Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan 17:9:1090468.
doi: 10.3389/fmed.2022.1090468. eCollection 2022.

Reliability assessment of ultrasound muscle echogenicity in patients with rheumatic diseases: Results of a multicenter international web-based study

Andrea Di Matteo  1   2 , Erica Moscioni  1 , Maria Giovanna Lommano  1 , Edoardo Cipolletta  1 , Gianluca Smerilli  1 , Sonia Farah  1 , Carla Airoldi  3 , Sibel Zehra Aydin  4 , Andrea Becciolini  5 , Karina Bonfiglioli  6 , Marina Carotti  7 , Greta Carrara  8 , Tomas Cazenave  9 , Davide Corradini  10 , Micaela Ana Cosatti  11 , Juan Josè de Agustin  12 , Giulia Maria Destro Castaniti  13 , Marco Di Carlo  1 , Eleonora Di Donato  5 , Luca Di Geso  14 , Ashley Elliott  15 , Daniela Fodor  16 , Francesca Francioso  1 , Alessandra Gabba  17   18 , Cristina Hernández-Díaz  19 , Rudolf Horvath  20 , Jana Hurnakova  20 , Diogo Jesus  21 , Josefina Marin  22 , Maria Victoria Martire  23 , Riccardo Mashadi Mirza  24 , Marco Massarotti  25 , Alice Andreea Musca  26 , Jagdish Nair  27 , Tadashi Okano  28 , Ioannis Papalopoulos  29 , Javier Rosa  22 , Marcos Rosemffet  9 , João Rovisco  30 , Davide Rozza  8 , Fausto Salaffi  1 , Crescenzio Scioscia  31 , Carlo Alberto Scirè  8 , Maria-Magdalena Tamas  32 , Shun Tanimura  33 , Lucio Ventura-Rios  19 , Catalina Villota-Eraso  34 , Orlando Villota  35 , Paraskevi V Voulgari  36 , Florentin Ananu Vreju  37 , Gentiana Vukatana  38 , Johana Zacariaz Hereter  22 , Anna Zanetti  8 , Walter Grassi  1 , Emilio Filippucci  1
Affiliations

Reliability assessment of ultrasound muscle echogenicity in patients with rheumatic diseases: Results of a multicenter international web-based study

Andrea Di Matteo et al. Front Med (Lausanne). .

Abstract

Objectives: To investigate the inter/intra-reliability of ultrasound (US) muscle echogenicity in patients with rheumatic diseases.

Methods: Forty-two rheumatologists and 2 radiologists from 13 countries were asked to assess US muscle echogenicity of quadriceps muscle in 80 static images and 20 clips from 64 patients with different rheumatic diseases and 8 healthy subjects. Two visual scales were evaluated, a visual semi-quantitative scale (0-3) and a continuous quantitative measurement ("VAS echogenicity," 0-100). The same assessment was repeated to calculate intra-observer reliability. US muscle echogenicity was also calculated by an independent research assistant using a software for the analysis of scientific images (ImageJ). Inter and intra reliabilities were assessed by means of prevalence-adjusted bias-adjusted Kappa (PABAK), intraclass correlation coefficient (ICC) and correlations through Kendall's Tau and Pearson's Rho coefficients.

Results: The semi-quantitative scale showed a moderate inter-reliability [PABAK = 0.58 (0.57-0.59)] and a substantial intra-reliability [PABAK = 0.71 (0.68-0.73)]. The lowest inter and intra-reliability results were obtained for the intermediate grades (i.e., grade 1 and 2) of the semi-quantitative scale. "VAS echogenicity" showed a high reliability both in the inter-observer [ICC = 0.80 (0.75-0.85)] and intra-observer [ICC = 0.88 (0.88-0.89)] evaluations. A substantial association was found between the participants assessment of the semi-quantitative scale and "VAS echogenicity" [ICC = 0.52 (0.50-0.54)]. The correlation between these two visual scales and ImageJ analysis was high (tau = 0.76 and rho = 0.89, respectively).

