Background
What are B-lines?
B-lines in connective tissue disease-associated interstitial lung disease
B-lines in systemic sclerosis-associated interstitial lung disease
Anatomical line | LUS by Gargani et al. [23] | Comprehensive LUS [25] | Simplified LUS [25] | Modified LUS [26] | |||||
---|---|---|---|---|---|---|---|---|---|
Right | Left | Right | Left | Right | Left | Right | Left | ||
Anterior | Parasternal | 2nd–5th ICS | 2nd–4th ICS | 2nd–5th ICS | 2nd–4th ICS | 2nd ICS | 2nd ICS | ||
Mid-clavicular | 2nd–5th ICS | 2nd–4th ICS | 2nd–5th ICS | 2nd–4th ICS | 4th ICS | 4th ICS | 4th ICS | 4th ICS | |
Lateral | Anterior axillary | 2nd–5th ICS | 2nd–4th ICS | 2nd–5th ICS | 2nd–4th ICS | 4th ICS | 4th ICS | 4th ICS | 4th ICS |
Mid-axillary | 2nd–5th ICS | 2nd–4th ICS | 2nd–5th ICS | 2nd–4th ICS | 4th ICS | 4th ICS | 4th ICS | 4th ICS | |
Posterior axillary | 2nd–10th ICS | 2nd–10th ICS | 7th–8th ICS | 7th–8th ICS | 8th ICS | 8th ICS | 8th ICS | 8th ICS | |
Posterior | Sub-scapular | 7th–10th ICS | 7th–10th ICS | 7th–8th ICS | 7th–8th ICS | 8th ICS | 8th ICS | 8th ICS | 8th ICS |
Paravertebral | 2nd–10th ICS | 2nd–10th ICS | 2nd–8th ICS | 2nd–8th ICS | 8th ICS | 8th ICS | |||
Total scanning sites | 72 ScS | 50 ScS | 14 ScS | 10 ScS |
B-lines in rheumatoid arthritis-associated interstitial lung disease
B-lines in Sjögren’s syndrome-associated interstitial lung disease
B-lines in anti-synthetase syndrome-associated interstitial lung disease
Study | Content | Construct | Criteria | Feasibility | Reliability | Discrimination | Responsiveness |
---|---|---|---|---|---|---|---|
Gargani et al. [23] | 33 SSc, including 10 dcSSc, and 23 lcSSc | LUS HRCT (gold standard) PFT | 72 ScS Total BN > 10 was defined positive WS | 100% | Intra-observer and inter-observer variability respectively 5.1% and 7.4% | Total BN correlated with WS (r = 0.72; p < 0.001) and DLCO (r = – 0.6, p < 0.05); BN higher in dcSSc than in lcSSc (73 ± 66 vs 21 ± 35; p < 0.05) | N/A |
Gutierrez et al. [25] | 28 SSc, 2 SS, 2 DM, 2 ASS, 1UCTD, and 1 MCTD | LUS HRCT (gold standard) | 50 ScS (comprehensive method) 14 ScS (simplified method); comprehensive BS was defined 0 = normal (<10 BN); 1 = mild (11–20 BN); 2 = moderate (21–50 BN), and 3 = marked (>50 BN). Simplified BS was defined 0 = normal (<5 BN); 1 = mild (6–15 BN); 2 = moderate (16–30 BN), and 3 = marked (>30 BN) WS | Simplified method required less time than the comprehensive (8.6 ± 1.4vs 23.3 ± 4.5 minutes, p < 0.001) | κ values for inter-observer reliability of comprehensive method 0.85–0.98. κ values for inter-observer agreement of simplified method 0.77–0.89 and for intra-observer 0.85–0.89 | BS of two methods correlated to WS (p = 0.0006), and simplified score also correlated to comprehensive method (p = 0.0001) | N/A |
Barskova et al. [29] | 58 SSc, including 32 VEDOSS | LUS HRCT (gold standard) | 72 ScS BN ≥ 3 was found in at least two adjacent scanning sites or when total BN > 5 | 100% | Intra-observer and inter-observer variability respectively 5.1% and 7.4% | Total BN significantly higher in SSc + ILD (57 ± 53 vs 9 ± 9, p < 0.0001), and with GGO (63 ± 47 vs 33 ± 40, p < 0.05) Sensitivity and specificity respectively 100% and 55%; NPV and PPV 100% and 78% respectively | N/A |
Tardella et al. [28] | 26 SSc, 2 SS, 1 UCTD, 2 ASS, 2 DM, and 1 MCTD | LUS HRCT (gold standard) PFT | 50 ScS Grading as comprehensive assessment (Gutierrez et al. [25]) | Yes | Overall agreement of inter-observer 92–97%; weighted κ value 0.85–0.98 | BS correlated with WS (p < 0.001; CC ρ = 0.875), and DLCO(p = 0.014) | N/A |
Moazedi-Fuerst et al. [31] | 25 SSc and 40 healthy controls | LUS HRCT (only for patients) | 18 ScS Positive area for B lines = ScS with predominant B lines; positive area for PI = predominant PLT > 2.8 mm BS: 0 = no positive areas; 1 = 1–5 positive areas; 2 = > 5 positive areas. Idem for PI | N/A | N/A | SSc + ILD had a BS of 2 in 55% and 1 in 45%; SSc – ILD had a BS of 2 in 5% and BS of 1 in 30%; SSc + ILD had a PI of 2 in 23% and 1 in 78%; SSc – ILD had a negative PI | N/A |
