Reliability of Muscle Quantity and Quality Measured With Extended-Field-of-View Ultrasound at Nine Body Sites

ObjectiveMeasuring muscle quantity and quality is very important because the loss of muscle quantity and quality is associated with several adverse effects specifically in older people. Ultrasound is a method widely used to measure muscle quantity and quality. One problem with ultrasound is its limited field of view, which makes it impossible to measure the muscle quantity and quality of certain muscles. In this study, we aimed to evaluate the intra- and inter-rater reliability of extended-field-of-view (EFOV) ultrasound for the measurement of muscle quantity and quality in nine muscles of the limbs and trunk.MethodsTwo examiners took two ultrasound EFOV images with a linear probe from each of the muscle sites. The intraclass correlation coefficient (ICC) was used, and the standard error of measurement and coefficient of variation were calculated.ResultsIntra-rater reliability was good to excellent (ICC = 0.2–1.00) for all muscle measurements. The inter-rater reliability for most of the muscle measurements was good to excellent (ICC = 0.82–0.98). Inter-rater reliability was moderate (0.58–0.72) for some muscle quantity measurements of the tibialis anterior, gastrocnemius, rectus femoris, biceps femoris and triceps brachii muscles.ConclusionMuscle quantity and quality can be measured reliably using EFOV US.     

Reliability of Real‐time Ultrasound Imaging for the Assessment of Trunk Stabilizer Muscles: A Systematic Review of the Literature

Rehabilitative ultrasound (US) imaging is one of the popular methods for investigating muscle morphologic characteristics and dimensions in recent years. The reliability of this method has been investigated in different studies. As studies have been performed with different designs and quality, reported values of rehabilitative US have a wide range. The objective of this study was to systematically review the literature conducted on the reliability of rehabilitative US imaging for the assessment of deep abdominal and lumbar trunk muscle dimensions. The PubMed/MEDLINE, Scopus, Google Scholar, Science Direct, Embase, Physiotherapy Evidence, Ovid, and CINAHL databases were searched to identify original research articles conducted on the reliability of rehabilitative US imaging published from June 2007 to August 2017. The articles were qualitatively assessed; reliability data were extracted; and the methodological quality was evaluated by 2 independent reviewers. Of the 26 included studies, 16 were considered of high methodological quality. Except for 2 studies, all high‐quality studies reported intraclass correlation coefficients (ICCs) for intra‐rater reliability of 0.70 or greater. Also, ICCs reported for inter‐rater reliability in high‐quality studies were generally greater than 0.70. Among low‐quality studies, reported ICCs ranged from 0.26 to 0.99 and 0.68 to 0.97 for intra‐ and inter‐rater reliability, respectively. Also, the reported standard error of measurement and minimal detectable change for rehabilitative US were generally in an acceptable range. Generally, the results of the reviewed studies indicate that rehabilitative US imaging has good levels of both inter‐ and intra‐rater reliability.     

Reliability and Validity of Panoramic Ultrasound Imaging for Evaluating Muscular Quality and Morphology: A Systematic Review

Panoramic ultrasound (US) is a novel method used to assess linear dimensions, cross-sectional area, fatty infiltrate and echo-intensity features of muscles that cannot be measured with B-mode US. However, a structured overview of its validity and reliability is lacking. MEDLINE, PubMed, SCOPUS and Web of Science databases were systematically searched for studies evaluating reliability or validity data on panoramic US imaging to determine the muscular morphology and/or quality of skeletal muscles. Most studies had acceptable methodological quality. Seventeen studies analyzing reliability (n = 16) or validity (n = 5) were included. Twelve studies assessed cross-sectional area, seven studies assessed echo-intensity, five assessed linear dimensions (fascicle/tendon length, muscle/subcutaneous adipose thickness or between-structure distance) and one assessed intramuscular fat. Panoramic US seems to be a reliable and valid tool for the assessment of muscle morphology and quality in healthy populations at specific locations, particularly the lower extremities. Studies including scanning procedures are needed to confirm these findings in locations not included in this revision and in both clinical and healthy populations.     

