Shear modulus estimation on vastus intermedius of elderly and young females over the entire range of isometric contraction

Comparison of elasticity changes in the paraspinal muscles of adolescent patients with scoliosis treated with surgery and bracing

Scoliosis is a three-dimensional spinal deformity, and paraspinal muscles play an important role as stabilizers of the spinal curve. In this prospective study, we compared elasticity changes in the paraspinal muscles of adolescent patients with scoliosis after surgery or bracing. Elasticity was measured on the concave and convex sides of the paraspinal muscles at the apex of the curve at the beginning of treatment and 6 and 12 months after treatment. Twenty-six patients with correction surgery (n = 15) or bracing (n = 11) were included. At initial evaluation, the Cobb angle was larger in the surgery group (72.3 ± 20.2° in surgery vs. 30.6 ± 5.1° in brace, p < 0.001). The estimated mean elasticity value of the paraspinal muscles was lower in the surgery group at baseline on the convex side (15.8 vs. 22.8 kPa, p = 0.037) and 6 months on both the concave (12.1 vs. 22.7 kPa, p = 0.004) and convex (13.4 vs. 23.8 kPa, p = 0.005) sides. There was a significant stiffness decrease from baseline to 6 months on the concave side in the surgery group (5.9 kPa, p = 0.025). However, the elasticity change recovered at 12 months without significant differences between the two groups.

Age-related changes in muscle thickness, echo intensity and shear modulus of the iliocapsularis

PURPOSE

This study aimed to clarify age-related changes in the iliocapsularis (IC) using indicators of quantity, quality, and mechanical properties. We also compared the age-related changes in the IC and other hip muscles.

METHODS

Eighty-seven healthy women (ages: 21-82 years, mean age: 45.9 ± 15.7 years) participated in the experiment. We measured thickness, echo intensity, and shear modulus of the IC, iliacus muscle, rectus femoris, and the thickness and shear modulus of the hip joint capsule. Spearman's rank correlation coefficient was used to measure the association of age with variables measured in the muscles and joint capsule.

RESULTS

Thickness of the iliacus muscle and rectus femoris decreased significantly with age, but the thickness of the IC and hip joint capsule showed no significant correlation. The echo intensities of the IC, iliacus muscle, and rectus femoris were positively correlated, which increased with age. Furthermore, the shear modulus of the iliacus, rectus femoris, and hip joint capsule showed an increase with age, whereas the shear modulus of the IC exhibited no correlation with age.

CONCLUSION

The muscle quality of the IC changed significantly, unlike that of the iliacus or rectus femoris. Additionally, the correlation with echo intensity was relatively weaker in the IC compared with the iliacus or rectus femoris.

Skeletal Muscle Assessment Using Quantitative Ultrasound: A Narrative Review

Ultrasound (US) is an important imaging tool for skeletal muscle analysis. The advantages of US include point-of-care access, real-time imaging, cost-effectiveness, and absence of ionizing radiation. However, US can be highly dependent on the operator and/or US system, and a portion of the potentially useful information carried by raw sonographic data is discarded in image formation for routine qualitative US. Quantitative ultrasound (QUS) methods provide analysis of the raw or post-processed data, revealing additional information about normal tissue structure and disease status. There are four QUS categories that can be used on muscle and are important to review. First, quantitative data derived from B-mode images can help determine the macrostructural anatomy and microstructural morphology of muscle tissues. Second, US elastography can provide information about muscle elasticity or stiffness through strain elastography or shear wave elastography (SWE). Strain elastography measures the induced tissue strain caused either by internal or external compression by tracking tissue displacement with detectable speckle in B-mode images of the examined tissue. SWE measures the speed of induced shear waves traveling through the tissue to estimate the tissue elasticity. These shear waves may be produced using external mechanical vibrations or internal "push pulse" ultrasound stimuli. Third, raw radiofrequency signal analyses provide estimates of fundamental tissue parameters, such as the speed of sound, attenuation coefficient, and backscatter coefficient, which correspond to information about muscle tissue microstructure and composition. Lastly, envelope statistical analyses apply various probability distributions to estimate the number density of scatterers and quantify coherent to incoherent signals, thus providing information about microstructural properties of muscle tissue. This review will examine these QUS techniques, published results on QUS evaluation of skeletal muscles, and the strengths and limitations of QUS in skeletal muscle analysis.

