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Łyźniak P, Świętoń D, Szurowska E. Lung ultrasound in a nutshell. Lines, signs, some applications, and misconceptions from a radiologist's point of view. Part 2. Pol J Radiol 2024; 89:e211-e224. [PMID: 38783909 PMCID: PMC11112417 DOI: 10.5114/pjr.2024.139286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 03/11/2024] [Indexed: 05/25/2024] Open
Abstract
In recent years, lung ultrasound (LUS) has developed rapidly, and it is gaining growing popularity in various scenarios. There are constant attempts to introduce it to new fields. In addition, knowledge regarding lung and LUS has been augmented by the recent COVID-19 pandemics. In the first part of this review we discuss lines, signs and pheno-mena, profiles, some applications, and misconceptions. An aim of the second part of the review is mainly to discuss some advanced applications of LUS, including lung elastography, lung spectroscopy, colour and spectral Doppler, contrast-enhanced ultrasound of lung, speckled tracking of pleura, quantification of pulmonary oedema, predicting success of talc pleurodesis, asthma exacerbations, detecting chest wall invasion by tumours, lung biopsy, estimating pleural effusion volume, and predicting mechanical ventilatory weaning outcome. For this purpose, we reviewed literature concerning LUS.
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Affiliation(s)
- Piotr Łyźniak
- 2 Department of Radiology, University Clinical Centre in Gdańsk, Gdańsk, Poland
| | - Dominik Świętoń
- 2 Department of Radiology, University Clinical Centre in Gdańsk, Gdańsk, Poland
| | - Edyta Szurowska
- 2 Department of Radiology, University Clinical Centre in Gdańsk, Gdańsk, Poland
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Ramos Hernández C, Tilve Gomez A, Sánchez Fernández A, Cordovilla R, Núñez Ares A, Ordoñez Gómez P, Wangüemert Pérez A, Castro Anón O, González Ramírez J, Valdivia Salas M, Pérez Pallares J, Ferrer Pargada D, Vargas Ursúa F, Lojo Rodriguez I, González Montaos A, Botana Rial M, Fernández Villar A. Multicentre study on the accuracy of lung ultrasound in the diagnosis and monitoring of respiratory sequelae in the medium and long term in patients with COVID-19. Front Med (Lausanne) 2023; 10:1199666. [PMID: 37305128 PMCID: PMC10248404 DOI: 10.3389/fmed.2023.1199666] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/03/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Lung ultrasound (LUS) has proven to be a more sensitive tool than radiography (X-ray) to detect alveolar-interstitial involvement in COVID-19 pneumonia. However, its usefulness in the detection of possible pulmonary alterations after overcoming the acute phase of COVID-19 is unknown. In this study we proposed studying the utility of LUS in the medium- and long-term follow-up of a cohort of patients hospitalized with COVID-19 pneumonia. Materials and methods This was a prospective, multicentre study that included patients, aged over 18 years, at 3 ± 1 and 12 ± 1 months after discharge after treatment for COVID-19 pneumonia. Demographic variables, the disease severity, and analytical, radiographic, and functional clinical details were collected. LUS was performed at each visit and 14 areas were evaluated and classified with a scoring system whose global sum was referred to as the "lung score." Two-dimensional shear wave elastography (2D-SWE) was performed in 2 anterior areas and in 2 posterior areas in a subgroup of patients. The results were compared with high-resolution computed tomography (CT) images reported by an expert radiologist. Results A total of 233 patients were included, of whom 76 (32.6%) required Intensive Care Unit (ICU) admission; 58 (24.9%) of them were intubated and non-invasive respiratory support was also necessary in 58 cases (24.9%). Compared with the results from CT images, when performed in the medium term, LUS showed a sensitivity (S) of 89.7%, specificity (E) 50%, and an area under the curve (AUC) of 78.8%, while the diagnostic usefulness of X-ray showed an S of 78% and E of 47%. Most of the patients improved in the long-term evaluation, with LUS showing an efficacy with an S of 76% and E of 74%, while the X-ray presented an S of 71% and E of 50%. 2D-SWE data were available in 108 (61.7%) patients, in whom we found a non-significant tendency toward the presentation of a higher shear wave velocity among those who developed interstitial alterations, with a median kPa of 22.76 ± 15.49) versus 19.45 ± 11.39; p = 0.1). Conclusion Lung ultrasound could be implemented as a first-line procedure in the evaluation of interstitial lung sequelae after COVID-19 pneumonia.
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Affiliation(s)
- Cristina Ramos Hernández
- Álvaro Cunqueiro Hospital in Vigo, Pneumology Service, NeumoVigo I + i, Southern Galicia Biomedical Research Institute (IISGS), Vigo, Spain
| | | | | | - Rosa Cordovilla
- Salamanca University Clinical Hospital, Pneumology Service, Salamanca, Spain
| | - Ana Núñez Ares
- Albacete University Hospital Complex, Pneumology Service, Albacete, Spain
| | | | | | | | | | - Mar Valdivia Salas
- Santa Lucía de Cartagena General University Hospital, Pneumology Service, Cartagena, Spain
| | - Javier Pérez Pallares
- Santa Lucía de Cartagena General University Hospital, Pneumology Service, Cartagena, Spain
| | - Diego Ferrer Pargada
- Marqués de Valdecilla Hospital, Servicio de Neumología, Pneumology Service, Valencia, Spain
| | - Fernando Vargas Ursúa
- Álvaro Cunqueiro Hospital in Vigo, Pneumology Service, NeumoVigo I + i, Southern Galicia Biomedical Research Institute (IISGS), Vigo, Spain
| | - Irene Lojo Rodriguez
- Álvaro Cunqueiro Hospital in Vigo, Pneumology Service, NeumoVigo I + i, Southern Galicia Biomedical Research Institute (IISGS), Vigo, Spain
| | - Almudena González Montaos
- Álvaro Cunqueiro Hospital in Vigo, Pneumology Service, NeumoVigo I + i, Southern Galicia Biomedical Research Institute (IISGS), Vigo, Spain
| | - Maribel Botana Rial
- Álvaro Cunqueiro Hospital in Vigo, Pneumology Service, NeumoVigo I + i, Southern Galicia Biomedical Research Institute (IISGS), Vigo, Spain
| | - Alberto Fernández Villar
- Álvaro Cunqueiro Hospital in Vigo, Pneumology Service, NeumoVigo I + i, Southern Galicia Biomedical Research Institute (IISGS), Vigo, Spain
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Mento F, Khan U, Faita F, Smargiassi A, Inchingolo R, Perrone T, Demi L. State of the Art in Lung Ultrasound, Shifting from Qualitative to Quantitative Analyses. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2398-2416. [PMID: 36155147 PMCID: PMC9499741 DOI: 10.1016/j.ultrasmedbio.2022.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 05/27/2023]
Abstract
Lung ultrasound (LUS) has been increasingly expanding since the 1990s, when the clinical relevance of vertical artifacts was first reported. However, the massive spread of LUS is only recent and is associated with the coronavirus disease 2019 (COVID-19) pandemic, during which semi-quantitative computer-aided techniques were proposed to automatically classify LUS data. In this review, we discuss the state of the art in LUS, from semi-quantitative image analysis approaches to quantitative techniques involving the analysis of radiofrequency data. We also discuss recent in vitro and in silico studies, as well as research on LUS safety. Finally, conclusions are drawn highlighting the potential future of LUS.
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Affiliation(s)
- Federico Mento
- Department of Information Engineering and Computer Science, University of Trento, Trento, Italy
| | - Umair Khan
- Department of Information Engineering and Computer Science, University of Trento, Trento, Italy
| | - Francesco Faita
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Andrea Smargiassi
- Department of Cardiovascular and Thoracic Sciences, Pulmonary Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Riccardo Inchingolo
- Department of Cardiovascular and Thoracic Sciences, Pulmonary Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Libertario Demi
- Department of Information Engineering and Computer Science, University of Trento, Trento, Italy.