Conclusion: The results of this large, multicenter study highlighted the overall good inter and intra-reliability of the US assessment of muscle echogenicity in patients with different rheumatic diseases.

Keywords: muscle echogenicity; musculoskeletal ultrasound; reliability; rheumatic diseases; sarcopenia.

PubMed Disclaimer

Conflict of interest statement

SA received honoraria from AbbVie, Celgene, UCB, Novartis, Janssen, Pfizer, and Sanofi. AB served as a speaker for AbbVie, Amgen, Sanofi-Genzyme, and UCB, outside the submitted work. EF had received speaking fees from AbbVie, Amgen, BMS, Janssen, Lilly, Novartis, Roche, Pfizer, and UCB, outside the submitted work. WG had received speaking fees from Celltrion and Pfizer, outside the submitted work.

Figures

FIGURE 1
FIGURE 1
Visual semi-quantitative scale for the assessment of muscle echogenicity. Ultrasound (US) transverse scan images of the quadriceps muscle obtained at the midpoint between the anterior superior iliac spine and the upper pole of the patella. Grade 0 = normal (i.e., normal hypoechoic muscle); Grade 1 = mild (homogeneously distributed overall increase of the echogenicity involving ≤ one-third of the entire muscle tissue); Grade 2 = moderate (homogeneously distributed overall increase of the echogenicity involving > one-third but ≤ two-thirds of the entire muscle tissue); Grade 3 = severe (homogeneously distributed overall increase of the echogenicity involving > two-thirds of the entire muscle tissue). f, femur; rf, rectus femoris muscle; vi, vastus intermedius muscle.
FIGURE 2
FIGURE 2
Boxplot of the joint semi-quantitative and quantitative (VAS echogenicity) ultrasound (US) scales distribution for muscle echogenicity. Box and whiskers plots showing the relationship between the semi-quantitative and the quantitative scores for muscle echogenicity. The upper and lower boundaries of the box represent the third and the first quartiles, respectively. The solid line in the box represents the median. Whiskers represent the maximum and the minimum values.
FIGURE 3
FIGURE 3
ImageJ analysis in patients with different grades of muscle echogenicity. Higher grades of the visual semi-quantitative scale for muscle echogenicity correspond to higher mean pixel analysis with ImageJ. During image analysis with ImageJ, particular attention was paid to include in the region of interest (ROI) only muscle tissues (i.e., without the surrounding fascia or cortical bone), which is the area included within the small squares and lines.
See this image and copyright information in PMC

References

    1. Cruz-Jentoft A, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Writing group for the European working group on sarcopenia in older people 2 (EWGSOP2), and the extended group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. (2019) 48:16–31. 10.1093/ageing/afy169 - DOI - PMC - PubMed
    1. Chen L, Woo J, Assantachai P, Auyeung T, Chou M, Iijima K, et al. Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc. (2020) 21:300–7.e2. 10.1016/j.jamda.2019.12.012 - DOI - PubMed
    1. Cesari M, Landi F, Vellas B, Bernabei R, Marzetti E. Sarcopenia and physical frailty: two sides of the same coin. Front Aging Neurosci. (2014) 6:192. 10.3389/fnagi.2014.00192 - DOI - PMC - PubMed
    1. Shin A, Choi S, Han M, Ha Y, Lee Y, Lee E, et al. Association between sarcopenia defined as low lean mass by dual-energy X-ray absorptiometry and comorbidities of rheumatoid arthritis: results of a nationwide cross-sectional health examination. Semin Arthritis Rheum. (2022) 57:152090. 10.1016/j.semarthrit.2022.152090 - DOI - PubMed
    1. Therakomen V, Petchlorlian A, Lakananurak N. Prevalence and risk factors of primary sarcopenia in community-dwelling outpatient elderly: a cross-sectional study. Sci Rep. (2020) 10:19551. 10.1038/s41598-020-75250-y - DOI - PMC - PubMed