Ultrasound Muscle Thickness Measurements Research Articles

Reliability of ultrasound measurements of muscle thickness and echointensity in older adults with type 2 diabetes

Ultrasound is an emerging tool for muscle-based measurements. However, the analysis of hyperechoic images (high muscle fat infiltration, as in type 2 diabetes [T2D]) can be challenging. ObjectiveTo evaluate the reliability of ultrasound image analysis of muscle thickness and echointensity in older adults with T2D and non-diabetic controls by experienced and novice analysts. We hypothesized that reliability would be high for the experienced analysts, and lower, but acceptable, for a novice analyst. MethodsWe recruited three groups: 1) adults >60 years with T2D; 2) age- and sex-matched normoglycemic controls; and 3) healthy adults 18–35 years. All participants underwent ultrasound imaging of the abdomen and anterior thigh. Ultrasound images were de-identified, randomized, and separately analyzed by two expert analysts (>3 years experience each). A subset of images was also analyzed by a novice analyst with no prior experience. Inter- and intra-rater reliability was assessed using coefficients of variation (CVs), intraclass correlation coefficients (ICCs), and Bland-Altman analysis. ResultsFor the expert analysts, ICCs were >0.90 and CVs were <10 % for all measurements, regardless of participant group. For the novice analyst, all ICCs were >0.90, except for rectus abdominus thickness measurements in the T2D group (ICC: 0.659 [95%CI: -0.134, 0.911]). CVs were <10 % for all measurements, except for rectus abdominus thickness in the T2D group (CV: 12.7 %). Ultrasound image analysis of muscle thickness and echointensity by experienced analysts was highly reliable. ConclusionNovice and expert analysts produced comparable measurements, except for rectus abdominus thickness in images obtained from older adults with T2D.

Reliability and Validity of an Ultrasound-Based Protocol for Measurement of Quadriceps Muscle Thickness in Children.

Introduction and aims: Accurate determination of skeletal muscle size is of great importance in multiple settings including resistance exercise, aging, disease, and disuse. Ultrasound (US) measurement of muscle thickness (MT) is a method of relatively high availability and low cost. The present study aims to evaluate a multisite ultrasonographic protocol for measurement of MT with respect to reproducibility and correlation to gold-standard measurements of muscle volume (MV) with magnetic resonance imaging (MRI) in children. Material and methods: 15 children completed the study (11 ± 1 year, 41 ± 8 kg, 137 ± 35 cm). Following 20 min supine rest, two investigators performed US MT measurements of all four heads of the m. quadriceps femoris, at pre-determined sites. Subsequently, MRI scanning was performed and MV was estimated by manual contouring of individual muscle heads. Results: Ultrasound measurement of MT had an intra-rater reliability of ICC = 0.985–0.998 (CI 95% = 0.972–0.998) and inter-rater reliability of ICC = 0.868–0.964 (CI 95% = 0.637–0.983). The US examinations took less than 15 min, per investigator. Muscle thickness of all individual quadriceps muscles correlated significantly with their corresponding MV as measured by MRI (overall r = 0.789, p < 0.001). Conclusion: The results of this study indicate that US measurement of MT using a multisite protocol is a competitive alternative to MRI scanning, especially with respect to availability and time consumption. Therefore, US MT could allow for wider clinical and scientific implementation.

Ultrasound measurements of abdominal muscle thickness are associated with postmenstrual age at full oral feedings in preterm infants: A preliminary study.

