Lung ultrasound for the diagnosis of cystic fibrosis pulmonary exacerbation

Maryam Hassanzad; Arda Kiani; Atefeh Abedini; Hoseinali Ghaffaripour; Habib Emami; Niloufar Alizadeh; Ghazal Zoghi; Saeed Hashemi; Ali Akbar Velayati

doi:10.1186/s12890-021-01728-8

Lung ultrasound for the diagnosis of cystic fibrosis pulmonary exacerbation

BMC Pulm Med. 2021 Nov 8;21(1):353. doi: 10.1186/s12890-021-01728-8.

Authors

Maryam Hassanzad¹, Arda Kiani², Atefeh Abedini², Hoseinali Ghaffaripour¹, Habib Emami³, Niloufar Alizadeh⁴, Ghazal Zoghi⁵, Saeed Hashemi⁶, Ali Akbar Velayati⁷

Affiliations

¹ Pediatric Respiratory Diseases Research Center (PRDRC), National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
² Chronic Respiratory Diseases Research Center, National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
³ Tobacco Prevention and Control Research Center, National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁴ Department of Biostatistics, National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁵ Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
⁶ Pediatric Respiratory Diseases Research Center (PRDRC), National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. hashemis57@yahoo.com.
⁷ Mycobacteriology Research Center (MRC), National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Background: High-resolution computed tomography (HRCT) is the gold standard for the evaluation of cystic fibrosis (CF) lung disease; however, lung ultrasound (LUS) is being increasingly used for the assessment of lung in these patients due to its lower cost, availability, and lack of irradiation. We aimed to determine the diagnostic performance of LUS for the evaluation of CF pulmonary exacerbation.

Methods: This cross-sectional study included patients with CF pulmonary exacerbation admitted to Masih Daneshvari Hospital, Tehran, Iran, from March 21, 2020 to March 20, 2021. Age, gender, and body mass index (BMI) of the patients were recorded. All patients underwent chest X-ray (CXR), HRCT, and LUS on admission. Pleural thickening, atelectasis, air bronchogram, B-line, and consolidation were noted in LUS and then compared with the corresponding findings in CXR and HRCT. Taking HRCT findings as reference, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) of LUS and CXR for the detection of each pulmonary abnormality were determined.

Results: Of the 30 patients included in this study, with a mean age of 19.62 ± 5.53 years, 14 (46.7%) were male. Of the 15 patients aged 2-20 years, BMI was below the 5^th percentile in 10 (66.7%), within the 5-10 percentiles in 1 (6.7%), 10-25 percentiles in 3 (20%), and 25-50 percentiles in 1 (6.7%). The mean BMI for 15 patients > 20 years was 18.03 ± 2.53 kg/m². LUS had better diagnostic performance compared to CXR for the detection of air bronchogram, consolidation, and pleural thickening (area under the receiver operating characteristic curve [AUROC]: 0.966 vs. 0.483, 0.900 vs. 0.575, and 0.656 vs. 0.531, respectively). Also, LUS was 100% and 96.7% specific for the diagnosis of pleural effusion and atelectasis, respectively.

Conclusions: LUS appears to be superior to CXR and comparable with HRCT for the evaluation of CF pulmonary exacerbation, especially in terms of air bronchogram and consolidation detection. LUS can be used to lengthen the HRCT evaluation intervals in this regard or utilized along with HRCT for better evaluation of CF pulmonary exacerbation.

Keywords: Cystic fibrosis; Pulmonary exacerbation; Ultrasound.

MeSH terms

Adolescent
Child
Cross-Sectional Studies
Cystic Fibrosis / diagnostic imaging*
Cystic Fibrosis / pathology*
Female
Humans
Iran
Lung / diagnostic imaging
Male
Pleural Effusion / diagnostic imaging
Sensitivity and Specificity
Ultrasonography / methods*
Young Adult