Vicente-Rabaneda Esther F, Bong David A, Busquets-Pérez Noemí, Möller Ingrid
Department of Rheumatology, Hospital Universitario de la Princesa, Madrid, Spain.
Faculty of Medicine, University of Barcelona-Bellvitge Campus, Barcelona, Spain; Instituto Poal de Reumatologia, Barcelona, Spain.
Eur J Rheumatol. 2022 Aug 9. doi: 10.5152/eujrheum.2022.20120.
The interpretation of lung ultrasound (US) is the result of the analysis of artifacts, rather than exact representations of anatomical structures, which appear when changes in the physical properties of the lung occur. Its application to the study of interstitial lung disease (ILD) associated with autoimmune diseases has aroused great interest in the last 10 years, as evidenced by a growing number of publications studying its usefulness in the diagnostic process, as a prognostic marker, and as an aid in monitoring of patients. The main elements in lung US interpretation in ILD are the B lines and the changes in the pleural line. B lines are vertical artifacts that are generated when there is a partial decrease in the air content of the lung parenchyma and/or the volume of the interstitial area expands. Pleural line alterations that can be seen are irregularities, thickening, fragmentation, or subpleural nodules. Both the B lines and the changes in the pleural line have shown a significant positive correlation with the evidence on chest computed tomography (high-resolution computed tomography [HRCT]) of ILD associated with autoimmune diseases, with sensitivity and negative predictive values of up to 100%. These results, together with the safety, accessibility, and low cost of lung US, support this imaging technique as a promising screening method for optimizing the indication for HRCT. The role of lung US regarding sensitivity to change needs further investigation with multicenter prospective studies.
肺部超声（US）的解读是对伪像进行分析的结果，而非肺部物理特性发生变化时所呈现的解剖结构的确切表征。在过去十年中，其在与自身免疫性疾病相关的间质性肺病（ILD）研究中的应用引起了极大关注，越来越多的出版物对其在诊断过程中的效用、作为预后标志物以及辅助监测患者等方面进行了研究，这一点得到了证明。ILD的肺部超声解读中的主要要素是B线和胸膜线的变化。B线是当肺实质内空气含量部分减少和/或间质区域体积扩大时产生的垂直伪像。可见的胸膜线改变包括不规则、增厚、破碎或胸膜下结节。B线和胸膜线的变化均与自身免疫性疾病相关ILD的胸部计算机断层扫描（高分辨率计算机断层扫描[HRCT]）证据显示出显著的正相关，敏感性和阴性预测值高达100%。这些结果，连同肺部超声的安全性、可及性和低成本，支持这种成像技术作为一种有前景的筛查方法，用于优化HRCT的指征。肺部超声对变化的敏感性作用需要通过多中心前瞻性研究进一步调查。
