Reliability of Rectus Femoris Ultrasound Measurements and Relationship With Truncal Muscle Mass in Healthy Individuals Using Concurrent CT Measurements as the Reference Standard: A Pilot Study.

Role of ultrasonography in upper airway assessment: A comparison with computerized tomography measurements

Can diagnostic ultrasound measure quadriceps size and vastus medialis to vastus lateralis ratio in patellofemoral pain syndrome?

Diagnostic ultrasound (US) provides a cost-effective, accessible alternative to the gold standard magnetic resonance imaging (MRI) for assessing muscle cross-sectional area (CSA). Since muscle CSA correlates directly with force production, accurate evaluation of rotator cuff CSA is essential for assessing shoulder strength and function. The present study investigated the same-day and between-day intrarater reliability of US measurements of supraspinatus and infraspinatus CSA, as well as the criterion validity of these measures compared with MRI. Cross-sectional study evaluating the intrarater reliability and criterion validity of US measures of supraspinatus and infraspinatus CSA. Thirty-two right-hand dominant adults with unilateral shoulder pain (mean age: 43 [13]y; 22 males) were enrolled including 12 participants who underwent both US and MRI. CSA of the supraspinatus and infraspinatus was measured using a standardized US protocol. Same-day intrarater reliability was assessed in all participants, and between-day reliability was evaluated in 14 participants who returned for a second US session. Criterion validity was tested by comparing US measurements to corollary MRI CSA values in the MRI subgroup. US demonstrated excellent same-day intrarater reliability (intraclass correlation coefficients [ICCs] .97-.99, standard error of measurements 0.36-0.52cm2) and excellent between-day (supraspinatus ICC: .87-.95, infraspinatus ICC: .92-.94; standard error of measurements 0.52-1.13cm2). Criterion validity compared with MRI was also excellent (supraspinatus ICC: .97, infraspinatus ICC: .99) with small measurement differences (mean difference -0.29 to 0.41cm2). US CSA measures of the supraspinatus and infraspinatus muscles demonstrated excellent criterion validity and same-day and between-day intrarater reliability. These findings support the use of US as a practical, accessible tool for monitoring rotator cuff muscle size and detecting clinically meaningful changes over time.

This study investigated the validity and reliability of measuring patellar tendon (PT) cross-sectional area (CSA) using magnetic resonance imaging (MRI) and ultrasound (US) imaging. Nineteen healthy participants (10 women, 9 men) participated in three imaging sessions of the PT, once via MRI and twice via US, with image acquisition conducted by two raters, one experienced (rater 2) and one inexperienced (rater 1). All PT segmentations were analyzed by both raters. The validity of US-derived estimates of PT CSA against MRI estimates was analyzed using linear regression. Within-day reliability of US and MRI measurements and between-day reliability of US measurements were quantified using typical error (TE) and intra-class correlation coefficients (ICC3,1). There was good agreement between US- and MRI-derived estimations of PT CSA (standard errors of the estimate of 3.3 mm2 for rater 1 and 2.6 mm2 for rater 2; Pearson's r=0.97 and 0.98 for raters 1 and 2, respectively). Within-session reliability for estimations of total PT CSA from US and MRI were excellent (ICC3,1 >0.95, coefficient of variation [CV] <4.1%, TE=1.3-3.6 mm2. Between-day reliability for US was excellent (ICC3,1 >0.97, CV <2.7%, TE=1.6-2.3 mm2), with little difference between raters. These findings suggest that MRI and US both provide reliable estimates of PT CSA and that US can provide a valid measure of PT CSA.

