Lung ultrasound (LUS) in pulmonary tuberculosis: correlation with chest CT and X-ray findings

The value of high-pitch scanning with Sn100kV and ADMIRE in CT examination of tuberculous destroyed lung: Identifying the optimal combination for ultra-low-dose imaging

OBJECTIVE

To investigate the application value of high-pitch scanning combined with energy spectrum purification using Sn100kV and ADMIRE in CT examinations of patients with tuberculous destroyed lung.

METHODS

A total of 60 patients with sputum mycobacterium tuberculosis smear positive and diagnosed with tuberculous lung damage on imaging were prospectively collected. The first CT examination utilized a conventional scanning mode with a fixed tube voltage of 120kV, CARE Dose4D activated, reference tube current set at 70mAs, and a pitch of 1.5. The interval between the initial and follow-up CT was over three months. During the follow-up CT, a high-pitch scanning mode combined with energy spectrum purification was employed, with a fixed tube voltage of Sn100kV, CARE Dose4D activated, reference tube current set at 300mAs, and a pitch of 3.2. The remaining parameters were consistent between the two CT scans. The first CT was recorded as Group A, and the follow-up CT as Group B. After the examinations, the reconstructed layer thickness was 1.00mm, and lung window and mediastinal window images with a layer spacing of 0.7mm were obtained. The image quality of the two CT examinations was scored by three physicians using a 5-point scale. Following the scoring, the consistency of the three physicians' scores was analyzed using the intraclass correlation coefficient.. A chief physician reviewed the lung window images from both CT scans, recorded the number of focal signs detected, and conducted Chi-square tests to compare these counts between the two groups. The CT values and noise levels in both the mediastinal window and pulmonary window were measured, SNR and CNR were calculated, and independent sample T-test was performed to analyze the differences in these parameters between the two groups. Motion artifacts in the two CT images were assessed and scored by three physicians using a 3-point values, and Mann-Whitney U test was applied to compare the scores between the groups. The radiation doses of two CT examinations was recorded, and the differences between the two groups were statistically analyzed using the Mann-Whitney U test. Data analysis was conducted using SPSS 26.0 software.

RESULTS

The image quality scores of both groups were 3 points or above, meeting the requirements for clinical diagnosis. The intraclass correlation coefficient (ICC) value for the consistency analysis of the pulmonary window scores among the three physicians was 0.819 (p < 0.001), and for the mediastinal window consistency analysis, the ICC value was 0.795 (p < 0.001), indicating good consistency in the subjective score diagnosis results. The detection rate of lesion signs in Group B was higher than that in Group A, but there was no statistical difference between the two groups (p > 0.05). There was no significant difference in noise, SNR, and CNR between the two groups (p > 0.05). However, the SNR and CNR in Group B were better than those in Group A. There was no statistical difference in the CT values of the aorta and muscle between the two groups of mediastinal window images, while noise, SNR, and CNR were statistically significant (p < 0.05). Noise in Group B was higher than that in Group A, while the SNR and CNR in Group B were lower than those in Group A. The motion artifacts of the two groups were significantly different (p < 0.001), with Group A having significantly more motion artifacts than Group B. The radiation dose of the two groups was statistically different (p < 0.001), with Group B's radiation dose reduced by 76.24% compared to Group A.

CONCLUSION

The combination of high-pitch scanning with Sn100kV and ADMIRE can be effectively used for ultra-low-dose CT examination of the tuberculous destroyed lung, obtaining satisfactory diagnostic images and reducing the occurrence of motion artifacts. This technique achieves conventional diagnostic outcomes at ultra-low doses and significantly reduces motion artifacts, holding significant potential and value for widespread clinical application in CT examinations for patients with tuberculous disfigured lung.

Lung Ultrasound-A Supplementary Tool for the Diagnosis of Pulmonary Tuberculosis in Children

BACKGROUND

There are logistic problems in obtaining adequate microbiological samples for the diagnosis of pulmonary tuberculosis (PTB) in children, globally. Most studies on ultrasound have evaluated mediastinal nodes in children with tuberculosis (TB), but very few studies are available on lung ultrasound (LUS) appearances in proven PTB.