A premature infant's discharge from the neonatal intensive care unit (NICU) is dependent on factors such as respiratory stability, adequate growth, and the ability to consume oral feeds. Once infants have achieved respiratory stability, a tool that can better predict age at discharge is desirable. Thus, we conducted a secondary data analysis to assess the association between ultrasound measurements of abdominal muscle thickness and postmenstrual age (PMA) at full oral feedings. Forty-nine (n = 49) healthy, premature infants (mean gestational age = 32 weeks) were recruited from the NICU. Anthropometric measurements and ultrasound measurements of the rectus abdominis were conducted when infants were medically stable. Fat-free mass (FFM) was obtained using air displacement plethysmography. The relationship between ultrasound measurements of muscle thickness and PMA at full oral feedings was assessed using linear regression analysis. The relationship between FFM z-scores and PMA at full oral feedings was also assessed for comparison. When adjusting for gestational age at birth, PMA at measurement, days of positive pressure respiratory support, weight, and length, ultrasound measurements of abdominal muscle thickness were independently, negatively associated with PMA at full oral feedings (β estimate: -0.71, P = .03). Preliminary results suggest infants with greater abdominal muscle thickness may reach full oral feedings at an earlier PMA (nearly 1 week per millimeter). Thus, ultrasound measurements of abdominal muscle thickness may be helpful in assessing readiness for discharge in healthy preterm infants. Further research is needed for development and validation of a prediction equation.

The ultrasonographic measurement of muscle thickness in sarcopenia. A prediction study

Sarcopenia is a common disease in the elderly. Although extensive research has been conducted on muscle mass and quality assessment tools, there are still certain drawbacks preventing their universal use. The aim of this study was the evaluation of the thickness of head, neck, upper and lower limb muscles measured with ultrasonography, as a potential predictory tool in sarcopenia. Prediction study. The Outpatient Sarcopenia Clinic of the Rehabilitation Department of the University Hospital of Patras. Ninety-four individuals (27 men and 67 women) with a mean age of 75.6 years (SD=6.6), referred for sarcopenia screening, participated in this study. The muscle thickness was measured with transverse and longitudinal ultrasound scans bilaterally. The thickness of the geniohyoid and medial head of gastrocnemius muscle in all ultrasound sections, and the thickness of the rectus femoris and vastus intermedius muscle, in specific sections, was found to be significantly decreased in patients with sarcopenia (P<0.05). The Receiver Operating Characteristic (ROC) curve analysis of the ultrasound muscle thickness measurements resulted in a significant association with sarcopenia. In the case of the geniohyoid muscle, the measured area under the ROC curve was found to be the highest (0.79). The optimal cut-off for the prediction of sarcopenia from the geniohyoid muscle was 0.65 cm with sensitivity equal to 75.0% and specificity equal to 66.7%. The results of this study have shown that the thickness of the neck and lower limb muscles measured ultrasonographically can be utilized in the prediction of sarcopenia with high sensitivity and specificity. The prevalence of sarcopenia in the geriatric population and the rehabilitation wards is reported to be high. Therefore, an easy, fast, low cost and with no risk, widely available method such as ultrasonography could be an extremely valuable tool for the screening and follow-up of sarcopenia.

Fortetropin inhibits disuse muscle atrophy in dogs after tibial plateau leveling osteotomy.

ObjectiveTo determine if a commercial myostatin reducer (Fortetropin®) would inhibit disuse muscle atrophy in dogs after a tibial plateau leveling osteotomy.DesignA prospective randomized, double-blinded, placebo-controlled clinical trial.AnimalsOne hundred client-owned dogs presenting for surgical correction of cranial cruciate ligament rupture by tibial plateau leveling osteotomy.ProceduresPatients were randomly assigned into the Fortetropin® or placebo group and clients were instructed to add the assigned supplement to the dog’s normal diet once daily for twelve weeks. Enrolled patients had ultrasound measurements of muscle thickness, tape measure measurements of thigh circumference, serum myostatin level assays, and static stance analysis evaluated at weeks 0, 8, and 12.ResultsFrom week 0 to week 8, there was no change for thigh circumference in the Fortetropin® group for the affected limb (-0.54cm, P = 0.31), but a significant decrease in thigh circumference for the placebo group (-1.21cm, P = 0.03). There was no significant change in serum myostatin levels of dogs in the Fortetropin® group at any time point (P>0.05), while there was a significant rise of serum myostatin levels of dogs in placebo group during the period of forced exercise restriction (week 0 to week 8; +2,892 pg/ml, P = 0.02). The percent of body weight supported by the affected limb increased in dogs treated with Fortetropin® (+7.0%, P<0.01) and the placebo group (+4.9%, P<0.01) at the end of the period of forced exercise restriction. The difference in weight bearing between the Fortetropin® and placebo groups was not statistically significant (P = 0.10).ConclusionDogs receiving Fortetropin® had a similar increase in stance force on the affected limb, no significant increase in serum myostatin levels, and no significant reduction in thigh circumference at the end of the period of forced exercise restriction compared to the placebo. These findings support the feeding of Fortetropin® to prevent disuse muscle atrophy in canine patients undergoing a tibial plateau leveling osteotomy.

