Diagnostic test accuracy of ultrasound for sarcopenia diagnosis: A systematic review and meta‐analysis

Abstract

Muscle ultrasound is an emerging tool for diagnosing sarcopenia. This review aims to summarize the current knowledge on the diagnostic test accuracy of ultrasound for the diagnosis of sarcopenia. We collected data from Ovid Medline, Embase and the Cochrane Central Register of Controlled Trials. Diagnostic test accuracy studies using muscle ultrasound to detect sarcopenia were included. Bivariate random‐effects models based on sensitivity and specificity pairs were used to calculate the pooled estimates of sensitivity, specificity and the area under the curves (AUCs) of summary receiver operating characteristic (SROC), if possible. We screened 7332 publications and included 17 studies with 2143 participants (mean age range: 52.6–82.8 years). All included studies had a high risk of bias. The study populations, reference standards and ultrasound measurement methods varied across the studies. Lower extremity muscles were commonly studied, whereas muscle thickness (MT) was the most widely measured parameter, followed by the cross‐sectional area (CSA). The MTs of the gastrocnemius, rectus femoris, tibialis anterior, soleus, rectus abdominis and geniohyoid muscles showed a moderate diagnostic accuracy for sarcopenia (SROC‐AUC 0.83, 8 studies; SROC‐AUC 0.78, 5 studies; AUC 0.82, 1 study; AUC 0.76–0.78, 2 studies; AUC 0.76, 1 study; and AUC 0.79, 1 study, respectively), whereas the MTs of vastus intermedius, quadriceps femoris and transversus abdominis muscles showed a low diagnostic accuracy (AUC 0.67–0.71, 3 studies; SROC‐AUC 0.64, 4 studies; and AUC 0.68, 1 study, respectively). The CSA of rectus femoris, biceps brachii muscles and gastrocnemius fascicle length also showed a moderate diagnostic accuracy (AUC 0.70–0.90, 3 studies; 0.81, 1 study; and 0.78–0.80, 1 study, respectively), whereas the echo intensity (EI) of rectus femoris, vastus intermedius, quadriceps femoris and biceps brachii muscles showed a low diagnostic accuracy (AUC 0.52–0.67, 2 studies; 0.48–0.50, 1 study; 0.43–0.49, 1 study; and 0.69, 1 study, respectively). The combination of CSA and EI of biceps brachii or rectus femoris muscles was better than either CSA or EI alone for diagnosing sarcopenia. Muscle ultrasound shows a low‐to‐moderate diagnostic test accuracy for sarcopenia diagnosis depending on different ultrasound parameters, measured muscles, reference standards and study populations. The combination of muscle quality indicators (e.g., EI) and muscle quantity indicators (e.g., MT) might provide better diagnostic test accuracy.

Biceps brachii muscle cross‐sectional area measured by ultrasonography is independently associated with one‐month mortality: A prospective observational study

“…While ultrasonographic evaluation of lower limb muscles, such as rectus femoris 50 and gastrocnemius 51 MT, has been commonly studied in the literature, and even with recommended cut‐off values, the upper limb muscles have received less attention 42 . It is because the lower limb muscles are simpler to measure and highly related to mobility and activities of daily living than the trunk or head muscles 52 . Additionally, another cause may be the age‐related volumetric changes in the upper limb muscles 53 .…”

“…42 It is because the lower limb muscles are simpler to measure and highly related to mobility and activities of daily living than the trunk or head muscles. 52 Additionally, another cause may be the age-related volumetric changes in the upper limb muscles. 53 However, upper limb exercises have been shown to improve survival rates and physical disabilities due to muscle atrophy.…”

Using magnetic resonance imaging to measure head muscles: An innovative method to opportunistically determine muscle mass and detect sarcopenia

“…There are concerns about reproducibility in individuals with higher body fat levels, as ultrasonography may encounter difficulties in accurately measuring muscle thickness due to interference from adipose tissue. 28 As a result, utilizing imaging studies commonly employed to assess other medical conditions could enhance the screening for sarcopenia and increase the treatment of this usually overlooked condition. 10 Regional CT and MRI could become accurate and more practical non-invasive methods to quantify muscle volume.…”

“…However, it requires trained professionals, specialized equipment and extra time. There are concerns about reproducibility in individuals with higher body fat levels, as ultrasonography may encounter difficulties in accurately measuring muscle thickness due to interference from adipose tissue 28 …”

Letter: the diagnostic value of ultrasound‐based versus CT‐based sarcopenia measurement in cirrhosis – authors' reply

“…It has been observed that, in the thigh, muscle groups might have different performances to detect sarcopenia, with the highest performance observed with the rectus femoris as compared to vastus intermedius or quadriceps femoris. 7 Interestingly, other muscle groups of the lower limb (e.g., gastrocnemius) but also belonging to other parts of the body (e.g., rectus abdominis) have shown similar performance as the rectus femoris. Hence, further studies performing proper multisite evaluations of US-based sarcopenia are needed to search for the best muscle groups (head-neck vs. trunk vs. limbs) and their parameters (thickness vs. area) that reflect whole-body muscle mass in advanced liver disease.…”