Background Sarcopenia is characterized by the loss of muscle mass and it is a strong predictor of disability and poor outcomes in several chronic gastrointestinal diseases such as inflammatory bowel diseases (IBD). Therefore, it is useful to evaluate muscle mass in patients with chronic gastrointestinal diseases at risk for sarcopenia. Radiological evaluation of muscle mass is obtained with computed tomography (CT), magnetic resonance (MRI) and bioelectrical impedance (BIA). We aimed at assessing the feasibility, reproducibility and diagnostic accuracy of ultrasound (US) measurement of psoas muscle thickness adjusted for body mass index (BMI) compared to skeletal muscle mass (SMM) evaluated with BIA normalized to height2 in the quantification of muscle mass among patients with IBD. Methods We enrolled a total of 86 consecutive patients with IBD (males 68.6%, mean age 50.4 ± 17.6, 7.4% with Crohn’s disease) who underwent US evaluation of psoas muscle thickness and BIA during the same day. US measurement (Philips Epiq, Bothell, USA) was performed by two sonographers, blind to each other. BIA was performed with the Seca mBCA 525 (Hamburg, Germany). A cut-off of 6.68 and 8.97 of SMM normalized to height2 was considered as normal value for women and men respectively. Sensitivity, specificity, positive and negative predictive values(PPV and NPV), positive and negative likelihood ratios (LR+ andLR−) were calculated, all with the respective 95% confidence inter-vals (95% CI). The reproducibility between the US operators was evaluated by intra-class correlation coefficient(ICC) for the quantitative variables of psoas muscle. The study was approved by our local ethics committee and partially funded by the Italian Ministry of Health. Results US psoas muscle thickness measurement was feasible in all the 86 enrolled patients. There was a significant correlation between US measurement and BIA with a Pearson r coefficient of 0.54 (p= &amp;lt;0.0001). Among men a cut off of 108.18 cmxkg/m*2 showed a sensitivity of 93.5% and a specificity of 53,6% in the detection of low SMM at BIA (Figure 1). Among women a cut off of 66.9 cmxkg/m*2 showed a sensitivity of 78.5% and a specificity of 69.2% in the detection of low SMM at BIA (Figure 2). Reproducibility among the operators had an ICC of 0.95 (CI 0.93-0.96). Conclusion Sarcopenia is a prognostic factor of poor outcomes in IBD, therefore it is important to identify patients at risk for it. Nowadays, assessment of muscle mass and eventually sarcopenia relies on radiological techniques (CT/MRI and BIA). At this purpose we propose a simple, non-ionizing, fast and reproducible US technique that compared to BIA showed a high sensitivity and thus can be used in clinical ractice to screen for muscle mass reduction in IBD patients.

This original research aimed to investigate the value of ultrasound (US), including grayscale US and shear wave elastography (SWE), in quantitatively evaluating muscle mass after kidney transplantation. A total of 52 patients and 54 healthy control participants were recruited. High-frequency US was used to evaluate the echo intensity and muscle morphologic features. Muscle stiffness in the rectus femoris was assessed with SWE. Interclass and intraclass correlation coefficients were used for evaluating measurement reliability. The diagnostic performance of SWE was determined by a receiver operating characteristic curve analysis. The intraobserver and interobserver repeatability was excellent (all correlation coefficients >0.940; P < .05). The best evaluation point after right iliac fossa transplantation was at the lower third of the right leg. In patients, the skin (0.154 versus 0.192 cm) and rectus femoris (0.700 versus 0.905 cm) were thinner, and the pinnate angle (6.500° versus 8.000°) and area (0.965 versus 1.270 cm2 ) were smaller (all P < .05). The US results showed that, compared with the controls, all patients' rectus femoris echo intensity (P < .001 in the transverse section) and elastic modulus (P < .001 in the Young modulus and shear wave speed) increased significantly. The cutoff values were 10.05 and 10.37, and the areas under the receiver operating characteristic curves were 0.843 and 0.845 for predicting kidney transplant and sarcopenia, respectively. This noninvasive and convenient technique might be effective for objectively evaluating the muscle mass of patients after kidney transplantation.