Can Ultrasound Measures of Muscle and Adipose Tissue Thickness Predict Body Composition of Premature Infants in the Neonatal Intensive Care Unit?

Premature infants are at risk for adverse metabolic and neurodevelopmental outcomes due to growth alterations in early infancy. Monitoring body composition by tracking gains in fat mass (FM) and fat-free mass (FFM) may assist clinicians in preventing obesity and metabolic disease while promoting optimal growth and development. A prospective, observational study was conducted to determine the ability of ultrasound (US) measurements of muscle and adipose tissue thickness to predict whole-body composition (FFM, FM, percent body fat [%BF]). Sixty-three healthy premature infants were recruited from the University of Minnesota's Neonatal Intensive Care Unit. Anthropometric measurements, air displacement plethysmography, and US measurements of abdomen, biceps, and quadriceps muscle and of adipose tissue thickness were conducted when infants were medically stable. The relationship between US measurements and body composition was assessed using stepwise linear regression analysis. In linear regression analyses, biceps adipose and the sum of adipose thickness measurements were significant predictors of %BF, but prediction models had low R2 (0.17 and 0.16, respectively) and high root-mean-square error. US measurements of muscle thickness were not predictive of whole-body FFM. US measurements of muscle and adipose tissue thickness at the examined sites are not adequate surrogates for whole-body composition in preterm infants. Exploration of alternate measurement sites may improve predictive ability.

Reliability of biceps femoris and semitendinosus muscle architecture measurements obtained with ultrasonography

Introduction Currently, little attention is given to the muscle architecture reliability studies of the hamstring using a robust statistical. Our purpose was to determine the reliability of ultrasound measurements of muscle thickness, fascicle length and pennation angle of the biceps femoris and semitendinosus muscles, including heteroskedasticity and internal consistency analyses. Methods Two images of biceps femoris and semitendinosus at 50% of the thigh length were acquired from 21 volunteers, in two visits. The parameters were measured three times in each image, and for each muscle. The reliability was analyzed by the intraclass correlation coefficient (ICC) and Cronbach’s alpha (αCronbach). The relative standard error of the measurements (%SEM) were calculated and Bland-Altman plots were generated. Results All parameters presented excellent ICC for the three repeated measurements (ICC from 0.93 ‒ 0.99) and moderate to excellent reliability intraday (ICC from 0.70 ‒ 0.95) for both muscles. The present study indicates that ultrasound is a reliable tool to estimate the biceps femoris fascicle length (ICC = 0.97, αCronbach = 0.98, %SEM = 7.86) and semitendinosus (ICC = 0.90, αCronbach = 0.95, %SEM = 7.55), as well as the biceps femoris muscle thickness (ICC = 0.89, αCronbach = 0.94, %SEM = 10.23) and semitendinosus muscle thickness (ICC = 0.87, αCronbach = 0.93, %SEM = 1.35). At last, biceps femoris pennation angle (ICC = 0.93, αCronbach = 0.96 and %SEM = 4.36) and semitendinosus (ICC = 0.96, αCronbach = 0.98 and %SEM = 4.25) also had good repeatability. Conclusion Ultrasonography show good repeatability in estimating of muscle architecture parameters.

Comment on “Protein Requirements in the Critically Ill: A Randomized Controlled Trial Using Parenteral Nutrition”

Background: Current recommendations for higher protein/amino acid provision in the critically ill are based on weak evidence. This double-blinded randomized controlled trial aimed to compare standard amino acid intake with the higher level recommended as the minimum for critically ill patients. Methods: In total, 119 patients requiring parenteral nutrition (PN) in an intensive care unit (ICU) were randomized to receive blinded PN solutions containing amino acids at either 0.8 g/kg or 1.2 g/kg. Primary outcome was handgrip strength at ICU discharge. Secondary outcomes measured at study day 7 included handgrip strength, fatigue score (using the Chalder scale), and ultrasound measurements of muscle thickness at defined body sites. Analysis of covariance was used to control for age, sex, nutrition status (Subjective Global Assessment), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and baseline measurement. Results: Actual amino acid delivery to the 2 groups was 0.9 and 1.1 g/kg respecti...

