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Abstract Number: 147

US Lung Examination in SSc Patients: A Comparison of Two Different Scoring Systems

Andrea Delle Sedie1, Cristina Lodato1, Elisa Cioffi1, Linda Carli2, Stefano Bombardieri1 and Lucrezia Riente1, 1Rheumatology Unit, University of Pisa, Pisa, Italy, 2GenOMeC PhD, University of Siena, Siena, Italy

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Imaging, Lung Disease, systemic sclerosis and ultrasound

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Session Information

Title: Imaging of Rheumatic Diseases: Ultrasound

Session Type: Abstract Submissions (ACR)

Background/Purpose

Systemic sclerosis (SSc) is a disease characterized by a progressive fibrosis of the skin and internal organs, which can lead to death. Lung involvement includes a wide range of disorders and interstitial lung disease (ILD) is the most common manifestation, being clinically significant in about 40% of patients. Recently, the role of US in the assessment of ILD (counting the B-lines, generated by the reflection of the US beam from thickened sub-pleural interlobar septa) has been confirmed after comparison with high-resolution computed tomography (HRCT) and a few scoring systems proposed. The comprehensive examination of lung intercostal spaces (LIS) is time consuming (54 LIS in each patient) (1) and a previous attempt to give a simplified US B-line scoring system has been made in patients with connective tissue diseases (2), an evaluation on 8 different thoracic areas is also performed (3-4).

Aim of the study was to compare the comprehensive examination and the 8-area scoring system and define which could be more effective in clinical practice.

Methods

79 SSc patients were enrolled independently of the presence of any dispnoea. Each patient underwent a lung US with comprehensive US B-line assessments by an experienced rheumatologist. A cut-off of >12 B-lines was decided based on the correlation between US and HRCT in 76 patients, then US was performed alone in the rest of the SSc patients. The presence/absence of B-lines was registered in each LIS. The second scoring system was positive when ≥3 B-lines were present in a single LIS in ≥1 area.

Results

46 patients were positive for ILD (ILD+) and 33 negative when using the comprehensive examination; the 8-area scanning protocol showed 44 ILD+ and 35 negative. Using the two different scoring systems ILD+ and ILD- patients were the same in 67 cases. Seven of the remaining patients were ILD+ only using the comprehensive scan (in 4 of them the total B-lines score was <16, so really close to the cut-off) and 5 only using the 8-area scan. The time needed for the comprehensive assessment was longer than the one for the 8-area scanning protocol (the latter does not assess posterior thorax and, if a LIS is positive, there is no need to scan the other LIS in the same area).

Conclusion

The results provided by the two scoring systems are largely overlapping in the identification of ILD+ patients. Considering the shorter time needed for the assessment, the 8-area scanning protocol could be more useful for screening.

 References

1 – Gargani L et al. Rheumatology (Oxford) 2009;48(11):1382-7.

2- Gutierrez M et al. Arthritis Res Ther 2011;13(4):R134.

3- Volpicelli G et al. Med Sci Monit 2008;14(3):CR122-8

4- Volpicelli G et al. Intensive Care Med 2012;38:577-91


Disclosure:

A. Delle Sedie,
None;

C. Lodato,
None;

E. Cioffi,
None;

L. Carli,
None;

S. Bombardieri,
None;

L. Riente,
None.

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