title: Integrated Use of Lung Ultrasound and Chest X-Ray in the Detection of Interstitial Lung Disease.
abstract: BACKGROUND
  Current data have shown that lung ultrasound (LUS) may be useful in the detection of interstitial lung disease (ILD) by the evaluation of B-lines, the sonographic marker of pulmonary interstitial syndrome. Nevertheless, no prospective study has compared LUS to chest X-ray (CXR) for ILD assessment, and there is no general agreement on the specific echographic diagnostic criteria for defining ILD.
  
  
  OBJECTIVE
  The aims of this study were (1) to compare the accuracy of LUS and CXR in the detection of ILD using high-resolution CT (HRCT) as the gold standard and (2) to compare the accuracy of different echographic diagnostic criteria for ILD diagnosis.
  
  
  METHODS
  LUS was performed on 104 patients undergoing HRCT for suspected ILD. In 49 patients, a CXR scan performed within 3 months of HRCT was analyzed. ILD was defined as the presence of ≥5 B-lines in ≥3 chest areas. A total B-line score (TBLS) was also calculated, as in previous studies. The observers evaluating LUS and CXR were blinded to the HRCT results and clinical data.
  
  
  RESULTS
  On HRCT, ILD was assessed in 50 patients. CXR was specific (91%; 95% CI 80-100) but not sensitive (48%; 95% CI 28-67). Conversely, LUS showed high sensitivity (92%; 95% CI 84-99) and low specificity (79%; 95% CI 69-90). Using a TBLS, sensitivity did not change, while specificity decreased.
  
  
  CONCLUSIONS
  LUS could be a sensitive tool for ILD detection. CXR and LUS have different but complementary features, and their combined use could reduce the need for HRCT. The use of different diagnostic criteria for defining ILD does not affect sensitivity but influences specificity.
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Vizioli
authors.forename: Federica
authors.initials: F
authors.lastname: Ciccarese
authors.forename: Paola
authors.initials: P
authors.lastname: Forti
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Chiesa
authors.forename: Marco
authors.initials: M
authors.lastname: Giovagnoli
authors.forename: Martina
authors.initials: M
authors.lastname: Mughetti
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zompatori
authors.forename: Marco
authors.initials: M
authors.lastname: Zoli
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography