Key summary points
Standardizing the use of ultrasound in the assessment of muscle and sarcopenia.
AbstractSection FindingsApproach of muscle assessment has been updated according to the most recent literature and anatomical landmarks for 39 different muscles are provided.
AbstractSection MessageUsing these recommendations, ultrasonographical muscle assessment can be standardized worldwide.
Abstract
Purpose
In 2018, the SARCUS working group published a first article on the standardization of the use of ultrasound to assess muscle. Recommendations were made for patient positioning, system settings and components to be measured. Also, shortcomings in knowledge were mentioned. An important issue that still required standardization was the definition of anatomical landmarks for many muscles.
Methods
A systematic search was performed in Medline, SCOPUS and Web of Sciences looking for all articles describing the use of ultrasound in the assessment of muscle not described in the first recommendations, published from 01/01/2018 until 31/01/2020. All relevant terms used for older people, ultrasound and muscles were used.
Results
For 39 muscles, different approaches for ultrasound assessment were found that likely impact the values measured. Standardized anatomical landmarks and measuring points were proposed for all muscles/muscle groups. Besides the five already known muscle parameters (muscle thickness, cross-section area, pennation angle, fascicle length and echo-intensity), four new parameters are discussed (muscle volume, stiffness, contraction potential and microcirculation). The former SARCUS article recommendations are updated with this new information that includes new muscle groups.
Conclusions
The emerging field of ultrasound assessment of muscle mass only highlights the need for a standardization of measurement technique. In this article, guidelines are updated and broadened to provide standardization instructions for a large number of muscles.
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References
Cruz-Jentoft AJ et al (2019) Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 48(1):16–31
McGregor RA, Cameron-Smith D, Poppitt SD (2014) It is not just muscle mass: a review of muscle quality, composition and metabolism during ageing as determinants of muscle function and mobility in later life. Longev Healthspan 3(1):9
Reinders I et al (2016) Muscle quality and myosteatosis: novel associations with mortality risk: the age, gene/environment susceptibility (AGES)-Reykjavik study. Am J Epidemiol 183(1):53–60
Beaudart C et al (2016) Sarcopenia in daily practice: assessment and management. BMC Geriatr 16(1):170
Nijholt W et al (2017) The reliability and validity of ultrasound to quantify muscles in older adults: a systematic review. J Cachexia Sarcopenia Muscle 8(5):702–712
Mourtzakis M, Wischmeyer P (2014) Bedside ultrasound measurement of skeletal muscle. Curr Opin Clin Nutr Metab Care 17(5):389–395
Tillquist M et al (2014) Bedside ultrasound is a practical and reliable measurement tool for assessing quadriceps muscle layer thickness. JPEN J Parenter Enteral Nutr 38(7):886–890
English C, Fisher L, Thoirs K (2012) Reliability of real-time ultrasound for measuring skeletal muscle size in human limbs in vivo: a systematic review. Clin Rehabil 26(10):934–944
Sanada K et al (2006) Prediction and validation of total and regional skeletal muscle mass by ultrasound in Japanese adults. Eur J Appl Physiol 96(1):24–31
Tandon P et al (2016) A model to identify sarcopenia in patients with cirrhosis. Clin Gastroenterol Hepatol 14(10):1473–1480
Reeves ND, Maganaris CN, Narici MV (2004) Ultrasonographic assessment of human skeletal muscle size. Eur J Appl Physiol 91:116–118
Thomaes T et al (2012) Reliability and validity of the ultrasound technique to measure the rectus femoris muscle diameter in older CAD-patients. BMC Med Imaging 12:7
Abe T et al (2016) Ultrasound-derived forearm muscle thickness is a powerful predictor for estimating DXA-derived appendicular lean mass in Japanese older adults. Ultrasound Med Biol 42(9):2341–2344
Takai Y et al (2014) Applicability of ultrasound muscle thickness measurements for predicting fat-free mass in elderly population. J Nutr Health Aging 18(6):579–585
Takai Y et al (2013) Validity of ultrasound muscle thickness measurements for predicting leg skeletal muscle mass in healthy Japanese middle-aged and older individuals. J Physiol Anthopol 32(1):12
Abe T et al (2015) Validity of ultrasound prediction equations for total and regional muscularity in middle-aged and older men and women. Ultrasound Med Biol 41(2):557–564
Perkisas S, Baudry S, Bauer J et al (2018) Application of ultrasound for muscle assessment in sarcopenia: towards standardized measurements. Eur Geriatr Med 9(6):739–757
The SARCUS project. 2019, February, 9. SARCUS instructional video. Retrieved from https://www.youtube.com/watch?v=y4gSmxwvujE.