Assessing the Effects of Aging on Muscle Stiffness Using Shear Wave Elastography and Myotonometer

The current study investigated the differences in muscle stiffness between older and young adults at rest and during contraction. We also evaluated the differences in muscle stiffness assessments using a myotonometer (MyotonPRO) and shear wave elastography (SWE). Twenty-two older adults (mean age, 66.6 ± 1.6 years) and 23 young adults (mean age, 66.6 ± 1.6 years) participated in this study. Muscle stiffness of the tibialis anterior (TA) and medial gastrocnemius (MG) muscles at rest and during contraction were measured using SWE and the MyotonPRO. The stiffness increase rate (SIR) was also calculated to determine the absolute stiffness difference. The mean muscle stiffness of the TA and MG muscles was significantly lower in older adults than in young adults at rest and during contraction (p < 0.05). Similarly, the SIR values of the TA and MG were significantly lower in older adults than in young adults (p < 0.05). Our results indicate that both instruments could be used to quantify muscle stiffness changes and serve as a cornerstone for assessing aging-related losses in muscle function. Stiffness measures may help exercise professionals to develop an in-depth understanding of muscle impairment at the tissue level.

Sonoelastography to Assess Muscular Stiffness Among Older Adults and its Use for the Diagnosis of Sarcopenia: A Systematic Review

Changes in muscle stiffness have been reported with sarcopenia. Sonoelastography is an accessible and non-radiating imaging technique allowing quantification of elastic properties of tissue. We performed a systematic review of the literature to investigate whether sonoelastography can be a reliable method to assess sarcopenia in older patients. We searched Medline, Google Scholar, Scopus, SpringerLink and Science direct from January 1, 1990 to April 1, 2020. Three independent review authors assessed trial eligibility, extracted the data, and assessed risk of bias. We intended to learn which types of elastography have been tested, if such measures are repeatable, and if they have been compared to the currently accepted diagnostic method. Ten studies met the inclusion criteria. Most followed a cross-sectional design with young and older adult subgroups. The gastrocnemius, rectus femoris, and vastus intermedius appeared most frequently. Nine of the included studies used shear wave elastography and one-strain elastography. The passive elastic constant was significantly greater in sarcopenic versus healthy subjects after passive stretching (124.98 ± 60.82 vs. 46.35 ± 15.85, P = 0.004). However, even in non-sarcopenic patients, the age of the patient was responsible for about 45.5 % of the variance in SWV. Among ten included articles, four reported higher stiffness in the muscles of older adults, two reported lower stiffness, and four found no significant difference. Due to the substantial heterogenicity of actual data, we could not make any conclusions about the potential usefulness of elastography to assess sarcopenia. Further studies are needed, including a larger sample of older patients and using a standardized and reproducible protocol.

Quantification of the Elastic Property of Normal Thigh Muscles Using MR Elastography: Our Initial Experience

Purpose

This study aimed to apply MR elastography (MRE) to achieve in vivo evaluation of the elastic properties of thigh muscles and validate the feasibility of quantifying the elasticity of normal thigh muscles using MRE.

Materials and Methods

This prospective study included 10 volunteer subjects [mean age, 32.5 years, (range, 23-45 years)] who reported normal activities of daily living and underwent both T2-weighted axial images and MRE of thigh muscles on the same day. A sequence with a motion-encoding gradient was used in the MRE to map the propagating shear waves in the muscle. Elastic properties were quantified as the shear modulus of the following four thigh muscles at rest; the vastus medialis, vastus lateralis, adductor magnus, and biceps femoris.