Reliability of Rehabilitative Ultrasound Imaging of the Transversus Abdominis and Lumbar Multifidus Muscles

Koppenhaver SL, Hebert JJ, Fritz JM, Parent EC, Teyhen DS, Magel JS. Reliability of rehabilitative ultrasound imaging of the transversus abdominis and lumbar multifidus muscles.

Objectives

To evaluate the intraexaminer and interexaminer reliability of rehabilitative ultrasound imaging (RUSI) in obtaining thickness measurements of the transversus abdominis (TrA) and lumbar multifidus muscles at rest and during contractions.

Design

Single-group repeated-measures reliability study.

Setting

University and orthopedic physical therapy clinic.

Participants

A volunteer sample of adults (N=30) with current nonspecific low back pain (LBP) was examined by 2 clinicians with minimal RUSI experience.

Interventions

Not applicable.

Main Outcome Measures

Thickness measurements of the TrA and lumbar multifidus muscles at rest and during contractions were obtained by using RUSI during 2 sessions 1 to 3 days apart. Percent thickness change was calculated as thickness_contracted-thickness_rest/thickness_rest. Intraclass correlation coefficients (ICC) were used to estimate reliability.

Results

By using the mean of 2 measures, intraexaminer reliability point estimates (ICC_3,2) ranged from 0.96 to 0.99 for same-day comparisons and from 0.87 to 0.98 for between-day comparisons. Interexaminer reliability estimates (ICC_2,2) ranged from 0.88 to 0.94 for within-day comparisons and from 0.80 to 0.92 for between-day comparisons. Reliability estimates comparing measurements by the 2 examiners of the same image (ICC_2,2) ranged from 0.96 to 0.98. Reliability estimates were lower for percent thickness change measures than the corresponding single thickness measures for all conditions.

Conclusions

RUSI thickness measurements of the TrA and lumbar multifidus muscles in patients with LBP, when based on the mean of 2 measures, are highly reliable when taken by a single examiner and adequately reliable when taken by different examiners.     

Quantity and Quality of the Lower Extremity Muscles in Women with Knee Osteoarthritis

The objective of the study described here was to compare lower extremity muscle quantity and quality between individuals with and those without knee osteoarthritis (OA). Twenty-one women with knee OA (mild, n = 8; severe, n = 13) and 23 healthy patients participated. Ultrasonography was used to measure muscle thickness (MT) and echo intensity (EI) of the rectus femoris, vastus intermedius, vastus lateralis, vastus medialis, biceps femoris, gluteus maximus, gluteus medius, gastrocnemius, soleus and tibialis anterior. MTs of the vastus medialis and vastus intermedius were smaller, and EIs of the vastus medialis, vastus intermedius, gluteus medius and tibialis anterior were larger, in the severe OA group compared than in the healthy group. Compared with the healthy group, the mild OA group had decreased MT and enhanced EI. Changes in quality and quantity occurring with knee OA progression differed among muscles. In the vastus medialis, change was observed from an earlier stage.     

Age-Related Ultrasound Changes in Muscle Quantity and Quality in Women

This study investigated the age-related changes in muscle quantity and quality in the trunk and limbs of women. A total of 128 females were divided into four age groups: young, middle-aged, young-old and old-old. Muscle thickness (MT) and echo intensity (EI) of the biceps brachii, quadriceps femoris, rectus abdominis, external oblique, internal oblique and transversus abdominis were measured using B-mode ultrasonography. The EIs of the biceps brachii, quadriceps femoris and transversus abdominis were significantly higher in the middle-aged group than in the young group; however, there were no significant differences in MT. Compared with the young group, all other groups had significant changes in both MT and EI of the rectus abdominis, external oblique and internal oblique muscles. Thus, qualitative changes in muscle may occur earlier than quantitative changes, and loss of muscle mass may occur earlier in the superficial abdominal muscles than in the other muscles.     