Protein Requirements in the Critically Ill: A Randomized Controlled Trial Using Parenteral Nutrition.

Current recommendations for higher protein/amino acid provision in the critically ill are based on weak evidence. This double-blinded randomized controlled trial aimed to compare standard amino acid intake with the higher level recommended as the minimum for critically ill patients. In total, 119 patients requiring parenteral nutrition (PN) in an intensive care unit (ICU) were randomized to receive blinded PN solutions containing amino acids at either 0.8 g/kg or 1.2 g/kg. Primary outcome was handgrip strength at ICU discharge. Secondary outcomes measured at study day 7 included handgrip strength, fatigue score (using the Chalder scale), and ultrasound measurements of muscle thickness at defined body sites. Analysis of covariance was used to control for age, sex, nutrition status (Subjective Global Assessment), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and baseline measurement. Actual amino acid delivery to the 2 groups was 0.9 and 1.1 g/kg respectively, averaged over the first 7 days. Grip strength at ICU discharge was not significantly different between groups (P =054) despite being improved at study day 7 in the group receiving the higher level of amino acids (mean [SD], 22.1 [10.1] vs 18.5 [11.8] kg, P =025). These patients also had less fatigue (Chalder score, mean [SD], 5.4 [2.2] vs 6.2 [2.2], P = .045) and greater forearm muscle thickness on ultrasound (mean [SD], 3.2 [0.4] vs 2.8 [0.4] cm, P < .0001). Nitrogen balance was significantly better at study day 3 but not at day 7. There was no difference between groups in mortality or length-of-stay measures. The higher level of amino acids was associated with small improvements in a number of different measures, supporting guideline recommendations for ICU patients. This trial was registered at Australian New Zealand Clinical Trials Registry (www.anzctr.org.au) as ACTRN12609000366257.

Can ultrasound measurements of muscle thickness be used to measure the size of individual quadriceps muscles in people with patellofemoral pain?

ObjectivesSelective atrophy of vastus medialis oblique (VMO) may be present in patellofemoral pain (PFP). This study investigated the validity of real-time ultrasound in measuring the thickness of each quadriceps muscle. DesignCross sectional-Validity. SettingUniversity laboratory. Participants10 limbs, 5 people with unilateral PFP. Main outcome measuresThe thickness of VMO, vastus lateralis (VL), vastus intermedius (VI), rectus femoris (RF), and vastus medialis (VM) measured with ultrasound were compared to magnetic resonance imaging (MRI) muscle thickness measurements, using Pearson's (r), and compared to MRI muscle cross-sectional area (CSA) measurements, using Spearman's correlation coefficient (rho). ResultsThere was a good correlation between ultrasound and MRI measures of the thickness of each superficial quadriceps muscle VMO (r = 0.86), VM (r = 0.86), VL (r = 0.94), RF (r = 0.86), and a poor for VI (r = 0.37). Ultrasound measures had a good correlation to MRI muscle CSA measures for VL (rho = 0.83) and RF (rho = 0.88), moderate for VM (rho = 0.73), and poor for VMO (rho = 0.20), and VI (rho = 0.310). ConclusionReal-time ultrasound muscle thickness measurements are correlated to MRI measured thickness of superficial quadriceps muscles (VMO, VL, VL, and RF) in PFP.

Applicability of ultrasound muscle thickness measurements for predicting fat-free mass in elderly population.

