Consistency of novel ultrasound equations for estimating percent intramuscular fat

Burton, Adam M.; Stock, Matt S.

doi:10.1111/cpf.12532

Cited by 22 publications

(27 citation statements)

References 18 publications

(56 reference statements)

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“…Results from our study may support the use of US measures of quadriceps morphology, as all observed changes across time points were greater than previously established between-session SEM in RF US (7.1%). 2 Furthermore, we observed similar percentage differences in quadriceps CSA in comparison with previous MRI assessments of muscle volume. For example, Grapar Žargi et al 11 revealed a 17.4% decrease in involved limb quadriceps muscle volume from preoperative to 4 weeks postoperative, while our cohort displayed a 21.5% decrease in CSA at 9 weeks.…”

Section: Discussionsupporting

confidence: 82%

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Longitudinal Assessment of Quadriceps Muscle Morphology Before and After Anterior Cruciate Ligament Reconstruction and Its Associations With Patient-Reported Outcomes

Garcia

Curran

Palmieri-Smith

2020

Sports Health: A Multidisciplinary Approach

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Background: Reductions in muscle size are common after anterior cruciate ligament reconstruction (ACLR) and may contribute to suboptimal patient outcomes. However, few studies have quantified postoperative alterations in muscle quality and evaluated its associations with patient-reported function. Hypotheses: Rectus femoris cross-sectional area (CSA) will decrease postoperatively but improve at return to activity (RTA), rectus femoris muscle quality (percentage fat [PF]) will increase postoperatively and be greater at RTA compared with preoperative values, and rectus femoris CSA and PF will be associated with International Knee Documentation Committee (IKDC) scores at both postoperative time points. Study Design: Case series. Level of Evidence: Level 4. Methods: A total of 26 individuals who sustained an ACL injury and underwent reconstructive surgery were evaluated preoperatively (T0), 9 weeks post-ACLR (T1), and at RTA. Rectus femoris CSA and PF were evaluated bilaterally via ultrasound imaging, and patient-reported function was assessed using the IKDC score. Results: Bilateral reductions in rectus femoris CSA were noted from T0 to T1 ( P < 0.01). Only the uninvolved limb returned to preoperative CSA ( P = 0.80), as the involved limb failed to return to preoperative levels at RTA ( P = 0.04). No significant changes in rectus femoris PF were observed across time points ( P > 0.05). Lesser PF ( P < 0.01) but not CSA ( P = 0.75) was associated with higher IKDC score at T1. Lesser PF ( P = 0.04) and greater CSA ( P = 0.05) was associated with higher IKDC score at RTA. Conclusion: Substantial atrophy occurs bilaterally after ACLR, and the involved limb does not return to preoperative muscle size despite the patient completing rehabilitation. Quadriceps muscle morphology is associated with patient-reported function and may be an important rehabilitation target after ACLR. Clinical Relevance: Quadriceps atrophy and poor muscle quality may contribute to suboptimal patient functioning and quadriceps dysfunction and may be important in RTA decision making. Assessing muscle morphology using ultrasound may be a feasible and clinically beneficial tool in patients after ACLR.

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Section: Discussionsupporting

confidence: 82%

“…9 Additionally, intersession reliability has been previously established for US assessment of RF CSA and PF (ICC, 0.988 and 0.980, respectively) and standard error of measurement (SEM, 7.01%, and 3.07%, respectively). 2…”

Section: Methodsmentioning

confidence: 99%

Longitudinal Assessment of Quadriceps Muscle Morphology Before and After Anterior Cruciate Ligament Reconstruction and Its Associations With Patient-Reported Outcomes

Garcia

Curran

Palmieri-Smith

2020

Sports Health: A Multidisciplinary Approach

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“…If raters do not follow the fascia border, they may include the fascia and thus arbitrarily increase CSA and EI; conversely, if they are too conservative, they may miss parts of the muscle. Very often EI is normalized to subcutaneous fat, but where and how each researcher records the depth plays a major role in determining the correct EI values ( 16 ) . All of these integral steps in analyzing US images are a potential place of error in data analysis.…”

