Reliability and validity of a standardised ultrasound examination protocol to quantify vastus lateralis muscle
DOI:
https://doi.org/10.2340/16501977-2854Keywords:
diagnostic imaging, ultrasound, magnetic resonance imaging, skeletal muscle, quadriceps muscle, subcutaneous fat, sarcopaenia, hypertrophyAbstract
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 measured 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 (R² = 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.
Downloads
References
Mitsiopoulos N, Baumgartner RN, Heymsfield SB, Lyons W, Gallagher D, Ross R. Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography. J Appl Physiol (1985) 1998; 85: 115-122. https://doi.org/10.1152/jappl.1998.85.1.115
Sanada K, Kearns CF, Midorikawa T, Abe T. Prediction and validation of total and regional skeletal muscle mass by ultrasound in Japanese adults. Eur J Appl Physiol 2006; 96: 24-31. https://doi.org/10.1007/s00421-005-0061-0
Tosato M, Marzetti E, Cesari M, Savera G, Miller RR, Bernabei R, et al. Measurement of muscle mass in sarcopenia: from imaging to biochemical markers. Aging Clin Exp Res 2017; 29: 19-27. https://doi.org/10.1007/s40520-016-0717-0
Ticinesi A, Meschi T, Narici MV, Lauretani F, Maggio M. Muscle ultrasound and sarcopenia in older individuals: a clinical perspective. J Am Med Dir Assoc 2017; 18: 290-300. https://doi.org/10.1016/j.jamda.2016.11.013
Leone AF, Schumacher SM, Krotish DE, Eleazer GP. Geriatricians' interest to learn bedside portable ultrasound (GEBUS) for application in the clinical practice and education. J Am Med Dir Assoc 2012; 13: 308.e7-308.e10. https://doi.org/10.1016/j.jamda.2011.06.002
Nijholt W, Scafoglieri A, Jager-Wittenaar H, Hobbelen JSM, van der Schans CP. The reliability and validity of ultrasound to quantify muscles in older adults: a systematic review. J Cachexia Sarcopenia Muscle 2017; 8: 702-712. https://doi.org/10.1002/jcsm.12210
English C, Fisher L, Thoirs K. Reliability of real-time ultrasound for measuring skeletal muscle size in human limbs in vivo: a systematic review. Clin Rehabil 2012; 26: 934-944. https://doi.org/10.1177/0269215511434994
Cruz-Jentoft AJ, Baeyens AP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working group on sarcopenia in older people. Age Aging 2010; 39: 412-423. https://doi.org/10.1093/ageing/afq034
Uchmanowicz I, Loboz-Rudnicka M, Szelag P, Jankowska-Polanska B, Loboz-Grudzien K. Frailty in heart failure. Curr Heart Fail Rep 2014; 11: 266-273. https://doi.org/10.1007/s11897-014-0198-4
Kato A. Muscle wasting is associated with reduced exercise capacity and advanced disease in patients with chronic heart failure. Future Cardiol 2013; 9: 767-770. https://doi.org/10.2217/fca.13.74
Benz E, Trajanoska K, Lahousse L, Schoufour JD, Terzikhan N, De Roos E, et al. Sarcopenia in COPD: a systematic review and meta-analysis. Eur Respir Rev 2019; 28: 190049. https://doi.org/10.1183/16000617.0049-2019
Wurzinger LJ. Hüfte, Oberschenkel und Knie [Hip, thigh and knee.]. In: Aumüller G, Aust G, Doll A, editors. Anatomie [Anatomy], Duale Reihe 2nd edn. Stuttgart: Georg Thieme Verlag KG; 2010, p.331 (in German).
