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01.08.2011 | Research article | Ausgabe 4/2011 Open Access

Arthritis Research & Therapy 4/2011

Utility of a simplified ultrasound assessment to assess interstitial pulmonary fibrosis in connective tissue disorders - preliminary results

Arthritis Research & Therapy > Ausgabe 4/2011
Marwin Gutierrez, Fausto Salaffi, Marina Carotti, Marika Tardella, Carlos Pineda, Chiara Bertolazzi, Elisabetta Bichisecchi, Emilio Filippucci, Walter Grassi
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​ar3446) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

MG participated in the study development, recruitment of patients, performed the ultrasound examinations (sonographer 1), prepared the sonographic images, conducted data evaluation and prepared the manuscript. FS participated in the statistical analysis and data evaluation and manuscript preparation. MC performed the HRCT exams, prepared the HRCT images, conducted data evaluation and prepared the manuscript. MT performed the ultrasound examinations (sonographer 2) and gave substantial input to data evaluation and manuscript preparation. CP gave substantial input to the data evaluation and manuscript preparation. CB participated actively in the recruitment of patients and manuscript preparation. EF participated in the study development and gave substantial input to the data evaluation and manuscript preparation. WG participated in the study development and gave substantial input to the data evaluation and manuscript preparation. All authors read and approved the final version of manuscript.



Interstitial pulmonary fibrosis (IPF) is a frequent manifestation in patients with connective tissue disorders (CTD). Recently the ultrasound (US) criterion validity for its assessment has been proposed; however, the US scoring systems adopted include the study of several lung intercostal spaces (LIS), which could be time-consuming in daily clinical practice. The aim of this study was to investigate the utility of a simplified US B-lines scoring system compared with both the US comprehensive assessment and the high-resolution computed tomography (HRCT) findings of IPF in CTD patients.


Thirty-six patients with a diagnosis of CTD were enrolled. Each patient underwent chest HRCT and lung US by an experienced radiologist and rheumatologist, respectively. Both comprehensive and simplified US B-lines assessments were scanned. The comprehensive US assessment was performed at 50 LIS level, whereas the simplified US assessment included bilaterally 14 LIS; for the anterior chest: the second LIS along the para-sternal lines, the fourth LIS along the mid-clavear, anterior axillary and mid-axillary lines; for the posterior chest: the eighth LIS along the paravertebral, sub-scapular and posterior axillary lines.
For criterion validity, HRCT was considered the gold standard. Feasibility, inter and intra-observer reliability was also investigated.


A highly significant correlation between comprehensive and simplified US assessment was found (P = 0.0001). A significant correlation was also found between the simplified US assessment and HRCT findings (P = 0.0006). Kappa values for the inter-observer simplified US assessment were in a range from 0.769 to 0.885, whereas the concordance correlation coefficient values for the intra-observer were from 0.856 to 0.955. There was a relevant difference in time spent on comprehensive (mean 23.3 ± SD 4.5 minutes) with respect to the simplified US assessment (mean 8.6 ± SD 1.4) (P < 0.00001).


Our results provide a new working hypothesis in favor of the utility of a simplified US B-lines assessment as an adjunct method to assess IPF in patients with CTD.
Authors’ original file for figure 1
Authors’ original file for figure 3
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