Section: Introductionmentioning

confidence: 99%

Intra-rater and inter-rater reliability of the process of obtaining cross-sectional area and echo intensity measurements of muscles from ultrasound images

et al. 2021

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Introduction: The use of ultrasound images for analyzing muscle quality and size is continuing to grow in the literature. However, many of these manuscripts fail to properly describe their measurement techniques and steps involved in analyzing ultrasound images. Aim of this study: To evaluate the intra- and inter-rater reliability of the steps involved when analyzing ultrasound images to measure cross-sectional area and echo intensity. Material and methods: Twenty ultrasound images of the rectus femoris and vastus lateralis images were blinded and replicated, and then analyzed by experienced raters. The raters then were asked to analyze the images using open-source software for scaling measurements, subcutaneous fat thickness, cross-sectional area, and echo intensity. Matched image values for each measurement where compared for intra- and inter-rater reliability. Results: Intra-rater reliability ranged from fair (ICC3,1 = 0.32) to high (0.98), with echo intensity values being the least reliable (>0.55), and scaling and depth measurements being the most reliable (<0.85). Inter-rater reliability ranged from good (0.77) to high (0.97). Conclusion: Ultrasound- derived measures of cross-sectional area and echo intensity can be measured reliably, with echo intensity being the most difficult to replicate. However, reliability measures are unique to the rater and study and, therefore, should be clearly reported in every paper.

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“…Specifically, we assessed the intraclass correlation coefficient (ICC [model 2, k]), standard error of measurement (SEM [expressed both in absolute terms and as a percentage of the mean]), and the minimal difference needed to be considered real (MD). As presented in a recent publication (Burton and Stock 2018), our laboratory's test-retest reliability statistics for rectus femoris echo intensity in college-aged females were: ICC = .928; SEM = 4.21 AU (4.22%); MD = 11.68 AU. For rectus femoris cross-sectional area, these statistics were as follows (Burton and Stock 2018): ICC = .982; SEM = 0.24 cm 2 (5.43%); MD = 0.67 cm 2 .…”

Section: Ultrasonography Test-retest Reliabilitymentioning

confidence: 61%

“…All visits to the laboratory occurred at the same time of day (± one hour) throughout the course of the study. All imaging and image analyses were performed by the same investigators utilizing methods described in our previous publications (Burton and Stock 2018;Mota et al 2017). Throughout the study, participants were asked to refrain from alcohol, keep their dietary habits consistent, and comply with the immobilization protocol.…”

Section: Experimental Approach To the Problemmentioning

confidence: 99%

Peer Review #1 of "Declines in skeletal muscle quality vs. size following two weeks of knee joint immobilization (v0.3)"

2020

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BACKGROUND. Disuse of a muscle group, which occurs during bedrest, spaceflight, and limb immobilization, results in atrophy. It is unclear, however, if the magnitude of decline in skeletal muscle quality is similar to that for muscle size. The purpose of this study was to examine the effects of two weeks of knee joint immobilization on vastus lateralis and rectus femoris echo intensity and cross-sectional area. METHODS. Thirteen females (mean ± SD age = 21 ± 2 years) underwent two weeks of left knee joint immobilization via ambulating on crutches and use of a brace. B-mode ultrasonography was utilized to obtain transverse plane images of the immobilized and control vastus lateralis and rectus femoris at pretest and following immobilization. Effect size statistics and two-way repeated measures analyses of variance were used to interpret the data. RESULTS. No meaningful changes were demonstrated for the control limb and the rectus femoris of the immobilized limb. Analyses showed a large increase in vastus lateralis echo intensity (i.e., decreased muscle quality) for the immobilized limb (p = .006, Cohen's d = .918). For vastus lateralis cross-sectional area, no time × limb interaction was observed (p = .103), but the effect size was moderate (d = .570). There was a significant association between the increase in vastus lateralis echo intensity and the decrease in cross-sectional area (r =-.649, p = .016). CONCLUSION. In female participants, two weeks of knee joint immobilization resulted in greater deterioration of muscle quality than muscle size. Echo intensity appears to be an attractive clinical tool for monitoring muscle quality during disuse.

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Consistency of novel ultrasound equations for estimating percent intramuscular fat

Abstract: The high ICCs and low SEMs suggest that ultrasonography-derived rectus femoris percent fat may be a reliable tool for tracking changes in lower extremity intramuscular adiposity.

Cited by 22 publications

References 18 publications

Longitudinal Assessment of Quadriceps Muscle Morphology Before and After Anterior Cruciate Ligament Reconstruction and Its Associations With Patient-Reported Outcomes

Longitudinal Assessment of Quadriceps Muscle Morphology Before and After Anterior Cruciate Ligament Reconstruction and Its Associations With Patient-Reported Outcomes

Intra-rater and inter-rater reliability of the process of obtaining cross-sectional area and echo intensity measurements of muscles from ultrasound images

Peer Review #1 of "Declines in skeletal muscle quality vs. size following two weeks of knee joint immobilization (v0.3)"

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