van de Glind EM et al (2012) Search filters to identify geriatric medicine in Medline. J Am Med Inform Assoc 19(3):468–472
Moher D et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62(10):1006–1012
Ouzzani M et al (2016) Rayyan-a web and mobile app for systematic reviews. Syst Rev 5(1):210
Lopez P, Pinto MD, Pinto RS (2018) Does rest time before ultrasonography imaging affect quadriceps femoris muscle thickness, cross-sectional area and echo intensity measurements? Ultrasound Med Biol 45(2):612–616
Merrigan JJ et al (2018) Differences in elbow extensor muscle characteristics between resistance-trained men and women. Eur J Appl Physiol 118(11):2359–2366
Alfuraih AM et al (2019) The effect of ageing on shear wave elastography muscle stiffness in adults. Aging Clin Exp Res 31(12):1755–1763
Cheng DTH et al (2018) Sonographic assessment of swallowing in irradiated nasopharyngeal carcinoma patients. The Laryngoscope 128(11):2552–2559
Dunford EC et al (2018) Cardiovascular aging and the microcirculation of skeletal muscle: using contrast-enhanced ultrasound. Am J Physiol Heart Circ Physiol. 315(5):H1194–H1199
Kruse NT, Hughes WE, Casey DP (2018) Mechanistic insights into the modulatory role of the mechanoreflex on central hemodynamics using passive leg movement in humans. J Appl Physiol 125(2):545–552
Alonso-Fernandez D et al (2018) Effects of the Nordic hamstring exercise on the architecture of the semitendinosus. Isokinet Exerc Sci 26(2):81–88
Ikezoe T et al (2012) Associations of muscle stiffness and thickness with muscle strength and muscle power in elderly women. Geriatr Gerontol Int 12(1):86–92
Creze M et al (2018) Shear wave sonoelastography of skeletal muscle: basic principles, biomechanical concepts, clinical applications, and future perspectives. Skeletal Radiol 47(4):457–471
Hug F et al (2015) Elastography for muscle biomechanics: toward the estimation of individual muscle force. Exerc Sport Sci Rev 43(3):125–133
Eby SF et al (2013) Validation of shear wave elastography in skeletal muscle. J Biomech 46(14):2381–2387
Pearson WG Jr, Langmore SE, Zumwalt AC (2011) Evaluating the structural properties of suprahyoid muscles and their potential for moving the hyoid. Dysphagia 26(4):345–351
Dunford EC et al (2018) Cardiovascular aging and the microcirculation of skeletal muscle: using contrast-enhanced ultrasound. Am J Physiol Heart Circ Physiol 315(5):H1194–H1199
Billot M et al (2020) Preserving mobility in older adults with physical frailty and sarcopenia: opportunities, challenges, and recommendations for physical activity interventions. Clin Interv Aging 15:1675–1690
Vincent MA et al (2006) Mixed meal and light exercise each recruit muscle capillaries in healthy humans. Am J Physiol Endocrinol Metab 290(6):E1191–E1197
Inyard AC et al (2007) Contraction stimulates nitric oxide independent microvascular recruitment and increases muscle insulin uptake. Diabetes 56(9):2194–2200
Chang KV et al (2018) Limb muscle quality and quantity in elderly adults with dynapenia but not sarcopenia: an ultrasound imaging study. Exp Gerontol 108:54–61
Hadda V et al (2018) Reliability of ultrasonographic arm muscle thickness measurement by various levels of health care providers in ICU. Clin Nutr Espen 24:78–81
Shah SP et al (2018) Comparison of bedside screening methods for frailty assessment in older adult trauma patients in the emergency department. Am J Emerg Med 37(1):12–18
Michael AE, Young P (2018) Is triceps hypertrophy associated with ulnar nerve luxation? Muscle Nerve 58(4):523–527
Yoshiko A et al (2018) Muscle quality characteristics of muscles in the thigh, upper arm and lower back in elderly men and women. Eur J Appl Physiol. 118(7):1385–1395
Abe T et al (2018) Prediction and validation of DXA-derived appendicular fat-free adipose tissue by a single ultrasound image of the forearm in japanese older adults. J Ultrasound Med 37(2):347–353
Misirlioglu TO, Taskiran OO (2018) Reliability of sonographic muscle thickness measurements of the thenar and hypothenar muscles. Muscle Nerve 57(1):E14–E17
Sterczala AJ et al (2018) Age-related differences in the motor unit action potential size in relation to recruitment threshold. Clin Physiol Funct Imaging. 38(4):610–616
Aboufazeli M et al (2018) Comparison of selective local and global muscle thicknesses in females with and without chronic low back pain. Ortopedia Traumatol Rehabil 20(3):197–204
Akazawa N et al (2018) Relationships between muscle mass, intramuscular adipose and fibrous tissues of the quadriceps, and gait independence in chronic stroke survivors: a cross-sectional study. Physiotherapy. 104(4):438–445
Fukumoto Y et al (2018) Association of physical activity with age-related changes in muscle echo intensity in older adults: a 4-year longitudinal study. J Appl Physiol 125(5):1468–1474