Results

The mean shear modulus was 0.98 ± 0.32 kPa and 1.00 ± 0.33 kPa for the vastus medialis, 1.10 ± 0.46 kPa and 1.07 ± 0.43 kPa for the vastus lateralis, 0.91 ± 0.41 kPa and 0.93 ± 0.47 kPa for the adductor magnus, and 0.99 ± 0.37 kPa and 0.94 ± 0.32 kPa for the biceps femoris, with reader 1 and 2, respectively. No significant difference was observed in the shear modulus based on sex (p < 0.05). Aging consistently showed a statistically significant negative correlation (p < 0.05) with the shear modulus of the thigh muscles, except for the vastus medialis (p = 0.194 for reader 1 and p = 0.355 for reader 2).

Conclusion

MRE is a quantitative technique used to measure the elastic properties of individual muscles with excellent inter-observer agreement. Age was consistently significantly negatively correlated with the shear stiffness of muscles, except for the vastus medialis.

Age-related increase in muscle stiffness is muscle length dependent and associated with muscle force in senior females

Background

In aging, muscle stiffness is considered as one of the factors associated with the reduction of force generation capability. There have been inconsistent findings on age-related alteration in the passive stiffness of quadriceps muscle in the female adults. Thus, the aim of this study was to determine the effect of aging on the shear moduli of the superficial muscle heads of the quadriceps and to explore its relationship with knee extension force.

Methods

Passive shear moduli of the rectus femoris (RF), vastus lateralis (VL), and vastus medialis (VM) were measured at rest using shear wave elastography in 20 young and 20 senior female adults. Measurements were repeated at four knee joint positions, that is, 30°, 60°, 90°, and 105° of knee flexion. Maximal isometric voluntary knee extension force was assessed at 30°, 60°, and 90° of knee flexion.

Results

As per our findings, senior adults were determined to have significantly higher passive muscle shear moduli in the RF (by 34% – 68%; all p < 0.05) and the VL muscle heads (by 13%–16%, all p < 0.05) at and beyond 60° of knee flexion. Age-related increase in the VM was evident at 105° knee flexion (by11%, p = 0.020). The RF shear modulus was negatively correlated to the maximal isometric voluntary contraction force measured at 60° (r =  − 0.485, p = 0.030) in senior adults.

Conclusions

Senior female adults had greater passive stiffness at the superficial muscle heads of the quadriceps muscles when measured at long muscle length. Among the senior female adults, the passive stiffness of RF has been determined to have a negative association with the knee extensor force only at 60° knee flexion. No significant association was noted for other angles and muscles.

Characteristics of the Passive Muscle Stiffness of the Vastus Lateralis: A Feasibility Study to Assess Muscle Fibrosis

Skeletal muscle fibrosis occurs with aging and has been suggested to impair muscle performance, thereby decreasing quality of life. Recently, muscle stiffness, a surrogate measure of muscle fibrosis, was noninvasively quantified as the shear modulus using ultrasound shear wave elastography (SWE) in humans. We aimed to investigate thigh muscle stiffness in females and males, respectively, across a broad range of ages by using SWE. Eighty-six community-dwelling Japanese people who were aged 30 to 79 years and did not regularly exercise participated in this study. The vastus lateralis (VL) shear modulus was measured at three different knee joint angles: full extension, 90° of flexion, and full flexion. There were no significant main effects of sex or age on the VL shear modulus in full extension or 90° of flexion of the knee. However, the VL shear modulus in knee full flexion was significantly smaller in females than in males and increased with age from 47.9 years. The results suggest that the accelerated increase in VL stiffness that occurs after an individual passes their late 40s may be an important therapeutic target for developing effective treatments and programs that preserve and improve quality of life.

