Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Ultrasound Lung Comets. Validity, Reproducibility and Feasibility of a Simplified Assessment of Pulmonary Interstitial Fibrosis in Connective Tissue Disorders.

Gutierrez1,  Marwin, Salaffi1,  Fausto, Carotti3,  Marina, Tardella1,  Marika, Bertolazzi1,  Chiara, Bichisecchi3,  Elisabetta, Giorgi3,  Mara

Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona, Italy
Instituto Nacional de Rehabilitacion, Mexico City, Mexico
S.O.D Radiologia Clinica, Dipartimento di Scienze Radiologiche, Ospedale Riuniti, Ancona.


To investigate the validity, reproducibility and feasibility of a simplified ultrasound lung comets (ULC) assessment compared with a comprehensive assessment of pulmonary interstitial fibrosis in patients with connective tissue disorders (CTD).


A total of 36 consecutive patients (32 female, 4 male, mean of age: 58.5 years, mean of disease duration: 60 months) with diagnosis of CTD (28 with systemic sclerosis, 2 with Sjögren's syndrome, 1 with undifferentiated CTD, 2 with anti-synthetase syndrome, 2 with dermatomyositis and 1 with mixed CTD) of Rheumatology Department of Università Politecnica delle Marche were enrolled in this study. The inclusion criteria were: previous diagnosis of CTD according to international criteria and a high resolution computed tomography (HRCT) performed no longer than 10 days prior to the beginning of the study. Each patient underwent a chest ultrasound exam by a rheumatologist experienced in ultrasound blinded to the HRCT findings, using a MyLab 70 XVG (Esaote Spa, Genoa-Italy) equipped with a 2–7 MHz multifrequency convex transducer. Both comprehensive, as previously proposed (1, 2) and simplified ULC assessments were scanned. The simplified ULC assessment included 14 sites bilaterally: third para-sternal, fifth mid-clavicular, anterior axillary, medial axillary and posterior axillary, and eighth sub-scapular and para-vertebral intercostal spaces. These sites were chosen on the basis of both the width of the acoustic window and the prevalence of ULC. The number of ULC was summed for each intercostal space and the total was scored using the following semiquantitative scoring (0= < 5; 1= 5–15; 2= 16–30; 3= >30 ULC) (3). For criterion validity, HRCT was considered the gold standard and an experienced radiologist interpreted it, adopting the topographic semiquantitative score proposed by Warrick et al. Inter and intra-observer reliability, with an other rheumatologist sonographer with less experience in the field of ultrasound, was also investigated.


A total of 1440 sites were evaluated by ultrasound. A highly significant agreement between the comprehensive and simplified ULC assessment was found (chi-square, p=0.0001). A significant positive correlation was also found between the simplified ULC assessment and Warrick scores (Spearman rank test, rho= 0.656, p< 0.0001). The concordance correlation coefficient values for the inter and intra-observer were in a range from 0.832 to 0.956 and 0.786 to 0.943 (p < 0.0001), respectively. Finally, there was a relevant difference in time spent on comprehensive (mean 20.6 minutes) with respect to the simplified (mean 7.4 minutes) ULC assessment.


Our results provide evidence in favour of the validity, reproducibility and feasibility of a simplified 14 sites ULC assessment as an adjunct method to assess pulmonary interstitial fibrosis in patients with CTD.

Gargani L et al. Ultrasound lung comets in sistemic sclerosis: a chest sonography hallmark of pulmonary interstitial fibrosis. Rheumatology 2009;48:1382-7.

Lichtenstein D et al. The comet-tail artifact: an ultrasound sign of alveolarinterstitial syndrome. Am J Respir Crit Care Med 1997;156:1640-6.

To cite this abstract, please use the following information:
Gutierrez, Marwin, Salaffi, Fausto, Carotti, Marina, Tardella, Marika, Bertolazzi, Chiara, Bichisecchi, Elisabetta, et al; Ultrasound Lung Comets. Validity, Reproducibility and Feasibility of a Simplified Assessment of Pulmonary Interstitial Fibrosis in Connective Tissue Disorders. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1635
DOI: 10.1002/art.29400

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