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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EApproximately two-thirds of patients with systemic sclerosis develop interstitial lung disease (ILD). High-resolution computed tomographyof the chest is the gold standard for diagnosing ILD, but it cannot be used often because of the risks that are associated with radiation exposure and cost concerns. Recent data have suggested that lung ultrasound can aid in the detection of ILD by evaluating B-lines, the sonographic marker of pulmonary interstitial syndrome.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatological Autoimmune Disorders Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EApproximately two-thirds of patients with systemic sclerosis develop interstitial lung disease (ILD). High-resolution computed tomography (HRCT) of the chest is the gold standard for diagnosing ILD, but it cannot be used often because of the risks that are associated with radiation exposure and cost concerns. Recent data have suggested that lung ultrasound (LUS) can aid in the detection of ILD by evaluating B-lines, the sonographic marker of pulmonary interstitial syndrome. The aims of this study [Barskova T et al. \u003Cem\u003EAnn Rheum Dis\u003C\/em\u003E 2012] were to verify the correlation between HRCT detection of ILD and B-lines and to evaluate the reliability of LUS as a screening tool in patients with very early systemic sclerosis.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EA total of 58 consecutive patients (54 women, mean age 51\u00b114 years) with systemic sclerosis were evaluated with chest HRCT and LUS. LUS was performed on the right and left hemithoraces to evaluate the location and number of B-lines. A B-line was defined as an echogenic coherent wedge-shaped signal with a narrow origin in the near field of the image [Volpicelli et al. \u003Cem\u003EIntensive Care Med\u003C\/em\u003E 2012]. The number of B-lines in the intercostal spaces was recorded and totaled to produce a score that denoted the extent of ILD. ILD was diagnosed when \u22653 B-lines were found in at least 2 adjacent scanning sites or when \u0026gt;5 B-lines were present.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EAmong the total population, 32 patients (29 women, mean age 51\u00b115 years) were diagnosed with very early systemic sclerosis. HRCT and LUS were performed a mean of 42\u00b146 days (median 27 days) apart. ILD was found on HRCT in 88% of the total population and in 41% of the very early systemic sclerosis population (p\u0026lt;0.01). Significantly more B-lines were found in patients with HRCT-detected ILD (mean 57\u00b153, median 43) versus those without (mean 9\u00b19, median 5; p\u0026lt;0.0001; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Patients with ground glass on HRCT (n=13; 63\u00b147) had a higher total number of B-lines than patients without ground glass (33\u00b140; p\u0026lt;0.05). There was no statistically significant difference in the number of B-lines that were detected between younger (\u226450 years) and older (\u0026gt;50) patients or between patients with shorter (\u0026lt;1 year) or longer (\u0026gt;1 year) disease duration.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/9\/20\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Difference in Number of B-Lines in Patients With and Without ILD on HRCT.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1822214426\u0022 data-figure-caption=\u0022Difference in Number of B-Lines in Patients With and Without ILD on HRCT.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/9\/20\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/9\/20\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/9\/20\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14220\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EDifference in Number of B-Lines in Patients With and Without ILD on HRCT.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from L. Gargani, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-6\u0022\u003EAnalysis of individual patients in the overall population showed 83% concordance between LUS and HRCT, with 100% sensitivity, 100% negative predictive value, 55% specificity, and 78% positive predictive value. All 10 discordant cases were false positive on LUS. Receiver operating characteristic (ROC) curve analysis confirmed the analytical relationship between the number of B-lines and the presence of ILD on HRCT (area under curve, 0.94; 95% CI, 0.89 to 0.99; p\u0026lt;0.0001). The presence of \u0026gt;5 B-lines had 100% sensitivity and 59% specificity. The presence of \u226520 B-lines had 83% sensitivity and 96% specificity.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThis study shows that LUS is highly sensitive for detecting ILD in patients with very early systemic sclerosis. The presence of B-lines on LUS examination correlates with detection of ILD on HRCT. LUS appears to be a reliable screening tool to determine which patients should be evaluated further with HRCT.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/9\/20.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzng4p\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzng4p\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}