Quantitative Lung Ultrasound Spectroscopy Applied to the Diagnosis of Pulmonary Fibrosis: The First Clinical Study

The application of ultrasound imaging to the diagnosis of lung diseases is nowadays receiving growing interest. However, lung ultrasound (LUS) is mainly limited to the analysis of imaging artifacts, such as B-lines, which correlate with a wide variety of diseases. Therefore, the results of LUS investigations remain qualitative and subjective, and specificity is obviously suboptimal. Focusing on the development of a quantitative method dedicated to the lung, in this work, we present the first clinical results obtained with quantitative LUS spectroscopy when applied to the differentiation of pulmonary fibrosis. A previously developed specific multifrequency ultrasound imaging technique was utilized to acquire ultrasound images from 26 selected patients. Themultifrequency imaging technique was implemented on the ULtrasound AdvancedOpen Platform(ULA-OP) platformand an LA533 (Esaote, Florence, Italy) linear- array probe was utilized. RF data obtained at different imaging frequencies (3, 4, 5, and 6 MHz) were acquired and processed in order to characterize B-lines based on their frequency content. In particular, B-line native frequencies (the frequency at which a B-line exhibits the highest intensity) and bandwidth (the range of frequencies over which a B-line shows intensities within -6 dB fromits highest intensity), as well as B-line intensity, were analyzed. The results show how the analysis of these features allows (in this group of patients) the differentiation of fibrosis with a sensitivity and specificity equal to 92% and 92%, respectively. These promising results strongly motivate toward the extension of the clinical study, aiming at analyzing a larger cohort of patients and including a broader range of pathologies.