Background and Objectives: Sarcopenia is a common yet underrecognized condition in cancer patients and is associated with increased treatment-related toxicity, functional decline, and poor clinical outcomes. Practical, rapid, and bedside-applicable tools are needed to detect sarcopenia early in routine oncology practice. This study aimed to evaluate the diagnostic value of rectus femoris muscle ultrasonography within an integrated clinical assessment combining handgrip strength and bioelectrical impedance analysis for the detection of sarcopenia in cancer patients. Materials and Methods: In this prospective cross-sectional study, 147 adult patients with malignancy were evaluated using a multimodal sarcopenia assessment framework. Muscle strength was assessed by handgrip dynamometry, muscle mass was estimated using bioelectrical impedance analysis (BIA)-derived appendicular skeletal muscle mass index (ASMI), and muscle morphology was evaluated using ultrasonographic measurements of the rectus femoris and biceps brachii muscles. Sarcopenia was defined and classified according to the EWGSOP2 criteria. Associations between clinical variables, BIA parameters, and ultrasonographic measurements were analyzed. Receiver operating characteristic (ROC) curve analyses were performed to assess the diagnostic performance of muscle ultrasonography for sarcopenia detection. Results: The mean age of the study population was 60.2 ± 11.2 years, and 51% of participants were male. Confirmed sarcopenia was identified in 12.2% of patients, while 27.2% were classified as having probable sarcopenia. Sarcopenic patients were significantly older (68.5 ± 7.6 vs. 59.0 ± 11.2 years, p = 0.001) and had lower handgrip strength (15.8 ± 6.0 vs. 24.3 ± 8.4 kg, p < 0.001) and ASMI values (5.96 ± 0.64 vs. 7.23 ± 1.18 kg/m2, p < 0.001). Rectus femoris muscle thickness was significantly reduced in patients with sarcopenia (6.40 ± 1.42 vs. 8.19 ± 2.21 mm, p = 0.001). Rectus femoris muscle thickness demonstrated good diagnostic performance for sarcopenia detection (AUC = 0.752; 95% CI: 0.650-0.853; p = 0.001), with an optimal cut-off value of ≤7.59 mm (sensitivity 83.3%, specificity 61.2%). Conclusions: Rectus femoris muscle ultrasonography is a practical, rapid bedside assessment for detecting sarcopenia in cancer patients. When integrated with handgrip strength and BIA, this multimodal approach provides a feasible, radiation-free strategy for early sarcopenia screening in routine oncology practice.

The purpose of this study was to determine intraobserver, interobserver, and inter-day reliability levels for stiffness measurements of the patellar tendon and rectus femoris muscle using shear wave elastography (SWE). This study was conducted on 12 healthy male individuals. Two examiners measured mean shear wave velocity values of the patellar tendons and rectus femoris muscles of both extremities using a 9L4 (4-9 MHz) transducer and an Acuson S3000 ultrasound system (Siemens Medical Solutions, Mountain View, CA). The elasticity images were acquired by the Virtual Touch tissue imaging quantification technique (Siemens Medical Solutions). Measurements were repeated 20 minutes and 1 week after the first measurements. The reliability of SWE measurements was assessed by means of the intraclass correlation coefficient (ICC). The 12 participants ranged in age from 19 to 33 years (mean age ± SD, 25.33 ± 4.56 years). For the patellar tendon stiffness measurements with SWE, it was found that intraobserver reliability (ICC, 0.91-0.92) and interday reliability (ICC, 0.81-0.83) were excellent, and interobserver reliability (ICC, 0.71) was good. For the rectus femoris muscle stiffness measurements with SWE, it was found that the intraobserver reliability (ICC, 0.93-0.94), interday reliability (ICC, 0.81-0.91), and interobserver reliability (ICC, 0.95) were perfect. Shear wave elastography using the Virtual Touch tissue imaging quantification technique is a reliable and repeatable technique for patellar tendon and rectus femoris stiffness measurements according to intraobserver, interday, and interobserver ICC values.

Interrater reliability of quantitative ultrasound measures of muscle in critically ill patients.

The aim of this study is to identify cutoff values for muscle ultrasound (US) to be used in Global Leadership Initiative on Malnutrition (GLIM) criteria, and to define the effect of reduced muscle mass assessment on malnutrition prevalence at hospital admission. A total of 118 inpatients were enrolled in this cross-sectional study. Six different muscles were evaluated by US. Following defining thresholds for muscle US to predict low muscle mass measured by bioelectrical impedance analysis, malnutrition was diagnosed by GLIM criteria with seven approaches, including calf circumference, mid-upper arm circumference (MAC), handgrip strength (HGS), skeletal muscle index (SMI), rectus femoris (RF) muscle thickness, and cross-sectional area (CSA) in addition to without using the reduced muscle mass criterion. The median age of patients was 64 (18-93) years, 55.9% were female. RF muscle thickness had moderate positive correlations with both HGS (r = 0.572) and SMI (r = 0.405). RF CSA had moderate correlation with HGS (r = 0.567) and low correlation with SMI (r = 0.389). The cutoff thresholds were 11.3 mm (area under the curve [AUC] = 0.835) and 17 mm (AUC = 0.737) for RF muscle thickness and 4 cm² (AUC = 0.937) and 7.2 cm² (AUC = 0.755) for RF CSA in females and males, respectively. Without using the reduced muscle mass criterion, malnutrition prevalence was 46.6%; otherwise, it ranged from 47.5% (using MAC) to 65.2% (using HGS). Muscle US may be used in GLIM criteria. However, muscle US needs a standard measurement technique and specific cutoff values in future studies.