Ultrasound shear wave elastography of the anterior talofibular and calcaneofibular ligaments in healthy subjects

Aim of study

Most sprained lateral ankle ligaments heal uneventfully, but in some cases the ligament’s elastic function is not restored, leading to chronic ankle instability. Ultrasound shear wave elastography can be used to quantify the elasticity of musculoskeletal soft tissues; it may serve as a test of ankle ligament function during healing to potentially help differentiate normal from ineffective healing. The purpose of this study was to determine baseline shear wave velocity values for the lateral ankle ligaments in healthy male subjects, and to assess inter-observer reliability.

Material and methods

Forty-six ankles in 23 healthy male subjects aged 20–40 years underwent shear wave elastography of the lateral ankle ligaments performed by two musculoskeletal radiologists. Each ligament was evaluated three times with the ankle relaxed by both examiners, and under stress by a single examiner. Mean shear wave velocity values were compared for each ligament by each examiner. Inter-observer agreement was evaluated.

Results

The mean shear wave velocity at rest for the anterior talofibular ligament was 2.09 ± 0.3 (range 1.41–3.17); and for the calcaneofibular ligament 1.99 ± 0.36 (range 1.29–2.88). Good inter-observer agreement was found for the anterior talofibular ligament and calcaneofibular ligament shear wave velocity measurements with the ankle in resting position. There was a significant difference in mean shear wave velocities between rest and stressed conditions for both anterior talofibular ligament (2.09 m/s vs 3.21 m/s; p <0.001) and calcaneofibular ligament (1.99 m/s vs 3.42 m/s; p <0.0001).

Conclusion

Shear wave elastography shows promise as a reproducible method to quantify ankle ligament stiffness. This study reveals that shear waves velocities of the normal lateral ankle ligaments increased with applied stress compared to the resting state.

Biceps brachii muscle hardness assessed by a push-in meter in comparison to ultrasound strain elastography

This study investigated the relationship between push-in meter (PM) and ultrasound strain elastography (USE) for biceps brachii (BB) muscle hardness. BB hardness of 21 young men was assessed by PM and USE during rest and isometric contractions of six different intensities (15, 30, 45, 60, 75, 90% of maximal voluntary contraction: MVC) at 30°, 60° and 90° elbow flexion. Muscle hardness (E) was calculated from the force-displacement relationship in PM, and strain ratio (SR) between an acoustic coupler (elastic modulus: 22.6 kPa) and different regions of interest (ROIs) in BB was calculated and converted to Young's modulus (YM) in USE. In resting muscle, E was 26.1 ± 6.4 kPa, and SR and YM for the whole BB was 0.88 ± 0.4 and 30.8 ± 12.8 kPa, respectively. A significant (p < 0.01) correlation was evident between E and logarithmical transformed SR (LTSR) for the ROI of whole BB (r = - 0.626), and E and converted YM (r = 0.615). E increased approximately ninefold from resting to 90% MVC, and E and LTSR (r = - 0.732 to - 0.880), and E and converted YM for the SR above 0.1 were correlated (r = 0.599-0.768, p < 0.01). These results suggest that muscle hardness values obtained by PM and USE are comparable.

Ultrasound Imaging and Rehabilitation of Muscle Disorders: Part 2: Nontraumatic Conditions

Because of its several advantages, ultrasound imaging has started to take place in the diagnostic and therapeutic algorithms of a wide range of musculoskeletal disorders. After the first part on traumatic conditions, in this review, the authors aim to discuss the applicability of ultrasound imaging for nontraumatic muscle disorders in the daily clinical/academic practice. While trying to summarize the whole spectrum (e.g., myofascial pain syndrome, inflammatory diseases, neuromuscular disorders), special emphasis will be given to sarcopenia, which is, by far, the most challenging clinical condition in the era of "aging world." Of note, rehabilitation with regard to the exemplified problems will also be briefed throughout.

