Lung ultrasound reproducibly outperforms computed tomography in the detection of extravascular lung water in patients undergoing haemodialysis
Corcoran, John P. Hew, Mark Shyamsundar, Murali Sutherland, Sheera Ventura, Kristine Benamore, Rachel St Noble, Victoria Piotrowska, Hania E. Pugh, Christopher W.
Corcoran, John P.
Hew, Mark
Shyamsundar, Murali
Sutherland, Sheera
Ventura, Kristine
Benamore, Rachel
St Noble, Victoria
Piotrowska, Hania E.
Pugh, Christopher W.
Affiliation
Oxford University Hospitals NHS Foundation Trust; University of Oxford; The Alfred Hospital, Melbourne, Australia; Monash University, Melbourne, Australia; South Warwickshire University NHS Foundation Trust; Queen's University Belfast; Odense University Hospital, Denmark; University of Southern Denmark
Other Contributors
Publication date
2024-03-11
Collections
Research Projects
Organizational Units
Journal Issue
Abstract
Background: Lung ultrasound (LUS) is increasingly used as an extension of physical examination, informing clinical diagnosis, and decision making. There is particular interest in the assessment of patients with pulmonary congestion and extravascular lung water, although gaps remain in the evidence base underpinning this practice as a result of the limited evaluation of its inter-rater reliability and comparison with more established radiologic tests.
Methods: 30 patients undergoing haemodialysis were prospectively recruited to an observational cohort study (NCT01949402). Patients underwent standardised LUS assessment before, during and after haemodialysis; their total LUS B-line score was generated, alongside a binary label of whether appearances were consistent with an interstitial syndrome. LUS video clips were recorded and independently scored by two blinded expert clinician sonographers. Low-dose non-contrast thoracic CT, pre- and post dialysis, was used as a "gold standard" radiologic comparison.
Results: LUS detected a progressive reduction in B-line scores in almost all patients undergoing haemodialysis, correlating with the volume of fluid removed once individuals with no or minimal B-lines upon pre-dialysis examination were discounted. When comparing CT scans pre- and post dialysis, radiologic evidence of the change in fluid status was only identified in a single patient.
Conclusions: This is the first study to demonstrate that LUS detects changes in extravascular lung water caused by changing fluid status during haemodialysis using a blinded outcome assessment and that LUS appears to be more sensitive than CT for this purpose. Further research is needed to better understand the role of LUS in this and similar patient populations, with the aim of improving clinical care and outcomes.
Keywords: extravascular lung water; interstitial syndrome; lung ultrasound.
Citation
Corcoran JP, Hew M, Attwood B, Shyamsundar M, Sutherland S, Ventura K, Benamore R, St Noble V, Piotrowska HE, Pugh CW, Laursen CB, Gleeson FV, Rahman NM. Lung Ultrasound Reproducibly Outperforms Computed Tomography in the Detection of Extravascular Lung Water in Patients Undergoing Haemodialysis. Diagnostics (Basel). 2024 Mar 11;14(6):589. doi: 10.3390/diagnostics14060589.
Type
Article