Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1826
Mona Saeed El-Houshy, Essam Gouda Hassanein, Ayman Ibrahim Baess, Rania Ahmad Sweed, Doaa Mokhtar Emara, Ahmed Farag Abouelnour
Objective: To obtain a cut off value strain ratio using strain elastography (SE) to distinguish between benign and malignant peripheral lung lesions. Methods: We recruited 101 patients with peripheral lung lesions in cross-sectional study. Sensitivity, specificity, accuracy of a cut-off value, positive predicted value (PPV), and negative predicted value (NPV) are acquired at the end of the study. Results: We evaluated strain ratios done using strain elastography targeting reference region (Ref) vs region of interest (ROI) in patients who had already been diagnosed by biopsy, histological investigation, microbiological testing, or radiological imaging. In our study, a cut off value regarding strain ratio ≥ 1.75 is considered statistically significant as malignant lesion (p < 0.001). Conclusion: Using strain elastography, a peripheral parenchymal lung lesion can be classified as malignant based on the strain ratio. Table (1):Strain ratios in patients with benign and malignant lesions Table (2):Diagnostic performance for strain ratio to discriminate Malignant (n=59) from Benign (n =42)
{"title":"Difference in strain elastosonography between benign and malignant peripheral lung lesions","authors":"Mona Saeed El-Houshy, Essam Gouda Hassanein, Ayman Ibrahim Baess, Rania Ahmad Sweed, Doaa Mokhtar Emara, Ahmed Farag Abouelnour","doi":"10.1183/13993003.congress-2023.pa1826","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1826","url":null,"abstract":"<b>Objective:</b> To obtain a cut off value strain ratio using strain elastography (SE) to distinguish between benign and malignant peripheral lung lesions. <b>Methods:</b> We recruited 101 patients with peripheral lung lesions in cross-sectional study. Sensitivity, specificity, accuracy of a cut-off value, positive predicted value (PPV), and negative predicted value (NPV) are acquired at the end of the study. <b>Results:</b> We evaluated strain ratios done using strain elastography targeting reference region (Ref) vs region of interest (ROI) in patients who had already been diagnosed by biopsy, histological investigation, microbiological testing, or radiological imaging. In our study, a cut off value regarding strain ratio ≥ 1.75 is considered statistically significant as malignant lesion (p < 0.001). <b>Conclusion:</b> Using strain elastography, a peripheral parenchymal lung lesion can be classified as malignant based on the strain ratio. Table (1):Strain ratios in patients with benign and malignant lesions Table (2):Diagnostic performance for strain ratio to discriminate Malignant (n=59) from Benign (n =42)","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136194813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1816
Isabel Martínez González-Posada, Juan Cascón Hernández, Pablo Lozano Cuesta, Ramón Fernández Alvarez, Lucía García Alfonso, Francisco Julián López González, Miguel Ariza Prota, Inés Ruiz Álvarez, Ina Guerassimova, Ángela Lanza Martínez, Laura Martínez Vega, Juan Nieves Salceda, Laura Abad Chamorro, Eduardo Sanchez Vázquez, Patricia Álvarez Alvarez, Maria Rodil Riera
Introduction: Pulmonary Function Tests (PFT) are commonly used to monitor respiratory function in patients with Amyotrophic Lateral Sclerosis (ALS). However, these may be difficult to perform for patients with bulbar involvement or advanced stages of the disease. Aim: Our aim is to analyze the relationship between Diaphragmatic Ultrasound (DU) and PFT and to assess its utility to detect ventilatory failure and need for NIVM. Methods: We carried out a prospective study from January to November 2022 including ALS patients not under NIMV. They underwent a DU and PFT every 3 months. DU included: diaphragmatic excursion in sniff test (ExST) and deep breathing (ExDB); end-inhalation (IDT) and end-expiration (EDT) diaphragmatic thickness. Diaphragmatic thickness fraction (DTF) was calculated. PFT included: FVC seated and decubitus, maximum inhalatory pressure (MIP) and arterial blood gas analysis (ABG). NIMV indication was also analyzed. Results: Ten patients were included. A strong correlation was found between FVC and both IDT (r= 0,89, p= 0,003) and ExDB (r=0,9, p= 0,014). Also between MIP and both IDT (r=0,95, p=0,004) and EDT (r=0,92, p=0,008). Regarding ABG, strong reverse correlation was found between Base Excess (BE) and HCO3-, and DTF (r=-0,81, p= 0,004), ExDB (r=-0,8, p= 0,016), ExST (r=-0,74, p=0,015) and IDT (r=0,76, p=0,011). HCO3- inversely correlates with ExDB (r=-0,79, p=0,021), IDT (r=-0,77, p=0,009), DTF (r=-0,75, p=0,012) and ExST (r=-0,72, p=0,019). 30% of patients were unable to complete PFT due to bulbar affection. Conclusions: There is a significant correlation between PFT, ABG (FVC, MIP, BE and HCO3-) and DU. DU is useful in patients unable to perform PFT.