Patients with essential hypertension have a high risk of muscle mass and strength decline. Ultrasound is a promising method for assessing sarcopenia. This study aimed to analyze the correlation between ultrasound and shear-wave elastography (SWE) features, and muscle mass, muscle strength, and physical performance, and to assess the clinical applicability of ultrasound in the diagnosis of sarcopenia in patients with essential hypertension. In total, 134 patients with essential hypertension were enrolled in this cross-sectional study. The appendicular skeletal muscle mass index (ASMI), handgrip strength, and 6-meter walking speed of all the patients were measured. The patients were classified into the sarcopenia group and the non-sarcopenia group. The ultrasound-derived muscle thickness (MT), cross-sectional area (CSA), and SWE of the rectus femoris muscle (RFM) were measured in both the relaxed and contracted states. In addition, ultrasound features, such as the muscle fascicle length (Fl), pennation angle (PA), MT, and SWE of the gastrocnemius medialis muscle (GMM), were measured in the relaxed state. Correlations between the clinical indicators, and the ultrasound and SWE features were analyzed. The clinical indicators, and the ultrasound and SWE features were then compared between the sarcopenia and non-sarcopenia groups to determine the independent predictors. Based on these predictors, diagnostic models were established by logistic regression analysis. Both the ASMI and grip strength were positively correlated with the ultrasound-derived MT and CSA of the RFM in the relaxed and contracted states, and positively correlated with the MT, Fl, PA, and SWE of the GMM in the relaxed state (all P<0.05). The 6-meter walking speed was positively correlated with the ultrasound-derived MT and CSA of the RFM in the relaxed and contracted states, and positively correlated with the Fl and SWE of the GMM in the relaxed state (all P<0.05). Compared with the non-sarcopenia patients, the sarcopenia patients had a decrease in the ultrasound-derived MT and CSA of the RFM in the relaxed and contracted states, and the MT, Fl and SWE of the GMM in the relaxed state (all P<0.05). Based on these results, the cut-off value of the prediction model was 0.443, and it had a diagnostic sensitivity of 84.5% and a specificity of 90.8%. Two-dimensional ultrasound combined with the SWE model can be used to diagnose sarcopenia in patients with essential hypertension. The model has high sensitivity and specificity, and can more accurately detect sarcopenia in patients with essential hypertension.

This study proposed a reliable and convenient methodology to assess rectus femoris (RF) and gastrocnemius muscles using ultrasound in critically ill patients. The focus was on reliability and convenience, considering both intra- and inter-observer reliability in the ICU and outpatient clinical settings. The RF and gastrocnemius muscles of 23 patients in the ICU were assessed using ultrasound. Two assessors, an expert and a novice, performed measurements across 2 consecutive days. Muscle thickness (MT), cross-sectional area (CSA), and echogenicity were measured in the RF, while MT, echogenicity, and pennate angle were measured in the gastrocnemius. The intra-class correlation coefficient (ICC) was assessed for intra- and inter-rater reliability for all markers. Intra- and inter-observer reliability was almost perfect (ICC > 0.80) for all markers, irrespective of the assessor's expertise. The CSA of the RF muscle exhibited the highest reliability (ICC > 0.95). MT of the gastrocnemius also demonstrated high intra- and inter-observer reliability (ICC > 0.91). In echogenicity measurements, gastrocnemius showed the highest (ICC > 0.91) intra- and inter-observer reliability. Ultrasound measurement of RF and gastrocnemius muscles in critically ill patients using the proposed methods demonstrated almost perfect reliability in both muscle mass and quality measurements. These methodologies, prioritizing convenience and reliability, could be employed for evaluating muscle status and changes in ICU settings and outpatient follow-ups.