PURPOSE

To study the LUS appearances in children with microbiologically proven PTB and to assess the inter-observer agreement.

MATERIALS AND METHODS

Thirty children with microbiologically proven PTB, were evaluated prospectively on LUS and chest radiograph (CR) in Radiology department of a tertiary care hospital, from November 2019 to November 2021. CR was interpreted by an experienced Radiologist (R2); LUS was conducted by a Radiology resident (R1), who was blinded to CR findings; and findings were recorded. Archived static images/videos of LUS were interpreted by R2 after a month, to avoid bias; and findings were recorded.

RESULTS

Composite LUS finding of either consolidation and subpleural nodule (SUN) was detected in 29/30 (96.7%) children with lower zone predominance (70%). Miliary pattern was observed on LUS in 11/30 (33.3%) children, but their CR was normal. Consolidation was detected on LUS in a significantly higher proportion of children (83.3%) than on CR (43.3%). Inter-observer agreement calculated for detection of consolidation and pleural effusion was k = 0.88, for B lines k = 0.79, confluent B lines k = 0.75, miliary nodules k = 0.70 and SUN k = 0.57.

CONCLUSION

We conclude that in low-resource endemic areas, LUS by virtue of being non -invasive and not using ionizing radiation, can be a useful supplementary tool in the diagnosis of childhood PTB.

Parenchymal Cavitations in Pulmonary Tuberculosis: Comparison between Lung Ultrasound, Chest X-ray and Computed Tomography

This article aims to detect lung cavitations using lung ultrasound (LUS) in a cohort of patients with pulmonary tuberculosis (TB) and correlate the findings with chest computed tomography (CT) and chest X-ray (CXR) to obtain LUS diagnostic sensitivity. Patients with suspected TB were enrolled after being evaluated with CXR and chest CT. A blinded radiologist performed LUS within 3 days after admission at the Infectious Diseases Department. Finally, 82 patients were enrolled in this study. Bronchoalveolar lavage (BAL) confirmed TB in 58/82 (71%). Chest CT showed pulmonary cavitations in 38/82 (43.6%; 32 TB patients and 6 non-TB ones), LUS in 15/82 (18.3%; 11 TB patients and 4 non-TB ones) and CXR in 27/82 (33%; 23 TB patients and 4 non-TB ones). Twelve patients with multiple cavitations were detected with CT and only one with LUS. LUS sensitivity was 39.5%, specificity 100%, PPV 100% and NPV 65.7%. CXR sensitivity was 68.4% and specificity 97.8%. No false positive cases were found. LUS sensitivity was rather low, as many cavitated consolidations did not reach the pleural surface. Aerated cavitations could be detected with LUS with relative confidence, highlighting a thin air crescent sign towards the pleural surface within a hypoechoic area of consolidation, easily distinguishable from a dynamic or static air bronchogram.

Diagnostic value of the dual-modal imaging radiomics model for subpleural pulmonary lesions

PURPOSE

To investigate the clinical value of the radiomics model of grayscale ultrasound (GUS) and contrast-enhanced ultrasound (CEUS) to diagnosis subpleural pulmonary tuberculosis and nonpulmonary tuberculosis based on GUS and CEUS images.

METHODS

This study included 221 patients with 228 lesions diagnosed using the composite reference standard. The patients were randomly divided into training (n = 183) and test (n = 45) cohorts in an 8:2 ratio. The regions of interest of the GUS and CEUS images were manually segmented to extract the radiomic features. The GUS, CEUS and GUS+CEUS radiomics models were constructed via the multistep selection of highly correlated features. Receiver operating characteristic curves of the different models were plotted, and the area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value and negative predictive value (NPV) of the different models were compared.

RESULTS

Following Least Absolute Shrinkage and Selection Operator dimension reduction we selected 4, 9, and 11 features to construct the GUS, CEUS, and GUS+CEUS radiomics models, respectively. The AUC values of the three groups in the test cohort were 0.689, 0.748 and 0.779, respectively, and they did not differ significantly. In the test cohort, the GUS+CEUS radiomics model exhibited the highest AUC (0.779), accuracy (75.56%), and NPV (68.7%) of the three models.