Pinal Fernández et al. [38] | 21 ASS | LUS HRCT (gold standard) | 72 ScS Percentage of positive B-lines calculated (dividing the positive points by studied points) WS | N/A | κ value of intra-observer and inter-observer 0.83 and 0.76 | BS no correlated with WS (CC = 0.135, p = 0.559); BS correlated with GGO (ρ = 0.502, p = 0.02) | N/A |
Cogliati et al. [36] | 39 RA | LUS (standard and PS-USD) HRCT (gold standard) PFT | 72 ScS BN > 10 identified positive WS | Yes |
r-value for inter-observer variability 0.96; κ coefficient of two devices 0.78 | BS correlated with WS (r = 0.806). Sensitivity and specificity of standard LUS vs HRCT 92% and 56%, and PS-USD vs HRCT 89% and 50% | N/A |
Moazedi-Fuerst et al. [35] | 64 RA and 40 healthy controls | LUS HRCT (gold standard, only for patients) | 18 ScS Grading as previous report (2012) | Yes | κ value of inter-observer 0.92 | Sensitivity and specificity of LUS respectively 97.1% and 97.3%; PPV and NPV 94.3% and 98.6% respectively (p < 0.001) | N/A |
Mohammadi et al. [26] | 70 SSc | LUS (modified TTUS) HRCT (gold standard) | 10 ScS BS: 0 = normal (≤5 BN); 1 = mild (6–15 BN); 2 = moderate (16–30 BN); 3 = severe (>30 BN) WS | Yes | κ value of intra-observer reliability 0.838. Agreement between LUS and HRCT 0.553 (p < 0.001) | BS correlated with WS (SCC = 0.695, p < 0.001); sensitivity and specificity respectively 73.5% and 88.23%; PPV and NPV 95.12% and 51.72% respectively | N/A |
Gigante et al. [24] | 39 SSc, including 24 dcSSc and 15 lcSSc | LUS HRCT (gold standard) PFT NVC | BN ≥ 3 was found in at least two adjacent scanning sites or when a total BN > 5 WS | N/A | Intra-observer variability 3.8% | BN correlated with WS (r = 0.81, p < 0.0001), DLCO (r = – 0.63, p < 0.0001), and DSS (r = 0.8, p < 0.01) | N/A |
Moazedi-Fuerst et al. [33] | 25 RA, 14 SSc, 6 SLE, and 40 healthy controls | LUS HRCT (gold standard, only for patients) | 18 ScS BN > 2 and PLT > 3 mm in any scanned area regarded as abnormal. Grading as previous report (2012) | Yes | N/A | Sensitivity and specificity of LUS respectively 86.9% and 100%; PPV and NPV 100% and 88% respectively | N/A |
Pinal-Fernandez et al. [32] | 16 SSc and 21 ASS | LUS HRCT (gold standard) PFT | 72 ScS Percentage of positive BN and PI calculated (dividing the positive points by studied points) WS and Wells scores | N/A | N/A | PI correlated with WS both in SSc (r = 0.6, p = 0.01) and ASS (r = 0.6, p = 0.005), higher performance than BS (p = 0.01). PI also correlated with Wells score (r = 0.7, p < 0.001) and with DLCO (r = – 0.5, p = 0.05) in SSc, and high diagnostic value for detecting ILD (AUC = 0.85, 95% CI 0.64–1) and classified limited and extensive (AUC = 0.81, 95% CI 0.57–1) | N/A |
Buda et al. [30] | 52 ILD (including 30 CTD and 16 IP) and 50 healthy controls | LUS HRCT (gold standard) | BN classified into three types: single (≤3 per one scan), numerous (≥4), and white lung. PI was described ragged, fragmentary, thickness (≥2 mm), and blurred WS | N/A | N/A | Sensitivity and specificity of white lung to GGO.95% and 99%; blurred pleural line to honeycombing 59% and 82% (p < 0.005); numerous B lines correlated with blurred pleural line (p<0.001) | N/A |
Sperandeo et al. [34] | 175 SSc | LUS HRCT (gold standard) | BN > 3; PLT > 3.0 mm; HRCT pattern classified: no fibrosis, reticular, reticular-nodular, and honeycombing + reticular-nodular pattern | N/A | κ value of inter-observer and intra-observer 0.6–0.8 | Sensitivity and specificity of PLT (>3.0 to ≤ 5.0) to reticular pattern 80% and 99% (AUC = 0.95); PLT (>3.5) to reticular nodular and honeycombing 74.3% and 99% (AUC = 0.99); PLT (>5) to honeycombing 90.1% and 99% (AUC = 0.99) Sensitivity and specificity of BS to all kinds of fibrosis 0.94 and 0.95 | N/A |
Vasco et al. [37] | 13 SS | LUS HRCT (gold standard) | 8ScS BN ≥ 3 in a single ScS | N/A | κ value of intra-rater 1 | BS correlated with HRCT (r = 0.84, p < 0.001); sensitivity and specificity respectively 100% and 89% | N/A |