Lung ultrasound for the screening of interstitial lung disease in very early systemic sclerosis
- Tatiana Barskova1,
- Luna Gargani2,
- Serena Guiducci1,
- Silvia Bellando Randone1,
- Cosimo Bruni1,
- Giulia Carnesecchi1,
- Maria Letizia Conforti1,
- Francesco Porta1,
- Alberto Pignone3,
- Davide Caramella4,
- Eugenio Picano2,
- Marco Matucci Cerinic1
- 1Department of Biomedicine, Division of Rheumatology AOUC, Excellence Centre for Research, Transfer and High Education DENOthe, University of Florence, Florence, Italy
- 2Institute of Clinical Physiology, National Council of Research, Pisa, Italy
- 3Department of Medicine, Division of Medicine AOUC, University of Florence, Florence, Italy
- 4Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
- Correspondence to Tatiana Barskova, Department of Biomedicine, Division of Rheumatology, AOUC, Excellence Centre for Research, Transfer and High Education DENOthe, University of Florence, Via Pieraccini, 18-50139, Firenze, Italy;
Contributors TB and LG performed lung ultrasound and analysis of patient data. SG, SB-R, MLC, FP are outpatient clinic doctors who performed medical examinations and visited patients. AP, EP, MM-C are chiefs of medical departments who managed the study. DC contributed to the assessment and analysis of the additional patients. CB and GC participated in drafting the manuscript and worked actively on the project.
- Received 18 November 2011
- Accepted 9 April 2012
- Published Online First 15 May 2012
Background A high percentage of patients with systemic sclerosis (SSc) develop interstitial lung disease (ILD) during the course of the disease. Promising data have recently shown that lung ultrasound (LUS) is able to detect ILD by the evaluation of B-lines (previously called ultrasound lung comets), the sonographic marker of pulmonary interstitial syndrome.
Objective To evaluate whether LUS is reliable in the screening of ILD in patients with SSc.
Methods Fifty-eight consecutive patients with SSc (54 women, mean age 51±14 years) who underwent a high resolution CT (HRCT) scan of the chest were also evaluated by LUS for detection of B-lines. Of these, 32 patients (29 women, mean age 51±15 years) fulfilled the criteria for a diagnosis of very early SSc.
Results At HRCT, ILD was detected in 88% of the SSc population and in 41% of the very early SSc population. A significant difference in the number of B-lines was found in patients with and without ILD on HRCT (57±53 vs 9±9; p<0.0001), with a concordance rate of 83%. All discordant cases were false positive at LUS, providing a sensitivity and negative predictive value of 100% in both SSc and very early SSc.
Conclusions ILD may be detected in patients with very early SSc. The presence of B-lines at LUS examination correlates with ILD at HRCT. LUS is very sensitive for detecting ILD even in patients with a diagnosis of very early SSc. The use of LUS as a screening tool for ILD may be feasible to guide further investigation with HRCT.
TB and LG contributed equally to this work
Funding This study was funded by a grant provided by the Regione Toscana, Italy (Regional Health Research Programme).
Competing interests None.
Patient consent Obtained.
Ethics approval Ethics approval was obtained from the Bioethical Committee of the Azienda Ospedaliero-Universitaria of Pisa, Italy.
Provenance and peer review Not commissioned; externally peer reviewed.