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.

2nd Department of Internal Medicine Iuliu Hatieganu University of Medicine and Pharmacy Cluj Napoca Romania

CEMIC Centro de Educación Médica e Investigaciones Médicas Norberto Quirno Buenos Aires Argentina

Centre for Experimental Medicine Queen's University Belfast Belfast United Kingdom

Department of Health Promotion Mother and Child Care Internal Medicine and Medical Specialties Rheumatology Section University of Palermo Palermo Italy

Department of Internal Medicine Ospedale Madonna del Soccorso San Benedetto del Tronto Marche Italy

Department of Orthopedic Surgery Osaka Metropolitan University Graduate School of Medicine Osaka Japan

Department of Paediatric and Adult Rheumatology University Hospital Motol Prague Czechia

Department of Radiology A O Ospedali Riuniti Marche Nord Pesaro Italy

Department of Radiology Ospedali Riuniti Università Politecnica delle Marche Ancona Italy

Department of Rheumatology Centro Hospitalar de Leiria Leiria Portugal

Department of Rheumatology Centro Hospitalar e Universitário de Coimbra Coimbra Portugal

Department of Rheumatology Clinical Immunology and Allergy University Hospital of Heraklion Heraklion Greece

Department of Rheumatology Colentina Clinical Hospital Bucharest Romania

Department of Rheumatology Hokkaido Medical Center for Rheumatic Diseases Sapporo Japan

Department of Rheumatology Iuliu Hatieganu University of Medicine and Pharmacy Cluj Napoca Romania

Department of Rheumatology Liverpool University Hospitals Foundation Trust Liverpool United Kingdom

Department of Rheumatology School of Health Science Faculty of Medicine University of Ioannina Ioannina Greece

Department of Rheumatology University Hospitals Dorset NHS Foundation Trust Christchurch Hospital Christchurch United Kingdom

Department of Rheumatology University of Medicine and Pharmacy of Craiova Craiova Romania

División de Reumatología Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra Mexico City Mexico

Division of Rheumatology Fundación Hospital San Pedro Pasto Colombia

Epidemiology Unit Italian Society of Rheumatology Milan Italy

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo SP Brazil

Hospital Italiano de Buenos Aires Buenos Aires Argentina

Hospital Provincial Rheumatology Rosario Argentina

Internal Medicine and Rheumatology Unit Department of Medicine Azienda Ospedaliero Universitaria di Parma Parma Italy

IPS Servicio Integral de Reumatología e Inmunología Doctor Orlando Villota Pasto Colombia

Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds Leeds United Kingdom

Local Health Unit Orosei NU Italy

Local Health Unit Samugheo OR Italy

Ottawa Hospital Research Institute University of Ottawa Ottawa ON Canada

Rheumatology Unit Department of Clinical and Molecular Sciences Carlo Urbani Hospital Polytechnic University of Marche Ancona Italy

Rheumatology Unit Department of Emergency and Organ Transplants University of Bari Bari Italy

Rheumatology Unit Instituto de Rehabilitación Psicofísica Buenos Aires Argentina

Rheumatology Unit IRCCS Policlinico S Orsola Malpighi Bologna Italy

Rheumatology Unit University Clinic AOU Cagliari Monserrato CA Italy

Rheumatology Unit Vall d'Hebron Hospital Universitari Vall d'Hebron Barcelona Hospital Campus Barcelona Spain

San Roque Hospital La Plata Argentina

Zobrazit více v PubMed

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 PubMed DOI PMC

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 PubMed DOI

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 PubMed DOI PMC

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 PubMed DOI

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 PubMed DOI PMC

An H, Tizaoui K, Terrazzino S, Cargnin S, Lee K, Nam S, et al. Sarcopenia in autoimmune and rheumatic diseases: a comprehensive review. Int J Mol Sci. (2020) 21:5678. 10.3390/ijms21165678 PubMed DOI PMC

Salaffi F, Di Matteo A, Farah S, Di Carlo M. Inflammaging and frailty in immune-mediated rheumatic diseases: how to address and score the issue. Clin Rev Allergy Immunol. (2022) 21. [Epub ahead of print]. 10.1007/s12016-022-08943-z PubMed DOI PMC

