Gangemi Andrew J, Dass Chandra A, Zhao Huaqing, Patel Maulin, Marchetti Nathaniel, Criner Gerard J, Desai Parag
Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.
Department of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.
Respir Med. 2024 Dec;235:107860. doi: 10.1016/j.rmed.2024.107860. Epub 2024 Nov 16.
Point of Care Ultrasound (POCUS) is widely used to evaluate pleural apposition in acute disease; however, the prevalence of abnormal findings among emphysematous patients is unknown. The aim of the study was to characterize POCUS findings in advanced emphysema and correlate parenchymal and spirometric changes with abnormal POCUS results.
We retrospectively evaluated POCUS images obtained in hyperinflated COPD patients. Images were obtained in the 2nd intercostal space (upper lobes) and above diaphragm insertion (lower lobes). Pleural sliding was graded as "present" or "absent," and M-mode images graded as "seashore," "barcode," or "hybrid" patterns; patients were then assigned to four groups based on the combination of findings. Differences between pulmonary function testing and high-resolution CT were made by Chi Square or ANOVA testing, and association by Spearman's correlation. Agreement among three scorers (two pulmonologists and one radiologist) was assessed using Kappa statistics.
Our study included 48 patients with 159 lobes imaged. We found a substantial percentage of lobes had either barcode M-mode appearance (13.8 %) or indeterminate/absent lung sliding (20.3 %). We identified 87 lobes (54.7 %) that did not fit any typical definition for M-mode ultrasound findings. There was no strong association of abnormal ultrasound patterns with airflow obstruction or emphysema percentage. There was wide interrater variability among B-mode (0.20-0.611) and M-mode (0.24-0.049) among the three graders.
Hyperinflated patients often show abnormal pleural sliding appearance on POCUS, with a high false positive rate of barcode pattern. This should be considered when interpretation of POCUS drives therapeutic decisions.
床旁超声（POCUS）被广泛用于评估急性疾病中的胸膜贴合情况；然而，肺气肿患者中异常发现的发生率尚不清楚。本研究的目的是描述晚期肺气肿患者的POCUS表现，并将实质和肺功能变化与异常的POCUS结果相关联。
我们回顾性评估了慢性阻塞性肺疾病（COPD）过度充气患者的POCUS图像。图像在第二肋间（上叶）和膈肌插入点上方（下叶）获取。胸膜滑动分为“存在”或“不存在”，M型图像分为“海岸”、“条形码”或“混合”模式；然后根据检查结果的组合将患者分为四组。通过卡方检验或方差分析检验肺功能测试和高分辨率CT之间的差异，并通过Spearman相关性分析两者之间的关联。使用Kappa统计量评估三位评分者（两位肺科医生和一位放射科医生）之间的一致性。
我们的研究纳入了48例患者，共对159个肺叶进行了成像。我们发现相当比例的肺叶具有条形码M型外观（13.8%）或不确定/无肺滑动（20.3%）。我们确定了87个肺叶（54.7%）不符合M型超声检查结果的任何典型定义。异常超声模式与气流阻塞或肺气肿百分比之间没有强关联。三位分级者在B型（0.20 - 0.611）和M型（0.24 - 0.049）之间存在较大的评分者间变异性。
过度充气的患者在POCUS上常显示胸膜滑动外观异常，条形码模式的假阳性率较高。在POCUS解释驱动治疗决策时应考虑到这一点。
