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© 2006 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 25:225-232 • 0278-4297

Diaphragm Ultrasonography as an Alternative to Whole-Body Plethysmography in Pulmonary Function Testing

Samantha Scott, BSc, Jonathan P. Fuld, MB, Roger Carter, PhD, Margaret McEntegart, MB and Niall G. MacFarlane, PhD

Centre for Exercise Science and Medicine, Institute of Biomedical and Life Sciences, Glasgow University, Glasgow, Scotland (S.S., M.M., N.G.M.); Department of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, Scotland (J.P.F., R.C.); and Department of Medical Cardiology, Western Infirmary, Glasgow, Scotland (M.M.).

Address correspondence to Niall G. MacFarlane, PhD, University of Glasgow, Room 354, West Medical Building, Glasgow G12 8QQ, Scotland. E-mail: N.MacFarlane{at}bio.gla.ac.uk

Objective. Whole-body plethysmography is a common method of measuring pulmonary function. Although this technique provides a sensitive measure of pulmonary function, it can be problematic and unsuitable in some patients. The development of more accessible techniques would be beneficial. Methods. A prospective study was performed to validate diaphragm ultrasonography as an alternative to whole-body plethysmography in patients referred for pulmonary function testing. Diaphragm movement and position were assessed by ultrasonography after standard pulmonary function testing using whole-body plethysmography. Results. A wide range of lung function was observed. Standard lung volumes were as follows: total lung capacity, 5.57 ± 1.31 L, residual volume, 2.27 ± 0.56 L; and vital capacity, 3.30 ± 0.98 L (mean ± SD). The ratio of forced expiratory volume in 1 second to forced vital capacity was calculated as 0.69 ± 0.08. Ultrasonography showed that mean diaphragm excursion values were 11.1 ± 3.8 mm (2-dimensional), 14.7 ± 4.1 mm during quiet breathing (M-mode), and 14.8 ± 3.9 mm during a maximal sniff (M-mode). The velocity of diaphragm movement rose sharply during the sniff maneuver from 15.2 ± 5.8 mm/s during quiet breathing to 104.0 ± 33.4 mm/s. Static 2-dimensional measures of diaphragm position at the end of quiet inspiration or expiration correlated with standard measures of lung volume on plethysmography (eg, a correlation coefficient of 0.83 was obtained with end inspiration and vital capacity). All measures of diaphragm movement (whether by 2-dimensional or M-mode techniques) were poorly correlated with any lung volumes measured. Conclusions. These data suggest that dynamic measurements using diaphragm ultrasonography provide a relatively poor measure of pulmonary function in relation to whole-body plethysmography.

Key Words: diaphragm • plethysmography • ultrasonography

Abbreviations: FEV1, forced expiratory volume in 1 second • FVC, forced vital capacity • PA, posterior-anterior • TLC, total lung capacity • 2D, 2-dimensional • VC, vital capacity

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Copyright © 2006 by the American Institute of Ultrasound in Medicine.