Magnetic resonance elastography (MRE) shows significant reduction of thigh muscle stiffness in healthy older adults

Determining the effect of ageing on thigh muscle stiffness using magnetic resonance elastography (MRE) and investigate whether fat fraction and muscle cross-sectional area (CSA) are related to stiffness. Six healthy older adults in their eighth and ninth decade and eight healthy young men were recruited and underwent a 3 T MRI protocol including MRE and Dixon fat fraction imaging. Muscle stiffness, fat fraction and muscle CSA were calculated in ROIs corresponding to the four quadriceps muscles (i.e. vastus lateralis (VL), vastus medialis (VM), vastus intermedius (VI), rectus femoris (RF)), combined quadriceps, combined hamstrings and adductors and whole thigh. Muscle stiffness was significantly reduced (p < 0.05) in the older group in all measured ROIs except the VI (p = 0.573) and RF (p = 0.081). Similarly, mean fat fraction was significantly increased (p < 0.05) in the older group over all ROIs with the exception of the VI (p = 0.059) and VL muscle groups (p = 0.142). Muscle CSA was significantly reduced in older participants in the VM (p = 0.003) and the combined quadriceps (p = 0.001), hamstrings and adductors (p = 0.008) and whole thigh (p = 0.003). Over the whole thigh, stiffness was significantly negatively correlated with fat fraction (r = − 0.560, p = 0.037) and positively correlated with CSA (r = 0.749, p = 0.002). Stepwise regression analysis revealed that age was the most significant predictor of muscle stiffness (p = 0.001). These results suggest that muscle stiffness is significantly decreased in healthy older adults. Muscle fat fraction and muscle CSA are also significantly changed in older adults; however, age is the most significant predictor of muscle stiffness.

Ultrasound imaging for sarcopenia, spasticity and painful muscle syndromes

PURPOSE OF REVIEW

On the basis of its various advantages and the relevant awareness of physicians, ultrasound imaging has overwhelmingly taken its place in the scientific arena. This is true both from the side of daily clinical applications and also from the side of research. Yet, ultrasound provides real-time (diagnostic) imaging and (interventional) guidance for a wide spectrum of muscle disorders. In this regard, this review aims to discuss the potential/actual utility of ultrasound imaging in particular muscle disorders, that is, sarcopenia, spasticity and fibromyalgia/myofascial pain syndrome.

RECENT FINDINGS

Due to the aging population worldwide and the importance of functionality in the older population, mounting interest has been given to the diagnosis and management of sarcopenia in the recent literature. Likewise, several articles started to report that ultrasound imaging can be used conveniently and effectively in the early diagnosis and quantification of sarcopenia.For spasticity, aside from ultrasound-guided botulinum toxin injections, intriguing attention has been paid to sonographic evaluation of muscle architecture, echogenicity and elasticity in the follow-up of these chronic conditions.As regards painful muscle syndromes, quantitative ultrasound techniques have been shown to detect statistically significant differences between healthy controls and patients with myofascial pain syndrome.

SUMMARY

Ultrasound imaging seems to be a promising tool that indisputably deserves further research in the management of a wide range of muscle disorders. VIDEO ABSTRACT: http://links.lww.com/COSPC/A17.

A micromechanical muscle model for determining the impact of motor unit fiber clustering on force transmission in aging skeletal muscle

This study used a micromechanical finite element muscle model to investigate the effects of the redistribution of spatial activation patterns in young and old muscle. The geometry consisted of a bundle of 19 active muscle fibers encased in endomysium sheets, surrounded by passive tissue to model a fascicle. Force was induced by activating combinations of the 19 active muscle fibers. The spacial clustering of muscle fibers modeled in this study showed unbalanced strains suggesting tissue damage at higher strain levels may occur during higher levels of activation and/or during dynamic conditions. These patterns of motor unit remodeling are one of the consequences of motor unit loss and reinnervation associated with aging. The results did not reveal evident quantitative changes in force transmission between old and young adults, but the patterns of stress and strain distribution were affected, suggesting an uneven distribution of the forces may occur within the fascicle that could provide a mechanism for muscle injury in older muscle.

