Ultra-high frequency lung ultrasound in preterm neonates: a test validation study on interpretation agreement and reliability

Objective: To verify if increasing frequency, through the use of ultra-high frequency transducers, has an impact on lung ultrasound pattern recognition.

Design: Test validation study.

Setting: Tertiary academic referral neonatal intensive care unit.

Patients: Neonates admitted with respiratory distress signs.

Interventions: Lung ultrasound performed with four micro-linear probes (10, 15, 20 and 22 MHz), in random order. Anonymised images (600 dpi) were randomly included in a pictorial database: physicians with different lung ultrasound experience (beginners (n=7), competents (n=6), experts (n=5)) blindly assessed it. Conformity and reliability of interpretation were analysed using intraclass correlation coefficient (ICC), area under the curve (AUC) of the multi-class ROC analysis, correlation and multivariate linear regressions (adjusting for frequency, expertise and their interaction).

Outcome measures: A (0-3) score based on classical lung ultrasound semiology was given to each image as done in the clinical routine.

Results: ICC (0.902 (95% CI: 0.862 to 0.936), p<0.001) and AUC (0.948, p<0.001) on the whole pictorial database (48 images acquired on 12 neonates), and irrespective of the frequency and physicians' expertise, were excellent. Physicians detected more B-lines with increasing frequency: there was a positive correlation between score and frequency (ρ=0.117, p=0.001); multivariate analysis confirmed the score to be higher using 22 MHz-probes (β=0.36 (0.02-0.7), p=0.041).

Conclusion: Overall conformity and reliability of interpretations of lung ultrasound patterns were excellent. There were differences in the identification of the B-patterns and severe B-patterns as increasing probe frequency is associated with higher score given to these patterns.