Ultrasound Imaging as a Diagnostic Tool to Assess the Functional Status of Muscles after a Spinal Cord Injury

The aim of this study was to evaluate the use of ultrasound imaging (USI) as a diagnostic tool to assess muscle function after a spinal cord injury (SCI). Ultrasound videos of the gastrocnemius medialis muscle were recorded both at rest and during attempted maximum voluntary contraction (MVC) for fifteen participants with a SCI and fifteen able-bodied controls. Measurements were repeated at monthly intervals for participants in the SCI group during their inpatient stay. Differences in muscle echogenicity and thickness were detected between both able-bodied and SCI groups and subgroups of SCI participants, suggesting USI can detect and monitor changes in muscle structure which are characteristic of atrophy. Decreased muscle movement in the SCI groups was also detected during attempted MVC. The ability of USI to distinguish between different levels of function demonstrates the potential of USI as a quantitative tool to assess muscles.     

Foreground Detection Analysis of Ultrasound Image Sequences Identifies Markers of Motor Neurone Disease across Diagnostically Relevant Skeletal Muscles

Diagnosis of motor neurone disease (MND) includes detection of small, involuntary muscle excitations, termed fasciculations. There is need to improve diagnosis and monitoring of MND through provision of objective markers of change. Fasciculations are visible in ultrasound image sequences. However, few approaches that objectively measure their occurrence have been proposed; their performance has been evaluated in only a few muscles; and their agreement with the clinical gold standard for fasciculation detection, intramuscular electromyography, has not been tested. We present a new application of adaptive foreground detection using a Gaussian mixture model (GMM), evaluating its accuracy across five skeletal muscles in healthy and MND-affected participants. The GMM provided good to excellent accuracy with the electromyography ground truth (80.17%–92.01%) and was robust to different ultrasound probe orientations. The GMM provides objective measurement of fasciculations in each of the body segments necessary for MND diagnosis and hence could provide a new, clinically relevant disease marker.     

Validity of Freehand 3-D Ultrasound System in Measurement of the 3-D Surface Shape of Shoulder Muscles

Freehand 3-D ultrasound (3DUS) system is a promising technique for accurately assessing muscle morphology. However, its accuracy has been validated mainly in terms of volume by examining lower limb muscles. This study was aimed at validating 3DUS in the measurements of 3-D surface shape and volume by comparing them with magnetic resonance imaging (MRI) measurements while ensuring the reproducibility of participant posture by focusing on the shoulder muscles. The supraspinatus, infraspinatus and posterior deltoid muscles of 10 healthy men were scanned using 3DUS and MRI while secured by an immobilization support customized for each participant. A 3-D surface model of each muscle was created from the 3DUS and MRI methods, and the agreement between them was assessed. For the muscle volume, the mean difference between the two models was within –0.51 cm³. For the 3-D surface shape, the distances between the closest points of the two models and the Dice similarity coefficient were calculated. The results indicated that the median surface distance was less than 1.12 mm and the Dice similarity coefficient was larger than 0.85. These results suggest that, given the aforementioned error is permitted, 3DUS can be used as an alternative to MRI in measuring volume and surface shape, even for the shoulder muscles.     

超声造影后血流动力学评估非典型肝脏局灶性病变的价值

目的 探讨非典型肝脏局灶性病变应用超声造影剂SonoVue后其内血流动力学改变.方法 对25例非典型肝脏局灶性病变(直径12～40 mm,平均25 mm,其中良性15例,恶性10例)进行超声造影及彩色多普勒血流显像.结果 25例肝肿瘤造影前后的瘤内彩色血流信号均有不同程度的增加,其中血流速度无显著性差异,而阻力指数则有显著性差异.结论 超声造影能够明显提高非典型肝脏局灶性病变内的血流显像,对评估病灶良恶性有重要的价值.     