Tagliafico A, Bignotti B, Torri L, Rossi F. Sarcopenia: how to measure, when and why. Radiol Med. (2022) 127:228–37. 10.1007/s11547-022-01450-3 PubMed DOI PMC

Ticinesi A, Meschi T, Narici M, Lauretani F, Maggio M. Muscle ultrasound and sarcopenia in older individuals: a clinical perspective. J Am Med Dir Assoc. (2017) 18:290–300. 10.1016/j.jamda.2016.11.013 PubMed DOI

Salaffi F, Carotti M, Di Matteo A, Ceccarelli L, Farah S, Villota-Eraso C, et al. Ultrasound and magnetic resonance imaging as diagnostic tools for sarcopenia in immune-mediated rheumatic diseases (IMRDs). Radiol Med. (2022) 127:1277–91. 10.1007/s11547-022-01560-y PubMed DOI PMC

Reeves N, Maganaris C, Narici M. Ultrasonographic assessment of human skeletal muscle size. Eur J Appl Physiol. (2004) 91:116–8. 10.1007/s00421-003-0961-9 PubMed DOI

Thomaes T, Thomis M, Onkelinx S, Coudyzer W, Cornelissen V, Vanhees L, et al. Reliability and validity of the ultrasound technique to measure the rectus femoris muscle diameter in older CAD-patients. BMC Med Imaging. (2012) 12:7. 10.1186/1471-2342-12-7 PubMed DOI PMC

Abe T, Loenneke J, Young K, Thiebaud R, Nahar V, Hollaway K, et al. Validity of ultrasound prediction equations for total and regional muscularity in middle-aged and older men and women. Ultrasound Med Biol. (2015) 41:557–64. 10.1016/j.ultrasmedbio.2014.09.007 PubMed DOI

Martin D, Medri M, Chow R, Oxorn V, Leekam R, Agur AM, et al. Comparing human skeletal muscle architectural parameters of cadavers with in vivo ultrasonographic measurements. J Anat. (2001) 199:429–34. 10.1046/j.1469-7580.2001.19940429.x PubMed DOI PMC

Kellis E, Galanis N, Natsis K, Kapetanos G. Validity of architectural properties of the hamstring muscles: correlation of ultrasound findings with cadaveric dissection. J Biomech. (2009) 42:2549–54. 10.1016/j.jbiomech.2009.07.011 PubMed DOI

Perkisas S, Bastijns S, Baudry S, Bauer J, Beaudart C, Beckwée D, et al. Application of ultrasound for muscle assessment in sarcopenia: 2020 SARCUS update. Eur Geriatr Med. (2021) 12:45–59. 10.1007/s41999-020-00433-9 PubMed DOI

Albano D, Messina C, Vitale J, Sconfienza L. Imaging of sarcopenia: old evidence and new insights. Eur Radiol. (2020) 30:2199–208. PubMed

Chianca V, Albano D, Messina C, Gitto S, Ruffo G, Guarino S, et al. Sarcopenia: imaging assessment and clinical application. Abdom Radiol. (2021) 23:1–12. 10.1007/s00261-021-03294-3 PubMed DOI PMC

Perkisas S, Baudry S, Bauer J, Beckwée D, De Cock A, Hobbelen H, et al. Application of ultrasound for muscle assessment in sarcopenia: towards standardized measurements. Eur Geriatr Med. (2018) 9:739–57. 10.1007/s41999-018-0104-9 PubMed DOI

Albayda J, van Alfen N. Diagnostic value of muscle ultrasound for myopathies and myositis. Curr Rheumatol Rep. (2020) 22:82. 10.1007/s11926-020-00947-y PubMed DOI PMC

Giovannini S, Brau F, Forino R, Berti A, D’Ignazio F, Loreti C, et al. Sarcopenia: diagnosis and management, state of the art and contribution of ultrasound. J Clin Med. (2021) 10:5552. 10.3390/jcm10235552 PubMed DOI PMC

Yoshida T, Kumon Y, Takamatsu N, Nozaki T, Inoue M, Nodera H, et al. Ultrasound assessment of sarcopenia in patients with rheumatoid arthritis. Mod Rheumatol. (2021) 13:roab049. 10.1093/mr/roab049 PubMed DOI

