, pulmonary function test, and systolic pulmonary artery pressure. Results: The number of B-lines detected on thoracic USG was correlated with the Warrick score (r=0.89; p=0.0001) and Medsger disease scale (r=0.55; p=0.0001) and negatively correlated with diffusing capacity of carbon monoxide (r= -0.56; p=0.0001) and forced vital capacity (r= -0.46; p=0.001). When HRCT was accepted as the gold standard; the sensitivity, specificity, positive predicted value, and negative predicted value for thoracic USG were 100%, 84.2%, 90.6%, and 100%, respectively. If thoracic USG was used instead of HRCT for the evaluation of Medsger scale, the results changed in only one of the 48 patients. Conclusion: Thoracic USG showed good correlation with HRCT findings for the evaluation of pulmonary parenchymal involvement in systemic sclerosis. Therefore, USG might be a noninvasive and useful tool for the long-term follow-up of systemic sclerosis patients after initial examination with USG and HRCT.

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Section: Discussionsupporting

confidence: 70%

“…If there was a fully white appearance in a region, it was accepted to be 10 B-lines. 12 The B-lines total sum of all LIS was recorded. According to the semiquantitative method, we recorded as follows: 0= normal (B-lines <5); 1= mild (B-lines 6-15); 2= moderate (B-lines 16-30); 3= prominent (B-lines >30).…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of Thoracic Ultrasonography in the Evaluation of the Severity of Pulmonary Involvement in Patients With Systemic Sclerosis

et al. 2016

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“…In some rare cases, thoracic surgery is included in the differential diagnosis. Current studies show the significance of LUS in diagnosing interstitial lung diseases [33,34,35,36,37]. …”

Section: Lus Compared With Other Methods In the Diagnosis Of Interstimentioning

confidence: 99%

Lung Ultrasound in Community-Acquired Pneumonia and in Interstitial Lung Diseases

Reißig

Copetti

2014

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Lung ultrasound (LUS) is an accurate tool for the diagnosis and follow-up of pneumonia in adults as well as in children. LUS is at least as accurate as chest radiography in diagnosing pneumonia. The most important parenchymal criterion is the positive air bronchogram within an echopoor area. Among pleural criteria, basal effusion was most often detected. The presence of multiple diffuse bilateral B-lines on lung examination indicates the interstitial syndrome (IS). For further differential diagnosis, an integrated consideration of history, clinical examination, LUS and echocardiography should be performed. LUS is an excellent tool for IS screening. Repeated LUS control examinations may reflect the dynamics of IS under therapy and so LUS may serve as a therapy guide.

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“…The number of B-lines has shown a good correlation with lung involvement on HRCT [32]. Nevertheless, the role of LUS in reducing the number of HRCTs in the follow-up of patients awaits further validation [33]. LUS cannot replace HRCT for diagnosis and for a complete evaluation of lung involvement.…”

Section: Identification and Follow-up Of Patients With Ssc-ildmentioning

confidence: 99%

Interstitial lung disease in systemic sclerosis: where do we stand?

et al. 2015

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Interstitial lung disease (ILD) is common in systemic sclerosis (SSc) patients and despite recent advances in the treatment is, at present, the major cause of death. Today, an early diagnosis of ILD is possible, and is mandatory to improve the prognosis of the disease.Pulmonary function tests and high-resolution computed tomography remain the mainstay for the diagnosis of SSc-ILD, but there is a growing interest in lung ultrasound. Recently, the correlation between severity of fibrosis and some peripheral blood biomarkers has been described.Nonselective immunosuppressors are still the main treatment for ILD, with cyclophosphamide (CYC) most widely used to obtain remission. Novel therapies towards specific molecular and cellular targets have been suggested; in particular, rituximab (RTX) has shown promising results, but further research is needed. It is of paramount importance to define the severity of the disease and the risk of progression in order to define the need for treatment and the treatment intensity. We propose the division of the treatment strategies at our disposal to induce remission into three categories: high intensity (haematopoietic stem cell transplantation), medium intensity (CYC and RTX) and low intensity (azathioprine (AZA) and mycophenolate mofetil (MMF)). After obtaining remission, maintenance treatment with AZA or MMF should be started.In this review we explore new advances in the pathogenesis, diagnosis and treatment of SSc-ILD. @ERSpublications Early diagnosis of ILD is possible, and is mandatory to improve the prognosis of the disease http://ow.ly/P28JHThe relevance of interstitial lung disease in systemic sclerosisPulmonary disease in systemic sclerosis (SSc) mainly comprises interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH). Over the past 40 years the SSc mortality rate has not changed significantly [1]. Nevertheless, while the frequency of deaths due to renal crisis has significantly decreased from 42% to 6%, the proportion of deaths due to ILD and PAH has increased [2]. In fact, ILD and PAH are the two main causes of death in SSc, accounting for 33% and 28% of deaths, respectively [2]. A European Scleroderma Trials and Research group (EUSTAR) analysis revealed, in a cohort of 3656 SSc patients, that ILD is present in 53% of cases with diffuse cutaneous SSc and in 35% of cases with limited

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Lung ultrasound for the screening of interstitial lung disease in very early systemic sclerosis

Cited by 153 publications

References 30 publications

Effectiveness of Thoracic Ultrasonography in the Evaluation of the Severity of Pulmonary Involvement in Patients With Systemic Sclerosis

Effectiveness of Thoracic Ultrasonography in the Evaluation of the Severity of Pulmonary Involvement in Patients With Systemic Sclerosis

Lung Ultrasound in Community-Acquired Pneumonia and in Interstitial Lung Diseases

Interstitial lung disease in systemic sclerosis: where do we stand?

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