Department of Kinesiology, University of Waterloo, Waterloo, Canada.
School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada.
J Cachexia Sarcopenia Muscle. 2017 Oct;8(5):713-726. doi: 10.1002/jcsm.12213. Epub 2017 Jul 19.
Ultrasound is a non-invasive and readily available tool that can be prospectively applied at the bedside to assess muscle mass in clinical settings. The four-site protocol, which images two anatomical sites on each quadriceps, may be a viable bedside method, but its ability to predict musculature has not been compared against whole-body reference methods. Our primary objectives were to (i) compare the four-site protocol's ability to predict appendicular lean tissue mass from dual-energy X-ray absorptiometry; (ii) optimize the predictability of the four-site protocol with additional anatomical muscle thicknesses and easily obtained covariates; and (iii) assess the ability of the optimized protocol to identify individuals with low lean tissue mass.
This observational cross-sectional study recruited 96 university and community dwelling adults. Participants underwent ultrasound scans for assessment of muscle thickness and whole-body dual-energy X-ray absorptiometry scans for assessment of appendicular lean tissue. Ultrasound protocols included (i) the nine-site protocol, which images nine anterior and posterior muscle groups in supine and prone positions, and (ii) the four-site protocol, which images two anterior sites on each quadriceps muscle group in a supine position.
The four-site protocol was strongly associated (R = 0.72) with appendicular lean tissue mass, but Bland-Altman analysis displayed wide limits of agreement (-5.67, 5.67 kg). Incorporating the anterior upper arm muscle thickness, and covariates age and sex, alongside the four-site protocol, improved the association (R = 0.91) with appendicular lean tissue and displayed narrower limits of agreement (-3.18, 3.18 kg). The optimized protocol demonstrated a strong ability to identify low lean tissue mass (area under the curve = 0.89).
The four-site protocol can be improved with the addition of the anterior upper arm muscle thickness, sex, and age when predicting appendicular lean tissue mass. This optimized protocol can accurately identify low lean tissue mass, while still being easily applied at the bedside.
超声是一种非侵入性且易于获得的工具，可以在临床环境中前瞻性地应用于床边，以评估肌肉质量。四部位方案（在每个股四头肌上成像两个解剖部位）可能是一种可行的床边方法，但它预测肌肉量的能力尚未与全身参考方法进行比较。我们的主要目标是：（i）比较四部位方案通过双能 X 射线吸收法预测四肢瘦组织量的能力；（ii）通过额外的解剖肌肉厚度和容易获得的协变量来优化四部位方案的可预测性；（iii）评估优化方案识别低瘦组织量个体的能力。
本观察性横断面研究招募了 96 名大学和社区居民成年人。参与者接受超声扫描以评估肌肉厚度，并进行全身双能 X 射线吸收扫描以评估四肢瘦组织。超声方案包括（i）九部位方案，在仰卧和俯卧位成像九个前侧和后侧肌肉群，以及（ii）四部位方案，在仰卧位成像每个股四头肌群的两个前侧部位。
四部位方案与四肢瘦组织量密切相关（R=0.72），但 Bland-Altman 分析显示出广泛的一致性区间（-5.67，5.67 kg）。在四部位方案中加入前上臂肌肉厚度以及协变量年龄和性别，可以提高与四肢瘦组织量的相关性（R=0.91），并显示出更窄的一致性区间（-3.18，3.18 kg）。优化方案在识别低瘦组织量方面具有很强的能力（曲线下面积=0.89）。
在预测四肢瘦组织量时，四部位方案可以通过增加前上臂肌肉厚度、性别和年龄来得到改善。这种优化方案可以准确识别低瘦组织量，同时仍然易于在床边应用。
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