Abstract Objective: To evaluate the optimal diaphragmatic examination methods by comparing the accuracy of different diaphragm measurements in chronic obstructive pulmonary disease(COPD) patients of different severity. Methods: A total of 120 patients with COPD were enrolled in our hospital. According to the global initiative for chronic obstructive pulmonary disease(GOLD), patients were divided into 4 groups with 30 patients in each group. M-mode ultrasound and B-ultrasound direct examination of the diaphragm were performed in all patients with GOLD 1～4. The diaphragm movement amplitude(DMA) when the patient was forced to exhale and the diaphragm movement amplitude in one second(DMA1) were recorded. All patients underwent X-ray diaphragm movement angle measurement in the same way, and the right diaphragm movement angle(DMAG) and diaphragm movement angle in one second(DMAG1) were recorded. Kappa consistency analysis was used to evaluate the consistency of ultrasound and X-ray measurements of diaphragm movement and lung function tests. ROC curves of ultrasound and X-ray were used to identify the accuracy of different severity of COPD. Results: The data obtained by the three diaphragm measurements were gradually decreased with the increase of GOLD grade, and the differences were statistically significant(P<0.05). M-mode ultrasound had the best agreement with GOLD classification(Kappa=0.911, P=0.000), followed by X-ray measurement(Kappa=0.700, P=0.000). M-mode ultrasound and X-ray measurements had lower AUC(0.711, 0.750) in the identification of GOLD 1 vs. GOLD 2. In the identification of GOLD 2 vs. GOLD 3, the best AUC(0.928, 0.938) were obtained for both M-mode ultrasound and X-ray measurements. In the identification of GOLD 3 vs. GOLD 4, the AUC(0.916) of the M-mode ultrasound method was greater than the X-ray measurement(0.764), and the difference was statistically significant(z=2.101, P=0.036). The best diagnostic point for M-mode ultrasound was 4.58 cm, where the sensitivity was 100% and the specificity was 73.33%. Conclusion: M-mode ultrasound method can identify COPD of different severity more accurately compared with X-ray measurement and B-ultrasound direct examination.
SHEN Hui-ying,ZHU Xin-xiu,CHEN Qi, et al. Comparison of different examination methods in evaluating diaphragmatic motion in patients with COPD[J]. JOURNAL OF CHINA MEDICAL IMAGING, 2019, 30(10): 698-702.
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