A systematic review of diagnostic methods to differentiate acute lung injury/acute respiratory distress syndrome from cardiogenic pulmonary edema

Table 3 Imaging to differentiate ALI/ARDS from CPE

Study	Design	No. of ALI/ARDS vs CPE	Marker	Timing of measurement	AUC	95% CI	Cutoff	For	Specificity (%)	Sensitivity (%)
Sekiguchi, 2015***	Prospective	42 vs 59	Combined cardiac and thoracic ultrasonography	Within 6 h of diagnosis
			Number of chest zones with positive B-lines		0.82	0.75–0.88	3	Miscellaneous causes	42 (95% CI 32–52)	100 (95% CI 89–100)
			Score; left pleural effusion >20 mm (+4), Moderate or severe LV dysfunction (+3), and IVC minimal diameter < =23 mm (-2).		0.79	0.70–0.87	> = 6	CPE	98 (95% CI 87–100)	39 (95% CI 26–52)
Komiya, 2013**	Retrospective	20 vs 41	Chest CT	Within 2 hours of arrival at ED
			Upper-lobe-predominant GGA					CPE	95	48.8
			Central-predominant GGA					CPE	90	58.5
			Central airspace consolidation					CPE	90	56.1
			Small ill-defined opacities					ARDS	87.8	35
			Left-dominant pleural effusion					ARDS	95.1	25
Copetti, 2008**	Prospective	18 vs 40	Chest sonography	Not stated
			Alveolar-interstitial syndrome					ALI/ARDS	0	100
								CPE	0	100
			Pleural line abnormalities					ALI/ARDS	45	100
								CPE	0	25
			Reduction or absence of lung sliding					ALI/ARDS	100	100
								CPE	0	0
			Spared areas					ALI/ARDS	100	100
								CPE	0	0
			Consolidations					ALI/ARDS	100	83.3
								CPE	0	0
			Pleural effusion					ALI/ARDS	5	66.6
								CPE	33.3	95
			Lung pulse					ALI/ARDS	100	50
								CPE	50	0

ALI acute lung injury, ARDS acute respiratory distress syndrome, AUC area under the curve, B-lines vertical narrow based lines arising from the pleural line to the edge of the ultrasound screen, CT computed tomography, CPE cardiogenic pulmonary edema, GGA ground-glass attenuation, ED emergency department, IVC inferior vena cava, LV left ventricular
***Good, or **moderate quality assessed based on biases using the modified Hayden’s criteria
Miscellaneous including unilateral pneumonia, atelectasis, COPD, pulmonary embolism or pneumothorax

ISSN: 1364-8535