Lung ultrasonography versus chest CT in COVID-19 pneumonia: a two-centered retrospective comparison study from China
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LETTER
Lung ultrasonography versus chest CT in COVID‑19 pneumonia: a two‑centered retrospective comparison study from China Yong Yang1, Yi Huang2, Feng Gao3, Lijun Yuan1* and Zhen Wang3,4* © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Dear Editor, The unexpectedly rapid spread and fast progression of coronavirus disease 2019 (COVID-19) call for early screening, detection and timely monitoring by imaging modalities. Chest computed tomography (CT) has been dominantly used for COVID-19 diagnosis; however, limitations including radiation exposure, limited mobility and expensive devices may constrain its usefulness, especially during this public health emergency with deficient medical resources. Lung ultrasonography (LUS) has been increasingly used as a reliable tool for lung disease assessment especially in intensive care medicine [1, 2]. Lesions of COVID-19 pneumonia have shown predominantly peripheral distribution [3], which makes LUS detection more suitable. However, there is no information available to determine the diagnostic value of LUS in COVID-19 in comparison with chest CT. In this retrospective study, patients with laboratoryconfirmed COVID-19 pneumonia (clinical classification: common type [4]) from two local government designated medical centers in Xi’an, China, receiving simultaneous LUS and chest CT scans (defined as exam interval ≤ 12 h) by independent investigators were included. To facilitate the comparison between LUS and chest CT, lungs were divided into 12 regions (Fig. 1a), and in each region, LUS features including A-lines, B-lines, consolidation and pleural effusion (PE) and CT features including ground *Correspondence: [email protected]; [email protected] 1 Department of Ultrasound Medicine, Tangdu Hospital, Fourth Military Medical University, Xi’an 710038, China 3 School of Aerospace Medicine, Fourth Military Medical University, Xi’an 710032, China Full author information is available at the end of the article Yong Yang and Yi Huang have contributed equally to this work.
glass opacity (GGO), consolidation and PE were evaluated. The regional alveolar-interstitial pattern (AIP) was defined as multiple B-lines (≥ 3) shown within a region by LUS and as the presence of GGO pattern by CT. Alveolar-interstitial syndrome (AIS) was defined as positive AIP regions (≥ 2) per side + bilateral positivity [5]. The consolidations and PE were diagnosed as previously described [1, 5] (see detailed methods in Supplementary File). We finally included 29 patients (aging 55.2 ± 16.2 years, 18 males) with 45 paired LUS + CT imaging data. In the total 540 lung regions, 340 (63%) positive regions were detected by LUS, including multiple B-lines (324 regions), consolidations (210 regions) and PE (67 hemithoraxes). In contrast, chest CT showed 209 (38.7%) regions with abnormal findings, including GGO (208 regions), consolidations (16 regions) and PE (14 hemithoraxes). LUS was more sensitive than chest CT in the diagnosis of regional AIP (60% vs. 38.5%, P
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