Sari A, Esme M, Aycicek G, Armagan B, Kilic L, Ertenli A, et al. Evaluating skeletal muscle mass with ultrasound in patients with systemic sclerosis. Nutrition. (2021) 84:110999. 10.1016/j.nut.2020.110999 PubMed DOI

Kaya A, Kara M, Tiftik T, Tezcan M, Ozel S, Ersöz M, et al. Ultrasonographic evaluation of the muscle architecture in patients with systemic lupus erythematosus. Clin Rheumatol. (2013) 32:1155–60. PubMed

Smerilli G, Castell S, Cipolletta E, Farah S, Carotti M, Salaffi F, et al. Ultrasound measurement of muscle thickness at the proximal forearm in a rheumatologic setting. Clin Exp Rheumatol. (2020) 38:985–8. PubMed

Cruz-Jentoft AJ, Romero-Yuste S, Chamizo Carmona E, Nolla J. Sarcopenia, immune-mediated rheumatic diseases, and nutritional interventions. Aging Clin Exp Res. (2021) 33:2929–39. 10.1007/s40520-021-01800-7 PubMed DOI PMC

Di Matteo A, Smerilli G, Cipolletta E, Wakefield R, De Angelis R, Risa A, et al. Muscle involvement in systemic lupus erythematosus: multimodal ultrasound assessment and relationship with physical performance. Rheumatology. (2022) 25:keac196. 10.1093/rheumatology/keac196 PubMed DOI

Di Matteo A, Cipolletta E, Destro Castaniti G, Smerilli G, Airoldi C, Aydin S, et al. Reliability assessment of the definition of ultrasound enthesitis in SpA: results of a large, multicentre, international web-based study. Rheumatology. (2022) 16:keac162. PubMed

Smerilli G, Cipolletta E, Tanimura S, Di Battista J, Di Carlo M, Carotti M, et al. Ultrasound measurement of muscle thickness at the anterior thigh level in rheumatology setting: a reliability study. Clin Rheumatol. (2020) 40:1055–60. PubMed

Schneider C, Rasband W, Eliceiri K. NIH Image to ImageJ: 25 years of image analysis. Nat Methods. (2012) 9:671–5. 10.1038/nmeth.2089 PubMed DOI PMC

Landis J, Koch G. An application of hierarchcal k-type statistics in the assessment of majority agreement among multiple observers. Biometrics. (1977) 33:363–74. 10.2307/2529786 PubMed DOI

Heckmatt J, Leeman S, Dubowitz V. Ultrasound imaging in the diagnosis of muscle disease. J Pediatr. (1982) 101:656–60. 10.1016/S0022-3476(82)80286-2 PubMed DOI

Buckinx F, Landi F, Cesari M, Fielding R, Visser M, Engelke K, et al. Pitfalls in the measurement of muscle mass: a need for a reference standard. J Cachexia Sarcopenia Muscle. (2018) 9:269–78. 10.1002/jcsm.12268 PubMed DOI PMC

Wijntjes J, van Alfen N. Muscle ultrasound: present state and future opportunities. Muscle Nerve. (2021) 63:455–66. 10.1002/mus.27081 PubMed DOI PMC

Casey P, Alasmar M, McLaughlin J, Ang Y, McPhee J, Heire P, et al. The current use of ultrasound to measure skeletal muscle and its ability to predict clinical outcomes: a systematic review. J Cachexia Sarcopenia Muscle. (2022) 13:2298–309. 10.1002/jcsm.13041 PubMed DOI PMC

Paramalingam S, Morgan K, Becce F, Diederichsen L, Ikeda K, Mandl P, et al. Conventional ultrasound and elastography as imaging outcome tools in autoimmune myositis: a systematic review by the OMERACT ultrasound group. Semin Arthritis Rheum. (2021) 51:661–76. 10.1016/j.semarthrit.2020.11.001 PubMed DOI

Pillen S, van Alfen N. Skeletal muscle ultrasound. Neurol Res. (2011) 33:1016–24. 10.1179/1743132811Y.0000000010 PubMed DOI