Nozoe M et al (2018) Quadriceps muscle thickness changes in patients with aneurysmal subarachnoid hemorrhage during the acute phase. Top Stroke Rehabil 25(3):209–213
Akazawa N et al (2019) Low body mass index negatively affects muscle mass and intramuscular fat of chronic stroke survivors. PLoS ONE 14(1):e0211145
Watanabe Y et al (2018) Association between echo intensity and attenuation of skeletal muscle in young and older adults: a comparison between ultrasonography and computed tomography. Clin Interv Aging 13:1871–1878
Silva CRD et al (2018) Quadriceps muscle architecture ultrasonography of individuals with type 2 diabetes: reliability and applicability. PLoS ONE 13(10):e0205724
Kawai H et al (2017) Morphological and qualitative characteristics of the quadriceps muscle of community-dwelling older adults based on ultrasound imaging: classification using latent class analysis. Aging Clin Exp Res 30(4):283–291
Harris-Love MO et al (2018) The comparative associations of ultrasound and computed tomography estimates of muscle quality with physical performance and metabolic parameters in older men. J Clin Med 7(10):340
Magrini MA et al (2018) Muscle size, strength, power, and echo intensity, but not specific tension, are affected by age in physically active adults. Isokinet Exerc Sci 26(2):95–103
de Lima FD et al (2018) Cancer-related fatigue and muscle quality in Hodgkin’s lymphoma survivors. Integr Cancer Ther 17(2):299–305
Hida T et al (2018) Ultrasound measurement of thigh muscle thickness for assessment of sarcopenia. Nagoya J Med Sci 80(4):519–527
Murtagh CF et al (2018) The neuromuscular determinants of unilateral jump performance in soccer players are direction-specific. Int J Sports Physiol Perform 13(5):604–611
Blue MNM et al (2018) The effects of high intensity interval training on muscle size and quality in overweight and obese adults. J Sci Med Sport. 21(2):207–212
Franchi MV et al (2018) Muscle thickness correlates to muscle cross-sectional area in the assessment of strength training-induced hypertrophy. Scand J Med Sci Sport 28(3):846–853
Bartolomei S et al (2019) Relationships between muscle architecture, deadlift performance, and maximal isometric force produced at the midthigh and midshin pull in resistance-trained individuals. J Strength Cond Res
Franchi MV et al (2018) Muscle thickness correlates to muscle cross-sectional area in the assessment of strength training-induced hypertrophy. Scand J Med Sci Sports 28(3):846–853
Bey ME et al (2019) Vastus lateralis architecture changes during pregnancy - a longitudinal study. Front Physiol 10:1163
Burton AM, Stock MS (2018) Consistency of novel ultrasound equations for estimating percent intramuscular fat. Clin Physiol Funct Imaging. 38(6):1062–1066
Gaffney KA et al (2018) Nil whey protein effect on glycemic control after intense mixed-mode training in type 2 diabetes. Med Sci Sports Exerc 50(1):11–17
Aubertin-Leheudre M et al (2019) The usefulness of muscle architecture assessed with ultrasound to identify hospitalized older adults with physical decline. Exp Gerontol 125:110678
Simunic B et al (2019) Tensiomyography detects early hallmarks of bed-rest-induced atrophy before changes in muscle architecture. J Appl Physiol 126(4):815–822
Akagi R et al (2018) Muscle size-strength relationship including ultrasonographic echo intensity and voluntary activation level of a muscle group. Arch Gerontol Geriatr 75:185–190
Allison SJ et al (2018) High and odd impact exercise training improved physical function and fall risk factors in community-dwelling older men. J Musculoskelet Neuronal Interact 18(1):100–107
Kato E, Nakamura M, Takahashi H (2018) Effect of compression garments on controlled force output after heel-rise exercise. J Strength Condition Res 32(4):1174–1179
Saito A et al (2018) Age-related changes in muscle elasticity and thickness of the lower extremities are associated with physical functions among community-dwelling older women. Geriatr Gerontol Int. 19(1):61–65
Lee HJ et al (2018) Intra- and inter-rater reliabilities for novel muscle thickness assessment during Co-contraction with dual-rehabilitative ultrasound imaging. Phys Therap Sport 32:109–114
Mickle KJ, Nester CJ (2018) Morphology of the toe flexor muscles in older adults with toe deformities. Arthritis Care Res (Hoboken). 70(6):902–907
McKenna LJ et al (2018) Measurement of muscle thickness of the serratus anterior and lower trapezius using ultrasound imaging in competitive recreational adult swimmers, with and without current shoulder pain. J Sci Med Sport 21(2):129–133
Holtzhausen S et al (2018) An investigation into the use of ultrasound as a surrogate measure of diaphragm function. Heart Lung 47(4):418–424