{"title":"Use of Diaphragmatic Ultrasound to evaluate respiratory function in patients with Amyotrophic Lateral Sclerosis","authors":"Isabel Martínez González-Posada, Juan Cascón Hernández, Pablo Lozano Cuesta, Ramón Fernández Alvarez, Lucía García Alfonso, Francisco Julián López González, Miguel Ariza Prota, Inés Ruiz Álvarez, Ina Guerassimova, Ángela Lanza Martínez, Laura Martínez Vega, Juan Nieves Salceda, Laura Abad Chamorro, Eduardo Sanchez Vázquez, Patricia Álvarez Alvarez, Maria Rodil Riera","doi":"10.1183/13993003.congress-2023.pa1816","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1816","url":null,"abstract":"<b>Introduction:</b> Pulmonary Function Tests (PFT) are commonly used to monitor respiratory function in patients with Amyotrophic Lateral Sclerosis (ALS). However, these may be difficult to perform for patients with bulbar involvement or advanced stages of the disease. <b>Aim:</b> Our aim is to analyze the relationship between Diaphragmatic Ultrasound (DU) and PFT and to assess its utility to detect ventilatory failure and need for NIVM. <b>Methods:</b> We carried out a prospective study from January to November 2022 including ALS patients not under NIMV. They underwent a DU and PFT every 3 months. DU included: diaphragmatic excursion in sniff test (ExST) and deep breathing (ExDB); end-inhalation (IDT) and end-expiration (EDT) diaphragmatic thickness. Diaphragmatic thickness fraction (DTF) was calculated. PFT included: FVC seated and decubitus, maximum inhalatory pressure (MIP) and arterial blood gas analysis (ABG). NIMV indication was also analyzed. <b>Results:</b> Ten patients were included. A strong correlation was found between FVC and both IDT (r= 0,89, p= 0,003) and ExDB (r=0,9, p= 0,014). Also between MIP and both IDT (r=0,95, p=0,004) and EDT (r=0,92, p=0,008). Regarding ABG, strong reverse correlation was found between Base Excess (BE) and HCO3-, and DTF (r=-0,81, p= 0,004), ExDB (r=-0,8, p= 0,016), ExST (r=-0,74, p=0,015) and IDT (r=0,76, p=0,011). HCO3- inversely correlates with ExDB (r=-0,79, p=0,021), IDT (r=-0,77, p=0,009), DTF (r=-0,75, p=0,012) and ExST (r=-0,72, p=0,019). 30% of patients were unable to complete PFT due to bulbar affection. <b>Conclusions:</b> There is a significant correlation between PFT, ABG (FVC, MIP, BE and HCO3-) and DU. DU is useful in patients unable to perform PFT.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136200490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1828
Søren Helbo Skaarup, Peter Juhl-Olsen, Brian Bridal Løgstrup
Introduction: The diaphragm is the most important respiratory muscle and dysfunction ultimately leads to respiratory failure. Numerous conditions may affect its function. Evaluation of diaphragm function is cumbersome. Fluoroscopy has been used in many years to measure excursion. Ultrasound can visualize diaphragm excursion and holds many advantages due to is portability and accessibility. However, correlation between fluoroscopy and ultrasound has never been studied. Aims: We aimed to compare fluoroscopy and ultrasound measures of diaphragm excursion to study if ultrasound can replace fluoroscopy. Methods: In patients with COPD or heart failure and in volunteers ultrasound and fluoroscopy was done simultaneously during sniff inspiration and in inspiratory capacity. Cranio-caudal excursion was measured om fluoroscopy recordings and compared directly to M-mode excursion, B-mode excursion, area change, resting thickness, thickening fraction and contraction velocity measured by ultrasound. Results: Forty-two participants were recruited. Pearson´s correlation between M-mode and fluoroscopy excursion was 0.61. The slope was 0.9 (90%CI 0.76 – 1.04) in a regression analysis. Using Bland-Altman method the bias was -0.39 cm (95%CI -1.04 – 0.26), p=0.24 with an error estimate on 3.8%. The correlations were lower during sniff inspiration the in inspiratory capacity breathing. Conclusion: Ultrasound has acceptable and low bias compared to fluoroscopy and can replace it as the primary tool to evaluate diaphragm excursion.
