The Validity of Muscle Ultrasound in the Diagnostic Workup of Sarcopenia Among Older Adults: A Scoping Review

Figures & data

Figure 1 Flow chart.

Table 1 Characteristics of Included Studies (n = 6)

Author (year)	Country	Number of participants (n)	Study participants	Mean age (years)	Proportion female (%)	Proportion sarcopenia (%)	Reference standard	Number of validity tests	Muscle measured (sonographic muscle parameter)	Reliability/ICC
Ozturk (2022)^Citation21	Turkey	313	Outpatient,65+, healthy	79.0^a	59.5%^b	13.4%	EWGSOP2	4	GM (MT) RF (MT) RF (CSA) RA (MT)	0.92 0.96 0.96 0.94
Chen (2022)^Citation23	Taiwan	91	Outpatient, no age restriction, able to walk ≥10m	68.3	61.5%	36.0%	AWGS2	3	RF (MT) RF (CSA) RF (MV)	n.r. n.r. n.r.
Sri-on (2022)^Citation22	Thailand	857	Outpatient, 60+, able to walk ≥6m	70.0	68.6%	22.2%	AWGS2	1	RF (MT)	0.95
Li (2020)^Citation25	China	179	Setting n.r., 60+, no muscular pathologies	69.0^c	72.6%	10.8%^d	AWGS1	5	BB (MT) BB (CSA) BB (CSA Equation 1)^e BB (CSA Equation 2)^f BB (FT)	n.r. n.r. n.r. n.r. n.r.
Isaka (2019)^Citation26	Japan	60	Setting n.r., no age restriction, healthy, able to walk without assistive device	75.8	0%	n.r.	AWGS1	10	GM (MT) GM (EI) GM (MT/EI)^g TA (MT) TA (EI) TA (MT/EI)^g TA (MT+EI) SOL (MT) SOL (EI) SOL (MT/EI)^g	0.86 0.85 n.r. 0.96 0.95 n.r. n.r. 0.85 n.r. n.r.
Rustani (2019)^Citation24	Italy	119	Inpatient, no age restriction	82.2	50.4%	38.7%	EWGSOP1	1	RF (MT)	n.r.

Notes: ^aIn sarcopenic group, 71 years in comparative non-sarcopenic group. ^bIn sarcopenic group, 65.3 years in non-sarcopenic group. ^cIn females, 70 years in males. ^dIn females, 16.3% in males. ^eprediction equation consisting of age, gender and CSA for sarcopenia: logit(P) = – 7.542 + 0.125*age – 1.584*gender (man=0, woman=1) – 0.449*CSA, P = elogit(P) /1+elogit(P). ^fprediction equation consisting of BMI, FT, MT, and CSA is: logit(P) = 2.416–0.095*BMI – 0.798*FT + 0.231*MT – 0.693*CSA, P = elogit(P) /1+elogit(P).

^gMT/EI Index was determined by the division of MT and EI.

Abbreviations: EWGSOP 2, European Working Group on Sarcopenia in Older People 2019; EWGSOP1, European Working Group on Sarcopenia in Older People 2010; AWGS2, Asian Working Group for Sarcopenia 2019; AWGS1, Asian Working Group for Sarcopenia 2014; GM, Gastrocnemius medialis; RF, Rectus femoris; RA, Rectus abdominis; BB, Biceps brachii; TA, Tibialis anterior; SOL, Soleus; MT, muscle thickness; CSA, cross-sectional area; MV, muscle volume; FT, fat thickness; EI, echo intensity; ICC, intraclass correlation coefficient; n.r., not reported.

