Background Systemic sclerosis (SSc) is a disease characterized by a progressive fibrosis of the skin and internal organs, which can lead to death. Lung involvement includes a wide range of disorders and interstitial lung disease (ILD) is the most common manifestation, being clinically significant in about 40% of patient. Recently, the role of US in the assessment of ILD (counting the B-lines, generated by the reflection of the US beam from thickened sub-pleural interlobar septa) has been confirmed after comparison with high-resolution computed tomography (HRCT) and a few scoring systems proposed. The comprehensive examination of lung intercostal spaces (LIS) is time consuming (54 LIS in each patient) and a previous attempt to give a simplified US B-line scoring system has been done in connective tissue diseases patient (1).
Objectives To investigate which LIS are more frequently involved in SSc patients, with and without ILD, in order to find a reduced number of LIS to scan using US.
Methods Seventy-nine SSc patients were enrolled independently of the presence of any dispnoea. Each patient underwent a lung US with comprehensive US B-line assessments by an experienced rheumatologist. A cut-off of >12 B-lines was decided based on the correlation between US and HRCT in 76 patients, then US was performed alone in the rest of the SSc patients. The presence/absence of B-lines was registered in each LIS.
Results A highly significant correlation between US assessment and HRCT was found (ICC=0.576; sensitivity and specificity were 81 and 73%, respectively). Single LIS significantly correlates to the diagnosis of ILD + in 41/54. In a multivariate analysis, even examining only 2 LIS, sensitivity and specificity of the US, with respect to the comprehensive scan, remains high (93.5 and 81.4%, respectively).
Conclusions Most of single LIS significantly correlate to the presence of ILD. Even scanning only the 5th right emiclavear and the 3rd left parasternal LIS, sensitivity and specificity of US examination remains high.
References: Gutierrez M, Salaffi F, Carotti M et al. Arthritis Res Ther 2011;13(4):R134.
Disclosure of Interest: None Declared
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