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FRI0497 Lung Ultrasound for Evaluation of Pulmofibrosis in Systemic Sclerosis
  1. R. Karalilova1,
  2. A. Batalov1,
  3. Y. Peeva2,
  4. K. Kraev1,
  5. Z. Batalov1,
  6. V. Popova1,
  7. M. Geneva-Popova1
  1. 1Clinic of Rheumatology
  2. 22Department of Social Medicine and Public Health, Medical University - Plovdiv, Plovdiv, Bulgaria

Abstract

Background Pulmofibrosis and in general pulmonary involvement is very common feature in patients with systemic sclerosis (SSc). It is detectable in more than 80% of SSc population and is one of the main cause of internal organ involvement and death. The golden standard of pulmonary involvement was high resolution CT (HRCT), but it has high cost and radiological risk for the patient. Typical alterations present increased ground glass opacities – increased lung attenuation in the absence of architectural distortion; intralobular interstitial thickening. Lung ultrasound (LUS) evaluates B-lines – the sonographic marker of pulmonary interstitial complication.

Objectives To estimate the diagnostic value of LUS in patients with SSc compared to HRCT.

Methods 49 patients (women, mean age 57±13 years) that fulfilled the ACR diagnostic criteria for SSc were evaluated by LUS, HRCT and pulmonary functional test. LUS was performed with 2.5-3.5 MHz transducer for anterior, posterior and lateral chest consecutively in determinated areas.

All patients underwent echocardiography examination to evaluate the pressure in pulmonary artery, left and right ventricular systolic and diastolic function and to detect pulmonary hypertension.

Results Pulmonary fibrosis was detected in 43 patients (87.76±4.68%) of the SSc population at HRCT and in 41 patients (83.67±5.28%) at lung ultrasound. There was no difference between detected number of B-lines in younger and older patients, duration of disease (P>0.05). One patient was false positive at LUS. The analysis of results showed a corelation between LUS and HRCT (rxy=0.91, p<0.05). ROC curve analysis was used to confirm the analytical relationship between the number of B-lines and the presence of ILD at HRCT (AUC=0.89, Std. Err. =0.92, 95% CI 0.7 to 1.063, p<0.0001; Test results to sensitivity is equal to 0.83; to specificity – 0.07. It means that the used lung ultrasound is validated and has a high efficiency and reliability as a prospective, wholesome method.

Conclusions Lung ultrasound is a reliable technique in the diagnostic assessement and recognition of pulmonary involvement in SSc. The presence of B-lines at LUS examination correlates with ILD at HRCT. LUS is very sensitive for detecting ILD. The use of LUS as a screening tool for ILD may be feasible to guide further investigation with HRCT.

References

  1. Barskova T, Gargani L, Guiducci S, Bellando Randone S, Bruni C, Carnesecchi G, Conforti M, Porta F, Pignone A, Caramella D, Oicano E, Matucci-Gerinic M. Lung ultrasound for the screening of interstitial lung disease in very early systemic sclerosis. Ann Rheum Dis 2013;72:390-395.

  2. Delle Sedie A, Carli L, Cioffi E, Bombardieri S, Riente L. The promising role of lung ultrasound in systemic sclerosis. Clin Rhematol (2012) 31:1537-1541.

  3. Gargani L, Doveri M, D'Errico L, Frassi F, Bazzichi M, Delle Sedie A, Scali M, Monti S, Mondillo S, Bombardieri S, Carmella D, Picano E. Ultrasound lung comets in systemic sclerosis: a chest sonography hallmark of pulmonary interstitial fibrosis. Rheumatology 2009;48:1382-1387.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.5207

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