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Ultraschall Med 2020; 41(03): 300-307
DOI: 10.1055/a-1154-8795
Original Article

A Clinical Study of Noninvasive Assessment of Lung Lesions in Patients with Coronavirus Disease-19 (COVID-19) by Bedside Ultrasound

Nicht-invasive Beurteilung von pulmonalen Läsionen bei Patienten mit Coronavirus-Erkrankung (COVID-19) durch Ultraschall direkt am Krankenbett
Wuzhu Lu‡
1   Ultrasound, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
,
Shushan Zhang‡
1   Ultrasound, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
,
Binghui Chen
2   Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
,
Jiaxin Chen
1   Ultrasound, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
,
Jianzhong Xian
1   Ultrasound, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
,
Yuhong Lin
1   Ultrasound, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
,
Hong Shan   *
3   Interventional Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
4   Guangdong Provincial Key Laboratory of Biomedical Imaging, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
,
Zhong Zhen Su   *
1   Ultrasound, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
3   Interventional Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
4   Guangdong Provincial Key Laboratory of Biomedical Imaging, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
› Author AffiliationsThis work was supported by the Natural Science Foundation of Guangdong Province (2018A0303130070).
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Abstract

Purpose This study was conducted to explore the clinical value of noninvasive assessment of bedside ultrasound in the diagnosis of lung lesions of Coronavirus Disease-19.

Methods In this retrospective study, 30 patients with Coronavirus Disease-19 admitted to our hospital from January 18 to February 5, 2020, were selected as the research subjects. All cases were examined by lung ultrasound and CT. Lung lesions were reviewed by blinded observers, with imaging scores being used to analyze the ultrasound findings of lung lesions in patients with Coronavirus Disease-19 and with chest CT being used as the reference standard. The clinical value of ultrasound in the noninvasive assessment of lung lesions was evaluated.

Results Lung ultrasound signs in patients with Coronavirus Disease-19 were mainly manifested as interstitial pulmonary edema (90.0 %, 27/30) and pulmonary consolidations (20.0 %, 6/30). The lung lesions were mainly distributed in the subpleural and peripheral pulmonary zones. The lower lobe and the dorsal region had a greater tendency to be involved. There was moderate agreement (Kappa = 0.529) between the noninvasive assessment of bedside ultrasound for lung lesions in patients with Coronavirus Disease-19 and CT. The ultrasound scores to evaluate mild, moderate and severe lung lesions exhibited sensitivity of 68.8 % (11/16), 77.8 % (7/9), 100.0 % (2/2), specificity of 85.7 % (12/14), 76.2 % (16/21), 92.9 % (26/28), and diagnostic accuracy of 76.7 % (23/30), 76.7 % (23/30), 93.3 % (28/30), respectively. The follow-up dynamic ultrasound examination showed that the condition of all patients worsened gradually, with the ultrasound scores of lung lesions increasing to varying degrees.

Conclusion Though the diagnostic efficacy of bedside ultrasound is relatively low for mild to moderate patients, it is high for severe patients. Bedside ultrasound has important clinical significance for noninvasive assessment and dynamic observation of lung lesions in patients with Coronavirus Disease-19, which is worth further consideration.

Zusammenfassung

Ziel Diese Studie wurde durchgeführt, um den klinischen Wert der nicht-invasiven Beurteilung von Ultraschall direkt am Krankenbett bei der Diagnose von Lungenläsionen bei COVID-19-Erkrankung zu untersuchen.

Methoden In dieser retrospektiven Studie wurden 30 COVID-19-Patienten, die vom 18. Januar bis zum 5. Februar 2020 in unser Krankenhaus eingeliefert wurden, als Probanden ausgewählt. Alle Fälle wurden mittels Lungenultraschall und CT untersucht. Die Lungenläsionen wurden von verblindeten Beobachtern überprüft, wobei die sonografischen Befunde der Lungenläsionen bei COVID-19-Patienten mittels Bildgebungs-Scores analysiert wurden und Thorax-CT als Referenzstandard diente. Der klinische Nutzen der Sonografie bei der nicht-invasiven Beurteilung von Lungenläsionen wurde bewertet.

Ergebnisse Bei COVID-19-Patienten manifestierten sich die Lungenultraschallzeichen in erster Linie als interstitielles Lungenödem (90,0 %, 27/30) und Lungenkonsolidierungen (20,0 %, 6/30). Die Läsionen der Lunge waren überwiegend in den subpleuralen und peripheren Lungenzonen verteilt. Der Unterlappen und die dorsale Region waren tendenziell stärker betroffen. Die Übereinstimmung zwischen der nicht-invasiven Beurteilung des Ultraschalls am Krankenbett und der CT für Lungenläsionen bei COVID-19-Patienten war moderat (Kappa = 0,529). Die Beurteilung mittels Ultraschall von leichten, moderaten und schweren Lungenläsionen ergab eine Sensitivität von 68,8 % (11/16), 77,8 % (7/9), 100,0 % (2/2), eine Spezifität von 85,7 % (12/14), 76,2 % (16/21), 92,9 % (26/28) und eine diagnostische Genauigkeit von 76,7 % (23/30), 76,7 % (23/30) bzw. 93,3 % (28/30). Die anschließende dynamische Ultraschalluntersuchung zeigte, dass sich der Zustand aller Patienten allmählich verschlechterte, wobei die Ultraschall-Scores der Lungenläsionen in unterschiedlichem Maße anstiegen.

