肺部超声与高分辨率CT对间质性肺疾病诊断敏感性分析

Diagnostic value of lung ultrasound with high-resolution CT for interstitial lung disease

目的比较肺部超声(LUS)与高分辨率CT(HRCT)诊断间质性肺疾病的敏感性。方法回顾性分析2018年6月至2019年6月在滨州医学院附属医院临床诊断的间质性肺病(ILD)患者30例,所有患者均在知情同意下接受双侧LUS检查和HRCT扫描。LUS和HRCT的检查间隔时间不超过1周。记录胸膜和肺实质声像图,观察B线条数,胸膜线厚度,胸膜线是否规则,胸膜下有无实变区,胸腔有无积液。以临床诊断为金标准,分别计算LUS及HRCT诊断ILD的敏感性。结果30例ILD患者中,LUS假阴性者4例(13.3%),HRCT假阴性者3例(10%),两者均未发现假阳性病例,所有患者均为ILD,因此无法对检查的特异性作统计。以临床诊断ILD为金标准,LUS与HRCT诊断ILD的敏感性分别为0.87(0.69~0.96)、0.90(0.73~0.98),两者敏感性差异无统计学意义。结论LUS在诊断ILD时敏感性不逊于HRCT,考虑到其安全性、成本低、携带方便、实用性强等特点,LUS可作为一种潜在的替代HRCT筛查ILD的影像学工具。

Objective To compare the sensitivity of lung ultrasound(LUS)with high-resolution computed tomography(HRCT)in the diagnosis of interstitial lung disease(ILD).Methods A retrospective analysis of 30 patients with clinically diagnosed ILD who were hospitalized in Binzhou Medical University Hospital from June 2018 to June 2019.All patients underwent bilateral LUS examination and chest high-resolution CT(HRCT)scan with informed consent.The interval between inspection and HRCT is no more than 24 hours.Record the pleural and lung parenchymal sonograms,observe the number of B lines,the thickness of the pleural line,whether the pleural line is regular,whether there is a hypoechoic area under the pleura,and whether there is fluid in the chest.The sensitivity of LUS and HRCT in the diagnosis of ILD was calculated by clinical diagnosis as the gold standard.Results Of the 30 patients with ILD,4 patients(13.3%)had false negative for LUS and 3(10%)had false negative for HRCT.No false positive cases were found.All patients were ILD,so the specificity of the examination could not be counted.With the clinical diagnosis of ILD as the gold standard,the sensitivity of LUS and HRCT for the diagnosis of ILD was 0.87(0.69-0.96)and 0.90(0.73-0.98),respectively.There was no significant difference in sensitivity between the two groups(P=1.00).Conclusion LUS is not inferior to HRCT in the diagnosis of ILD.Considering its safety,low cost,portability and practicability,LUS can be used as a potential imaging tool to replace HRCT screening ILD.