Clinica Reumatologica, Via dei Colli 52, 60035, Università Politecnica delle Marche, Jesi,Ancona, Italy.
Arthritis Res Ther. 2011 Aug 18;13(4):R134. doi: 10.1186/ar3446.
Interstitial pulmonary fibrosis (IPF) is a frequent manifestation in patients with connective tissue disorders (CTD). Recently the ultrasound (US) criterion validity for its assessment has been proposed; however, the US scoring systems adopted include the study of several lung intercostal spaces (LIS), which could be time-consuming in daily clinical practice. The aim of this study was to investigate the utility of a simplified US B-lines scoring system compared with both the US comprehensive assessment and the high-resolution computed tomography (HRCT) findings of IPF in CTD patients.
Thirty-six patients with a diagnosis of CTD were enrolled. Each patient underwent chest HRCT and lung US by an experienced radiologist and rheumatologist, respectively. Both comprehensive and simplified US B-lines assessments were scanned. The comprehensive US assessment was performed at 50 LIS level, whereas the simplified US assessment included bilaterally 14 LIS; for the anterior chest: the second LIS along the para-sternal lines, the fourth LIS along the mid-clavear, anterior axillary and mid-axillary lines; for the posterior chest: the eighth LIS along the paravertebral, sub-scapular and posterior axillary lines. For criterion validity, HRCT was considered the gold standard. Feasibility, inter and intra-observer reliability was also investigated.
A highly significant correlation between comprehensive and simplified US assessment was found (P = 0.0001). A significant correlation was also found between the simplified US assessment and HRCT findings (P = 0.0006). Kappa values for the inter-observer simplified US assessment were in a range from 0.769 to 0.885, whereas the concordance correlation coefficient values for the intra-observer were from 0.856 to 0.955. There was a relevant difference in time spent on comprehensive (mean 23.3 ± SD 4.5 minutes) with respect to the simplified US assessment (mean 8.6 ± SD 1.4) (P < 0.00001).
Our results provide a new working hypothesis in favor of the utility of a simplified US B-lines assessment as an adjunct method to assess IPF in patients with CTD.
间质性肺纤维化（IPF）是结缔组织疾病（CTD）患者的常见表现。最近提出了超声（US）评估其的标准效度；然而，采用的 US 评分系统包括对几个肺肋间空间（LIS）的研究，这在日常临床实践中可能很耗时。本研究旨在探讨简化的 US B 线评分系统与 CTD 患者的 IPF 的 US 综合评估和高分辨率计算机断层扫描（HRCT）结果相比的效用。
共纳入 36 例诊断为 CTD 的患者。每位患者均由有经验的放射科医生和风湿病医生分别进行胸部 HRCT 和肺部 US。分别对综合和简化的 US B 线评估进行扫描。全面的 US 评估在 50 个 LIS 水平进行，而简化的 US 评估包括双侧 14 个 LIS；前胸部：胸骨旁线的第二个 LIS，中锁骨干线、腋前线和腋中线的第四个 LIS；后胸部：沿椎旁、肩胛下线和腋后线的第八个 LIS。对于标准效度，HRCT 被认为是金标准。还研究了可行性、观察者间和观察者内的可靠性。
综合和简化的 US 评估之间存在高度显著相关性（P = 0.0001）。简化的 US 评估与 HRCT 结果之间也存在显著相关性（P = 0.0006）。观察者间简化 US 评估的 Kappa 值范围为 0.769 至 0.885，而观察者内的一致性相关系数值为 0.856 至 0.955。综合评估的用时（平均 23.3 ± SD 4.5 分钟）与简化 US 评估（平均 8.6 ± SD 1.4 分钟）之间存在显著差异（P < 0.00001）。
我们的结果提供了一个新的工作假设，即简化的 US B 线评估作为一种辅助方法来评估 CTD 患者的 IPF 是有用的。
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