Reliability and validity of a standardised ultrasound examination protocol to quantify vastus lateralis muscle

Abstract

Objective To evaluate the reliability and validity of a standardized ultrasound examination protocol for measuring vastus lateralis muscle size. Design Prospective cohort study. Subjects Sixteen staff members of the university hospital of Heidelberg. Methods Muscle thickness, cross-sectional area and subcutaneous adipose tissue thickness were measurxsed at 3 standardized sites on the right and left vastus lateralis muscle. Ultrasound measurements were collected by 2 independent investigators on 2 different days and compared with magnetic resonance imaging measurements. Results Intraclass correlation coefficients (ICC) for intra- and inter-rater reliability showed very good closeness of agreement for all parameters (ICC = 0.929–0.994, p < 0.001). Muscle thickness and subcutaneous adipose tissue thickness ultrasound and magnetic resonance imaging measurements revealed good to very good closeness of agreement (ICC = 0.835–0.969, p < 0.001), whereas cross-sectional area showed only average closeness of agreement (ICC = 0.727, p < 0.001). A strong predictive positive correlation for ultrasound and magnetic resonance imaging-based measurements of cross-sectional area was found (R ² = 0.793, p < 0.001). Conclusion By standardization of an examination protocol, quantitative vastus lateralis muscle ultrasound proved to be a reliable method for assessing vastus lateralis muscle size. Furthermore, this protocol is valid for measuring muscle thickness and subcutaneous adipose tissue thickness, although there seems to be a systematic underestimation of cross-sectional area depending on subcutaneous adipose tissue thickness. LAY ABSTRACT The quantification of muscle mass is crucial for diagnosis and monitoring of muscle atrophy caused by inactivity or in the context of diseases, and could also be used for monitoring the development of muscle hypertrophy during resistance training. Application of a standardized examination protocol for quantitative vastus lateralis muscle ultrasound proved to be a reliable method for assessing vastus lateralis muscle size in people with varying body weight and body composition, respectively. In this regard, it could be considered an alternative examination tool to time- and cost-consuming gold-standard magnetic resonance imaging (MRI), which is seldom readily available in clinical practice. However, compared with MRI measurements, muscle cross-sectional area measured using ultrasound seems to be systematically underestimated, depending on subcutaneous adipose tissue thickness.

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

“…The ICC values varied for the different muscles; however, the confidence intervals were overlapping. The current study presents a good to excellent inter-rater reliability, in line to those of previous studies ( Tillquist et al, 2014 ; Zaidman et al, 2014 ; Hadda et al, 2017 ; Filippo et al, 2019 ; Mechelli et al, 2019 ; Betz et al, 2021 ; Takahashi et al, 2021 ). However, variations in methodology including site(s), time in-between measurements and number of measurements make direct comparisons difficult.…”

“…An accurate determination of skeletal muscle mass is of great importance when investigating muscle adaptation during hypertrophy ( Aagaard et al, 2001 ; Morse et al, 2005 ; D'Antona et al, 2006 ; Franchi et al, 2018 ) and atrophy ( Abe et al, 1997 ; LeBlanc et al, 2000 ; Alkner and Tesch, 2004 ; Maurits et al, 2004 ; Rittweger et al, 2005 ; Petterson et al, 2008 ; Dirks et al, 2016 ; Johnson et al, 2018 ). Several methods for assessing or estimating skeletal muscle size have been described including bioimpedance ( Salinari et al, 2002 ), computerized tomography ( Van Roie et al, 2013 ), magnetic resonance imaging (MRI) ( Walton et al, 1997 ; Alkner and Tesch, 2004 ; Nordez et al, 2009 ) and ultrasound (US) ( Miyatani et al, 2002 ; Miyatani et al, 2004 ; Reeves et al, 2004 ; Sanada et al, 2006 ; Moreau et al, 2010 ; Baldwin et al, 2011 ; Scott et al, 2012 ; Strasser et al, 2013 ; Tillquist et al, 2014 ; Fukumoto et al, 2015 ; Giles et al, 2015 ; Nakatani et al, 2016 ; Hadda et al, 2017 ; Matta et al, 2017 ; Stock et al, 2017 ; Franchi et al, 2018 ; Pardo et al, 2018 ; Filippo et al, 2019 ; Mechelli et al, 2019 ; Cheon et al, 2020 ; Betz et al, 2021 ; Lee et al, 2021 ; Mpampoulis et al, 2021 ; Takahashi et al, 2021 ). Muscle volume (MV) estimated from multiple cross-sectional areas (CSA) using MRI is considered the current gold standard, however, this process is time consuming and labor-intensive ( Nordez et al, 2009 ), therefore the feasibility of MRI is limited, especially for repeated measurements in large cohorts.…”

