Study On The Diagnostic Value Of Modified Transthoracic Lung Ultrasound Scoring Method In Interstitial Lung Disease

ObjectiveTo evaluate the diagnostic value of a modified transthoracic lung ultrasound(TLUS)scoring method in interstitial lung disease(ILD).MethodsA total of 75 patients with clinically suspected ILD in the respiratory department and immunology department of our hospital from June 2019 to October 2020 were studied.High resolution computed tomography(HRCT)and TLUS were used to examine all patients.The ultrasonographic results were evaluated by the modified ultrasound scoring method and the Buda ultrasound scoring method.The imaging results were evaluated by the HRCT Warrick scoring method.The diagnostic effectiveness and consistency of the three methods for ILD was analyzed.Modified ultrasound scoring method and Buda ultrasound scoring method were analyzed the difference in different severity of ILD,and the correlation between modified ultrasound score and Buda ultrasound score/HRCT score were evaluated.Then,the HRCT Warrick scoring method was used as the criterion to judge the severity of ILD,and the modified ultrasound score was calculated by using the receiver operator characteristic(ROC)curve to predict the cutoff point of different degrees of ILD.Results1.The main ultrasonic features of ILD included:(1)Abnormalities of pleural lines: including thickening of pleural lines(54/54),irregular and rough pleural lines(41/54),discontinuous pleural lines,fragmented(28/54);(2)Lung parenchyma: at least one section B line < 4(54/54),at least one section B line 4 ～ 6(36/54),one section B line > 6 or "White lung"(29/54);(3)Complications: pulmonary balloon signs(Am line)(6/54)and rarely free pleural effusion(2/54).2.The sensitivity of the modified ultrasound scoring method,the Buda ultrasound scoring method and the HRCT scoring method to assess ILD were100%,94.4%,and 100%,respectively,and the specificities were 90.5%,90.5%,and 95.2%,respectively;The area under the ROC curve(AUC)were 0.952(95%CI=0.878～1.000),0.925(95%CI=0.843～1.000),0.976(95%CI =0.923～1.000),respectively.There was no significant difference in the diagnostic power of the three methods(P>0.05).3.With clinical diagnosis as the gold standard,the Kappa value of HRCT scoring method for diagnosing ILD=0.966(P<0.001);the Kappa value of modified ultrasound scoring method for diagnosing ILD=0.932(P<0.001);the Kappa value of Buda ultrasound scoring method for diagnosing ILD= 0.837(P<0.001).4.The values of the modified ultrasound scoring method and the Buda ultrasound scoring method consistently and significantly increased with the increasing severity of ILD.For the former,there were significant differences between the mild group,the moderate group and the severe group(P<0.05).For the latter,There were significant differences between the mild/moderate group and the severe group(all P < 0.05),while there was no significant difference between the mild group and the moderate group(P > 0.05).5.The correlation between the modified ultrasound score and the HRCT Warrick score / the Buda ultrasound score was high(r value was 0.944/0.928,P<0.001).The correlation between the Buda ultrasound score and the HRCT Warrick score was slightly lower(r value was 0.870,P<0.001).6.The correlation between the pleural line score and HRCT score was 0.857(P<0.001);the correlation between the B line score and HRCT score was 0.859(P<0.001).7.The ROC curve used to calculate the modified ultrasound score predicted the critical values of mild(Warrick score <8 points)and severe(Warrick score> 15points)pulmonary fibrotic lesions at 34 points [sensitivity 100%,specificity 92.5%,AUC = 0.933,95% CI(0.807～1.000)] and 64.5 points [sensitivity 92.0%,specificity 85.3%,AUC = 0.972,95% CI(0.929～1.000)].Conclusions1.Modified ultrasound scoring method,Buda ultrasound scoring method and HRCT Warrick scoring method can diagnose ILD well.2.Compared with the Buda ultrasound scoring method,the modified ultrasound scoring method is more comprehensive,more consistent with HRCT diagnosis.It has a higher correlation with HRCT,and can better distinguish the severity of ILD.3.The modified ultrasound scoring method can evaluate the severity of ILD and provide important help for early clinical treatment and prognosis assessment.