The aim of this study is to describe radiographic, ultrasonographic, and computedtomographic appearance of normal cinereous vulture’s eye and to determine normal biometricvalues of intraocular structures. Twenty-six eyes of thirteen healthy cinereous vultureswere examined. Under general anesthesia with isoflurane, ultrasonography (US), computedtomography (CT) and skull radiography were performed. Differences between both eyes aswell as between US and CT measurements were investigated and correlation of measurementsbetween both eyes as well as correlation between CT and US measurements of the variousocular structures were calculated. Most of paired data did not show any significantdifferences between both eyes and the CT and US measurements, while there were significantdifferences (P<0.05) between CT and US measurements of depth of bothvitreous and anterior chambers, and axial length of the lens in right eyes. There was alsoa significant difference (P<0.05) between both eyes in depth ofvitreous measured by CT. All the measurements had strong correlations between both eyesand between US and CT. In conclusion, ocular imaging techniques provided useful data ofbiometry and morphology, showing good correlation between CT and US in cinereous vulture’seye. Especially, when ophthalmoscopic examinations would not be available due to opaqueanterior segment, imaging techniques could be essential for diagnosing and managing of theeye.

Background: Chronic obstructive pulmonary disease (COPD) is a systemic condition, resulting in changes in muscle size, function and quality. Computed tomography (CT) measured intercostal mass correlates with COPD severity defined by forced expiratory volume (FEV1). Aims and Objectives: This pilot study aimed to 1) assess the reliability of ultrasound (US) measures of intercostal muscle quantity (thickness) and quality (echogenicity) using quantitative grayscale analysis; 2) determine the validity of US measures against COPD disease severity. We hypothesized that US measurement of intercostal muscles is reliable and correlates to COPD severity. Methods: 20 stable patients with COPD underwent US by a single operator with repeated measures of 2nd and 3rd parasternal intercostal muscle, quadriceps and diaphragm thickness and muscle echogenicity. Relationships between COPD severity and US parameters were analysed. Results: Intraclass correlation (ICC) for intra-rater measurement of US intercostal thickness ranged between 0.87-0.97 depending on side and level with ICC 0.63-0.91 for echogenicity. There was a moderate linear relationship between intercostal thickness and FEV1 (r = 0.58), quadriceps thickness (r = 0.42) and diaphragm thickness (r = 0.33). There was a negative correlation between intercostal thickness and higher echogenicity scores (indicating greater muscle deterioration) (r = -0.5). Conclusions: Intra-rater reliability of parasternal intercostal muscles US in COPD is good to excellent. Lower intercostal muscle quantity and deterioration in muscle quality (as measured by echogenicity) is related to higher spirometry-defined disease severity.

PurposeIntrinsic foot muscles maintain foot structural integrity and contribute to functional movement, posture and balance. Thus, assessing intrinsic foot muscle size and strength are important. Magnetic resonance imaging (MRI) has been shown to accurately image the individual muscles but is costly and time consuming. Ultrasound (US) imaging may provide an alternative that is less costly and more readily available. The purpose of this study was to investigate the validity and intratester reliability of US imaging in measuring intrinsic foot muscle size in comparison to MRI.MethodsUS and MRI were employed to measure the intrinsic foot muscle size involving 35 participants (females = 13; males = 22). The scanned intrinsic foot muscles included the flexor hallucis brevis (FHB), abductor hallucis (ABDH), flexor digitorum brevis (FDB), quadratus plantae (QP) and abductor digiti minimi (ADM). Pearson product correlation (r), intraclass correlation coefficients (ICC), standard error of the measurement (SEm) and minimal detectable difference (MDD) were calculated.ResultsHigh correlations were detected between the US and MRI cross-sectional area (CSA) measurements (r = .971 to 0.995). Test reliability was excellent for both MRI and US (ICC = 0.994 to 0.999). Limits of agreement between MRI and US measurements from ranged from 5.7 to 12.2% of muscle size. SEm values for US ranged from 0.026 to 0.044 cm2, while the SEm for MRI ranged from 0.018 to 0.023 cm2. MDD values for US ranged from 0.073 to 0.122 cm2, while MRI ranged from 0.045 to 0.064 cm2.ConclusionsUS appears to be a valid and reliable alternative to MRI when measuring intrinsic foot muscle CSA. While US is less costly and more readily available, the MRI results were shown to be slightly more precise.