CONCLUSIONS

The GUS+CEUS radiomics model possesses good clinical value in diagnosing pulmonary tuberculosis.

Automated Lung Ultrasound Pulmonary Disease Quantification Using an Unsupervised Machine Learning Technique for COVID-19

COVID-19 is an ongoing global health pandemic. Although COVID-19 can be diagnosed with various tests such as PCR, these tests do not establish pulmonary disease burden. Whereas point-of-care lung ultrasound (POCUS) can directly assess the severity of characteristic pulmonary findings of COVID-19, the advantage of using US is that it is inexpensive, portable, and widely available for use in many clinical settings. For automated assessment of pulmonary findings, we have developed an unsupervised learning technique termed the calculated lung ultrasound (CLU) index. The CLU can quantify various types of lung findings, such as A or B lines, consolidations, and pleural effusions, and it uses these findings to calculate a CLU index score, which is a quantitative measure of pulmonary disease burden. This is accomplished using an unsupervised, patient-specific approach that does not require training on a large dataset. The CLU was tested on 52 lung ultrasound examinations from several institutions. CLU demonstrated excellent concordance with radiologist findings in different pulmonary disease states. Given the global nature of COVID-19, the CLU would be useful for sonographers and physicians in resource-strapped areas with limited ultrasound training and diagnostic capacities for more accurate assessment of pulmonary status.

The Role of Ultrasound in the Diagnosis of Pulmonary Infection Caused by Intracellular, Fungal Pathogens and Mycobacteria: A Systematic Review

BACKGROUND

Lung ultrasound (LUS) is a widely available technique allowing rapid bedside detection of different respiratory disorders. Its reliability in the diagnosis of community-acquired lung infection has been confirmed. However, its usefulness in identifying infections caused by specific and less common pathogens (e.g., in immunocompromised patients) is still uncertain.

METHODS

This systematic review aimed to explore the most common LUS patterns in infections caused by intracellular, fungal pathogens or mycobacteria.

RESULTS

We included 17 studies, reporting a total of 274 patients with M. pneumoniae, 30 with fungal infection and 213 with pulmonary tuberculosis (TB). Most of the studies on M. pneumoniae in children found a specific LUS pattern, mainly consolidated areas associated with diffuse B lines. The typical LUS pattern in TB consisted of consolidation and small subpleural nodes. Only one study on fungal disease reported LUS specific patterns (e.g., indicating "halo sign" or "reverse halo sign").

CONCLUSIONS

Considering the preliminary data, LUS appears to be a promising point-of-care tool, showing patterns of atypical pneumonia and TB which seem different from patterns characterizing common bacterial infection. The role of LUS in the diagnosis of fungal disease is still at an early stage of exploration. Large trials to investigate sonography in these lung infections are granted.

Cardiovascular Involvement in Tuberculosis: From Pathophysiology to Diagnosis and Complications-A Narrative Review

Although primarily a lung disease, extra-pulmonary tuberculosis (TB) can affect any organ or system. Of these, cardiovascular complications associated with disease or drug toxicity significantly worsen the prognosis. Approximately 60% of patients with TB have a cardiovascular disease, the most common associated pathological entities being pericarditis, myocarditis, and coronary artery disease. We searched the electronic databases PubMed, MEDLINE, and EMBASE for studies that evaluated the impact of TB on the cardiovascular system, from pathophysiological mechanisms to clinical and paraclinical diagnosis of cardiovascular involvement as well as the management of cardiotoxicity associated with antituberculosis medication. The occurrence of pericarditis in all its forms and the possibility of developing constrictive pericarditis, the association of concomitant myocarditis with severe systolic dysfunction and complication with acute heart failure phenomena, and the long-term development of aortic aneurysms with risk of complications, as well as drug-induced toxicity, pose complex additional problems in the management of patients with TB. In the era of multidisciplinarity and polymedication, evidence-based medicine provides various tools that facilitate an integrative management that allows early diagnosis and treatment of cardiac pathologies associated with TB.