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Diagnostic value of lung ultrasound versus chest CT in COVID-19

https://doi.org/10.47093/2218-7332.2020.11.2.5-18

Abstract

Lung ultrasound demonstrates a high diagnostic value in the assessment of lung diseases.

Aim. To determine the diagnostic accuracy of lung ultrasound compared to chest computed tomography (CT) in the diagnosis of lung changes in COVID-19.

Materials and methods. The retrospective study included 45 patients (28 men) aged 37 to 90 years who underwent polypositional lung ultrasound with an assessment of 14 zones. The study compared lung echograms with chest CT data in assessing the prevalence of the process and the nature of structural changes. The diagnostic accuracy, sensitivity, and specificity of lung ultrasound in comparison with CT scans were determined, 95% confidence intervals (CI) were calculated.

Results. In 44 patients (98%), CT revealed pathological changes with subpleural localization in both lungs. Of these, in 30 cases, the inflammation was limited only to the subpleural parts, and in 14 cases, the changes spread to the basal parts of the lungs, while ultrasound revealed changes at the depth of the lesion no more than 4 cm. The lesion of 10–11 zones according to lung ultrasound corresponds to CT 1–2 degrees, the lesion of 13–14 zones — CT 3–4 degrees. The sensitivity of ultrasound to detect lung changes of various types was ≥ 92%. The highest sensitivity of 97.9% (95% CI: 92.8–99.8%) was determined for small consolidations on the background of interstitial changes (degree 1A+, 1B+), which corresponded to “crazy-paving” pattern on CT. The specificity depended on the nature of the changes and varied from 46.7 to 70.0%. Diagnostic accuracy was ≥ 81%, the maximum values of 90.6% (95% CI: 85.6–94.2%) were obtained for moderate interstitial changes (grade 1A) corresponding to ground-glass opacity (type one) according to CT data.

Conclusion. The sensitivity of ultrasound to detect lung changes in COVID-19 is more than 90%. Lung ultrasound has some limitations: inability to determine the prevalence of the process clearly and identify centrally located areas of changes in the lung tissue.

About the Authors

S. S. Petrikov
N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Health Department; A.I. Yevdokimov Moscow State University of Medicine and Dentistry
Russian Federation

Sergey S. Petrikov, MD, PhD, DMSc, Professor, Corresponding Member of RAS, Director; Professor, Department of Neurosurgery and Neuroresuscitation

3, Bolshaya Sukharevskaya sq., Moscow, 129090

20/1, Delegatskaya str., Moscow, 127473



I. E. Popova
N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Health Department
Russian Federation

Irina E. Popova, MD, PhD, Senior Researcher, Department of Diagnostic Radiology

3, Bolshaya Sukharevskaya sq., Moscow, 129090

+ 7 (916) 174-60-75

 



V. M. Abuchina
N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Health Department
Russian Federation

Vera M. Abuchina, Physician, Department of Ultrasound and Functional Methods of Examination

3, Bolshaya Sukharevskaya sq., Moscow, 129090



R. Sh. Muslimov
N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Health Department
Russian Federation

Rustam Sh. Muslimov, MD, PhD, Leading Researcher, Department of Diagnostic Radiology

3, Bolshaya Sukharevskaya sq., Moscow, 129090



L. T. Khamidova
N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Health Department
Russian Federation

Laila T. Khamidova, MD, PhD, Head of the Department of Ultrasound and Functional Diagnostics 

3, Bolshaya Sukharevskaya sq., Moscow, 129090



K. A. Popugayev
N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Health Department; A.I. Burnazyan Federal Medical Biophysical Center of the Federal Medical and Biological Agency of Russian Federation
Russian Federation

Konstantin A. Popugayev, MD, PhD, DMSc, Deputy Director, Head of the regional vascular center; Head of the Department of Anesthesiology, Resuscitation Intensive Care

3, Bolshaya Sukharevskaya sq., Moscow, 129090

46/8, Zhivopisnaya str., Moscow, 123098



L. S. Kokov,
N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Health Department; Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Leonid S. Kokov, MD, PhD, DMSc, Professor, Academician of the RAS, Head of the Department of Diagnostic Radiology; Head of the Department of Diagnostic Radiology

3, Bolshaya Sukharevskaya sq., Moscow, 129090

8/2, Trubetskaya str., Moscow, 119991



References

1. WHO World Health Organization: Director-General’s opening remarks at the media briefing on COVID-19 — 11 March 2020.URL: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—11-march-2020 (accessed 14.06.2020).