This study aimed to examine the applicability of ultrasound muscle thickness (MT) measurements for predicting whole body fat-free mass (FFM) in elderly individuals. Cross-sectional study of 77 healthy elderly individuals. MTs at nine sites of the body and FFM were determined using B-mode ultrasound and dual-energy x-ray absorptiometry (DXA), respectively, in 44 women and 33 men aged 52 to 78 yrs. Stepwise multiple regression analysis produced two equations for predicting DXA-based FFM with sex (dummy: woman = 0 and man = 1) and either MTs at the anterior and posterior of thigh and lower leg (Eq1) or the product of MT and limb length (MT×LL) at thigh anterior and posterior, lower leg posterior, and upper arm anterior (Eq2) as independent variables. The R2 and SEE for each of the two equations were 0.929 and 2.5 kg for Eq1 and 0.955 and 2.0 kg for Eq2. The estimated FFM from each of Eq1 (44.4 ± 8.9 kg) and Eq2 (44.4 ± 9.0 kg) did not significantly differ from that of the DXA-based FFM (44.4 ± 9.2 kg), without systematic error. However, the absolute value of the difference between the DXA-based and estimated FFM was significantly greater with Eq1 (2.0 ± 1.5 kg) than with Eq2 (1.5 ± 1.3 kg). The current results indicate that ultrasound MT measurement is useful to predict FFM in the elderly, and its accuracy is improved by using the product of MT and limb length as an independent variable.

Validity of ultrasound muscle thickness measurements for predicting leg skeletal muscle mass in healthy Japanese middle-aged and older individuals

BackgroundThe skeletal muscle mass of the lower limb plays a role in its mobility during daily life. From the perspective of physical resources, leg muscle mass dominantly decreases after the end of the fifth decade. Therefore, an accurate estimate of the muscle mass is important for the middle-aged and older population. The present study aimed to clarify the validity of ultrasound muscle thickness (MT) measurements for predicting leg skeletal muscle mass (SM) in the healthy Japanese middle-aged and older population.FindingsMTs at four sites of the lower limb and the bone-free lean tissue mass (LTM) of the right leg were determined using brightness-mode ultrasonography and dual-energy X-ray absorptiometry (DXA), respectively, in 44 women and 33 men, 52- to 78-years old. LTM was used as a representative variable of leg skeletal muscle mass. In the model-development group (30 women and 22 men), regression analysis produced an equation with R2 and standard error of the estimate (SEE) of 0.958 and 0.3 kg, respectively: LTM (kg) = 0.01464 × (MTSUM×L) (cm2) - 2.767, where MTSUM is the sum of the product of MTs at four sites, and L is length of segment where MT is determined. The estimated LTM (7.0 ± 1.7 kg) did not significantly differ from the measured LTM (7.0 ± 1.7 kg), without a significant systematic error on a Bland-Altman plot. The application of this equation for the cross-validation group (14 women and 11 men) did not yield a significant difference between the measured (7.2 ± 1.6 kg) or estimated (7.2 ± 1.6 kg) LTM and systematic error.ConclusionThe developed prediction equation may be useful for estimating the lean tissue mass of the lower extremity for the healthy Japanese middle-aged and older population.

Erratum to: Association between ultrasound measurements of muscle thickness, pennation angle, echogenicity and skeletal muscle strength in the elderly

Erratum to: Association between ultrasound measurements of muscle thickness, pennation angle, echogenicity and skeletal muscle strength in the elderly

Association between ultrasound measurements of muscle thickness, pennation angle, echogenicity and skeletal muscle strength in the elderly

The increase of elderly in our society requires simple tools for quantification of sarcopenia in inpatient and outpatient settings. The aim of this study was to compare parameters determined with musculoskeletal ultrasound (M-US) with muscle strength in young and elderly patients. In this prospective, randomised and observer blind study, 26 young (24.2 ± 3.7 years) and 26 old (age 67.8 ± 4.8 years) patients were included. Muscle thickness, pennation angle and echogenicity of all muscles of musculus quadriceps were measured by M-US and correlated with isometric maximum voluntary contraction force (MVC) of musculus quadriceps. Reproducibility of M-US measurements as well as simple and multiple regression models were calculated. Of all measured M-US variables the highest reproducibility was found for measurements of thickness (intraclass correlation coefficients, 85-97%). Simple regression analysis showed a highly significant correlation of thickness measurements of all muscles of musculus quadriceps with MVC in the elderly and in the young. Multiple regression analysis revealed that thickness of musculus vastus medialis had the best correlation with MVC in the elderly. This study showed that measurement of muscle thickness, especially of musculus vastus medialis, by M-US is a reliable, bedside method for monitoring the extent of sarcopenia.