Shear-Wave Elastography: Basic Physics and Musculoskeletal Applications

In the past 2 decades, sonoelastography has been progressively used as a tool to help evaluate soft-tissue elasticity and add to information obtained with conventional gray-scale and Doppler ultrasonographic techniques. Recently introduced on clinical scanners, shear-wave elastography (SWE) is considered to be more objective, quantitative, and reproducible than compression sonoelastography with increasing applications to the musculoskeletal system. SWE uses an acoustic radiation force pulse sequence to generate shear waves, which propagate perpendicular to the ultrasound beam, causing transient displacements. The distribution of shear-wave velocities at each pixel is directly related to the shear modulus, an absolute measure of the tissue's elastic properties. Shear-wave images are automatically coregistered with standard B-mode images to provide quantitative color elastograms with anatomic specificity. Shear waves propagate faster through stiffer contracted tissue, as well as along the long axis of tendon and muscle. SWE has a promising role in determining the severity of disease and treatment follow-up of various musculoskeletal tissues including tendons, muscles, nerves, and ligaments. This article describes the basic ultrasound physics of SWE and its applications in the evaluation of various traumatic and pathologic conditions of the musculoskeletal system. ^©RSNA, 2017.

Age and Sex Effects on the Active Stiffness of Vastus Intermedius under Isometric Contraction

Previously, a novel technique was proposed to quantify the relationship between the muscle stiffness and its nonfatigue contraction intensity. The method extended the measured range of isometric contraction to 100% maximum voluntary contraction (MVC) using an ultrasonic shear wave measurement setup. Yet, it has not been revealed how this relationship could be affected by factors like age or sex. To clarify these questions, vastus intermedius (VI) stiffness of 40 healthy subjects was assessed under 11 step levels of isometric contraction. The subjects were divided into four groups: young males, young females, elderly males, and elderly females (n = 10 for each). In a relaxed state, no significant difference was observed between the male and female subjects (p = 0.156) nor between the young and elderly subjects (p = 0.221). However, when performing isometric contraction, the VI stiffness of males was found to be significantly higher than that of females at the same level (p < 0.001), and that of the young was higher than the elderly (p < 0.001). Meanwhile, for two knee joint angles used, the stiffness measured at a 90° knee joint angle was always significantly larger than that measured at 60° (p < 0.001). Recognizing the active muscle stiffness of VI contributes to body stability, and these results may provide insight into the age and sex bias in musculoskeletal studies, such as those on fall risks.

The neuromotor effects of transverse friction massage

BACKGROUND

Transverse friction massage (TFM), as an often used technique by therapists, is known for its effect in reducing the pain and loosing the scar tissues. Nevertheless, its effects on neuromotor driving mechanism including the electromechanical delay (EMD), force transmission and excitation-contraction (EC) coupling which could be used as markers of stiffness changes, has not been computed using ultrafast ultrasound (US) when combined with external sensors.

AIM

Hence, the aim of this study was to find out produced neuromotor changes associated to stiffness when TFM was applied over Quadriceps femoris (QF) tendon in healthy subjcets.

METHODS

Fourteen healthy males and fifteen age-gender matched controls were recruited. Surface EMG (sEMG), ultrafast US and Force sensors were synchronized and signals were analyzed to depict the time delays corresponding to EC coupling, force transmission, EMD, torque and rate of force development (RFD).

RESULTS

TFM has been found to increase the time corresponding to EC coupling and EMD, whilst, reducing the time belonging to force transmission during the voluntary muscle contractions.

CONCLUSIONS

A detection of the increased time of EC coupling from muscle itself would suggest that TFM applied over the tendon shows an influence on changing the neuro-motor driving mechanism possibly via afferent pathways and therefore decreasing the active muscle stiffness. On the other hand, detection of decreased time belonging to force transmission during voluntary contraction would suggest that TFM increases the stiffness of tendon, caused by faster force transmission along non-contractile elements. Torque and RFD have not been influenced by TFM.

