Utility of Ultrasound as a Valid and Accurate Diagnostic Tool for Sarcopenia

Abstract

Objectives Patients with chronic kidney disease (CKD) have aberrant changes in body composition, including low skeletal muscle mass, a feature of “sarcopenia.” The measurement of the (quadriceps) rectus femoris (RF) cross‐sectional area (CSA) is widely used as a marker of muscle size. Cutoff values are needed to help discriminate the condition of an individual's muscle (eg, presence of sarcopenia) quickly and accurately. This could help distinguish those at greater risk and aid in targeted treatment programs. Methods Transverse images of the RF were obtained by B‐mode 2‐dimensional ultrasound imaging. Sarcopenic levels of muscle mass were defined by established criteria (1, appendicular skeletal muscle mass [ASM]; 2, ASM/height2; and 3, ASM/body mass index) based on the ASM and total muscle mass measured by a bioelectrical impedance analysis. The discriminative power of RF‐CSA was assessed by receiver operating characteristic curves, and optimal cutoffs were determined by the maximum Youden index (J). Results One hundred thirteen patients with CKD (mean age [SD], 62.0 [14.1] years; 48% male; estimated glomerular filtration rate, 38.0 [21.5] mL/min/1.73m2) were included. The RF‐CSA was a moderate predictor of ASM (R2 = 0.426; P < .001) and total muscle mass (R2 = 0.438; P < .001). With a maximum J of 0.47, in male patients, an RF‐CSA cutoff of less than 8.9 cm2 was deemed an appropriate cutoff for detecting sarcopenic muscle mass. In female patients, an RF‐CSA cutoff of less than 5.7 cm2 was calculated on the basis of ASM/height2 (J = 0.71). Conclusions Ultrasound may provide a low‐cost and simple means to diagnose sarcopenia in patients with CKD. This would allow for early management and timely intervention to help mitigate the effects in this group.

Global Leadership Initiative on Malnutrition criteria with different muscle assessments including muscle ultrasound with hospitalized internal medicine patients

“…There were studies assessing some muscle US cutoff values via DXA, MRI, CT, and BIA in the literature. [17][18][19][20][21][22] Therefore, there were cutoff-based studies to predict low muscle strength.In this study, we defined cutoff values to predict low muscle mass in hospitalized patients to use in GLIM criteria for our population. 23 We used SMI as the reference method.…”

“…They also concluded that RF CSA is able to distinguish patients with low muscle mass. 31 Sahathevan et al reported US as a reliable tool in measuring quadriceps femoris thickness and RF CSA compared with CT in hemodialysis patients. 32 RF muscle measurement by US has also been assessed in critical care patients.…”

‘Self-Management Intervention through Lifestyle Education for Kidney health’ (the SMILE-K study): protocol for a single-blind longitudinal randomised control trial with nested pilot study

“…These are painless, non-invasive methods for measuring body composition. Our group has recently validated our BIA device against dual-energy X-ray absorptiometry (DXA) 37 whilst ultrasonography can be used to assess sarcopenia in CKD 38 39 .…”

Quantitative Muscle Ultrasonography Using 2D Textural Analysis: A Novel Approach to Assess Skeletal Muscle Structure and Quality in Chronic Kidney Disease

“…Transverse ultrasound images of the right rectus femoris were obtained with a B-mode 2D ultrasound imaging device (Hitachi EUB-6500). As previously described by work from our group 6 , 8 and per procedures from the SARCUS working group on behalf of the Sarcopenia Special Interest Group of the European Geriatric Medicine Society, during the scan, patients were sat upright with knee flexion of ~120° and legs flat out in front. A linear transducer (7.5-MHz, 58-dB gain) was positioned perpendicular to the longitudinal axis of the quadriceps femoris at the midpoint between the greater trochanter and the proximal end of the patella.…”

“…Ultrasonography may provide healthcare professionals and researchers with a safe, non-invasive, low-cost means to measure and evaluate skeletal muscle and its morphologic changes (5). Ultrasound is a valid 6 and recommended tool to monitor skeletal muscle health in CKD, 7 used to accurately diagnose sarcopenia 8 and predict mortality risk in CKD. 9 The features extracted from ultrasound images commonly evaluate muscle size, for example, cross-sectional area (CSA) or muscle thickness.…”