Newborn brachial plexus palsy: Evaluation of severity using quantitative ultrasound of muscle

We studied ultrasound features of muscle after nerve injury. We evaluated ultrasound measurements of muscle thickness and backscatter in injured and contralateral uninjured elbow flexors of 51 children with newborn brachial plexus palsy (NBPP) and compared the results to elbow flexor function (Active Movement Scale), defined as normal, moderate, or severe. Compared with uninjured limbs, muscle in injured arms was 15% thinner with severe impairment, 17% thicker with moderate impairment, and no different with normal function. Relative to uninjured limbs, moderately impaired muscle was thicker than both severely impaired and normal strength muscle. Backscatter was higher in injured than in uninjured limbs regardless of function. In 17 patients with sequential measures, muscle thickness, but not backscatter, increased with function over time. Muscle thickness differentiates moderate from severe impairment after NBPP and increases with recovery over time. Muscle backscatter identifies prior injury regardless of function.

Measurement of thigh muscle size using tape or ultrasound is a poor indicator of thigh muscle strength

Although commonly used, the validity of measures of thigh circumference and ultrasound measurements of muscle thickness as indicators of muscle strength is unclear (Maylia et al 1999). This study aimed to determine the relationship of these two simple measures of muscle size to the concentric isokinetic quadriceps and hamstrings strength of a group of Irish Gaelic footballers.

An MRI Investigation Into the Function of the Transversus Abdominis Muscle During “Drawing-In” of the Abdominal Wall

An operator blinded dual modality trial of measurement of the abdominal muscles during "drawing-in" of the abdominal wall. 1) To investigate, using magnetic resonance imaging (MRI), the function of the transversus abdominis muscle bilaterally during a drawing-in of the abdominal wall. 2) To validate the use of real-time ultrasound imaging as a measure of the deep abdominal muscle during a drawing-in of the abdominal wall. Previous research has implicated the deep abdominal muscle, transversus abdominis, in the support and protection of the spine and provided evidence that training this muscle is important in the rehabilitation of low back pain. One of the most important actions of the transversus abdominis is to "draw-in" the abdominal wall, and this action has been shown to stiffen the sacroiliac joints. It is hypothesized that in response to a draw in, the transversus abdominis muscle forms a deep musculofascial "corset" and that MRI could be used to view this corset and verify its mechanism of action on the lumbopelvic region. Thirteen healthy asymptomatic male elite cricket players aged 21.3 +/- 2.1 years were imaged using MRI and ultrasound imaging as they drew in their abdominal walls. Measurements of the thickness of the transversus abdominis and internal oblique muscles and the slide of the anterior abdominal fascia were measured using both MRI and ultrasound. Measurement of the whole abdominal cross-sectional area (CSA) was conducted using MRI. Results of the MRI demonstrated that, as a result of draw-in, there was a significant increase in thickness of the transversus abdominis (P < 0.001) and the internal oblique muscles (P < 0.001). There was a significant decrease in the CSA of the trunk (P < 0.001). The mean slide (+/-SD) of the anterior abdominal fascia was 1.54 +/- 0.38 cm for the left side and 1.48 +/- 0.35 cm for the right side. Ultrasound measurements of muscle thickness of both transversus abdominis and the internal oblique, as well as fascial slide, correlated with measures obtained using MRI (interclass correlations from 0.78 to 0.95). The MRI results demonstrated that during a drawing-in action, the transversus abdominis contracts bilaterally to form a musculofascial band that appears to tighten (like a corset) and most likely improves the stabilization of the lumbopelvic region. Real-time ultrasound imaging can also be used to measure changes in the transversus abdominis during the draw-in maneuver.

Comparison of ultrasound muscle thickness measurements in ICU patients in muscle groups known to undergo atrophy vs muscle groups that do not undergo atrophy

Comparison of ultrasound muscle thickness measurements in ICU patients in muscle groups known to undergo atrophy vs muscle groups that do not undergo atrophy