Schlussfolgerung Ultraschall direkt am Krankenbett hat eine wichtige klinische Bedeutung für die nicht-invasive Beurteilung und die dynamische Beobachtung von Lungenläsionen bei COVID-19-Patienten und sollte weiter in Betracht gezogen werden.

Key words

COVID-19 - ultrasound - CT - LUS

* These authors are co-corresponding authors.




Publication History

Received: 18 March 2020

Accepted: 06 April 2020

Article published online:
15 April 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Chan JF, Yuan S, Kok KH. et al A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020; 395: 514-523 . doi:https://doi.org/10.1016/S0140-6736(20)30154-9
    CrossrefPubMedGoogle Scholar
  • 2 Bernheim A, Mei X, Huang M. et al. Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology 2020; DOI: https://doi.org/10.1148/radiol.2020200463.
    CrossrefPubMedGoogle Scholar
  • 3 Porcel JM. Time to embrace POCUS as part of the bedside diagnosis of respiratory diseases. Respirology 2019; DOI: 10.1111/resp.13692.
    CrossrefPubMedGoogle Scholar
  • 4 Rouby JJ, Arbelot C, Gao Y. et al Training for lung ultrasound score measurement in critically ill patients. Am J Respir Crit Care Med 2018; 198: 389-401 . doi:10.1164/rccm.201802-0227LE
    PubMedGoogle Scholar
  • 5 Lu XF, Gong W, Wang L. et al. Clinical features and high resolution CT imaging findings of preliminary diagnosis COVID-19. Chinese Journal of Radiology 2020; 54 DOI: 10.3760/cma.j.issn.1005-1201.2020.0006.
    CrossrefPubMedGoogle Scholar
  • 6 Man MA, Dantes E, Domokos Hancu B. et al Correlation between transthoracic lung ultrasound score and HRCT features in patients with interstitial lung diseases. Journal of Clinical Medicine 2019; 8: 1199 . doi:10.3390/jcm8081199
    CrossrefPubMedGoogle Scholar
  • 7 Liang ZY, Meng Q, You CM. Quantitative assessment of the severity of neonatal respiratory distress syndrome by pulmonary ultrasound score and its clinical significance. Chinese Journal of Ultrasound in Medicine 2019; 35: 779-782 . doi:10.13929/j.1003-3289.201701072
    PubMedGoogle Scholar
  • 8 Liu Q, Wang RS, Qu GQ. et al. Report on the autopsy results of patient with COVID-19. Journal of Forensic Medicine 2020; 36: 19-21
    PubMedGoogle Scholar
  • 9 Liu J, Zheng X, Tong Q. et al. Overlapping and discrete aspects of the pathology and pathogenesis of the emerging human pathogenic coronaviruses SARS-CoV, MERS-CoV, and 2019-nCoV. Journal of Medical Virology 2020; DOI: 10.1002/jmv.25709.
    CrossrefPubMedGoogle Scholar
  • 10 Hasan AA, Makhlouf HA. B-lines: Transthoracic chest ultrasound signs useful in assessment of interstitial lung diseases. Ann Thorac Med 2014; 9: 99-103 . doi:10.4103/1817-1737.128856
    CrossrefPubMedGoogle Scholar
  • 11 Chung M, Bernheim A, Mei X. et al. CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology 2020; DOI: https://doi.org/10.1148/radiol.2020200230.
    CrossrefPubMedGoogle Scholar
  • 12 Chen Y, Liu Q, Guo D. Emerging coronaviruses: Genome structure, replication, and pathogenesis. J Med Virol 2020; 92: 418-423 . doi:10.1002/jmv.25681
    CrossrefPubMedGoogle Scholar
  • 13 Chiumello D, Umbrello M, Sferrazza Papa GF. et al Global and regional diagnostic accuracy of lung ultrasound compared to CT in patients with acute respiratory distress syndrome. Crit Care Med 2019; 47: 1599-1606 . doi:10.1097/CCM.0000000000003971
    CrossrefPubMedGoogle Scholar
  • 14 Pan Y, Guan H, Zhou S. et al. Initial CT findings and temporal changes in patients with the COVID-19 (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol 2020; DOI: https://doi.org/10.1007/s00330-020-06731-x.
    CrossrefPubMedGoogle Scholar
  • 15 Lichenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest 2008; 134: 117-125 . doi:10.1378/chest.07-2800
    CrossrefPubMedGoogle Scholar
  • 16 Shrestha GS, Weeratunga D, Baker K. Point-of-Care lung ultrasound in critically ill patients. Rev Recent Clin Trials 2018; 13: 15-26 . doi:10.2174/15748871126661709111257
    PubMedGoogle Scholar