Ultrasound of Muscle

doi:10.1067/j.cpradiol.2007.08.006

Current Problems in Diagnostic Radiology

Volume 37, Issue 5, September–October 2008, Pages 219-230

https://doi.org/10.1067/j.cpradiol.2007.08.006 Get rights and content

This pictorial review illustrates the ultrasound appearances of pathological conditions affecting muscle with particular emphasis on extended field-of-view imaging.

Section snippets

Normal Ultrasound Anatomy

Advances in technology in recent years have improved the image quality and presentation. Linear-array transducers with frequencies between 7 and 17.5 MHz are ideally used for imaging muscle, depending on the muscle and the depth of the overlying tissue. For nonsuperficial muscles, curved-array probes may be required, particularly in patients of large build. Extended field-of-view (EFOV) images allow coverage of areas up to 60 cm long,1, 2 enabling more precise measurements while also providing

Muscle Trauma

Ultrasound is an excellent modality for detecting and evaluating muscle injury. Muscle injuries may be direct (eg, muscle contusion) or indirect (eg, muscle strain or tear).

Rhabdomyolysis

Rhabdomyolysis, or muscle necrosis, is a rare consequence of trauma that leads to systemic release of injured cellular contents of affected muscles. The condition may occur as a result of prolonged pressure in an unconscious patient or be a consequence of burns, infection, or crush injury. In the acute phase, ultrasound may demonstrate muscle edema with patchy areas of heterogeneous altered echogenicity with loss of the normal architecture.5, 16 There is usually associated muscle swelling and

Intramuscular Soft-Tissue Masses

Ultrasound is often the first investigation in a patient with a suspected soft-tissue lump. It is a quick and reliable means of differentiating solid from cystic masses and can also determine the site, size, shape, and anatomical relations of a mass. Certain lesions such as lipomas, hemangiomas, and neuromas can have characteristic features that may allow a definitive diagnosis without the need for biopsy.

Muscle Inflammation

Myositis can be the result of a variety of disease processes including autoimmune disease, infection, and trauma. The normal muscle architecture is disrupted with edema, swelling, and increased blood flow on Doppler imaging. The ultrasound appearances, however, are usually nonspecific and close clinical correlation is essential. Ultimately, biopsy may be required for diagnosis.

References (36)

T.J. Noonan et al.
Injuries at the myotendinous junction
Clin Sports Med
(1992)
R.J. Schroeder et al.
Vascularization of reactively enlarged lymph nodes analyzed by color duplex sonography
J Oral Maxillofac Surg
(1999)
J. Teh
Applications of Doppler imaging in the musculoskeletal system
Curr Probl Diagn Radiol
(2006)
A.T. Ahuja et al.
Accuracy of high-resolution sonography compared with magnetic resonance imaging in the diagnosis of head and neck venous vascular malformations
Clin Radiol
(2003)
C.L. Chau et al.
Musculoskeletal infections: Ultrasound appearances
Clin Radiol
(2005)
C.D. Reimers et al.
Muscular ultrasound in idiopathic inflammatory myopathies of adults
J Neurol Sci
(1993)
S.E. Campbell et al.
Ultrasound of muscle abnormalities
Ultrasound Q
(2005)
S. Ostlere
Ultrasound of soft-tissue masses
P. Peetrons
Ultrasound of muscles
Eur Radiol
(2002)
B.D. Fornage et al.
Ultrasonography in the evaluation of muscular trauma
J Ultrasound Med
(1983)

B.D. Fornage

The case for ultrasound of muscles and tendons

Semin Musculoskelet Radiol

(2000)

J.S. Newman et al.

Detection of soft-tissue hyperemia: Value of power Doppler sonography

AJR

(1994)

J. Lin et al.

An illustrated tutorial of musculoskeletal sonography: Part 4, musculoskeletal masses, sonographically guided interventions, and miscellaneous topics

AJR

(2000)

P. Aspelin et al.

Ultrasound examination of soft tissue injury of the lower limb in athletes

Am J Sports Med

(1992)

M. Torriani et al.

Musculoskeletal ultrasound: An alternative imaging modality for sports-related injuries

Top Magn Reson Imaging

(2003)

G.F. Evans et al.

Submaximal delayed-onset muscle soreness: Correlations between MR imaging findings and clinical measures

Radiology

(1998)

T.J. Noonan et al.

