Lung Ultrasound B-Lines in the Evaluation of the Extent of Interstitial Lung Disease in Systemic Sclerosis

Cosimo Bruni; Lavinia Mattolini; Lorenzo Tofani; Luna Gargani; Nicholas Landini; Nicola Roma; Gemma Lepri; Martina Orlandi; Serena Guiducci; Silvia Bellando-Randone; Chiara Romei; Yukai Wang; Marco Matucci-Cerinic

doi:10.3390/diagnostics12071696

Lung Ultrasound B-Lines in the Evaluation of the Extent of Interstitial Lung Disease in Systemic Sclerosis

Diagnostics (Basel). 2022 Jul 12;12(7):1696. doi: 10.3390/diagnostics12071696.

Authors

Cosimo Bruni^{1

2}, Lavinia Mattolini³, Lorenzo Tofani^{1

4}, Luna Gargani⁵, Nicholas Landini^{3

6

7}, Nicola Roma⁶, Gemma Lepri¹, Martina Orlandi¹, Serena Guiducci¹, Silvia Bellando-Randone¹, Chiara Romei⁸, Yukai Wang⁹, Marco Matucci-Cerinic^{1

10}

Affiliations

¹ Department Experimental and Clinical Medicine, Division of Rheumatology, Careggi University Hospital, University of Florence, 50141 Florence, Italy.
² Department of Rheumatology, University Hospital Zurich, University of Zurich, 8006 Zürich, Switzerland.
³ Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, Careggi University Hospital, University of Florence, 50141 Florence, Italy.
⁴ Department of Statistics, Computer Science, Applications, University of Florence, 50141 Florence, Italy.
⁵ Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy.
⁶ Department of Radiology, Ca' Foncello General Hospital, 31100 Treviso, Italy.
⁷ Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy.
⁸ Department of Radiology, Pisa University Hospital, 56124 Pisa, Italy.
⁹ Rheumatology and Immunology Department, Shantou Central Hospital, Shantou 515031, China.
¹⁰ Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy.

Abstract

Background: Chest computed tomography (CT) is the gold standard for the evaluation of systemic sclerosis-related interstitial lung disease (SSc-ILD). Lung ultrasound (LUS) is a radiation-free tool that identifies the B-lines as a main feature of ILD. We aimed to investigate the role of LUS in the evaluation of the extent of SSc-ILD. Methods: Adult SSc patients underwent pulmonary function tests (PFTs), LUS and CT. The CT images were qualitatively, semi-quantitatively (the Wells score on five levels and the categorical Goh et al. staging) and quantitatively (histogram-based densitometry) analysed for ILD. LUS quantified B-lines in 21 intercostal spaces on both the anterior and posterior chest wall. Results: Out of the 77 SSc patients eligible for the study, 35 presented with ILD on CT (21 limited, 14 extensive). Total B-lines significantly differentiated ILD vs. no ILD (median 24 vs. 8, p < 0.001). Posterior and total B-lines significantly differentiated limited from absent ILD, while anterior B-lines distinguished extensive from limited ILD. Total B-lines correlated with the Wells score (r = 0.446, p < 0.001) and MLA (r = −0.571, p < 0.001); similar results were confirmed when anterior and posterior B-lines were analysed separately. Conclusions: LUS is a useful tool to identify SSc-ILD and to correlate with different evaluations of ILD extent and severity.

Keywords: computed tomography; interstitial lung disease; radiomics; systemic sclerosis; ultrasound.

Grants and funding

This research received no external funding.