Delle Sedie Andrea, Terslev Lene, Bruyn George A W, Cazenave Tomas, Chrysidis Stavros, Diaz Mario, Di Carlo Marco, Frigato Marilena, Gargani Luna, Gutierrez Marwin, Hocevar Alojzija, Iagnocco Annamaria, Juche Aaron, Keen Helen, Mandl Peter, Naredo Esperanza, Mortada Mohamed, Pineda Carlos, Karalilova Rositsa, Porta Francesco, Ravagnani Viviana, Scirè Carlo, Serban Teodora, Smith Kate, Stoenoiu Maria S, Tardella Marika, Torralba Karina, Wakefield Richard, D'Agostino Maria Antonietta
Rheumatology Unit, University of Pisa, Pisa, Italy.
Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark.
Semin Arthritis Rheum. 2024 Apr;65:152406. doi: 10.1016/j.semarthrit.2024.152406. Epub 2024 Feb 5.
Over the last years ultrasound has shown to be an important tool for evaluating lung involvement, including interstitial lung disease (ILD) a potentially severe systemic involvement in many rheumatic and musculoskeletal diseases (RMD). Despite the potential sensitivity of the technique the actual use is hampered by the lack of consensual definitions of elementary lesions to be assessed and of the scanning protocol to apply. Within the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group we aimed at developing consensus-based definitions for ultrasound detected ILD findings in RMDs and assessing their reliability in dynamic images.
Based on the results from a systematic literature review, several findings were identified for defining the presence of ILD by ultrasound (i.e., Am-lines, B-lines, pleural cysts and pleural line irregularity). Therefore, a Delphi survey was conducted among 23 experts in sonography to agree on which findings should be included and on their definitions. Subsequently, a web-reliability exercise was performed to test the reliability of the agreed definitions on video-clips, by using kappa statistics.
After three rounds of Delphi an agreement >75 % was obtained to include and define B-lines and pleural line irregularity as elementary lesions to assess. The reliability in the web-based exercise, consisting of 80 video-clips (30 for pleural line irregularity, 50 for B-lines), showed moderate inter-reader reliability for both B-lines (kappa = 0.51) and pleural line irregularity (kappa = 0.58), while intra-reader reliability was good for both B-lines (kappa = 0.72) and pleural line irregularity (kappa = 0.75).
Consensus-based ultrasound definitions for B-lines and pleural line irregularity were obtained, with moderate to good reliability to detect these lesions using video-clips. The next step will be testing the reliability in patients with ILD linked to RMDs and to propose a consensual and standardized protocol to scan such patients.
在过去几年中，超声已被证明是评估肺部受累情况的重要工具，包括间质性肺疾病（ILD），这是许多风湿性和肌肉骨骼疾病（RMD）中一种潜在的严重全身性受累情况。尽管该技术具有潜在的敏感性，但实际应用受到阻碍，因为缺乏对要评估的基本病变以及应用的扫描方案的共识性定义。在风湿病结局评估（OMERACT）超声工作组中，我们旨在为超声检测到的RMD中的ILD表现制定基于共识的定义，并评估其在动态图像中的可靠性。
基于系统文献综述的结果，确定了几个通过超声定义ILD存在的表现（即A线、B线、胸膜囊肿和胸膜线不规则）。因此，对23名超声检查专家进行了德尔菲调查，以就应包括哪些表现及其定义达成一致。随后，通过使用kappa统计量进行网络可靠性测试，以检验商定定义在视频片段上的可靠性。
经过三轮德尔菲调查，超过75%的人同意将B线和胸膜线不规则作为要评估的基本病变纳入并进行定义。由80个视频片段组成的网络测试（30个用于胸膜线不规则，50个用于B线）显示，B线（kappa = 0.51）和胸膜线不规则（kappa = 0.58）的读者间可靠性中等，而B线（kappa = 0.72）和胸膜线不规则（kappa = 0.75）的读者内可靠性良好。
获得了基于共识的B线和胸膜线不规则的超声定义，使用视频片段检测这些病变具有中等至良好的可靠性。下一步将是测试与RMD相关的ILD患者的可靠性，并提出针对此类患者的共识性和标准化扫描方案。
