Lung Ultrasonography in the Evaluation of Interstitial Lung Disease in Systemic Connective Tissue Diseases: Criteria and Severity of Pulmonary Fibrosis – Analysis of 52 Patients

Abstract

Objectives: Patients with a diagnosed systemic connective tissue disease require regular monitoring from the point of view of interstitial lung disease. The main aim of this work is a description of the criteria for pulmonary fibrosis and the degree of the severity of the fibrosis during the course of interstitial lung disease through the TLU (transthoracic lung ultrasound).

Materials and Methods: 52 patients with diagnosed diffuse interstitial lung disease were qualified for this research, together with 50 volunteers in the control group. The patients in both groups were over 18 years of age and were of both sexes. The results of the TLU of the patients underwent statistical analysis and were compared to High-Resolution Computed Tomography (HRCT) results.

Results: As a consequence of the statistical analysis, we defined our own criteria for pulmonary fibrosis in TLU: irregularity of the pleura line, tightening of the pleura line, the fragmentary nature of the pleura line, blurring of the pleura line, thickening of the pleura line, artifacts of line B ≤ 3 and ≥ 4, artifacts of Am line and subpleural consolidations < 5 mm. As a result of the conducted research, a scale of severity of pulmonary fibrosis in TLU was devised (UFI – Ultrasound Fibrosis Index), enabling a division to be made into mild, moderate and severe cases.

Conclusions: Transthoracic Lung Ultrasonography (TLU) gives a new outlook on the diagnostic possibilities, non-invasive and devoid of ionising radiation, of pulmonary fibrosis. This research work has allowed to discover two new ultrasound symptoms of pulmonary fibrosis (blurred pleural line and Am lines).

Zusammenfassung

Ziel: Patienten mit Diagnose einer systemischen Kollagenose brauchen eine regelmäßige Überwachung im Hinblick auf eine interstitielle Lungenerkrankung. Das Hauptziel dieser Arbeit ist die Beschreibung der Kriterien für eine pulmonale Fibrose und dem Schweregrad der Fibrose bei einer interstitiellen Lungenerkrankung mittels TLU (transthorakaler Lungenultraschall).

Material und Methoden: 52 Patienten mit Diagnose einer diffusen interstitiellen Lungenerkrankung wurden für diese Untersuchung ausgewählt zusammen mit 50 Freiwilligen einer Kontrollgruppe. Die Patienten beider Gruppen waren über 18 Jahre alt und beiderlei Geschlechts. Das Ergebnis des TLU der Patienten wurde statistisch analysiert und mit der High-Resolution-Computertomografie verglichen.

Ergebnisse: Als Folge der statistischen Analyse definierten wir unsere eigenen Kriterien für Lungenfibrose im TLU: Ungleichmäßigkeit der Pleuralinie, Straffung der Pleuralinie, unvollständige Pleuralinie, Unschärfe der Pleuralinie, Verdickung der Pleuralinie, B-Linien-Artefakte ≤ 3 und ≥ 4, Artefakte der Am-Linie und subpleurale Verdichtungen < 5 mm. Als Ergebnis aus den durchgeführten Untersuchungen wurde eine Skala der Schwere der Lungenfibrose im TLU entwickelt (UFI- Ultraschall-Fibrose-Index), die eine Unterteilung in leichte, moderate und schwere Fälle ermöglicht.

Schlussfolgerung: Der transthorakale Lungenultraschall (TLU) ermöglicht neue Perspektiven der diagnostischen Möglichkeiten bei pulmonaler Fibrose, die nicht-invasiv und ohne ionisierende Strahlen sind. Diese Forschungsarbeit hat die Beschreibung von zwei neuen Ultraschallmarkern bei Lungenfibrose (unscharfe Pleuralinie und Am-Linien) ermöglicht.

Key words

pleura - thorax - ultrasound - interstitial diseases of the lungs - pulmonary fibrosis

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