{"title":"Replacing fluoroscopy with ultrasound to evaluate diaphragm excursion? A method comparative study.","authors":"Søren Helbo Skaarup, Peter Juhl-Olsen, Brian Bridal Løgstrup","doi":"10.1183/13993003.congress-2023.pa1828","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1828","url":null,"abstract":"<b>Introduction:</b> The diaphragm is the most important respiratory muscle and dysfunction ultimately leads to respiratory failure. Numerous conditions may affect its function. Evaluation of diaphragm function is cumbersome. Fluoroscopy has been used in many years to measure excursion. Ultrasound can visualize diaphragm excursion and holds many advantages due to is portability and accessibility. However, correlation between fluoroscopy and ultrasound has never been studied. <b>Aims:</b> We aimed to compare fluoroscopy and ultrasound measures of diaphragm excursion to study if ultrasound can replace fluoroscopy. <b>Methods:</b> In patients with COPD or heart failure and in volunteers ultrasound and fluoroscopy was done simultaneously during sniff inspiration and in inspiratory capacity. Cranio-caudal excursion was measured om fluoroscopy recordings and compared directly to M-mode excursion, B-mode excursion, area change, resting thickness, thickening fraction and contraction velocity measured by ultrasound. <b>Results:</b> Forty-two participants were recruited. Pearson´s correlation between M-mode and fluoroscopy excursion was 0.61. The slope was 0.9 (90%CI 0.76 – 1.04) in a regression analysis. Using Bland-Altman method the bias was -0.39 cm (95%CI -1.04 – 0.26), p=0.24 with an error estimate on 3.8%. The correlations were lower during sniff inspiration the in inspiratory capacity breathing. <b>Conclusion:</b> Ultrasound has acceptable and low bias compared to fluoroscopy and can replace it as the primary tool to evaluate diaphragm excursion.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136200714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: During the use of CPAP ( Continuos Positive Airway Pressure), with contained pressures, the excursion of the diaphragm tends to increase. Conversely during NIMV ( Non Invasive Mechanical Ventilation ), with the increase in pressure support, there is a decrease in work of breathing (WOB) and in diaphragm excursion. Aims: The purpose of the study was to evaluate whether diaphragm sonography could be a useful aid to promote adaptation during the ventilation of patients in CPAP or NIV who have difficulty on accepting this treatment. Methods: We studied the diaphragmatic excursion of 20 patients using a portable sonography with a convex probe from 1 to 5 MgHz. The patient9s position was generally supine at 45°. The probe was placed in the right subcostal position (the window of the liver is larger than that of the spleen). The patient breathes spontaneously and the machine record the excursion from the maximum inspiratory point to the lowest expiratory point. The monitor was turned towards the patient9s face so he can see what happens during each breath.Subsequently the patient was vented with nasal or oronasal mask and the measurement was remade during CPAP/NIMV ventilation. The modification, breath on breath, of the diaphragmatic excursions, seen by the patient live, facilitated the approach to the use of the ventilatory device. Results: All 20 patients evaluated with this method accepted more easily to use the ventilator device. Conclusion: The Diaphragm sonography can be an excellent, safe, fast, not expensive method to be performed, at the patient9s bed, to reinforce an respiratory educational program in patient9s with problem9s of adaptation to CPAP/NIMV ventilation.
{"title":"Diaphragm sonography as an educational aid in CPAP and NIMV treatment","authors":"Angelo Longoni, Carla Bassino, Tiziana Cappelletti, Francesca Frassanito, Lorenza Fusetti, Giacomo Concas, Mariele Vago, Antonio Paddeu","doi":"10.1183/13993003.congress-2023.pa1822","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1822","url":null,"abstract":"<b>Background:</b> During the use of CPAP ( Continuos Positive Airway Pressure), with contained pressures, the excursion of the diaphragm tends to increase. Conversely during NIMV ( Non Invasive Mechanical Ventilation ), with the increase in pressure support, there is a decrease in work of breathing (WOB) and in diaphragm excursion. <b>Aims:</b> The purpose of the study was to evaluate whether diaphragm sonography could be a useful aid to promote adaptation during the ventilation of patients in CPAP or NIV who have difficulty on accepting this treatment. <b>Methods:</b> We studied the diaphragmatic excursion of 20 patients using a portable sonography with a convex probe from 1 to 5 MgHz. The patient9s position was generally supine at 45°. The probe was placed in the right subcostal position (the window of the liver is larger than that of the spleen). The patient breathes spontaneously and the machine record the excursion from the maximum inspiratory point to the lowest expiratory point. The monitor was turned towards the patient9s face so he can see what happens during each breath.Subsequently the patient was vented with nasal or oronasal mask and the measurement was remade during CPAP/NIMV ventilation. The modification, breath on breath, of the diaphragmatic excursions, seen by the patient live, facilitated the approach to the use of the ventilatory device. <b>Results:</b> All 20 patients evaluated with this method accepted more easily to use the ventilator device. <b>Conclusion:</b> The Diaphragm sonography can be an excellent, safe, fast, not expensive method to be performed, at the patient9s bed, to reinforce an respiratory educational program in patient9s with problem9s of adaptation to CPAP/NIMV ventilation.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136195397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1833
Niamh Boyle, Jack Mccarthy, Caitlyn Paclibar, Colm Quigley
Appropriate use of thoracic ultrasound (TUS) reduces the risk of iatrogenic complications from pleural procedures in comparison with unguided intervention(1). The ERS has introduced a TUS certification programme in order to improve thoracic ultrasound competency. This retrospective review compared ultrasound-guided thoracocentesis with non-ultrasound guided thoracocentesis in a level 3 hospital with regards to diagnostic yield and complication rate. Ultrasound-guided procedures were defined as being performed by trainees with ERS TUS certification. Thoracocentesis performed after being marked by radiology were defined as non-ultrasound guided. Chest radiograph was reviewed to determine pneumothorax rate. Lights criteria and pleural cytology were reviewed to determine diagnostic yield. 20 patients were reviewed; 10 who underwent thoracocentesis with TUS and 10 patients without TUS guidance. Pneumothorax occurred in 5 patients without TUS guidance compared with no occurrence when TUS was used. There was no occurrence of bleeding in either group. In the ultrasound group, pleural fluid was sent for light’s criteria and cytology in all cases. In the non-ultrasound group, pleural fluid was sent for light’s criteria in 70% of cases and cytology in 60%. This review highlights the importance of ultrasound competency training for trainees in reducing the risk of pneumothorax and improving the diagnostic yield for our patients. 1. McCracken DJ, Laursen CB, Barker G, Gleeson FV, Cullen KM, Rahman NM. Thoracic ultrasound competence for ultrasound-guided pleural procedures. European Respiratory Review. 2019;28(154):190090.
{"title":"Comparison of diagnostic yield and complications in ultrasound-guided thoracocentesis versus non-ultrasound guided thoracocentesis in a Level 3 Hospital","authors":"Niamh Boyle, Jack Mccarthy, Caitlyn Paclibar, Colm Quigley","doi":"10.1183/13993003.congress-2023.pa1833","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1833","url":null,"abstract":"Appropriate use of thoracic ultrasound (TUS) reduces the risk of iatrogenic complications from pleural procedures in comparison with unguided intervention(1). The ERS has introduced a TUS certification programme in order to improve thoracic ultrasound competency. This retrospective review compared ultrasound-guided thoracocentesis with non-ultrasound guided thoracocentesis in a level 3 hospital with regards to diagnostic yield and complication rate. Ultrasound-guided procedures were defined as being performed by trainees with ERS TUS certification. Thoracocentesis performed after being marked by radiology were defined as non-ultrasound guided. Chest radiograph was reviewed to determine pneumothorax rate. Lights criteria and pleural cytology were reviewed to determine diagnostic yield. 20 patients were reviewed; 10 who underwent thoracocentesis with TUS and 10 patients without TUS guidance. Pneumothorax occurred in 5 patients without TUS guidance compared with no occurrence when TUS was used. There was no occurrence of bleeding in either group. In the ultrasound group, pleural fluid was sent for light’s criteria and cytology in all cases. In the non-ultrasound group, pleural fluid was sent for light’s criteria in 70% of cases and cytology in 60%. This review highlights the importance of ultrasound competency training for trainees in reducing the risk of pneumothorax and improving the diagnostic yield for our patients. 1. McCracken DJ, Laursen CB, Barker G, Gleeson FV, Cullen KM, Rahman NM. Thoracic ultrasound competence for ultrasound-guided pleural procedures. European Respiratory Review. 2019;28(154):190090.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136200893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1824
Rune Wiig, Casper Falster, Niels Jacobsen, Stefan Posth, August Emil Licht, Christian Laursen
Aims: Ultrasound is a valuable diagnostic tool in the diagnostic work-up of dyspnea and can identify even small pleural effusions. Incorporating Shear Wave Elastography (SWE) represents a possible tool in stratifying pleural effusions by risk of underlying malignancy. No previous studies have been conducted in an emergency department (ED), where it might have a clinical impact by hastening referral for diagnostic work-up of underlying malignancy. The aim of this study was to appraise the diagnostic accuracy of ultrasonographic findings associated with thoracic malignancy, as well as calculating optimal cut-off values for SWE in this regard. Methods: Patients with unilateral pleural effusion of unknown origin were included in the ED and subjected to a Focused Lung Ultrasound (FLUS) scan during their first 48 hours after admittance. Two index tests were applied: i) traditional 2D FLUS examination registering presence of diaphragmatic noduli, pleural thickenings and other findings associated with malignancy, and ii) a SWE examination of different Regions of Interest. Reference test was defined as subsequent diagnosis of malignant pleural effusion (MPE) in the three months following inclusion. Results: 39 patients were included. The 2D index test yielded a sensitivity of 28.57% (95%CI 3.67-70.96%) and a specificity of 90.62% (95%CI 74.98%-98.02%). The SWE max of intercostal space yielded a sensitivity of 100% (95%CI 47.82-100%) and a specificity of 59.09% (95%CI 36.35%-79.29%). Conclusion: FLUS with integrated SWE may aid in identifying MPE9s and improving referral to diagnostic work-up of underlying malignancy. Larger adequately powered studies are warranted.
{"title":"Diagnostic accuracy of lung ultrasound with elastography in predicting malignant origin of pleural effusions in an emergency department","authors":"Rune Wiig, Casper Falster, Niels Jacobsen, Stefan Posth, August Emil Licht, Christian Laursen","doi":"10.1183/13993003.congress-2023.pa1824","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1824","url":null,"abstract":"<b>Aims:</b> Ultrasound is a valuable diagnostic tool in the diagnostic work-up of dyspnea and can identify even small pleural effusions. Incorporating Shear Wave Elastography (SWE) represents a possible tool in stratifying pleural effusions by risk of underlying malignancy. No previous studies have been conducted in an emergency department (ED), where it might have a clinical impact by hastening referral for diagnostic work-up of underlying malignancy. The aim of this study was to appraise the diagnostic accuracy of ultrasonographic findings associated with thoracic malignancy, as well as calculating optimal cut-off values for SWE in this regard. <b>Methods:</b> Patients with unilateral pleural effusion of unknown origin were included in the ED and subjected to a Focused Lung Ultrasound (FLUS) scan during their first 48 hours after admittance. Two index tests were applied: i) traditional 2D FLUS examination registering presence of diaphragmatic noduli, pleural thickenings and other findings associated with malignancy, and ii) a SWE examination of different Regions of Interest. Reference test was defined as subsequent diagnosis of malignant pleural effusion (MPE) in the three months following inclusion. <b>Results:</b> 39 patients were included. The 2D index test yielded a sensitivity of 28.57% (95%CI 3.67-70.96%) and a specificity of 90.62% (95%CI 74.98%-98.02%). The SWE max of intercostal space yielded a sensitivity of 100% (95%CI 47.82-100%) and a specificity of 59.09% (95%CI 36.35%-79.29%). <b>Conclusion:</b> FLUS with integrated SWE may aid in identifying MPE9s and improving referral to diagnostic work-up of underlying malignancy. Larger adequately powered studies are warranted.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136201157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1830
Gang Hou, Jieru Lin, Mingming Deng
Background: Airway dimension measurements are an important component of treatment efficacy assessment and longitudinal follow-up in patients with subglottic stenosis (SGS) and tracheal stenosis. However, noninvasive, nonradioactive method is lack to assess the degree of stenosis. Methods: In this study, volunteers and patients with a diagnosis of SGS underwent point-of-care ultrasonography (POCUS), CT and flexible bronchoscopy. Radiologist determined the anteroposterior and transverse diameters of the trachea on the CT image and calculated the mean value (CT-mean). Air column width (ACW) and anterior tracheal wall thickness (ATWT) were obtained from POCUS, and the diameter of the subglottic and cervical trachea calculated using the radius of curvature (CR) formula. Results: A total of 123 volunteers without tracheal disease and 15 patients with SGS were enrolled. Both in control group and patients with SGS, there is a strong correlation between US-CR and CT-mean (r =0.96 and 0.98, P <0.001, respectively). The diameter of subglottic and cervical trachea assessed by US-CR is more accurate than the direct measurement of US-ACW. The intraobserver and interobserver repeatability of US-CR was excellent (all correlation coefficients > 0.95; P < 0.05). In patients with SGS, the degree of stenosis determined by US-ATWT correlate best with the CT-ATWT with coefficients of 0.98 (P<0.001), while a moderate correlation was observed between methods for ATWT (r = 0.65, P<0.001) in control group. Conclusion: The airway dimension measured using POCUS based on the radius of the curvature is a reliable tool for assessing the subglottic and cervical tracheal diameters.
