Esther F Vicente-Rabaneda, David A Bong, Noemí Busquets-Pérez, Ingrid Möller
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引用次数: 0
摘要
肺部超声波(US)的解释是对伪影分析的结果,而不是对解剖结构的准确描述,伪影是在肺部物理特性发生变化时出现的。在过去十年中,该技术在与自身免疫性疾病相关的间质性肺病(ILD)研究中的应用引起了人们的极大兴趣,越来越多的出版物研究了该技术在诊断过程中的作用、作为预后标记的作用以及作为监测患者的辅助手段的作用。B 线和胸膜线的变化是肺部 US 对 ILD 进行解释的主要因素。B 线是垂直伪影,当肺实质含气量部分减少和/或肺间质体积增大时产生。胸膜线的改变可表现为不规则、增厚、破碎或胸膜下结节。B 线和胸膜线的变化与胸部计算机断层扫描(高分辨率计算机断层扫描 [HRCT])显示的与自身免疫性疾病相关的 ILD 的证据有显著的正相关性,灵敏度和阴性预测值高达 100%。这些结果,加上肺部 US 的安全性、可及性和低成本,都支持将这种成像技术作为一种有前途的筛查方法,以优化 HRCT 的适应症。关于肺部 US 在敏感性变化方面的作用,还需要通过多中心前瞻性研究进行进一步调查。
Ultrasound evaluation of interstitial lung disease in rheumatoid arthritis and autoimmune diseases.
The interpretation of lung ultrasound (US) is the result of the analysis of artifacts, rather than exact representations of anatomical structures, which appear when changes in the physical properties of the lung occur. Its application to the study of interstitial lung disease (ILD) associated with autoimmune diseases has aroused great interest in the last 10 years, as evidenced by a growing number of publications studying its usefulness in the diagnostic process, as a prognostic marker, and as an aid in monitoring of patients. The main elements in lung US interpretation in ILD are the B lines and the changes in the pleural line. B lines are vertical artifacts that are generated when there is a partial decrease in the air content of the lung parenchyma and/or the volume of the interstitial area expands. Pleural line alterations that can be seen are irregularities, thickening, fragmentation, or subpleural nodules. Both the B lines and the changes in the pleural line have shown a significant positive correlation with the evidence on chest computed tomography (high-resolution computed tomography [HRCT]) of ILD associated with autoimmune diseases, with sensitivity and negative predictive values of up to 100%. These results, together with the safety, accessibility, and low cost of lung US, support this imaging technique as a promising screening method for optimizing the indication for HRCT. The role of lung US regarding sensitivity to change needs further investigation with multicenter prospective studies.