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Identifier 000413042
Title Διαθωρακική υπερηχοτομογραφία πνευμόνων σε ασθενείς με ιδιοπαθή πνευμονική ίνωση : συσχέτιση με τα ευρήματα της υψηλής ευκρίνειας αξονικής τομογραφίας θώρακος και συγκριτική αξιολόγηση νέων απεικονιστικών πρωτοκόλλων.
Alternative Title Transthoracic lung ultrasonography in patients with idiopathic pulmonary fibrosis
Author Βασσάλου, Ευαγγελία Ε.
Thesis advisor Καραντάνας, Απόστολος
Reviewer Γεωργόπουλος, Δημήτριος
Αντωνίου Αικατερίνη
Σιδηρόπουλος, Πρόδρομος
Ραϊσάκη Μαρία
Μπερτσιάς, Γεώργιος
Σχίζα, Σοφία
Abstract Objectives: The objectives of the present study were to (i) investigate a potential correlation between transthoracic lung ultrasound (US) findings and high-resolution computed tomography (HRCT), (ii) to compare a comprehensive lung US protocol in two different patient positions (sitting/supine and lateral decubitus) with regard to feasibility, duration, patient convenience and assessment of B-lines, using HRCT as a reference standard and (iii) to compare a simplified US protocol in two different patient positions (sitting and lateral decubitus) with the same-positioned comprehensive US assessments and HRCT findings, in patients with idiopathic pulmonary fibrosis (IPF). Methods: Twenty-five consecutive patients with an established IPF diagnosis according to international guidelines were prospectively enrolled and examined in two sessions. During session 1, patients were examined twice with a 56-lung intercostal space (LIS) US protocol, in the supine/sitting (comprehensive protocol 1) and lateral decubitus (comprehensive protocol 2) positions. During session 2, patients were evaluated twice with a 16-LIS US protocol, in sitting (simplified protocol 1) and left/right lateral decubitus (simplified protocol 2) positions. The 16-LIS were chosen based on the prevalence of IPF-related changes on HRCT. For each patient, the sum of B-lines counted in all LIS during comprehensive protocol 1, comprehensive protocol 2, simplified protocol 1 and simplified protocol 2, formed the comprehensive US score 1 (cUS score 1), comprehensive US score 2 (cUS score 2), simplified US score 1 (sUS score 1) and simplified US score 2 (sUS score 2), respectively. HRCTrelated Warrick scores (WS) were compared to US scores. The duration of each protocol was recorded in minutes. All patients were questioned about their preference for comprehensive protocol 1 versus comprehensive protocol 2 and simplifiedprotocol 1 versus simplified protocol 2, in terms of convenience. The interobserver and intraobserver variability were assessed for comprehensive and simplified protocols. Results: Twenty-five patients (19 males, 6 females; mean age ± SD: 69.8 ± 7.56 years; age range: 55-83 years) were included. Mean WS was 18 (SD 4.72). A total of 1.400 LIS was assessed, for each comprehensive US protocol with four exceptions: the examination of the left 4th LIS along the parasternal line in one patient, the examination of the left 3rd and 4th LIS along the parasternal line in another patient and the depiction of the left 11th LIS along the paravertebral line in a third patient. A total of 400 LIS was evaluated for each simplified US protocol with one exception: the depiction of the left 11th LIS along the paravertebral line. A significant correlation was found between all US scores and Warrick scores (P&llllllt;.0001). The cUS scores 2 and sUS scores 2 showed slight higher correlation with Warrick scores compared to cUS scores 1 and sUS scores 1, respectively. A positive correlation was found between cUS score 1 and sUS score 1 (r2=0.9; P<0.0001) as well as between cUS score 2 and sUS score 2 (r2=0.91; P<0.0001). There was no statistically significant difference between cUS scores 1 and cUS scores 2 (P=0.297) as well as between sUS score 1 and sUS score 2 (P=0.065); however, the cUS scores 2 and sUS scores 2 were lower than cUS scores 1 and sUS score 1, respectively, in all patients. Mean duration of simplified protocols 1 and 2 was 4.76 and 6.2 minutes, respectively (P<0.005) and mean duration of comprehensive protocols 1 and 2 was 22.8 and 19.2 minutes, respectively (P<0.0001). Significant differences between the duration of the simplified protocol 1 and 2 compared to those of comprehensive protocol 1 and 2, respectively, was found (P<0.0001). For comprehensive protocols 1 and 2, the kappa values for interobserver/intraobserver variability were 0.809/0.817 and 0.825/0.812, respectively. For simplified protocols 1 and 2, the kappa values for interobserver/intraobserver variability were 0.794/0.828 and 0.834/0.846, respectively. Twenty-four out of 25 patients (96%) reported preference for comprehensive protocol 2 versus 1, while 14 patients (56%) preferred simplified protocol 2 versus 1. Conclusions: The degree of pulmonary fibrosis could be assessed by both comprehensive and simplified US methods, in IPF patients. Comprehensive and simplified lung US protocols in lateral decubitus position appeared to be faster and more convenient for the patients, while there was no difference regarding feasibility compared to the sitting/supine position. The number of B-lines detected during comprehensive and simplified methods correlated with HRCT findings, while examination in the lateral decubitus position showed slight higher correlation. Simplified lung US protocols correlated with comprehensive protocols, regardless of patient positioning.
Language Greek
Issue date 2017-12-12
Collection   Faculty/Department--School of Medicine--Department of Medicine--Doctoral theses
  Type of Work--Doctoral theses
Permanent Link https://elocus.lib.uoc.gr//dlib/5/b/2/metadata-dlib-1512640504-253051-19231.tkl Bookmark and Share
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