{"title":"Point-of-care ultrasound for the assessment of subglottic and cervical tracheal stenosis: A Prospective, Multicenter, Exploratory Study","authors":"Gang Hou, Jieru Lin, Mingming Deng","doi":"10.1183/13993003.congress-2023.pa1830","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1830","url":null,"abstract":"<b>Background:</b> Airway dimension measurements are an important component of treatment efficacy assessment and longitudinal follow-up in patients with subglottic stenosis (SGS) and tracheal stenosis. However, noninvasive, nonradioactive method is lack to assess the degree of stenosis. <b>Methods:</b> In this study, volunteers and patients with a diagnosis of SGS underwent point-of-care ultrasonography (POCUS), CT and flexible bronchoscopy. Radiologist determined the anteroposterior and transverse diameters of the trachea on the CT image and calculated the mean value (CT-mean). Air column width (ACW) and anterior tracheal wall thickness (ATWT) were obtained from POCUS, and the diameter of the subglottic and cervical trachea calculated using the radius of curvature (CR) formula. <b>Results:</b> A total of 123 volunteers without tracheal disease and 15 patients with SGS were enrolled. Both in control group and patients with SGS, there is a strong correlation between US-CR and CT-mean (r =0.96 and 0.98, P <0.001, respectively). The diameter of subglottic and cervical trachea assessed by US-CR is more accurate than the direct measurement of US-ACW. The intraobserver and interobserver repeatability of US-CR was excellent (all correlation coefficients > 0.95; P < 0.05). In patients with SGS, the degree of stenosis determined by US-ATWT correlate best with the CT-ATWT with coefficients of 0.98 (P<0.001), while a moderate correlation was observed between methods for ATWT (r = 0.65, P<0.001) in control group. <b>Conclusion:</b> The airway dimension measured using POCUS based on the radius of the curvature is a reliable tool for assessing the subglottic and cervical tracheal diameters.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"175 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136194597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1831
Yao-Wen Kuo, Yen-Lin Chen, Huey-Dong Wu, Hao-Chien Wang
Purpose: This study used shear-wave ultrasound elastography to measure the stiffness of pleural lesions. The research hypothesis is that shear-wave elastography can add the elasticity information of the pleural lesions and help in the diagnosis of pleural diseases. Methods: This prospective observational study included one derivation cohort from May 2018 to Oct 2021 and one validation cohort from Nov 2021 to Aug 2022. The inclusion criterion was patients with radiographic evidence of pleural lesions or pleural effusion. We used the Toshiba Aplio 500 Platinum Ultrasound Machine to locate the pleural lesions and measure the elasticity of the pleural lesions. Diagnoses were made based on microbiological studies, pathology of pleural effusion or pleura, or following up the clinical course for at least 6 months. Results: A total of 210 patients with pleural lesions were included. The mean elasticity of the malignant pleural lesions was significantly higher than that of the benign pleural lesions (91.9 vs. 61.2 kPa, p< 0.001). Among the 103 patients in the derivation cohort, a receiver operating characteristic curve was constructed and the cut-off point to differentiate benign from malignant lesions was 60.2 kPa with an accuracy of 72.7% (sensitivity 81.3%, specificity 57.1%, and area under the ROC curve 0.69). Among the 107 patients in the validation cohort, the diagnostic performance was maintained with an accuracy of 73.8%. Conclusions: This study validated the use of shear-wave ultrasound elastography for assessing pleural malignancy. Additional studies using shear-wave elastography-guided pleural biopsy are warranted to further investigate the diagnostic yield.