Ticinesi A, Narici M, Lauretani F, Nouvenne A, Colizzi E, Mantovani M, et al. Assessing sarcopenia with vastus lateralis muscle ultrasound: an operative protocol. Aging Clin Exp Res 2018; 30: 1437-1443. https://doi.org/10.1007/s40520-018-0958-1
Koo T, Li M. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 2016; 15: 155-163.
https://doi.org/10.1016/j.jcm.2016.02.012
Reeves ND, Maganaris CN, Narici MV. Ultrasonographic assessment of human skeletal muscle size. Eur J Appl Physiol 2004; 91: 116-118.
https://doi.org/10.1007/s00421-003-0961-9
Ahtiainen J, Hoffren N, Hulmi J, Pietikäinen M, Mero AA, Avela J, et al. Panoramic ultrasonography is a valid method to measure changes in skeletal muscle cross-sectional area. Eur J Appl Physiol 2010; 108: 273-279. https://doi.org/10.1007/s00421-009-1211-6
Staehli S, Glatthorn JF, Casartelli N, Maffiuletti NA. Test-retest reliability of quadriceps muscle function outcomes inpatients with knee osteoarthritis. J Electromyogr Kinesiol 2010; 20: 1058-1065. https://doi.org/10.1016/j.jelekin.2010.07.006
Raj I, Bird S, Shield A. Reliability of ultrasonographic measurement of the architecture of the vastus lateralis and gastrocnemius medialis muscles in older adults. Clin Physiol Funct Imaging 2012; 32: 65-70. https://doi.org/10.1111/j.1475-097X.2011.01056.x
Strasser E, Draskovits T, Praschak M, Quittan M, Graf A. Association between ultrasound measurements of muscle thickness, pennation angle, echogenicity and skeletal muscle strength in the elderly. Age 2013; 35: 2377-2388. https://doi.org/10.1007/s11357-013-9517-z
Minetto MA, Caresio C, Menapace T, Hajdarevic A, Marchini A, Molinari F, et al. Ultrasound based detection of low muscle mass for diagnosis of sarcopenia in older adults. PM R 2016; 8: 453-462. https://doi.org/10.1016/j.pmrj.2015.09.014
Janssen I, Heymsfield S, Wang Z, Ross R. Skeletal muscle mass and distribution in 468 men and women aged 18-88 yr. J Appl Physiol 2000; 89: 81-88. https://doi.org/10.1152/jappl.2000.89.1.81
Gallagher D, Visser M, De Meersman R, Sepulveda D, Baumgartner RN, Piersner RN, et al. Appendicular skeletal muscle mass: effects of age, gender and ethnicity. J Appl Physiol (1985) 1997; 83: 229-239. https://doi.org/10.1152/jappl.1997.83.1.229
Narici MV, Roi GS, Landoni L, Minetti AE, Cerretelli P. Changes in force, cross-sectional area and neural activation during strength training and detraining of the human quadriceps. Eur J Appl Physiol Occup Physiol 1989; 59: 310-319. https://doi.org/10.1007/BF02388334
Mechelli F, Arendt-Nielsen L, Stokes M. Validity of ultrasound imaging versus magnetic resonance imaging for measuring anterior thigh muscle, subcutaneous fat, and fascia thickness. Methods Protoc 2019; 2: 58. https://doi.org/10.3390/mps2030058
Thomaes T, Thomis M, Onkelinx S, Coudyzer W, Cornelissen V, Vanhees L. Reliability and validity of the ultrasound technique to measure the rectus femoris muscle diameter in older CAD-patients. BMC Med Imaging 2012; 12: 7.
https://doi.org/10.1186/1471-2342-12-7
Worsley P, Kitsell F, Samuel D, Stokes M. Validity of measuring distal vastus medialis muscle using rehabilitative ultrasound imaging versus magnetic resonance imaging. Man Ther 2014; 19: 259-263. https://doi.org/10.1016/j.math.2014.02.002
Noorkoiv M, Nosaka K, Blazevich A. Assessment of quadriceps muscle cross-sectional area by ultrasound extended-field-of-view imaging. Eur J Appl Physiol 2010; 109: 631-639. https://doi.org/10.1007/s00421-010-1402-1
Published
How to Cite
License
Copyright (c) 2021 Theresa Maria Betz, Michaela Wehrstein, Fabian Preisner, Martin Bendszus, Birgit Friedmann-Bette
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.