Muscle strain injury: Diagnosis and treatment

J Am Acad Orthop Surg

(1999)

S. Takebayashi et al.

Sonographic findings in muscle strain injury: Clinical and MR imaging correlation

J Ultrasound Med

(1995)

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Muscle thickness and echo-intensity changes of the quadriceps femoris muscle during a strength training program
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Citation Excerpt :
A healthy muscle is displayed in an US image as an hypoechoic structure with its fascicles bounded by the perimysium (hyperechoic tissue).8,11 Skeletal muscles of more active subjects show, in general, lower EI due to an increase in myocyte size relative to the volume of perimysium tissue, and higher vascularization.2,12–14 Although neural adaptations prevail during the first weeks of strength training, muscle hypertrophy starts to develop after a few weeks of training and becomes a major reason for improvements in muscle strength and performance in the long term.15
Ultrasound (US) has an important role in musculoskeletal (MSK) evaluation, allowing the study of muscle morphology and function. Muscle thickness (MT) and muscle echo-intensity (EI) are two important parameters that may quantify muscle structural adaptations to a variety of stimuli. The aim was to explore the potential of quantitative US imaging for assessing the adaptations and responses of the muscle tissue to increased contractile activity using B-mode US. This study was centred on the quadriceps femoris muscle contractile activity on MT and EI.
Twenty-eight young male adults participated in the study, divided in a control group and two training groups performing concentric or eccentric strength training, respectively. The effect of a 15-week strength program was studied on MT and EI in several regions of the heads of the quadriceps femoris using B-mode US. All images acquisitions and measurements were done by the same experience sonographer.
Strength training resulted in an increase of MT at all muscles and sites (p < 0.05), except the VM. Strength training failed in changing EI in most of the quadriceps femoris, except in the VI and some regions of the VL. No statistically significant differences were observed in our quantitative US parameters between concentric and eccentric training (p > 0.05).
These results emphasise the value of MT as a quantifiable muscle US method for evaluating muscle adaptation to exercise training. However, the inconsistency of the EI values indicates that more studies are needed to develop it as an accurate diagnostic tool.
Reproducibility of ultrasound-derived muscle thickness and echo-intensity for the entire quadriceps femoris muscle
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Citation Excerpt :
Imaging modalities are being increasingly employed to study skeletal muscles changes occurring due to disuse, ageing, training, or disease.1 Compared with magnetic resonance imaging, ultrasound is less expensive and more accessible.2 Furthermore, ultrasound equipment is portable and allows dynamic assessments to be performed in real time, which is useful in assessing physiological changes3–5 and in diagnosing muscle injury and dysfunction.6,7
Muscle thickness (MT) and muscle echo-intensity (EI) allow the study of skeletal muscle adaptive changes with ultrasound. This study investigates the intra- and inter-session reliability and agreement of MT and EI measurements for each of the four heads of the quadriceps femoris in transverse and longitudinal scans, using two sizes for the region of interest (ROI); EI measurements only.
Three B-mode images from two views were acquired from each head of quadriceps femoris from twenty participants (10 females) in two sessions, 7 days apart. EI was measured using a large and a small ROI. Reliability was examined with the mixed two-way intra-class correlation coefficient (ICC), the standard error of mean (SEM) and the smallest detectable change (SDC). Bland–Altman's plots were used to study agreement.
High to very high inter-session ICC values were found for MT for all muscle heads, particularly for measurements from transverse scans. For EI measurement, ICC values ranged from low to high, with higher ICC values seen with the largest ROI. SDC values ranged between 0.19 and 0.53 cm for MT and between 3.73 and 18.56 arbitrary units (a.u.) for two ROIs. Good agreement existed between MT measurements made in both scans. A small bias and larger 95% limits of agreement were seen for EI measurements collected with the two ROI sizes.
Ultrasound measures of MT and EI show moderate to very high reliability. The reliability and agreement of MT and EI measurements are improved in transverse scans and with larger ROIs.
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Original articleUltrasound of Muscle

Section snippets

Normal Ultrasound Anatomy

Muscle Trauma

Rhabdomyolysis

Intramuscular Soft-Tissue Masses

Muscle Inflammation

Clin Sports Med

J Oral Maxillofac Surg

Curr Probl Diagn Radiol

Clin Radiol

Clin Radiol

J Neurol Sci