“…However, the literature is mainly focused on measuring the Muscle thickness (MT) of m. rectus femoris (RF) and to some extent, the thickness of m. vastus intermedius (VI) underneath ( Moreau et al, 2010 ; Galindo Martín et al, 2017 ; Hadda et al, 2017 ; Pardo et al, 2018 ; Takahashi et al, 2021 ). Some have investigated the other muscles of the m. quadriceps femoris (QF) ( Moreau et al, 2010 ; Franchi et al, 2018 ; Cheon et al, 2020 ; Betz et al, 2021 ; Mpampoulis et al, 2021 ), and others have utilized a multisite approach, measuring all the individual muscles of the QF ( Cadore et al, 2012 ; Strasser et al, 2013 ; Matta et al, 2017 ; Santos and Armada-da-Silva, 2017 ; Lee et al, 2021 ). These studies utilized varying methodologies, and none have provided conclusive evidence of both validity, compared to MRI, and intra and inter-rater reliability.…”

Agreement and reliability of lower limb muscle architecture measurements using a portable ultrasound device

“…Moreover, reported agreement in validation studies of ultrasonography based muscle architecture assessment using cadaveric dissection was higher as well (Bénard et al, 2009;Kellis et al, 2009). In terms of test-retest reliability of ultrasonographic architecture assessment in all here investigated muscles, ICCs between 0.7 and 0.98, 0.7 to 0.98 and 0.74 to 0.99 have been reported for muscle thickness, fascicle length, and pennation angle, respectively (Narici et al, 2003;Blazevich et al, 2006;Ema et al, 2013;Bolsterlee et al, 2015;Trezise et al, 2016;Geremia et al, 2019;Nijholt et al, 2020;Betz et al, 2021;May et al, 2021;Hagoort et al, 2022). Reported SEM% were between 0.6 and 4.8%, 2-18.9%, and 4.3-23% for muscle thickness, fascicle length, and pennation angle, respectively (Narici et al, 2003;Bénard et al, 2009;Ema et al, 2013;Bolsterlee et al, 2015;Trezise et al, 2016;Oranchuk et al, 2020;May et al, 2021;Hagoort et al, 2022).…”

Critical evaluation of commonly used methods to determine the concordance between sonography and magnetic resonance imaging: A comparative study

“…Accordingly, a high concordance between measurement procedures with very low measurement error is mandatory to rule out the possibility that measured changes could be explained due to measurement error. To investigate MT, sonography is commonly used (Sarto et al, 2021) and is described as a valid and reliable assessment with inter-day reliability of an intraclass correlation coefficient (ICC) of 0.72-0.99 (Wong et al, 2013;Rosenberg et al, 2014) and intra-day reliability of ICC = 0.97-0.99 in the multifidus lumborum and the gastrocnemius muscle, as well as very high inter-rater-and intra-rater reliability of ICC = 0.78-0.94 (Wallwork et al, 2007;Teyhen and Koppenhaver, 2011;Chiaramonte et al, 2019;Betz et al, 2021) measured in the quadriceps and multifidus muscle. However, reviews by English et al (2012) and Hebert et al (2009) only showed moderate reliability for intra-and interday reliability (ICC = 0.62-0.97) when investigating muscle size via sonography.…”