Screening value of lung ultrasound in connective tissue disease related interstitial lung disease

Huang, Yupeng; Liu, Tao; Huang, Songya; Qiu, Li; Luo, Fengming; Yin, Geng; Xie, Qibing

doi:10.1016/j.hrtlng.2022.09.011

Cited by 7 publications

(5 citation statements)

References 33 publications

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“…The cardiogenic pulmonary edema is primarily observed in patients with non-gravitydependent interstitial deaeration 14,43 . Different LUS phenotypes can be used to diagnose and evaluate disease conditions 29,44,45 and to guide precise treatment in the future 33 .…”

Section: Discussionmentioning

confidence: 99%

Establishment of seven lung ultrasound phenotypes: a retrospective observational study

Wang,

Zou,

Zeng

et al. 2024

Preprint

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Background Lung phenotypes have been extensively utilized to assess lung injury and guide precise treatment. However, current phenotypic evaluation methods rely on CT scans and other techniques. Although lung ultrasound (LUS) is widely employed in critically ill patients, there is a lack of comprehensive and systematic identification of LUS phenotypes based on clinical data and assessment of their clinical value. Methods Our study was based on a retrospective database. A total of 821 patients were included from September 2019 to October 2020. 1902 LUS examinations were performed in this period. Using a dataset of 55 LUS examinations focused on lung injuries, a group of experts developed an algorithm for classifying LUS phenotypes based on clinical practice, expert experience, and lecture review. This algorithm was subsequently validated and refined using images from an additional 140 LUS examinations. Finally, machine learning was used to apply the validated algorithm to 1902 LUS phenotypes. After sampling 30% of LUS phenotypes, experts substantiated the efficacy of the machine learning algorithm through meticulous manual verification. By utilizing K-means cluster analysis and expert selection of images from a total of 1902 LUS examinations, we established seven distinct LUS phenotypes. To further explore the diagnostic value of these phenotypes for clinical diagnosis, we investigated their auxiliary diagnostic capabilities. Results A total of 1902 LUS phenotypes were tested by randomly selecting 30% to verify the phenotypic accuracy. With the 1902 LUS phenotypes, seven lung ultrasound phenotypes were established through statistical K-means cluster analysis and expert screening. The acute respiratory distress syndrome (ARDS) exhibited gravity-dependent phenotypes, while the cardiogenic pulmonary edema exhibited nongravity phenotypes. The baseline characteristics of the 821 patients included age (66.14 ± 11.76), sex (560/321), heart rate (96.99 ± 23.75), mean arterial pressure (86.5 ± 13.57), Acute Physiology and Chronic Health Evaluation II( APACHE II )score (20.49 ± 8.60), and duration of ICU stay (24.50 ± 26.22); among the 821 patients, 78.8% were cured. In severe pneumonia patients, the gravity-dependent phenotype accounted for 42% of the cases, whereas the nongravity-dependent phenotype constituted 58%. These findings highlight the value of applying different LUS phenotypes in various diagnoses. Conclusions Seven sets of LUS phenotypes were established through machine learning analysis of retrospective data; these phenotypes could represent the typical characteristics of patients with different types of critical illness.

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Section: Discussionmentioning

confidence: 99%

Establishment of seven lung ultrasound phenotypes: a retrospective observational study

Wang,

Zou,

Zeng

et al. 2024

Preprint

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“…In order to determine if lung ultrasound could be used to screen fibrotic changes in post-COVID-19 patients, we compared the LUS scores in two groups of patients: with and without fibrotic changes in CT. Some publications discuss the use of transthoracic lung ultrasonography to assess interstitial lung fibrosis among patients with systemic connective tissue diseases (CTDs) presenting with lung involvement [ 50 , 51 , 52 , 53 ]. The diagnostic gold standard is HRCT, but it exposes individuals (often young) to ionizing radiation.…”

Section: Discussionmentioning

confidence: 99%

Lung Ultrasonography in the Evaluation of Late Sequelae of COVID-19 Pneumonia—A Comparison with Chest Computed Tomography: A Prospective Study

Zimna,

Sobiecka,

Wakuliński

et al. 2024

Viruses

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The onset of the COVID-19 pandemic allowed physicians to gain experience in lung ultrasound (LUS) during the acute phase of the disease. However, limited data are available on LUS findings during the recovery phase. The aim of this study was to evaluate the utility of LUS to assess lung involvement in patients with post-COVID-19 syndrome. This study prospectively enrolled 72 patients who underwent paired LUS and chest CT scans (112 pairs including follow-up). The most frequent CT findings were ground glass opacities (83.3%), subpleural lines (72.2%), traction bronchiectasis (37.5%), and consolidations (31.9%). LUS revealed irregular pleural lines as a common abnormality initially (56.9%), along with subpleural consolidation >2.5 mm ≤10 mm (26.5%) and B-lines (26.5%). A strong correlation was found between LUS score, calculated by artificial intelligence percentage involvement in ground glass opacities described in CT (r = 0.702, p < 0.05). LUS score was significantly higher in the group with fibrotic changes compared to the non-fibrotic group with a mean value of 19.4 ± 5.7 to 11 ± 6.6, respectively (p < 0.0001). LUS might be considered valuable for examining patients with persistent symptoms after recovering from COVID-19 pneumonia. Abnormalities identified through LUS align with CT scan findings; thus, LUS might potentially reduce the need for frequent chest CT examinations.

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“…At least in SJIA-LD, lung ultrasound appeared to correspond with HRCT findings and showed very distinct abnormalities in the pleura and subpleura [20 & ]. It will be interesting to follow this research further and see if lung ultrasound is applicable to other pediatric rheumatic lung diseases as well, as has been shown in adult connective tissue disease [21].…”

Section: Systemic Juvenile Idiopathic Arthritis-associated Lung Diseasementioning

confidence: 95%

New developments related to lung complications in pediatric rheumatic disease

Rai

Schulert

Towe

2023

Current Opinion in Rheumatology

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Purpose of review While substantial progress has been made understanding lung disease in adult patients with rheumatic disease, pediatric lung disease has not been well addressed. Several recent studies provide new insights into diagnosis, management and treatment of lung disease in children with rheumatic disease. Recent findings Building on previous research, newly diagnosed patients may have abnormalities in pulmonary function tests and chest computed tomography imaging even when asymptomatic. New guidelines for screening for rheumatic-associated lung disease provide important recommendations for clinicians. New theories have been proposed about immunologic shifts leading to the development of lung disease in children with systemic juvenile idiopathic arthritis. Additionally, there are new antifibrotic agents that are being explored as treatments in pediatric patients with fibrotic lung diseases. Summary Patients appear to have frequent lung function abnormalities while being clinically asymptomatic, emphasizing importance for rheumatologists to refer for pulmonary function tests and imaging at diagnosis. New advances are helping define optimal approaches to treatment of lung disease, including use of biologic agents and antifibrotic medicines for pediatric patients with rheumatologic diseases.

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Screening value of lung ultrasound in connective tissue disease related interstitial lung disease

Cited by 7 publications

References 33 publications

Establishment of seven lung ultrasound phenotypes: a retrospective observational study

Establishment of seven lung ultrasound phenotypes: a retrospective observational study

Lung Ultrasonography in the Evaluation of Late Sequelae of COVID-19 Pneumonia—A Comparison with Chest Computed Tomography: A Prospective Study

New developments related to lung complications in pediatric rheumatic disease

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