Table 2 Results of Validity Tests (n = 24)

Muscle and muscle parameter	Author, Year	Reference standard for sarcopenia (method of muscle mass measurement)	Sensitivity	Specificity	Positive likelihood ratio	Negative likelihood ratio	OR (95% CI)	AUC (95% CI)	Sonographic Cut-off value
Rectus femoris MT	Ozturk 2022	EWGSOP2 (BIA)	88.2% (m) 80.0% (f)	60.6% (m) 61% (f)	28.8 (m) 22.5 (f)	96.6 (m) 65.6 (f)	0.73 (0.64–0.84)^a* 0.80 (0.68–0.93)^b*	0.74 (0.64–0.82) (m) 0.76 (0.70–0.82) (f)	≤15.5mm (m) ≤13.0cm (f)
	Chen 2022	AWGS2 (DXA)	n.r.	n.r.	n.r.	n.r.	n.r.	0.64 (m), 0.78 (f)	n.r.
	Sri-On 2022	AWGS2 (BIA)	90.9% ^c	92.2% ^d	76.6^e	97.3^f	n.r.	0.92 (0.89–0.94)	≤11.0mm (m) ≤10.0mm (f)
	Rustani 2019	EWGSOP1 (mid-arm muscle circumference)	100%	64%	64.3	100	n.r.	0.90, 0.94 (m), 0.92 (f)	≤9.0mm (m) ≤7.0mm (f)
Rectus femoris CSA	Ozturk 2022	EWGSOP2 (BIA)	64.7% (m) 68.0% (f)	81.1% (m) 74.1% (f)	39.3 (m) 27.9 (f)	92.4 (m) 94.0 (f)	0.54 (0.42–0.70)^a* 0.60 (0.44–0.80)^b*	0.77 (0.68–0.85) (m) 0.77 (0.70–0.82) (f)	≤5.2 cm² (m) ≤4.3 cm² (f)
	Chen 2022	AWGS2 (DXA)	n.r.	n.r.	n.r.	n.r.	n.r.	0.86 (m), 0.76 (f)	n.r.
Rectus femoris MV	Chen 2022	AWGS2 (DXA)	n.r.	n.r.	n.r.	n.r.	n.r.	0.83, 0.89 (m), 0.80 (f)	n.r.
Gastrocnemius medialis MT	Ozturk 2022	EWGSOP2 (BIA)	70.6% (m) 96% (f)	63.8% (m) 65.5% (f)	26.1 (m) 28.2 (f)	92.3 (m) 99.1 (f)	0.71 (0.63–0.80)^a* 0.77 (0.67–0.90)^b*	0.71 (0.61–0.79) (m) 0.82 (0.76–0.87) (f)	≤13.8mm (m) ≤13.9mm (f)
	Isaka 2019	AWGS1 (BIA)	n.r.	n.r.	n.r.	n.r.	0.62 (0.15–2.59)^g** (m)	n.r.	≤14.4mm
Gastrocnemius medialis EI	Isaka 2019	AWGS1 (BIA)	n.r.	n.r.	n.r.	n.r.	3.35 (0.75–1.42) ^g* (m)	n.r.	≥40.7 AU
Gastrocnemius medialis MT/EI Index	Isaka 2019	AWGS1 (BIA)	n.r.	n.r.	n.r.	n.r.	1.25 (0.96–1.76)^g* (m)	n.r.	n.r
Tibialis Anterior MT	Isaka 2019	AWGS1 (BIA)	n.r.	n.r.	n.r.	n.r.	5.08 (1.87–20.81)^g* (m)	n.r.	≤14.4mm
Tibialis anterior EI	Isaka 2019	AWGS1 (BIA)	n.r.	n.r.	n.r.	n.r.	4.88 (1.74–19.10)^g* (m)	n.r.	≥59 AU
Tibialis anterior MT/EI Index	Isaka 2019	AWGS1 (BIA)	n.r.	n.r.	n.r.	n.r.	2.99 (1.47–7.84)^g* (m)	n.r.	n.r
Tibialis anterior Combination MT, EI^h	Isaka 2019	AWGS1 (BIA)	n.r.	n.r.	n.r.	n.r.	11.14 (2.73–45.46)* (m)	n.r.	≤14.4mm ≥40.7 AU
Soleus MT	Isaka 2019	AWGS1 (BIA)	n.r.	n.r.	n.r.	n.r.	1.37 (0.55–3.37)^g* (m)	0.76	≤22.9mm
Soleus EI	Isaka 2019	AWGS1 (BIA)	n.r.	n.r.	n.r.	n.r.	1.99 (0.81–5.46)^g* (m)	n.r.	≥63.2 AU
Soleus MT/EI Index	Isaka 2019	AWGS1 (BIA)	n.r.	n.r.	n.r.	n.r.	2.11 (1.17–4.39)^g* (m)	n.r.	n.r.
Biceps brachii Equation^i	Li 2020	AWGS1 (DXA)	n.r.	n.r.	n.r.	n.r.	n.r.	0.82 (0.73–0.92)	n.r.^i
Biceps brachii Equation^j	Li 2020	AWGS1 (DXA)	n.r.	n.r.	n.r.	n.r.	n.r.	0.80 (0.69–0.92)	n.r.^j
Biceps brachii CSA	Li 2020	AWGS1 (DXA)	n.r.	n.r.	n.r.	n.r.	0.47 (0.23–0.96)*	n.r.	n.r.
Biceps brachii MT	Li 2020	AWGS1 (DXA)	n.r.	n.r.	n.r.	n.r.	1.31 (0.96–1.78)	n.r.	n.r.
Biceps brachii FT	Li 2020	AWGS1 (DXA)	n.r.	n.r.	n.r.	n.r.	0.56 (0.28–1.10)	n.r.	n.r.
Rectus abdominis MT	Ozturk 2022	EWGSOP2 (DXA)	58.8% (m) 84.0% (f)	81.5% (m) 58.8% (f)	37.0 (m) 22.3 (f)	91.5 (m) 96.3 (f)	0.68 (0.55–0.84)* 0.70 (0.54–0.90)*	0.69 (0.59–0.77) (m) 0.74 (0.67–0.80) (f)	≤7mm (m) ≤6.6mm (f)

