The artificial count of artifacts for thoracic ultrasound: what is the clinical usefulness?
- PDF / 648,138 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 49 Downloads / 168 Views
LETTER TO THE EDITOR
The artificial count of artifacts for thoracic ultrasound: what is the clinical usefulness? Carla Maria Irene Quarato1 · Mariapia Venuti1 · Marco Sperandeo2 Received: 4 January 2020 / Accepted: 4 February 2020 © Springer Nature B.V. 2020
Abstract Many works in the literature have shown that the increase in the number of B lines is a nonspecific sign of underlying pulmonary disease. Actually these artifacts are the result of a physical effect of ultrasound between the chest wall and the pulmonary air. Nevertheless the intra- and inter-operator variability in B-lines counting does not only reside only in the count itself but depends also on the type and frequency of the probe used, as well as the ultrasound scan machine setting and the patient’s chest shape. In our opinion, proposing a software algorithm to count lines B seems like an unproductive effort. Keywords Transthoracic ultrasound · Ultrasound artifacts · B-lines · Inter-observer reliability · Intra-observer reliability Dear Editor, Recently Pičuljan et al. [1] published on this journal an article in which compared the number of B-lines detected in forty mechanically ventilated adult ICU patients by observers with three different levels of ultrasound experience with that detected by a software algorithm and proposed the use of such software algorithm for counting B-lines and, therefore, avoiding intra/interoperator variability. On this regard we feel the need to clarify some points and raise some doubts. Our greatest concern regards the authors’ claims that the cause of B-lines “is fluid-thickening of the interlobular septa, due to increased extravascular lung water” [1]. This appears to suggest that B-lines have gained widespread scientific acceptance as a marker of “interstitial edema”, but, to our knowledge, it is not always true. B-lines are ultrasound imaging errors, namely “artifacts”, depending on the great difference in acoustic impedance encountered by the ultrasound beam when it crosses surfaces with a different density (i.e. chest wall/aerated lung or gas/fluid-film). In particular, * Carla Maria Irene Quarato [email protected] 1
Department of Medical and Surgical Sciences, Institute of Respiratory Disease, University of Foggia, Foggia, Italy
Department of Internal Medicine, Unit of Interventional and Diagnostic Ultrasound of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
2
these artifacts are generated when sound waves interact with gas microbubbles causing the fluid film trapped between them to resonate and have been initially described in fluidfilled dilated bowel loops [2, 3]. In lung, B-line are visible not only in pulmonary edema, but also in all those pathological pleuro-pulmonary conditions where the proportion of air/liquid film changed [4], such as such as pneumonia, atelectasis, acute lung injury/acute respiratory distress syndrome, pleural effusion (also minimal), acute exacerbation of chronic obstructive pulmonary disease, neoplastic lymphangitis, pu
Data Loading...
