The Study Of Application Tissue Doppler Imaging To Quantify Pleural Line Movement And Diagnose Pneumothorax

Part 1 Tissue Doppler quantitative analysis of pleura line movement in healthy volunteersObjective: To analyze the pleura line motion of healthy volunteers by tissue Doppler and its quantitative software,so as to lay a foundation for the diagnosis of pneumothorax by tissue DopplerMethods: 15 healthy volunteers were included in this study.The pleural line was found in the upper and lower blue point of bilateral chest under B-ultrasound,then switch mode to tissue Doppler mode.The tissue Doppler quantitative analysis software(TDI-QA)was started,and the region of interest(ROI)was placed in the middle of the pleural line and the chest wall tissue 0.5cm away from the middle of the pleural line.After running the software,two curves been obtained,the time-velocity curve and time-strain curve.The peak velocity of pleura line(PVmax)and peak strain of pleura line(PSmax)were measured by tissue Doppler quantitative software.PVmax and PSmax of the pleura line movement of the upper and lower blue point of the chest were compared.At the same time,the peak velocity of chest wall tissue(CVmax)and peak strain of chest wall tissue(CSmax)near the pleura line were measured,and the CVmax and CSmax of chest wall tissue near the pleura line at the upper and lower blue point of each bilateral chest were compared.PVmax/CVmax and PSmax/CSmax were calculated,and PVmax / CVmax and PSmax / CSmax of bilateral upper and lower blue point were compared.Result: A total of 60 ultrasound images were collected from 15 volunteers.(1).In healthy volunteers,the PVmax and PSmax of the pleural line movement of the upper blue point on the left chest were 0.61(0.56,0.74)cm/s and 2.19(1.83,2.71)%,respectively.The PVmax and PSmax of the pleural line movement of the lower blue point of the left chest were 0.63(0.52,0.73)cm/s and 1.84(1.67,2.21)%,respectively.The PVmax and PSmax of the pleural line movement of the upper blue point on the right chest were 0.62(0.55,0.72)cm/s and 2.24(1.76,2.51)%,respectively.The PVmax and PSmax of the pleural line movement of the lower blue point of the right chest were 0.65(0.57,0.73)cm/s and 2.12(1.70,2.53)%,respectively.There was no significant difference in PVmax and PSmax between the upper blue point on the left chest,the lower blue point on the left chest,the upper blue point on the right chest,and the lower blue point on the right chest(P>0.05).(2).In healthy volunteers,the CVmax and CSmax of the chest wall tissue movement near the upper blue point of the left chest of were 0.18(0.14,0.23)cm/s and 1.51(1.31,1.74)%,respectively.The CVmax and CSmax of the chest wall tissue movement near the lower blue point of the left chest were 0.18(0.15,0.21)cm/s and1.31(1.13,1.82)%,respectively.The CVmax and CSmax of the chest wall tissue movement near the upper blue point of the right chest were 0.23(0.17,0.24)cm/s and1.72(1.27,2.05)%,respectively.The CVmax and CSmax of the chest wall tissue movement near the lower blue point of the right chest were 0.20(0.16,0.23)cm/s and1.80(1.31,2.29)%,respectively.The upper blue point on the left chest,the lower blue point on the left chest,the upper blue point on the right chest,and the lower blue point on the right chest had no significant difference in CVmax and CSmax among the groups of chest wall tissue movement(P>0.05).(3).In healthy volunteers,the PVmax/CVmax and PSmax/CSmax of the upper blue point on the left chest of were 3.32(2.89,4.05)and 1.56(1.31,1.80),respectively.The PVmax/CVmax and PSmax/CSmax of the lower blue point of the left chest are3.27(2.90,4.20)and 1.44(1.23,1.60),respectively.The PVmax/CVmax and PSmax/CSmax of the upper blue point on the right chest are 2.81(2.60,3.59)and1.40(1.13,1.65),respectively.The PVmax/CVmax and PSmax/CSmax of the lower blue point of the right chest are 3.70(2.65,4.15)and 1.30(1.15,1.41),respectively.The upper blue point on the left chest,the lower blue point on the left chest,the upper blue point on the right chest,and the lower blue point on the right chest had no significant difference in PVmax/CVmax and PSmax/CSmax among the groups(P>0.05).Conclusion: Tissue Doppler technique can quantify the movement of the pleural line with respiration.The PVmax and PSmax of the upper and lower blue point on both sides of the chest are in good consistency.After excluding the influence of breathing exercise,the relative PVmax/CVmax and PSmax/CSmax of the upper and lower blue point on both sides of the chest are also in good consistent.Part 2.Quantitative tissue Doppler technique to detect changes in peak velocity and peak strain of pleural line movement during pneumothorax.Objective: To compare the PVmax and PSmax of the pneumothorax position of patients with unilateral pneumothorax and the changes in the pleural line motion PVmax and PSmax of the corresponding part of the contralateral side,and to explore the cut-off value of tissue Doppler technique for quantitative pleural line motion parameters to diagnose pneumothorax.Method: 15 cases of diagnosed unilateral pneumothorax patients who met the inclusion criteria in the Department of Critical Care Medicine of our hospital from January 2019 to August 2019 were recruited.Images