Notes: Significant ORs are displayed in bold print. * indicates a positive association between ultrasound muscle measurement and the sarcopenia diagnosis ** indicates a negative association between ultrasound muscle measurement and the sarcopenia diagnosis. ^amultivariable OR, adjusted for age, sex, and body mass index. ^bunivariable OR, unadjusted. ^c95% CI 85.8–94.6%. ^d95% CI 89.9–94.1%. ^e95% CI 70.4–82.0%. ^f95% CI 95.7–98.4%. ^gmultivariable OR, adjusted for age, body mass index, calf circumference, diabetes, statin use. ^hcombined assessment of MT and EI. prediction equation consisting of age, gender and CSA for sarcopenia: logit(P) = – 7.542 + 0.125*age – 1.584*gender (man=0, woman=1) – 0.449*CSA, P = elogit(P) /1+elogit(P). ^jprediction equation consisting of BMI, FT, MT, and CSA is: logit(P) = 2.416–0.095*BMI – 0.798*FT + 0.231*MT – 0.693*CSA, P = elogit(P) /1+elogit(P).

Abbreviations: m, males; f, females; DXA, dual energy x-ray absorptiometry; BIA, bioelectrical impedance analysis; EWGSOP 2, European Working Group on Sarcopenia in Older People 2019; EWGSOP1, European Working Group on Sarcopenia in Older People 2010; AWGS2, Asian Working Group for Sarcopenia 2019; AWGS1, Asian Working Group for Sarcopenia 2014; GM, Gastrocnemius medialis; RF, Rectus femoris; RA, Rectus abdominis; BB, Biceps brachii; TA, Tibialis anterior; SOL, Soleus; MT, muscle thickness; CSA, cross-sectional area; MV, muscle volume; FT, fat thickness; EI, echo intensity; ICC, intraclass correlation coefficient; n.r., not reported.

Figure 2 Bubble chart presenting the number of validity tests performed for each muscle and muscle parameter* (n=24).

Notes: *The area of the bubble represents the number of validity tests that were performed for the type of muscle and muscle parameter, respectively. The size of the following bubble equals

n = 1 validity test.

Abbreviations: Biceps br., Biceps brachii; Gastrocn., Gastrocnemius; Rect. Abdo, Rectus abdominis; Rect. Femoris, Rectus femoris; Tib. ant., tibialis anterior; MT, Muscle thickness; CSA, cross-sectional area; MV muscle volume; EI, Echointensity, FT, Fat thickness; Model, Models entail equations (eg, MT/EI Index) that were established by the study teams to predict sarcopenia (Details in Table 2).

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