The Impact of Different Lung Ultrasound Protocols in the Assessment of Lung Lesions in COVID-19 Patients: Is There an Ideal Lung Ultrasound Protocol?

J Ultrasound. 2022 Sep;25(3):483-491. doi: 10.1007/s40477-021-00610-x. Epub 2021 Dec 2.


Background: In the past months, several lung ultrasonography (LUS) protocols have been proposed, mainly on previously validated schemes independent of coronavirus disease 2019 (COVID-19).

Objectives: The main purpose of this study was to determine the impact and accuracy of different LUS protocols proposed in COVID-19.

Methods: Patients were evaluated with a standard sequence of LUS scans in 72 intercostal spaces along 14 anatomic lines in the chest. A scoring system of LUS findings was reported and then analyzed separately according to each proposed LUS protocol zones. This score was then correlated to a validated Pulmonary Inflammation Index (PII) on chest Computed Tomography (CT).

Results: Thirty-two patients were enrolled. The most frequent pattern was ground-glass opacities in the chest X-ray (53.1%), chest CT (59.1%) and subpleural or lobar consolidations (40.8%) in the posteroinferior areas (p < 0.001) on LUS. The Interclass Correlation Coefficient (ICC) was significantly correlated with almost every protocol analyzed except the 8-zone (p = 0.119) and the 10-zone protocol that only included one posterior point (p = 0.052). The highest ICC was obtained with a 12-zone protocol (ICC 0.500; p = 0.027) and decreased as more points were included.

Conclusions: In conclusion, our study results suggest that performing an ultrasound protocol with 12-zone scanning, including the superior and inferior areas of the anterior, lateral and posterior regions of the chest was consistent with higher ICC and higher degree of concordance with CT. We emphasize the need of a more standardization technique to further implement and develop this imaging modality in COVID-19.

Keywords: Coronavirus disease 2019 (COVID-19); Lung ultrasonography (LUS); Point-of-care ultrasonography (POCUS); Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

MeSH terms

  • COVID-19* / diagnostic imaging
  • Humans
  • Lung / diagnostic imaging
  • SARS-CoV-2
  • Tomography, X-Ray Computed / methods
  • Ultrasonography / methods