Reliability and measurement error of the proximal, medial and distal portions of the vastus lateralis muscle thickness measured with extended field of view ultrasonography

Abstract

The image obtained by static ultrasonography (US), despite being a validated measure to identify muscle thickness (MT), has a visualization capacity limited by the size of the transducer. The extended field of view (EFOV) is a more recent technique of obtaining muscle images by the US, which allows observing MT over the entire length of the muscle. The purpose of the study was to determine the reliability and the intra- and inter-rater error of the MT measurement in the proximal, medial and distal portions of the vastus lateralis using the EFOV US. Twenty-five men (age = 24 ± 4 years) paid a visit to the laboratory. Two independent US technicians identified the anatomical landmarks and collected the images using EFOV US, with a 4 cm linear transducer, 10 MHz frequency and 6 cm image depth. After all collections, a third researcher codified the images, which were sent to two independent image raters. After a week, the images were shuffled, recoded and sent back to the same evaluators. The values ​​of the typical error of the measurement, coefficient of variation and intraclass correlation coefficient intra and inter-rater ranged between 0.01 and 0.03 cm, 0.47 and 2.32%, 0.990 and 0.998, respectively, for the two evaluators. The Bland-Altman analysis indicated high agreement and homoscedastic error of all comparisons. The high reliability and low errors observed, less than the increments typically found in training studies, reveal the great potential for EFOV US to determine MT in different portions of the vastus lateralis muscle.

Validity, reliability and measurement error of quadriceps femoris muscle thickness obtained by ultrasound in healthy adults: a systematic review

“…In the first study, our group presented an intra-rater TEM of 0.07 cm for vastus lateralis MT 43 . In a recent study, intra-and inter-rater TEM decreased to 0.01 to 0.03 cm for the same variable 26 .…”

“…Twenty-five studies included in the review performed relative reliability analysis. The lowest ICC value was 0.441 22 , and the highest was 0.99, observed in 9 studies 23,26,28,29,31,34,37,41,42 . The low reliability found in the study by Barotsis et al 22 may have occurred because the MT measurement was performed four times during 24 hours to observe the measurement's reproducibility throughout the day.…”

“…The studies included in the systematic review showed that US is valid and reliable for measuring quadriceps femoris MT in healthy adults and having a low absolute and relative measurement error, both intra-and inter-raters. However, for the measurement to be reproducible, the raters must pay attention to the description of the method they will use, including the definition of the measurement location 8 , anatomical landmarks 26 , stability of the subject 35 , positioning of the transducer 34 , and experience in image analysis 28 .…”

“…Of the 26 studies included, 4 were validity studies [18][19][20][21] , and 4 were reliability only [22][23][24][25] . Eighteen were of reliability and measurement error [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] . Four hundred ninety subjects were included, from which 311 men, 164 women, and 15 were not identified.…”

“…The risk of bias analysis performed using the COSMIN tool showed that four studies were classified as "very good" in the seven criteria 20,21,26,39 and two with at least one "inadequate" criterion 22,27 . Table 2 presents the classification of studies for each of the seven criteria.…”