Application of ultrasound for muscle assessment in sarcopenia: towards standardized measurements

Abstract

Purpose Measurement of muscle mass is paramount in the screening and diagnosis of sarcopenia. Besides muscle quantity however, also quality assessment is important. Ultrasonography (US) has the advantage over dual-energy X-ray absorptiometry (DEXA) and bio-impedance analysis (BIA) to give both quantitative and qualitative information on muscle. However, before its use in clinical practice, several methodological aspects still need to be addressed. Both standardization in measurement techniques and the availability of reference values are currently lacking. This review aims to provide an evidence-based standardization of assessing appendicular muscle with the use of US. Methods A systematic review was performed for ultrasonography to assess muscle in older people. Pubmed, SCOPUS and Web of Sciences were searched. All articles regarding the use of US in assessing appendicular muscle were used. Description of US-specific parameters and localization of the measurement were retrieved. Results Through this process, five items of muscle assessment were identified in the evaluated articles: thickness, crosssectional area, echogenicity, fascicle length and pennation angle. Different techniques for measurement and location of measurement used were noted, as also the different muscles in which this was evaluated. Then, a translation for a clinical setting in a standardized way was proposed. Conclusions The results of this review provide thus an evidence base for an ultrasound protocol in the assessment of skeletal muscle. This standardization of measurements is the first step in creating conditions to further test the applicability of US for use on a large scale as a routine assessment and follow-up tool for appendicular muscle.

Sarcopenia: A Time for Action. An SCWD Position Paper

“…While BIA was not strongly supported by the EWGSOP2, to measure muscle mass, they recognize that its portability, affordability, and availability make BIA a feasible tool to estimate muscle mass in many care settings. Ultrasound of muscle such as the quadriceps is emerging as a potential tool to measure muscle quantity and, because it excludes intermuscular adipose tissue from the measurement, also muscle quality; a protocol for using ultrasounds in sarcopenia has recently been proposed by the European Geriatric Medicine Society …”

“…Ultrasound of muscle such as the quadriceps is emerging as a potential tool to measure muscle quantity and, because it excludes intermuscular adipose tissue from the measurement, also muscle quality 24,25 ; a protocol for using ultrasounds in sarcopenia has recently been proposed by the European Geriatric Medicine Society. 26 There is increasing evidence that creatine dilution, implemented by ingesting a dose of the deuterium labelled isotope, may also offer an accurate approach for measuring muscle mass. 27,28 Studies so far suggest creatine dilution estimates of muscle mass may have good correlations with functional outcomes.…”

Ultrasound assessment of muscle mass and quality: it has never been so easy!

“…Furthermore, as showed by Ramirez-Fuentes et al, the association between muscle quantity and quality evaluated with US, makes it possible to screen and diagnose sarcopenia also in bedridden, cognitively impaired patients who would not comply with any of the available functional assessments. Importantly, the study by Ramirez-Fuentes et al has been designed in line with the recently published by Perkisas et al, the evidence for the protocol of standardized ultrasound assessment for sarcopenia in old age [3].…”

“…EWGSOP2, for the first time, included the ultrasound assessment of muscles which is listed as promising "alternative or new test and tools" [1]. Being not only absolutely safe, completely non-invasive, and radiation-free instrument, but also handy, accessible in most clinical settings, relatively inexpensive tool, US has an obvious advantage over radiological techniques employed in the diagnosis of sarcopenia thus far [1,3]. Of note, along the lines outlined by EWGSOP2, US assessment correlates well not only with muscle mass but also muscular function which in the new consensus has been justly given a prominent role [1].…”

The SARCUS project: evidence-based muscle assessment through ultrasound

“…As the implementation of ultrasonographic assessment of muscle in the study of sarcopenia is relatively new, the road we (researchers/clinicians) take now is more important than ever. The review from the SARCUS group [2] aimed at providing a starting point to improve the technical and practical aspects of ultrasonography assessment of sarcopenia based on the available evidence, which was in some cases sparse to more often absent. This approach was supported by the will to not only consider 'best clinical practice' but also to stress the scientific credibility of ultrasound in this field.…”