Feasibility of coded vibration in a vibro-ultrasound system for tissue elasticity measurement

The ability of various methods for elasticity measurement and imaging is hampered by the vibration amplitude on biological tissues. Based on the inference that coded excitation will improve the performance of the cross-correlation function of the tissue displacement waves, the idea of exerting encoded external vibration on tested samples for measuring its elasticity is proposed. It was implemented by integrating a programmable vibration generation function into a customized vibro-ultrasound system to generate Barker coded vibration for elasticity measurement. Experiments were conducted on silicone phantoms and porcine muscles. The results showed that coded excitation of the vibration enhanced the accuracy and robustness of the elasticity measurement especially in low signal-to-noise ratio scenarios. In the phantom study, the measured shear modulus values with coded vibration had an R(2 )= 0.993 linear correlation to that of referenced indentation, while for single-cycle pulse the R(2) decreased to 0.987. In porcine muscle study, the coded vibration also obtained a shear modulus value which is more accurate than the single-cycle pulse by 0.16 kPa and 0.33 kPa at two different depths. These results demonstrated the feasibility and potentiality of the coded vibration for enhancing the quality of elasticity measurement and imaging.

Age-Related Differences in Muscle Shear Moduli in the Lower Extremity

This study investigated the age-related differences in shear moduli of the rectus femoris muscle (RF), the lateral head of the gastrocnemius muscle (LG) and the soleus muscle (SOL) using shear wave ultrasound elastography. Thirty-one young individuals and 49 elderly individuals volunteered for this study. The shear modulus of RF was determined at 50% of the thigh length, and those of LG and SOL were determined at 30% of the lower leg length. RF and LG shear moduli were significantly higher in young individuals than in elderly individuals, but there was no age-related difference in SOL shear modulus. From the standpoint of an index reflecting muscle mechanical properties, it is suggested that the lower muscle shear moduli of RF and LG are the reason for the decreased explosive muscle strength in the lower extremity and the increased risk of falls for elderly individuals.

Reliability of ultrasound elastography for the quantification of transversus abdominis elasticity

Background

The transversus abdominis (TrA), which is considered to be involved in controlling spinal stability, is covered by two muscles (i.e. the external and internal oblique muscles) as well as subcutaneous fat. Therefore, there were doubts about whether it was possible to perform highly reliable measurements of muscle elasticity.

Purpose

To investigate the reliability of ultrasound elastography for the quantification of elasticity of the TrA.

Material and Methods

A skilled and an unskilled operator of ultrasound elastography measured TrA elasticity in 10 healthy men (age, 24 ± 4 years; height, 172.0 ± 5.2 cm; weight, 72.3 ± 12.0 kg) in the supine position. The tests were repeated six times; of the six measured values, a group of four measurements showing the lowest coefficient of variation (CV) was adopted and the mean values were used for further analysis. This procedure was repeated twice on each participant on two different days.

Results

The intra-class correlation coefficients (ICCs) between days for skilled and unskilled operators were 0.86 (P < 0.00) and 0.59 (P = 0.02), respectively, and the CVs were 8.7% and 13.8%, respectively. The ICCs between operators and CVs were in the range of 0.56–0.57 (P = 0.02–0.03) and 13.5–15.5%, respectively. No systematic error was found for any comparison.

Conclusion

The reliabilities of the skilled and unskilled operators were high and moderate, respectively.

Sarcopenia: Current Concepts and Imaging Implications

OBJECTIVE

The purpose of this article is to review the nomenclature, clinical impact, and diagnostic techniques characterizing sarcopenia.

CONCLUSION

Sarcopenia-defined as significant loss of muscle-is associated with cachexia and frailty. Specific diagnostic criteria for sarcopenia continue to evolve, but imaging can play a role in the detection and quantification of muscle depletion. Emerging evidence indicates that sarcopenia is a relevant predictor of quality and quantity of life, particularly in patients who are elderly, have cancer, or undergo surgery.