Diffuse Parenchymal Lung Disease on Chest Radiographs and CT

Background

We prospectively identified B-lines in patients undergoing ultrasound examinations following liver transplants who also had a chest x-ray (CXR) and/or chest CT scan on the same day to determine if an association between the presence of B-lines s from the thorax on ultrasound images correlates with the presence of pulmonary abnormalities on chest radiographs.

Materials and Methods

Following IRB approval, patients undergoing routine postoperative liver transplant ultrasound examinations and a CXR and/or CT scan on the same day between 1/1/2015 through 7/1/2016 were prospectively identified.Two readers blinded to CXR and CT images and reports independently reviewed the US. Inter-reader agreement for presence/absence of the B-lines was evaluated for the presence or absence of diffuse parenchymal lung disease on CXR and CT, as well as on clinical evaluation. Receiver operating characteristic (ROC) curves were constructed.

Results

There was good agreement between the two readers on the presence/absence of B-lines (kappa: 0.94) The area under the ROC curve (AUC) for discriminating between DPLD+ and DPLD- for both readers was 0.79 (95% CI: 0.71-0.87.

Conclusion

There is an association between the presence of extensive B-lines to the point of confluence and “dirty shadowing” on ultrasound examinations of the chest and associated findings on chest radiographs and CT scans of diffuse parenchymal lung disease. Conversely, isolated B-lines do not always correlate with abnormalities on chest X-ray or and in fact appear sometimes to be a normal variant.

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