Sonoelastography to Assess Muscular Stiffness Among Older Adults and its Use for the Diagnosis of Sarcopenia: A Systematic Review

Abstract

Changes in muscle stiffness have been reported with sarcopenia. Sonoelastography is an accessible and non-radiating imaging technique allowing quantification of elastic properties of tissue. We performed a systematic review of the literature to investigate whether sonoelastography can be a reliable method to assess sarcopenia in older patients. We searched Medline, Google Scholar, Scopus, SpringerLink and Science direct from January 1, 1990 to April 1, 2020. Three independent review authors assessed trial eligibility, extracted the data, and assessed risk of bias. We intended to learn which types of elastography have been tested, if such measures are repeatable, and if they have been compared to the currently accepted diagnostic method. Ten studies met the inclusion criteria. Most followed a cross-sectional design with young and older adult subgroups. The gastrocnemius, rectus femoris, and vastus intermedius appeared most frequently. Nine of the included studies used shear wave elastography and one-strain elastography. The passive elastic constant was significantly greater in sarcopenic versus healthy subjects after passive stretching (124.98 ± 60.82 vs. 46.35 ± 15.85, P = 0.004). However, even in non-sarcopenic patients, the age of the patient was responsible for about 45.5 % of the variance in SWV. Among ten included articles, four reported higher stiffness in the muscles of older adults, two reported lower stiffness, and four found no significant difference. Due to the substantial heterogenicity of actual data, we could not make any conclusions about the potential usefulness of elastography to assess sarcopenia. Further studies are needed, including a larger sample of older patients and using a standardized and reproducible protocol.

Zusammenfassung

Bei Sarkopenie wurden Veränderungen der Muskelsteifheit berichtet. Die Sonoelastografie ist eine einfach zugängliche und strahlungsfreie Bildgebungstechnik, die die Quantifizierung der elastischen Eigenschaften des Gewebes ermöglicht. Wir führten eine systematische Überprüfung der Literatur durch, um zu untersuchen, ob die Sonoelastografie eine zuverlässige Methode zur Beurteilung der Sarkopenie bei älteren Patienten sein kann. Wir haben MEDLINE, Google Scholar, Scopus, SpringerLink und ScienceDirect vom 1. Januar 1990 bis zum 1. April 2020 durchsucht. Drei unabhängige Review-Autoren bewerteten die Eignung der Studien, extrahierten die Daten und schätzten das Bias-Risiko ein. Wir wollten herausfinden, welche elastografischen Methoden eingesetzt wurden, ob entsprechende Messungen wiederholbar sind und ob sie mit der derzeit anerkannten Diagnostik verglichen wurden. Zehn Studien erfüllten die Einschlusskriterien. Die meisten folgten einem Querschnittsdesign mit Untergruppen von jungen und älteren Erwachsenen. Am häufigsten wurden M. gastrocnemius, M. rectus femoris und M. vastus intermedius untersucht. Neun der eingeschlossenen Studien verwendeten Scherwellen-Elastografie und eine Strain-Elastografie. Die passive Elastizitätskonstante war bei sarkopenischen gegenüber gesunden Probanden nach passiver Dehnung signifikant höher (124,98 ± 60,82 vs. 46,35 ± 15,85; p = 0,004). Selbst bei nichtsarkopenischen Patienten war das Alter des Patienten für etwa 45,5 % der Varianz der SWV verantwortlich. Von den 10 eingeschlossenen Arbeiten berichteten 4 über eine höhere Steifheit in den Muskeln älterer Erwachsener, 2 über eine geringere Steifheit und 4 fanden keinen signifikanten Unterschied. Aufgrund der erheblichen Heterogenität der derzeitigen Daten konnten wir den potenziellen Nutzen der Elastografie zur Bewertung der Sarkopenie nicht abschließend beurteilen. Es sind weitere Studien erforderlich, einschließlich einer größeren Stichprobe älterer Patienten und dem Einsatz eines standardisierten und reproduzierbaren Protokolls.

Key words

older adults - sarcopenia - elastography - sonoelastography - elasticity imaging techniques

Publication History

Received: 20 July 2020

Accepted: 12 October 2020

Article published online:
13 November 2020

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