2. Zhu N., Zhang D., Wang W., et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020; 382(8): 727–33. https://doi.org/10.1056/NEJMoa2001017 PMID: 31978945

3. Huang C., Wang Y., Li X., et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223): 497–506. https://doi.org/ 10.1016/S0140-6736(20)30183-5 PMID: 31986264

4. Li Q., Guan X., Wu P., et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020; 382(13): 1199–207.https://doi.org/10.1056/NEJMoa2001316 PMID: 31995857

5. Rubin G.D., Ryerson C.J., Haramati L.B., et al. The role of chest imaging in patient management during the COVID-19 pandemic: a multinational consensus statement from the Fleischner Society. Chest. 2020; 158(1): 106–16. https://doi.org/10.1016/j.chest.2020.04.003 PMID: 32275978

6. Diagnosis and treatment protocol for novel coronavirus pneumonia (Trial Version 7). Chin Med J (Engl). 2020; 133(9): 1087–95. https://doi.org/10.1097/CM9.0000000000000819 PMID: 32358325

7. Revel M.P., Parkar A.P., Prosch H., et al. COVID-19 patients and the Radiology department — advice from the European Society of Radiology (ESR) and the European Society of Thoracic Imaging (ESTI). Eur Radiol. 2020; 30(9): 4903–9. https://doi.org/10.1007/s00330-020-06865-y PMID: 32314058

8. Ternovoi S.K., Serova N.S., Belyaev A.S., Belyaeva K.A. COVID19: pervye rezul’taty luchevoi diagnostiki v otvete na novyi vyzov [COVID-19: first results of radiology in response to a new challenge]. REJR. 2020; 10(1): 8–15 (In Russian).https://doi.org/10.21569/2222-7415-2020-10-1-8-15

9. Petrikov S.S., Popova I.E., Muslimov R.Sh., et al. Vozmozhnosti komp’yuternoi tomografii v otsenke stepeni porazheniya legkikh u bol’nykh COVID-19 v usloviyakh dinamicheskogo nablyudeniya. [Computer tomography in assessing and monitoring the degree of lung ingury due to COVID-19]. REJR. 2020; 10(2):14–26 (In Russian). https://doi.org/10.21569/2222-7415-2020-10-2-14-26

10. Fang Y., Zhang H., Xie J., et al. Sensitivity of chest CT for COVID-19: comparison to RT-PCR. Radiology. 2020 Aug; 296(2): E115-E117 https://doi.org/10.1148/radiol.2020200432 PMID: 32073353

11. Karmazanovskii G.G., Zamyatina K.A., Stashkiv V.I., et al. Komp’yuterno-tomograficheskaya diagnostika i monitoring techeniya virusnoi pnevmonii, obuslovlennoi virusom SARS-COV-2, pri rabote “Gospitalya COVID-19” na baze Federal’nogo spetsializirovannogo meditsinskogo nauchnogo tsentra. [CT diagnostics and monitoring of the course of viral pneumonia caused by the SARS-CoV-2 virus during the work of the “COVID-19 Hospital”, based on the Federal Specialized Medical Scientific Center]. Medical Visualization. 2020; 24(2): 11–36 (In Russian).https://doi.org/10.24835/1607-0763-2020-2-11-36

12. Yasukawa K., Minami T. Point-of-Care Lung Ultrasound Findings in Patients with Novel Coronavirus Disease (COVID-19) Pneumonia. Am J Trop Med Hyg. 2020; 102(6): 1198–202.https://doi.org/10.4269/ajtmh.20-0280 PMID: 32333544

13. Petrikov S.S., Popugaev K.A., Khamidova L.T., et al. Pervyi opyt primeneniya ul’trazvukovogo issledovaniya legkikh u patsientov s ostroi virusnoi infektsiei, vyzvannoi SARS-CoV-2. [First experience of lung ultrasound application in patients with acute viral infection caused by SARS-CoV-2]. Medical Visualization. 2020; 24(2): 50–62 (In Russian). https://doi.org/10.24835/1607-0763-2020-2-50-62

14. Smith M.J., Hayward S.A., Innes S.M., Miller A. Point-of-care lung ultrasound in patients with COVID-19 — a narrative review. Anaesthesia. 2020; 75(8): 1096–104. https://doi.org/10.1111/anae.15082 PMID: 32275766

15. Kalafat E., Yaprak E., Cinar G., et al. Lung ultrasound and computed tomographic findings in pregnant woman with COVID-19. Ultrasound Obstet Gynecol. 2020; 55(6): 835–37. https://doi.org/10.1002/uog.22034 PMID: 32249471

16. Soldati G., Smargiassi A., Inchingolo R., et al. Proposal for international standardization of the use of lung ultrasound for COVID-19 patients; a simple, quantitative, reproducible method. J Ultrasound Med. 2020; 39(7): 1413–19. https://doi.org/10.1002/jum.15285 PMID: 32227492

17. Lichtenstein D.A., Mezière G.A. Relevance of Lung Ultrasound in the Diagnosis of Acute Respiratory Failure: The BLUE Protocol. Chest 2008 Jul; 134(1): 117–25. https://doi.org/10.1378/chest.07-2800 PMID: 18403664