Cappellini I et al (2018) Recovery of muscle function after deep neuromuscular block by means of diaphragm ultrasonography and adductor of pollicis acceleromyography with comparison of neostigmine vs. sugammadex as reversal drugs: study protocol for a randomized controlled trial. Trials 19(1):135
Aboufazeli M, Afshar-Mohajer N (2018) Within-day and between-day reliability of thickness measurements of abdominal muscles using ultrasound during abdominal hollowing and bracing maneuvers. J Bodywork Mov Therap 22(1):122–128
Emami F, Yoosefinejad AK, Razeghi M (2018) Correlations between core muscle geometry, pain intensity, functional disability and postural balance in patients with nonspecific mechanical low back pain. Med Eng Phys 60:39–46
Kim DK et al (2018) A comparison of ultrasonography measurement on the abdominal muscle thickness between adolescent idiopathic scoliosis and healthy subjects. J Back Musculoskelet Rehabil 31(1):65–74
Mangum LC et al (2018) Ultrasound assessment of the transverse abdominis during functional movement. J Ultrasound Med 37(5):1225–1231
Sutherlin MA et al (2018) Changes in muscle thickness across positions on ultrasound imaging in participants with or without a history of low back pain. J Athletic Train 53(6):553–559
Cuellar WA et al (2019) Vitamin D supplements for trunk muscle morphology in older adults: secondary analysis of a randomized controlled trial. J Cachexia Sarcopenia Muscle 10(1):177–187
Hasegawa Y et al (2019) Temporal muscle thickness as a new indicator of nutritional status in older individuals. Geriatr Gerontol Int 19(2):135–140
Park KM et al (2018) The relationship between masseter muscle thickness measured by ultrasonography and facial profile in young Korean adults. Imaging Sci Dentistry. 48(3):213–221
Poveda-Roda R et al (2018) Myofascial pain: ultrasound width of the masseter muscle. J Oral Facial Pain Head 32(3):298–303
Carletti TM et al (2019) Influence of lower complete denture use on masseter muscles and masticatory function: a longitudinal study. J Oral Rehabil 46(2):127–133
Kajisa E et al (2018) The relationship between jaw-opening force and the cross-sectional area of the suprahyoid muscles in healthy elderly. J Oral Rehabil. 45(3):222–227
Kwan BCH et al (2018) Influence of respiratory mechanics and drive on genioglossus movement under ultrasound imaging. PLoS ONE 13(4):e0195884
Ogawa N et al (2017) Ultrasonography to measure swallowing muscle mass and quality in older patients with Sarcopenic dysphagia. J Am Med Dir Assoc. 19(6):516–522
Chantaramanee A et al (2019) Association between echo intensity of the tongue and its thickness and function in elderly subjects. J Oral Rehabil 46(7):634–639
Goodarzi F et al (2018) The effects of forward head posture on neck extensor muscle thickness: an ultrasonographic study. J Manipulative Physiol Ther 41(1):34–41
Hemelryck W et al (2018) Ultrasonographic assessment of neck muscular size and range of motion in rugby players. Int J Sports Phys Therap 13(1):28–38
Hacker ED, Peters T, Garkova M (2016) Ultrasound assessment of the rectus femoris cross-sectional area: subject position implications. West J Nurs Res 38(9):1221–1230
Linek P (2018) The importance of body mass normalisation for ultrasound measurements of the morphology of oblique abdominis muscles: the effect of age, gender, and sport practice. Folia Morphol (Warsz) 77(1):123–130
Macedo Fraiz G et al (2020) Relationship between muscle thickness and calf circumference in healthy older women. Arch Gerontol Geriatr 86:103942
Infantolino BW, Challis JH (2014) Short communication: pennation angle variability in human muscle. J Appl Biomech 30(5):663–667
Miyatani M et al (2004) The accuracy of volume estimates using ultrasound muscle thickness measurements in different muscle groups. Eur J Appl Physiol 91(2–3):264–272
Drenth H et al (2016) The Contribution of Advanced Glycation End product (AGE) accumulation to the decline in motor function. Eur Rev Aging Phys Act 13:3
Nijholt W et al (2020) Reliability and validity of ultrasound to estimate muscles: a comparison between different transducers and parameters. Clin Nutr ESPEN 35:146–152
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The protocol for this updated systematic review has been registered at PROSPERO (registration number CRD42019126106) on the 9th of August 2019.
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Perkisas, S., Bastijns, S., Baudry, S. et al. Application of ultrasound for muscle assessment in sarcopenia: 2020 SARCUS update. Eur Geriatr Med 12, 45–59 (2021). https://doi.org/10.1007/s41999-020-00433-9
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DOI: https://doi.org/10.1007/s41999-020-00433-9