Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2025 May:241:108083.
doi: 10.1016/j.rmed.2025.108083. Epub 2025 Apr 4.

Ultrasound as diagnostic tool in diaphragm dysfunction: a prospective construct validity study

Wytze S de Boer  1 , Krista L Parlevliet  2 , Leonie A Kooistra  3 , David Koster  4 , Jellie A Nieuwenhuis  5 , Mireille A Edens  6 , Jan Willem K van den Berg  7 , Martijn F Boomsma  8 , Jos A Stigt  9 , Dirk Jan Slebos  10 , Marieke L Duiverman  11
Affiliations
Observational Study

Ultrasound as diagnostic tool in diaphragm dysfunction: a prospective construct validity study

Wytze S de Boer et al. Respir Med. 2025 May.

Abstract

Introduction: Diaphragm dysfunction is a frequently overlooked cause of dyspnea. Diagnosis typically relies on a combination of history, symptoms, and imaging. Diaphragm ultrasound is a promising alternative for fluoroscopy. This study evaluated the construct validity of ultrasound compared to traditional diagnostic methods in diaphragm dysfunction.

Methods: A prospective, operator-blinded study was conducted at two centers in the Netherlands. Thirty-six adults with suspected diaphragm dysfunction underwent fluoroscopy, pulmonary function tests, and ultrasound examination. The primary outcome was the agreement between predefined ultrasound diagnostic criteria and traditional diagnostic criteria (fluoroscopy, pulmonary function tests). Secondary outcomes included concordance of diagnostic criteria with the treating physician's final diagnosis, agreement of individual test parameters, and inter-rater reliability.

Results: The diagnostic criteria for ultrasound and traditional tests were concordant in 55.6 % (95 %CI: 0.381-0.721) of cases. Ultrasound criteria showed higher concordance with the treating physician's final diagnosis (75.0 %, 95 %CI: 0.578-0.879) compared to traditional test criteria (63.9 %, 95 %CI: 0.462-0.792). Individual parameters; visual ultrasound assessment, Thickening Fraction (TF), Diaphragm Excursion (DE), and fluoroscopy, had high concordance with the final diagnosis at 91.4 %, 90.3 %, 88.3 %, and 91.7 %, respectively. Inter-rater reliability was good for fluoroscopy, visual ultrasound assessment, and DE, but poor for TF.

Conclusion: This study demonstrates that ultrasound is a reliable tool for diagnosing diaphragm dysfunction, showing high concordance with the treating physician's final diagnosis and strong performance of individual parameters. The robust inter-rater reliability for visual assessment and DE supports its use as alternative to traditional methods like fluoroscopy in clinical practice. (ClinicalTrials.gov number: NCT05682027).

Keywords: Diaphragm; Fluoroscopy; Ultrasound.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: W.S. de Boer reports was provided by Isala Hospital. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Associated data