were collected in the pneumothorax position and the corresponding parts of the healthy side.PVmax and PSmax of the pleural line movement of the corresponding parts of the pneumothorax and the contralateral side were measured,the CVmax and CSmax of the movement of the chest wall tissue on the pneumothorax and contralateral side were measured.Calculate the PVmax/CVmax and PSmax/CSmax of the pneumothorax and the contralateral side,respectively.Draw ROC curve,use Youden index to calculate the best cut-off value for diagnosing pneumothorax,and the corresponding sensitivity,specificity,accuracy,positive predictive value(PPV)and negative Predictive value(Negative predictive value,NPV).Result:(1)The PVmax and PSmax of the pleural line movement of the pneumothorax were 0.23(0.16,0.29)cm/s and 1.34(0.82,1.57)%,respectively.The PVmax and PSmax of the pleural line movement of the corresponding part of the contralateral side were 0.65(0.51,Compared with 0.74)cm/s and 2.10(1.45,2.51)%,respectively.The PVmax and PSmax of the pneumothorax and the corresponding parts of the contralateral pleural line movement,the difference was statistically significant(P<0.05).(2)The CVmax and CSmax of the chest wall tissue in the pneumothorax position were 0.21(0.15,0.27)cm/s and 1.23(0.93,2.03)%,respectively.The CVmax and CSmax of the chest wall tissue in the corresponding part of the contralateral side were 0.17(0.13,0.20)cm/s and 1.35(0.99,1.93)%,respectively.The comparison of CVmax and CSmax of chest wall tissues in the pneumothorax position and the corresponding part of the contralateral side was no statistically significant(P>0.05).(3)The relative PVmax/CVmax and PSmax/CSmax of the pleural line movement in the pneumothorax position are 1.11(0.89,1.39)and 1.08(0.93,1.41),respectively.The PVmax/CVmax and PSmax/CSmax of the pleural line movement of the corresponding part of the contralateral side are respectively They were 3.92(2.90,4.67)and 1.38(1.09,1.65),the difference was statistically significant(P<0.05).(4)The cut-off values of PVmax,PSmax,PVmax/CVmax,PSmax/CSmax to diagnose pneumothorax by ROC curve analysis were 0.44cm/s,1.63%,1.74,1.30,and the corresponding sensitivities were: 100%,87%,100 %,73%,the corresponding specificity is 93%,67%,100%,67%,the corresponding area under the curve and 95% confidence interval are: 0.99(0.96,1.00),0.81(0.66,0.96),1.00(1.00,1.00),0.72(0.50,0.86),respectively.Conclusion:The tissue Doppler parameters PVmax,PSmax,PVmax/CVmax,PSmax/CVmax on the pneumothorax side are lower than those on non-pneumothorax.The cut-off values of PVmax,PSmax and PVmax/CVmax for diagnosis of pneumothorax are 0.44cm/s,1.63%,and 1.74,respectively,which have good diagnostic value for pneumothorax.Among them,PVmax/CVmax has the largest AUC,suggesting it is the best index for pneumothorax diagnosis.Part 3 The value of quantitative pleural line movement by tissue Doppler in the diagnosis of pneumothorax.Objective: To compare the results of the BLUE protocol and the BLUE protocol combined with the quantitative pleural line movement of tissue Doppler imaging quantitative analysis in the screening of pneumothorax in patients with dyspnea.To verify the value of quantitative pleural line movement by tissue Doppler in the diagnosis of pneumothorax.Methods: 104 patients with dyspnea in our hospital from September 2019 to February 2021 were recruit.CT results are the gold standard,BLUE protocol and BLUE protocol combined with tissue Doppler quantitative pleural line movement were used to diagnose.Chi-square test was used to compare the sensitivity,specificity and accuracy of BLUE protocol and BLUE protocol combined with tissue Doppler imaging quantitative analysis in the diagnosis of pneumothorax.Results: In 104 patients with dyspnea,there were 23 pneumothorax patients(22.12%)and 81 non-pneumothorax patients(77.88%).BLUE protocol examination result analysis.BLUE protocol results: BLUE protocol found pneumothorax in 21 patients(20.19%),non-pneumothorax in 83 patients(79.81%)with 3 misdiagnosed patients(3.7%)and 5 missed diagnosed patients(21.73%).Compared with the results of CT,the sensitivity,specificity and accuracy of diagnose pneumothorax were 78.26%,96.30% and 92.31%,respectively.BLUE protocol combined with tissue Doppler imaging quantitative analysis of pleural line movement examination results: BLUE protocol combined with tissue Doppler imaging quantitative analysis of pleural line movement found pneumothorax in 22 patients(21.15%),82 patients with non-pneumothorax(78.84%),misdiagnosed in 1 case(1.23%),missed diagnosis in 2 cases(8.7%).Compared with the results of CT,the sensitivity,specificity and accuracy of diagnosing pneumothorax were 91.30%(21/23),98.77%(80/81)and 97.11%(101/104),respectively.There was significant difference in sensitivity and missed diagnosis rate between BLUE protocol and BLUE combined with tissue Doppler imaging(P < 0.05).The sensitivity and missed diagnosis rate of BLUE protocol and BLUE combined tissue Doppler imaging are statistically different(P<0.05);The specificity,accuracy and misdiagnosis rate of BLUE protocol and BLUE combined tissue Doppler imaging are not significance(P>0.05).Conclusion : Compared with BLUE protocol,BLUE combined with TDI-QA is more effective in diagnosis.