The aim of the present study was to assess the reliability of shear elastic modulus measurements performed using supersonic shear imaging (SSI) in nine resting muscles (i.e. gastrocnemius medialis, tibialis anterior, vastus lateralis, rectus femoris, triceps brachii, biceps brachii, brachioradialis, adductor pollicis obliquus and abductor digiti minimi) of different architectures and typologies. Thirty healthy subjects were randomly assigned to the intra-session reliability (n = 20), inter-day reliability (n = 21) and the inter-observer reliability (n = 16) experiments. Muscle shear elastic modulus ranged from 2.99 (gastrocnemius medialis) to 4.50 kPa (adductor digiti minimi and tibialis anterior). On the whole, very good reliability was observed, with a coefficient of variation (CV) ranging from 4.6% to 8%, except for the inter-operator reliability of adductor pollicis obliquus (CV = 11.5%). The intraclass correlation coefficients were good (0.871 ± 0.045 for the intra-session reliability, 0.815 ± 0.065 for the inter-day reliability and 0.709 ± 0.141 for the inter-observer reliability). Both the reliability and the ease of use of SSI make it a potentially interesting technique that would be of benefit to fundamental, applied and clinical research projects that need an accurate assessment of muscle mechanical properties.

This pilot study was designed to determine whether the shear elastic modulus measured using supersonic shear imaging can be used to accurately estimate muscle activity level. Using direct visual feedback of torque, six healthy subjects were asked to perform two incremental isometric elbow flexions, consisting of linear torque ramps of 30 s from 0 to 40% of maximal voluntary contraction. Both electromyographic (EMG) activity and shear elastic modulus were continuously measured in the biceps brachii during the two ramps. There was significant linear regression (P<0.001) between shear elastic modulus and EMG activity level for both ramps of all six subjects (R2=0.94+/-0.05, ranging from 0.82 to 0.98). Good repeatability was found for shear elastic modulus estimated at both 3% (trial 1: 21.7+/-6.7 kPa; trial 2: 23.2+/-7.2 kPa, intraclass correlation coefficient=0.89, standard error in measurement=2.3 kPa, coefficient of variation=12.7%) and 7% (trial 1: 42.6+/-14.1 kPa; trial 2: 44.8+/-15.8 kPa, intraclass correlation coefficient=0.94, standard error in measurement=3.7 kPa, coefficient of variation=7.1%) of maximal EMG activity. The shear elastic modulus estimated at both 3 and 7% of maximal EMG activity was not significantly different (P>0.05) between the two trials. These results confirm our hypothesis that the use of supersonic shear imaging greatly improves the correlation between muscle shear elastic modulus and EMG activity level. Due to the nonlinearity of muscle mechanical properties, the muscle elasticity should be linked to the muscle stress. Therefore, the present study represents a first step in attempting to show that supersonic shear imaging can be used to indirectly estimate muscle stress.

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Imaging plays an important role in the diagnosis and therapeutic response evaluation of muscular diseases. However, one important limitation is its incapacity to assess the in vivo biomechanical properties of the muscles. The emerging shear wave sonoelastography technique offers a quantifiable spatial representation of the viscoelastic characteristics of skeletal muscle. Elastography is a non-invasive tool used to analyze the physiologic and biomechanical properties of muscles in healthy and pathologic conditions. However, radiologists need to familiarize themselves with the muscular biomechanical concepts and technical challenges of shear wave elastography. This review introduces the basic principles of muscle shear wave elastography, analyzes the factors that can influence measurements and provides an overview of its potential clinical applications in the field of muscular diseases.

Our results show homogeneous changes in muscle shear elastic modulus within and between elbow flexors. The greater increase in shear elastic modulus observed at long muscle lengths suggests the putative involvement of both cross-bridges number and titin in the modifications of muscle shear elastic modulus after damaging exercise.