目的:本研究采用剪切波超声弹性成像测量胸膜病变的刚度。研究假设横波弹性成像可以增加胸膜病变的弹性信息，有助于胸膜疾病的诊断。方法:本前瞻性观察研究包括2018年5月至2021年10月的一个衍生队列和2021年11月至2022年8月的一个验证队列。纳入标准是胸膜病变或胸膜积液的影像学证据。我们使用东芝Aplio 500白金超声机定位胸膜病变并测量胸膜病变的弹性。诊断依据微生物学检查、胸腔积液或胸膜病理，或随访临床病程至少6个月。结果:共纳入210例胸膜病变患者。恶性胸膜病变的平均弹性明显高于良性胸膜病变(91.9 vs 61.2 kPa, p<0.001)。在衍生队列的103例患者中，构建了接受者工作特征曲线，区分良恶性病变的截断点为60.2 kPa，准确率为72.7%(敏感性81.3%，特异性57.1%，ROC曲线下面积0.69)。在验证队列中的107例患者中，诊断性能保持在73.8%的准确率。结论:本研究证实了剪切波超声弹性成像在评估胸膜恶性肿瘤中的应用。使用剪切波弹性成像引导胸膜活检的进一步研究是有必要的，以进一步研究诊断率。
{"title":"Validation of transthoracic shear-wave ultrasound elastography in diagnosing pleural lesions","authors":"Yao-Wen Kuo, Yen-Lin Chen, Huey-Dong Wu, Hao-Chien Wang","doi":"10.1183/13993003.congress-2023.pa1831","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1831","url":null,"abstract":"<b>Purpose:</b> This study used shear-wave ultrasound elastography to measure the stiffness of pleural lesions. The research hypothesis is that shear-wave elastography can add the elasticity information of the pleural lesions and help in the diagnosis of pleural diseases. <b>Methods:</b> This prospective observational study included one derivation cohort from May 2018 to Oct 2021 and one validation cohort from Nov 2021 to Aug 2022. The inclusion criterion was patients with radiographic evidence of pleural lesions or pleural effusion. We used the Toshiba Aplio 500 Platinum Ultrasound Machine to locate the pleural lesions and measure the elasticity of the pleural lesions. Diagnoses were made based on microbiological studies, pathology of pleural effusion or pleura, or following up the clinical course for at least 6 months. <b>Results:</b> A total of 210 patients with pleural lesions were included. The mean elasticity of the malignant pleural lesions was significantly higher than that of the benign pleural lesions (91.9 vs. 61.2 kPa, p< 0.001). Among the 103 patients in the derivation cohort, a receiver operating characteristic curve was constructed and the cut-off point to differentiate benign from malignant lesions was 60.2 kPa with an accuracy of 72.7% (sensitivity 81.3%, specificity 57.1%, and area under the ROC curve 0.69). Among the 107 patients in the validation cohort, the diagnostic performance was maintained with an accuracy of 73.8%. <b>Conclusions:</b> This study validated the use of shear-wave ultrasound elastography for assessing pleural malignancy. Additional studies using shear-wave elastography-guided pleural biopsy are warranted to further investigate the diagnostic yield.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136201209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1814
Pia Iben Pietersen, Rahul Bhatnagar, Freja Andreasen, Lars Konge, Christian Laursen, Najib M. Rahman, Anders B. Nielsen
Background: Clinicians increasingly use thoracic ultrasound in several settings due to its high diagnostic accuracy for many common causes of respiratory failure and dyspnoea. However, ultrasound examinations are operator-dependent, and sufficient competences are needed to obtain high diagnostic accuracy and to attain the ability to interpret the images and integrate them into the patient history and other examinations. This study aims to explore and gather validity evidence for the 2022 ERS thoracic ultrasound objective structured clinical examination (OSCE). Methods: An expert panel created the test, which included two theoretical and three practical stations comprising cases with diagnoses which can be established by point-of-care thoracic ultrasound. Twenty-five participants with different levels of experience thoracic ultrasound completed the test. Data from the test scores and questionnaires on participants’ experiences were used for item analysis. Validation was done according to Messick’s framework. The contrasting groups9 standard-setting method was used to establish a pass/fail score. Results: The summarised internal consistency reliability was high with a Cronbach’s alpha=0.83. The novice group (n=4) had a mean test score of 26.9±10.0 points, the intermediate group (n=8) scored 55.2±5.8 points, and the experienced group (n=13) 62.0±6.1 points (one-way ANOVA, p<0.001). A pass/fail score of 48 points was thus derived (maximum score =75 points). Conslusion: We developed a test for the assessment thoracic ultrasound competences with solid validity evidence, and a pass/fail standard with no false positives or false negatives.