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Wiley BM, Zhou B, Pandompatam G, Zhou J, Kucuk HO, Zhang X. Lung Ultrasound Surface Wave Elastography for Assessing Patients With Pulmonary Edema. IEEE Trans Biomed Eng 2021; 68:3417-3423. [PMID: 33848239 DOI: 10.1109/tbme.2021.3072891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
B-Mode ultrasound insonation of lungs that are dense with extravascular lung water (EVLW) produces characteristic reverberation artifacts termed B-lines. The number of B-lines present demonstrates reasonable correlation to the amount of EVLW. However, analysis of B-line artifacts generated by this modality is semi-quantitative relying on visual interpretation, and as a result, can be subject to inter-observer variability. The purpose of this study was to translate the use of a novel, quantitative lung ultrasound surface wave elastography technique (LUSWE) into the bedside assessment of pulmonary edema in patients admitted with acute congestive heart failure. B-mode lung ultrasound and LUSWE assessment of the lungs were performed using anterior and lateral intercostal spaces in the supine patient. 14 patients were evaluated at admission with reassessment performed 1-2 days after initiation of diuretic therapy. Each exam recorded the total lung B-lines, lung surface wave speeds (at 100, 150, and 200 Hz) and net fluid balance. The patient cohort experienced effective diuresis (average net fluid balance of negative 2.1 liters) with corresponding decrease in pulmonary edema visualized by B-mode ultrasound (average decrease of 13 B-Lines). In addition, LUSWE demonstrated a statistically significant reduction in the magnitude of wave speed from admission to follow-up. The reduction in lung surface wave speed suggests a decrease in lung stiffness (decreased elasticity) mediated by successful reduction of pulmonary edema. In summary, LUSWE is a noninvasive technique for quantifying elastic properties of superficial lung tissue that may prove useful as a diagnostic test, performed at the bedside, for the quantitative assessment of pulmonary edema.
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Zhou B, Yang X, Zhang X, Curran WJ, Liu T. Ultrasound Elastography for Lung Disease Assessment. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:2249-2257. [PMID: 32970595 PMCID: PMC8544928 DOI: 10.1109/tuffc.2020.3026536] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/20/2020] [Indexed: 06/11/2023]
Abstract
Ultrasound elastography (US-E) is a noninvasive, safe, cost-effective and reliable technique to assess the mechanical properties of soft tissue and provide imaging biomarkers for pathological processes. Many lung diseases such as acute respiratory distress syndrome, chronic obstructive pulmonary disease, and interstitial lung disease are associated with dramatic changes in mechanical properties of lung tissues. Nevertheless, US-E is rarely used to image the lung because it is filled with air. The large difference in acoustic impedance between air and lung tissue results in the reflection of the ultrasound wave at the lung surface and, consequently, the loss of most ultrasound energy. In recent years, there has been an increasing interest in US-E applications in evaluating lung diseases. This article provides a comprehensive review of the technological advances of US-E research on lung disease diagnosis. We introduce the basic principles and major techniques of US-E and provide information on various applications in lung disease assessment. Finally, the potential applications of US-E to the diagnosis of COVID-19 pneumonia is discussed.
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Affiliation(s)
- Boran Zhou
- Department of Radiation OncologyEmory UniversityAtlantaGA30322USA
- Winship Cancer Institute, Emory UniversityAtlantaGA30322USA
| | - Xiaofeng Yang
- Department of Radiation OncologyEmory UniversityAtlantaGA30322USA
- Winship Cancer Institute, Emory UniversityAtlantaGA30322USA
| | | | - Walter J. Curran
- Department of Radiation OncologyEmory UniversityAtlantaGA30322USA
- Winship Cancer Institute, Emory UniversityAtlantaGA30322USA
| | - Tian Liu
- Department of Radiation OncologyEmory UniversityAtlantaGA30322USA
- Winship Cancer Institute, Emory UniversityAtlantaGA30322USA
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Zhang X, Zhou B, Zhang AX. A Pilot Study of Wet Lung Using Lung Ultrasound Surface Wave Elastography in an Ex Vivo Swine Lung Model. APPLIED SCIENCES (BASEL, SWITZERLAND) 2019; 9:3923. [PMID: 36016765 PMCID: PMC9400451 DOI: 10.3390/app9183923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Extravascular lung water (EVLW) is a basic symptom of congestive heart failure and other conditions. Computed tomography (CT) is standard to assess EVLW, but it requires ionizing radiation and radiology facilities. Lung ultrasound reverberation artifacts called B-lines have been used to assess EVLW. However, B-line artifact analysis relies on visual interpretation and subjects to inter-observer variability. We developed lung ultrasound surface wave elastography (LUSWE) to measure lung surface wave speed. This research aims to develop LUSWE to measure the change of lung surface wave speed due to lung water in an ex vivo swine lung model. The surface wave speeds of a fresh ex vivo swine lung were measured at four frequencies of 100 Hz, 200 Hz, 300 Hz, and 400 Hz. An amount of water was then filled into the lung through its trachea. Ultrasound imaging was used to guide the water filling until significant changes were visible on the imaging. The lung surface wave speeds were measured. An additional 120 ml of water was then filled into the lung. The lung surface wave speeds were then measured again. The results demonstrated that the lung surface wave speed decreased with respect to water content.
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Affiliation(s)
- Xiaoming Zhang
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Boran Zhou
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Alex X. Zhang
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA
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