彩色多普勒在阳萎诊断中的应用

用彩色多普勒血流显像配合罂粟碱试验观察２６例阳萎阴茎深动脉峰值流速（Ｖｐ）、舒张末期最小流速（Ｖｍｉｎ）。结果表明：对罂粟碱反应良好１２例，反应低下１４例，Ｖｐ分别为３７．８±７．６ｃｍ／ｓ及２７．６±５．９ｃｍ／ｓ（Ｐ＜０．０１），取９５％可信限，Ｖｐ大于３ｋｍ／ｓ可认为动脉功能正常。反应低下中６例有海绵体静脉疹，８例为动脉供血不足，二者Ｖｐ分别为３４．２±６．１ｃｍ／ｓ及２１．２±５．８ｃｍ／ｓ（Ｐ＜０．０１），Ｖｍｉｎ分别为７．６±２．４ｃｍ／ｓ及２．２±１．１ｃｍ／ｓ（Ｐ＜０．０１）。动脉供血不足者Ｖｐ均小于３０ｃｍ／ｓ。多普勒超声不仅能区别血管性与非血管性阳萎，而且对血管性阳萎中的动脉供血抑或静脉机能不全有所提示。影响流速测值的因素有：仪器类型、探头频率，是否采用角度校正以及注药后流速测定的时间。     

脉络膜黑色素瘤的三维与二维超声成像的比较

目的 :通过三维与二维超声成像对脉络膜黑色素瘤的检查及比较 ,了解三维诊断技术的优越性。方法 :应用 OTI3Di- Scan眼科专用超声仪首先进行二维 B超检查 ,取肿瘤最清晰方位作三维检查 ,探头旋转 1 80度 ,连续取二维扫描图像 ,然后重建成三维图像。体积测定按需要设定病变的切割厚度 ,画出各切面的轮廓 ,由计算机算出体积。结果 :4例脉络膜黑色素瘤三维图像中 1例呈圆球形 ,3例为椭圆球形 ,并可观察任何切面的肿块内部结构。精确测定出肿块体积 ,其中最大 1例体积为 1 4 99.9mm3 。二维超声显像显示 1例圆形 ,3例为椭圆形。 4例都有挖空现象 ,3例有脉络膜凹陷及球后声影。测量肿块面积最大 1例为 1 1 .1 5mm× 1 7.66mm。结论 :诊断脉络膜黑色素瘤三维超声成像比二维超声成像更具有优越性。外部形态呈立体球形 ,与肿瘤实际形态接近 ,并可观察任意切面内部结构 ,能够精确测量肿瘤的体积     

Proceedings: Beyond Ultrasound First Forum on Improving the Quality of Ultrasound Imaging in Obstetrics and Gynecology

The Beyond Ultrasound First Forum was conceived to increase awareness that the quality of obstetric and gynecologic ultrasound can be improved, and is inconsistent throughout the country, likely due to multiple factors, including the lack of a standardized curriculum and competency assessment in ultrasound teaching. The forum brought together representatives from many professional associations; the imaging community including radiology, obstetrics and gynecology, and emergency medicine among others; in addition to government agencies, insurers, industry, and others with common interest in obstetric and gynecologic ultrasound. This group worked together in focus sessions aimed at developing solutions on how to standardize and improve ultrasound training at the resident level and beyond. A new curriculum and competency assessment program for teaching residents (obstetrics and gynecology, radiology, and any other specialty doing obstetrics and gynecology ultrasound) was presented, and performance measures of ultrasound quality in clinical practice were discussed. The aim of this forum was to increase and unify the quality of ultrasound examinations in obstetrics and gynecology with the ultimate goal of improving patient safety and quality of clinical care. This report describes the proceedings of this conference including possible approaches to resident teaching and means to improve the inconsistent quality of ultrasound examinations performed today.     

正常成人主肺动脉的超声测量及其意义

目的　探讨通过正常成人主肺动脉的超声测量诊断肺动脉高压与否的可能性。方法　连续测量14 9例正常成人主肺动脉直径 (内径 )并测量膈处降主动脉直径 (内径 )的比值 ,另外采用相同方法测量 17例 6 0～ 78岁一组经彩色 Doppler证实的慢性肺阻塞疾病 (chronic obstructive pulmonary disease,COPD)患者主肺动脉直径及与降主动脉直径的比值并与正常组比较。结果　正常成人不同年龄主肺动脉直径不同并有随年龄增长而增大的趋势 (P<0 .0 5 ) ,其比值与年龄有关 (P<0 .0 5 ) ,且其比值与 COPD患者的比值比较存在显著差异 (P<0 .0 1)。结论　正常成人不同年龄组主肺动脉与降主动脉的比值可作为判断肺动脉高压与否的简单、敏感的指标。