Assessing Low Skeletal Mass in Patients Undergoing Hip Surgery: The Role of Sonoelastography

Abstract

Purpose: To analyze the utility of sonoelastography-a radiation-free procedure to characterize muscle properties-as an instrument to qualitatively and quantitatively assess the rectus femoris muscle. Materials and Methods: Fifty-one consecutive patients who underwent a pelvic computed tomography (CT) exam were enrolled prospectively. The final analysis was conducted using data from 39 patients after 12 were removed due to exclusion criteria (muscle strength could not be measured due to poor cognition [n=11]; too young [n=1]). The potential correlation between average Hounsfield unit (HFU) at the rectus femoris muscle (measured by CT) and muscle quality grade (determined by sonoelastography) was assessed along with a retrospective analysis of the relationship between hand grip strength, knee extensor power, history of intensive care unit stay, length of hospital day and sonoelastographic grade. Results: There was a significant correlation between sonoelastographic grade and the average HFU (P<0.001). Furthermore, hand grip strength (P<0.001) and knee extensor power (P<0.001) decreased significantly as the sonoelastographic grade increased. The likelihood of an intensive care unit stay and prevalence of low skeletal mass increased significantly with an increase in sonoelastography grade (P=0.037, P<0.001, respectively). The sensitivity, specificity, and accuracy of sonoelastographic images for predicting low skeletal mass were 77.3%, 100%, and 87.5%, respectively. Conclusion: Sonoelastography advantages, including the lack of radiation and greater accessibility, may make it a valuable alternative to qualitatively and quantitatively identify sarcopenia and low skeletal mass.

Biomarkers and Nutrients in Musculoskeletal Disorders

“…Future studies should address the role of ultrasound imaging as a promising tool for nutrient and biomarker status in musculoskeletal disorders [10]. The analysis of muscle tissue by sonoelastography may provide an alternative tool to indirectly evaluate sarcopenia and the lack of skeletal muscle mass from both qualitative and quantitative points of view, presenting a sensitivity of 77.3%, a specificity of 100% and a diagnostic accuracy of 87.5% [11]. The expression of mediators of neoangiogenesis and vascular density of the synovial characteristics in patients with rheumatoid arthritis provided a good correlation (r = 0.73) with the vascular area at histological level, linked to the cellular profile and pro-inflammatory cytokines, which provided considerable validity for using these measurements as objective assessments of synovial inflammation in clinical practice [12].…”