18. Profilaktika, diagnostika i lechenie novoi koronavirusnoi infektsii (COVID-19). Vremennye metodicheskie rekomendatsii. Ministerstvo zdravookhraneniya Rossiiskoi Federatsii. Versiya 6. [Prevention, diagnosis and treatment of new coronavirus infection (COVID-19). The provisional guidelines. Ministry of health of the Russian Federation. Version 6. (28.04.2020)]. Moscow; 2020:164 (In Russian). URL: https://static-1.rosminzdrav.ru/system/attachments/attaches/000/050/116/original/28042020_%D0%9CR_COVID-19_v6.pdf (accessed 28.05.20).

19. Sinitsyn V.E., Tyurin I.E., Mit’kov V.V. Rossiiskoe obshchestvo rentgenologov i radiologov (RORR), Rossiiskaya assotsiatsiya spetsialistov ul’trazvukovoi diagnostiki v meditsine (RASUDM). Vremennye soglasitel’nye metodicheskie rekomendatsii Rossiiskogo obshchestva rentgenologov i radiologov (RORR) i Rossiiskoi assotsiatsii spetsialistov ul’trazvukovoi diagnostiki v meditsine (RASUDM) “Metody luchevoi diagnostiki pnevmonii pri novoi koronavirusnoi infektsii COVID-19” (versiya 1). [Russian society of roentgenologists and radiologists (of RSRR), Russian Association of specialists in ultrasound diagnostics in medicine (RASUDM). Temporary consensual guidelines of the Russian society of radiologists and radiologists (RORR) and the Russian Association of specialists in ultrasound diagnostics in medicine (RASUDM) “Methods of radiation diagnosis of pneumonia in new coronavirus infection COVID-19” (version 1)] (In Russian). URL: http://www.rasudm.org/files/RSR-RASUDM-2020-v1-appendix1&2.pdf (accessed 10.07.20).

20. Mit’kov V.V., Safonov D.V., Mit’kova M.D., et al. Konsensusnoe zayavlenie RASUDM ob ul’trazvukovom issledovanii legkikh v usloviyakh pandemii COVID-19 (versiya 2). [RASUDM consensus statement on lung ultrasound in the context of the COVID-19 pandemic (version 2)] Ul’trazvukovaya i funktsional’naya diagnostika. 2020; 1: 46–77 (In Russian). https://doi.org/10.24835/1607-0771-2020-1-46-77

21. Prikaz Departamenta zdravookhraneniya g. Moskvy ot 08.04.2020 No 373 “Ob utverzhdenii algoritma deistvii vracha pri postuplenii v statsionar patsienta s podozreniem na vnebol’nichnuyu pnevmoniyu, koronavirusnuyu infektsiyu (COVID-19), poryadka vypiski iz statsionara patsientov s vnebol’nichnoi pnevmoniei, koronavirusnoi infektsiei (COVID-19), dlya prodolzheniya lecheniya v ambulatornykh usloviyakh (na domu)”. [The order of Department of health of Moscow from 08.04.2020 No 373 “On approval of the actions of the physician in the admission to hospital of a patient with suspected community-acquired pneumonia, coronavirus infection (COVID-19), about the discharge from hospital of patients with community-acquired pneumonia, coronavirus infection (COVID-19), to continue treatment as an outpatient (at home)”]. Moscow; 2020 (In Russian). URL: http://docs.cntd.ru/document/564644474 (accessed 14.06.20).

22. Vlasov V.V. Ehffektivnost’ diagnosticheskikh issledovanii [Effectiveness of diagnostic studies]. Moscow: Meditsina; 1998:256 (In Russian).

23. Lichtenstein D.A. Lung Ultrasound in the Critically Ill. The BLUE Protocol. Cham: Springer; 2016:376. https://doi.org/10.1186/2110-5820-4-1

24. Zabozlaev F.G., Kravchenko E.V., Gallyamova A.R., Letunovskiy N.N. Patologicheskaya anatomiya legkikh pri novoi koronavirusnoi infektsii (COVID-19). Predvaritel’nyi analiz autopsiinykh issledovanii. [Pulmonary Pathology of the New Coronavirus Disease (COVID-19). The preliminary analysis of post-mortem findings]. Journal of Clinical Practice. 2020; 11(2): 21–37 (In Russian). https://doi.org/10.17816/clinpract34849

25. Yang, Y., Huang, Y., Gao, F., et al. Lung ultrasonography versus chest CT in COVID-19 pneumonia: a two-centered retrospective comparison study from China. Intensive Care Med. 2020; 46(9): 1761–3. https://doi.org/10.1007/s00134-020-06096-1 PMID: 32451581


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