Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy; Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy.
MRC-ARUK Centre of Excellence for Musculoskeletal Ageing Research, School of Medicine, University of Nottingham, Derby, United Kingdom.
J Am Med Dir Assoc. 2017 Apr 1;18(4):290-300. doi: 10.1016/j.jamda.2016.11.013. Epub 2017 Feb 13.
A precise quantitative measurement of skeletal muscle mass is fundamental for diagnosing sarcopenia in older individuals. The current techniques of assessment, including dual-energy x-ray absorptiometry (DXA), bioimpedance analysis (BIA), and magnetic resonance imaging (MRI) are either difficult to perform in everyday clinical practice or biased by concurrent clinical confounders. B-mode muscle ultrasound can be helpful in assessing muscle mass and architecture, and thus possibly useful for diagnosing or screening sarcopenia.
A literature search of published articles on muscle ultrasound and sarcopenia in older individuals as of July 31, 2016, was made on PubMed and Scopus. Manual search and cross-referencing from reviews and original articles was also performed.
Most of the existing studies were carried out on healthy well-fit subjects, with a low prevalence of sarcopenia. The main parameters that can be assessed through muscle ultrasound are muscle thickness, cross-sectional area, echo intensity, and, for pennate muscles, fascicle length and pennation angle. In older subjects, all these parameters show some degree of alteration compared to young adults, particularly in lower limb muscles with antigravitary function, such as the quadriceps femoris and gastrocnemius medialis. Each of these parameters may be theoretically useful for detecting the loss of muscle mass and functionality in geriatric patients. They are also poorly influenced by the presence of acute and chronic diseases and fluid balance, unlike DXA and BIA, but a high degree of standardization in ultrasound protocols is necessary. Frontier applications of ultrasound in the assessment of sarcopenia may include contrast-enhanced and diaphragm ultrasound.
The current literature does not allow to make conclusive recommendations about the use of muscle ultrasound in geriatric practice. However, this technique is very promising, and further studies should validate its applications in the context of sarcopenia assessment.
精确测量骨骼肌量对于诊断老年人的肌肉减少症至关重要。目前的评估技术，包括双能 X 射线吸收法（DXA）、生物阻抗分析（BIA）和磁共振成像（MRI），要么难以在日常临床实践中进行，要么受到并发临床混杂因素的影响。B 型超声肌肉成像可有助于评估肌肉量和结构，因此可能对诊断或筛查肌肉减少症有用。
截至 2016 年 7 月 31 日，我们在 PubMed 和 Scopus 上对发表的关于肌肉超声和老年人肌肉减少症的文章进行了文献检索。还进行了综述和原始文章的手动搜索和交叉引用。
大多数现有研究都在健康、身体状况良好的受试者中进行，肌肉减少症的患病率较低。通过肌肉超声评估的主要参数是肌肉厚度、横截面积、回声强度，以及对于羽状肌，还有肌束长度和羽状角。与年轻人相比，老年人的所有这些参数都有一定程度的改变，尤其是在具有抗重力功能的下肢肌肉，如股四头肌和腓肠肌内侧。这些参数中的每一个在理论上都可能有助于检测老年患者的肌肉质量和功能丧失。与 DXA 和 BIA 不同，它们也不受急性和慢性疾病以及液体平衡的影响，但需要对超声协议进行高度标准化。超声在评估肌肉减少症方面的前沿应用可能包括对比增强和膈肌超声。
目前的文献还不能对肌肉超声在老年患者中的应用做出明确的推荐。然而，这项技术很有前途，应进一步研究验证其在肌肉减少症评估中的应用。
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