Sarcopenia, More Than Just Muscle Atrophy: Imaging Methods for the Assessment of Muscle Quantity and Quality

Abstract

Background Sarcopenia, a progressive reduction of muscle mass and function, is associated with adverse outcomes in the elderly. Sarcopenia and muscle atrophy are not equal processes. Low muscle strength in association with muscle quantity/quality reduction is currently the optimal method for assessing sarcopenia. There is a practical need for indirect measurement of muscle strength using state-of-the-art imaging techniques.

Methods The following provides a narrative, broad review of all current imaging techniques for evaluating muscles and identifying sarcopenia, including DEXA, CT, MRI, and high-resolution ultrasound, their main strengths, weaknesses, and possible solutions to problems regarding each technique.

Results and Conclusion Well-recognized imaging methods for the assessment of muscle mass are explained, including evaluation with DEXA, CT, and MRI muscle quantity assessment, ultrasound evaluation of muscle thickness and CSA, and their correlations with established muscle mass calculation methods. A special focus is on imaging methods for muscle quality evaluation. Several innovative and promising techniques that are still in the research phase but show potential in the assessment of different properties of muscle quality, including MRI DIXON sequences, MRI spectroscopy, Diffusion Tensor Imaging, ultrasound echo intensity, ultrasound elastography, and speed-of-sound ultrasound imaging are briefly mentioned.

Key Points: 

• Sarcopenia definition includes low muscle strength and low muscle quantity/quality.

• DEXA is a low-radiation method for whole-body composition measurement in a single image.

• CT has established cut-off values for muscle quality/quantity evaluation and sarcopenia diagnosis.

• MRI is the most sophisticated muscle quality assessment method capable of evaluating myosteatosis, myofibrosis, and microstructure.

• Ultrasound can evaluate muscle quality, including tissue architecture, and elasticity with excellent spatial resolution.

Citation Format

• Vasilevska Nikodinovska V, Ivanoski S, . Sarcopenia, More Than Just Muscle Atrophy: Imaging Methods for the Assessment of Muscle Quantity and Quality. Fortschr Röntgenstr 2023; 195: 777 – 789

Zusammenfassung

Hintergrund Sarkopenie, eine fortschreitende Abnahme der Muskelmasse und -funktion, ist bei älteren Menschen mit ungünstigem Verlauf verbunden. Sarkopenie und Muskelschwund sind keine gleichwertigen Prozesse. Eine geringe Muskelkraft in Verbindung mit einer Verringerung der Muskelquantität/-qualität ist derzeit das optimale Verfahren, um die Sarkopenie zu beurteilen. Daher besteht ein praktischer Bedarf an einer indirekten Messung der Muskelkraft mit Hilfe modernster bildgebender Verfahren.

Methoden Im Folgenden wird ein umfassender Überblick gegeben über alle aktuellen bildgebenden Verfahren zur Beurteilung von Muskeln und zur Identifizierung der Sarkopenie, darunter DEXA, CT, MRT und hochauflösender Ultraschall, über ihre wichtigsten Stärken und Schwächen sowie mögliche Lösungen für die Probleme der einzelnen Techniken.

Ergebnisse und Schlussfolgerungen Anerkannte bildgebende Verfahren zur Bewertung der Muskelmasse werden erläutert, darunter die Bewertung mit DEXA, CT und MRT zur Bestimmung der Muskelmasse, der Ultraschallbewertung der Muskeldicke und der Querschnittsfläche (CSA) sowie ihrer Korrelationen mit etablierten Verfahren zur Berechnung der Muskelmasse. Ein besonderer Fokus liegt auf den bildgebenden Verfahren zur Bewertung der Muskelqualität. Mehrere innovative und vielversprechende Techniken, die sich noch in der Forschungsphase befinden, aber Potenzial für die Bewertung verschiedener Eigenschaften der Muskelqualität zeigen, wie z. B. MRT-DIXON-Sequenzen, MRT-Spektroskopie, Diffusions-Tensor-Bildgebung, Ultraschall-Echointensität, Ultraschall-Elastografie und der Speed-of-Sound Bildgebung, werden kurz erwähnt.

Kernaussagen 

• Die Definition der Sarkopenie umfasst eine geringe Muskelkraft und eine geringe Muskelquantität/-qualität.

• DEXA ist ein strahlungsarmes Verfahren zur Bestimmung der Ganzkörperzusammensetzung in einem einzigen Bild.

• Für die CT wurden Cutoff-Werte für die Bewertung der Muskelqualität/-quantität und die Diagnose der Sarkopenie festgelegt.

• Die MRT ist die fortschrittlichste Methode zur Beurteilung der Muskelqualität, mit der Myosteatose, Myofibrose und Mikrostruktur bewertet werden können.

• Ultraschall kann die Muskelqualität, einschließlich der Gewebearchitektur, und die Elastizität mit hervorragender räumlicher Auflösung beurteilen.

Key words

sarcopenia - muscle quantity and quality - DEXA - computed tomography - magnetic resonance - ultrasound

Publikationsverlauf

Eingereicht: 28. November 2022

Angenommen: 06. März 2023

Artikel online veröffentlicht:
09. Mai 2023

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