{"title":"Validity evidence of the 2022 ERS thoracic ultrasound Objective Structured Clinical Examination (OSCE)","authors":"Pia Iben Pietersen, Rahul Bhatnagar, Freja Andreasen, Lars Konge, Christian Laursen, Najib M. Rahman, Anders B. Nielsen","doi":"10.1183/13993003.congress-2023.pa1814","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1814","url":null,"abstract":"<b>Background:</b> Clinicians increasingly use thoracic ultrasound in several settings due to its high diagnostic accuracy for many common causes of respiratory failure and dyspnoea. However, ultrasound examinations are operator-dependent, and sufficient competences are needed to obtain high diagnostic accuracy and to attain the ability to interpret the images and integrate them into the patient history and other examinations. This study aims to explore and gather validity evidence for the 2022 ERS thoracic ultrasound objective structured clinical examination (OSCE). <b>Methods:</b> An expert panel created the test, which included two theoretical and three practical stations comprising cases with diagnoses which can be established by point-of-care thoracic ultrasound. Twenty-five participants with different levels of experience thoracic ultrasound completed the test. Data from the test scores and questionnaires on participants’ experiences were used for item analysis. Validation was done according to Messick’s framework. The contrasting groups9 standard-setting method was used to establish a pass/fail score. <b>Results:</b> The summarised internal consistency reliability was high with a Cronbach’s alpha=0.83. The novice group (n=4) had a mean test score of 26.9±10.0 points, the intermediate group (n=8) scored 55.2±5.8 points, and the experienced group (n=13) 62.0±6.1 points (one-way ANOVA, p<0.001). A pass/fail score of 48 points was thus derived (maximum score =75 points). <b>Conslusion:</b> We developed a test for the assessment thoracic ultrasound competences with solid validity evidence, and a pass/fail standard with no false positives or false negatives.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136193688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1817
Bruno S. Silva, Beatriz Ferraz, Filipa Correia, Maria Inês Costa, Maria Esteves Brandão, Nuno Cortesão
Introduction: Lung ultrasound (LUS) performed by non-radiologist doctors has evolved over the last few decades, placing it as a useful diagnostic, prognostic and monitoring bedside tool in patients with respiratory disease. Despite its proven clinical applications, LUS training has not been standardized in Portugal. Objetctives: To characterize LUS learning processes and clinical usage amongst portuguese pulmonologists as well as to assess future needs. Methods: From August to November 2022 an online survey was sent to all members of the Portuguese Pulmonology Society. Degrees of confidence were assessed through Likert scales. Pearson’s chi-squared test and non-parametric tests were used. Outcomes were considered statistically significant if the probability of error was below 5% (p < 0.05). Results: 114 valid answers were obtained. Most responders (81%) had LUS training and 22% had attended other ultrasound-related courses. The majority had an ultrasound machine available. However, only 17% performed LUS > 3 times per week. Overall confidence in LUS usage for diagnostic purpose (median: 7/10), disease monitoring (median: 7/10) and support of invasive procedures (median: 8/10) were high. There was a significant relation between higher levels of confidence and regularly attending LUS courses and performing LUS > 3 times per week. The main reasons preventing regular use of LUS were availability/cost of courses, availability/cost of equipment and lack of time. Conclusions: Physician`s confidence degree on ultrasound utility is related to regular LUS training as well as regular usage. Costs involved with LUS training hamper its wider use.
{"title":"Survey on lung ultrasound usage by portuguese pulmonologists","authors":"Bruno S. Silva, Beatriz Ferraz, Filipa Correia, Maria Inês Costa, Maria Esteves Brandão, Nuno Cortesão","doi":"10.1183/13993003.congress-2023.pa1817","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1817","url":null,"abstract":"<b>Introduction:</b> Lung ultrasound (LUS) performed by non-radiologist doctors has evolved over the last few decades, placing it as a useful diagnostic, prognostic and monitoring bedside tool in patients with respiratory disease. Despite its proven clinical applications, LUS training has not been standardized in Portugal. <b>Objetctives:</b> To characterize LUS learning processes and clinical usage amongst portuguese pulmonologists as well as to assess future needs. <b>Methods:</b> From August to November 2022 an online survey was sent to all members of the Portuguese Pulmonology Society. Degrees of confidence were assessed through Likert scales. Pearson’s chi-squared test and non-parametric tests were used. Outcomes were considered statistically significant if the probability of error was below 5% (p < 0.05). <b>Results:</b> 114 valid answers were obtained. Most responders (81%) had LUS training and 22% had attended other ultrasound-related courses. The majority had an ultrasound machine available. However, only 17% performed LUS > 3 times per week. Overall confidence in LUS usage for diagnostic purpose (median: 7/10), disease monitoring (median: 7/10) and support of invasive procedures (median: 8/10) were high. There was a significant relation between higher levels of confidence and regularly attending LUS courses and performing LUS > 3 times per week. The main reasons preventing regular use of LUS were availability/cost of courses, availability/cost of equipment and lack of time. <b>Conclusions:</b> Physician`s confidence degree on ultrasound utility is related to regular LUS training as well as regular usage. Costs involved with LUS training hamper its wider use.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136194438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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