title: Utility of a simplified ultrasound assessment to assess interstitial pulmonary fibrosis in connective tissue disorders--preliminary results.
abstract: BACKGROUND
  Interstitial pulmonary fibrosis (IPF) is a frequent manifestation in patients with connective tissue disorders (CTD). Recently the ultrasound (US) criterion validity for its assessment has been proposed; however, the US scoring systems adopted include the study of several lung intercostal spaces (LIS), which could be time-consuming in daily clinical practice. The aim of this study was to investigate the utility of a simplified US B-lines scoring system compared with both the US comprehensive assessment and the high-resolution computed tomography (HRCT) findings of IPF in CTD patients.
  
  
  METHODS
  Thirty-six patients with a diagnosis of CTD were enrolled. Each patient underwent chest HRCT and lung US by an experienced radiologist and rheumatologist, respectively. Both comprehensive and simplified US B-lines assessments were scanned. The comprehensive US assessment was performed at 50 LIS level, whereas the simplified US assessment included bilaterally 14 LIS; for the anterior chest: the second LIS along the para-sternal lines, the fourth LIS along the mid-clavear, anterior axillary and mid-axillary lines; for the posterior chest: the eighth LIS along the paravertebral, sub-scapular and posterior axillary lines. For criterion validity, HRCT was considered the gold standard. Feasibility, inter and intra-observer reliability was also investigated.
  
  
  RESULTS
  A highly significant correlation between comprehensive and simplified US assessment was found (P = 0.0001). A significant correlation was also found between the simplified US assessment and HRCT findings (P = 0.0006). Kappa values for the inter-observer simplified US assessment were in a range from 0.769 to 0.885, whereas the concordance correlation coefficient values for the intra-observer were from 0.856 to 0.955. There was a relevant difference in time spent on comprehensive (mean 23.3 ± SD 4.5 minutes) with respect to the simplified US assessment (mean 8.6 ± SD 1.4) (P < 0.00001).
  
  
  CONCLUSIONS
  Our results provide a new working hypothesis in favor of the utility of a simplified US B-lines assessment as an adjunct method to assess IPF in patients with CTD.
authors.affiliation: Clinica Reumatologica, Via dei Colli 52, 60035, Università Politecnica delle Marche, Jesi,Ancona, Italy. dr.gmarwin@gmail.com
authors.forename: Marwin
authors.initials: M
authors.lastname: Gutierrez
authors.forename: Fausto
authors.initials: F
authors.lastname: Salaffi
authors.forename: Marina
authors.initials: M
authors.lastname: Carotti
authors.forename: Marika
authors.initials: M
authors.lastname: Tardella
authors.forename: Carlos
authors.initials: C
authors.lastname: Pineda
authors.forename: Chiara
authors.initials: C
authors.lastname: Bertolazzi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Bichisecchi
authors.forename: Emilio
authors.initials: E
authors.lastname: Filippucci
authors.forename: Walter
authors.initials: W
authors.lastname: Grassi
mesh_terms: D000328:Adult; D000368:Aged; D003240:Connective Tissue Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging* / Q000209:etiology; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult