Skeletal muscle sonography: a correlative study of echogenicity and morphology
Abstract
In skeletal muscle sonography high echogenicities have proved to be of diagnostic value. The following study examines whether these echointensities are caused mainly by interstitial fat or fibrosis. Consequently, the echogenicities of 86 muscles, their diameters, and the thickness of subcutaneous fat layers superficial to these muscles were measured and compared for content of fat and connective tissue, which were assessed by morphometry and biochemical testing in the corresponding muscle biopsy samples. The results indicate that fat replacement constitutes the main cause of increased muscle echogenicity, whereas intramuscular fibrosis did not significantly affect the muscles' echogenicity.
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Degree of echogenicity differs based on bioenergetics of muscle and its location.
“The degree of echogenicity also appears to differ based on the bioenergetics of the muscle and its location (Reimers et al., 1993).”
From Myosteatosis in the Context of Skeletal Muscle Function Deficit: An Interdisciplinary Workshop at the National Institute on Aging (2020) · cites this paper as Reimers et al., 1993
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Skeletal Muscle Ultrasound: Correlation Between Fibrous Tissue and Echo Intensity
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“Until now, only two studies have examined the correlation between muscle biopsy findings and muscle echo intensity (Reimers et al. 1993a, 1993b).”
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“…quality can also be evaluated using the non-invasive, easily accessible, and safe method of ultrasound imaging, whereby an enhanced echo intensity (EI) represents changes caused by increased intramuscular fibrous and adipose tissue (Heckmatt et al. 1982; Pillen et al. 2009; Reimers et al. 1993).”
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“An increase in echogenicity as seen in this study results in themuscle appearingwhiter or brighter (hyperechoic) [31,32].”
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“…been proposed as an alternative imaging modality for the use of sarcopenia screening and staging due to its portability, relatively low cost, and potential ability to provide proxy estimates of muscle tissue composition (Reimers et al., 1993; Sipilä and Suominen, 1993; Harris-Love et al., 2014).”
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Atrophy and Fatty Infiltration of the Supraspinatus Muscle: Sonography Versus MRI
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“Fatty Infiltration On sonography, fat replacement of skeletal muscles is generally hyperechoic and is the main cause of hyperechogenicity of skeletal muscle [27].”
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“, the mean gray value of the muscle), and this can be used to delineate normal from diseased muscle.(2,6,16,19) Echo intensity can be evaluated visually, but assessment using this approach is rather subjective and depends on the experience of the observer.”
BackgroundSkeletal Muscle Wasting and Function Impairment in Intensive Care Patients With Severe COVID-19
de Andrade, M. C., de Salles, I. C. D., de Brito, C. M. M., Pastore, L., Righetti, R. F., & Yamaguti, W. P. (2021) · Frontiers in Physiology · doi:10.3389/fphys.2021.640973 · Cited by 120 · see citing works
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“In essence, the whiter the image the higher the proportion of slow-twitch muscle fibre and intra-muscular adipose tissue; high ultrasound echogenicity values have been correlated with lower muscle quality and grip strength (21, 22, 37).”
MUSCULOSKELETAL SONOGRAPHY AND MR IMAGING
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InfluentialQuantitative Muscle Ultrasonography in Amyotrophic Lateral Sclerosis
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“Muscle quality can be estimated from echo intensity (EI) using ultrasound imaging; enhanced EI is associated with increasing intramuscular adipose and fibrous tissue (Heckmatt et al. 1982; Pillen et al. 2009; Reimers et al. 1993).”
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Indications for neuromuscular ultrasound: Expert opinion and review of the literature
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“Measures of muscle echogenicity have been shown to be significantly associated intramuscular adipose tissue, rather than fibrotic tissue, based on the biochemical analysis of biopsied tissue samples from 82 people with muscle pathology (Reimers et al., 1993).”
Exercise induced changes in echo intensity within the muscle: a brief review
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“In addition, females displayed greater mEI for the VL, likely indicating greater amounts of noncontractile tissue (ie intramuscular fat).(18,36) Despite similar activity levels, males displayed greater contractile tissue (larger mCSA, lower mEI), which might help explain the greater age‐related decline in muscle thick…”
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“Through gray-scale histogram analysis, ultrasound has been used for years to help identify tissue pathologies typical in children affected by Duchenne muscular dystrophy(103,117) and other various inflammatory myopathies.(119,120) Recent evidence also suggests ultrasound may be a particularly attractive technology to…”
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“It has been recently demonstrated that muscle echo intensity (EI) on ultrasound imaging, which is utilized as an objective assessment of muscle quality represents the amount of intramuscular non-contractile tissue (Pillen et al., 2009; Reimers et al., 1993).”
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“15 Our findings align with these previous reports.”
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“(18) who reported increased muscle echogenicity was due to increases in intramuscular fat.”
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“Fatty replacement was found to correlate better with increased muscle echogenicity than fibrosis [26].”
BackgroundStock, M. S., Whitson, M., Burton, A. M., Dawson, N. T., Sobolewski, E. J., & Thompson, B. J. (2018) · Ultrasound in Medicine & Biology · doi:10.1016/j.ultrasmedbio.2018.04.009 · Cited by 56 · see citing works
Rahmani, N., Bandpei, M. A. M., Vameghi, R., Salavati, M., & Abdollahi, I. (2015) · Ultrasound in Medicine & Biology · doi:10.1016/j.ultrasmedbio.2015.04.027 · Cited by 54 · see citing works
Outcome assessment in the adult and juvenile idiopathic inflammatory myopathies
Rider, L. G. (2002) · Rheumatic Disease Clinics of North America · doi:10.1016/s0889-857x(02)00027-3 · Cited by 54 · see citing works
“In patients with PM or DM, increased echo-intensity of muscles is observed due to inflammation or fatty replacement, and muscle atrophy is also present in chronic disease [140–142].”
BackgroundMüller, J. N., Lanferdini, F. J., Karam, J. Y. P., & Fontana, H. D. B. (2020) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2020-0413 · Cited by 53 · see citing works
Harris‐Love, M. O., Avila, N. A., Adams, B., Zhou, J., Seamon, B. A., Ismail, C., Zaidi, S. H. E., Kassner, C. A., Liu, F., & Blackman, M. R. (2018) · Journal of Clinical Medicine · doi:10.3390/jcm7100340 · Cited by 53 · see citing works
“However, findings utilizing biopsied muscle tissue reveal that echogenicity has a significant positive association with the proportion of intramuscular fat in a sample of people with neuromuscular disease [16].”
BackgroundQualitative and quantitative muscle ultrasound changes in patients with COVID-19–related ARDS
Umbrello, M., Guglielmetti, L., Formenti, P., Antonucci, E., Cereghini, S., Filardo, C., Montanari, G., & Muttini, S. (2021) · Nutrition · doi:10.1016/j.nut.2021.111449 · Cited by 52 · see citing works
“In both cases, the change increments in muscle echo density are presumed to be the consequence of either inflammation or infection, or edema due to fluid shifts in the context of volume resuscitation with a positive fluid balance [54].”
Quantitative muscle ultrasonography in the follow‐up of juvenile dermatomyositis
Habers, G. E. A., van Brussel, M., Bhansing, K. J., Hoppenreijs, E., Janssen, A. J. W. M., van Royen‐Kerkhof, A., & Pillen, S. (2014) · Muscle & Nerve · doi:10.1002/mus.24564 · Cited by 51 · see citing works
Verdebout, C. M., Botteron, S., & Kiliaridis, S. (2007) · European Journal of Orthodontics · doi:10.1093/ejo/cjm045 · Cited by 51 · see citing works
“This is due to muscle cell replacement with fat and connective tissue ( Heckmatt et al. , 1982; Reimers et al. , 1993 ), and explains the classical observations of increased lingual volume.”
Backgroundvan den Engel-Hoek, L., Lagarde, M., & van Alfen, N. (2016) · Clinical Anatomy · doi:10.1002/ca.22818 · Cited by 49 · see citing works
“For these reasons, several groups have worked on developing QMUS analysis techniques (Heckmatt et al., 1989; Reimers et al., 1993; Pillen, 2009).”
BackgroundYoshiko, A., Kaji, T., Sugiyama, H., Koike, T., Oshida, Y., & Akima, H. (2017) · Experimental Gerontology · doi:10.1016/j.exger.2017.08.036 · Cited by 49 · see citing works
“Furthermore, histochemical analysis has shown that muscle EI is associated with steatosis, not fibrosis (Reimers et al., 1993).”
Quantitative muscle ultrasound and muscle force in healthy children: A 4‐year follow‐up study
Jacobs, J., Jansen, M., Janssen, H., Raijmann, W., van Alfen, N., & Pillen, S. (2012) · Muscle & Nerve · doi:10.1002/mus.23690 · Cited by 48 · see citing works
Obst, S. J., Boyd, R. N., Read, F., & Barber, L. A. (2017) · Ultrasound in Medicine & Biology · doi:10.1016/j.ultrasmedbio.2017.08.929 · Cited by 48 · see citing works
López, P., Pinto, M. D., & Pinto, R. S. (2018) · Ultrasound in Medicine & Biology · doi:10.1016/j.ultrasmedbio.2018.10.010 · Cited by 48 · see citing works
Yoshiko, A., Ogawa, M., Shimizu, K., Radaelli, R., Neske, R., Maeda, H., Maeda, K., Teodoro, J. L., Tanaka, N., Pinto, R. S., et al. (2021) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2021.104463 · Cited by 45 · see citing works
Muscle imaging in myositis: MRI, US, and PET
Albayda, J., Demonceau, G., & Carlier, P. G. (2022) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2022.101765 · Cited by 45 · see citing works
Ultrasonography as a Diagnostic Aid in Bovine Musculoskeletal Disorders
Kofler, J. (2009) · Veterinary Clinics of North America Food Animal Practice · doi:10.1016/j.cvfa.2009.07.011 · Cited by 44 · see citing works
Pillen, S. (2010) · European Journal of Translational Myology · doi:10.4081/ejtm.2010.1812 · Cited by 44 · see citing works
Wearing, J., Stokes, M. J., & de Bruin, E. D. (2019) · PLoS ONE · doi:10.1371/journal.pone.0223016 · Cited by 44 · see citing works
“High muscle echo intensity is associated with low tissue density in CT scans [38] and high adipose tissue content in muscle biopsies [39].”
BackgroundRespiratory and peripheral muscular ultrasound characteristics in ICU COVID 19 ARDS patients
Formenti, P., Umbrello, M., Castagna, V., Cenci, S., Bichi, F., Pozzi, T., Bonifazi, M., Coppola, S., & Chiumello, D. (2021) · Journal of Critical Care · doi:10.1016/j.jcrc.2021.09.007 · Cited by 44 · see citing works
“In fact, leanmuscle tissue has a low echogenicity, whereas intramuscular fat and connective tissue are characterized by a high echogenicity [9].”
BackgroundResultTrip, J., Pillen, S., Faber, C. G., van Engelen, B. G. M., Zwarts, M. J., & Drost, G. (2009) · Neuromuscular Disorders · doi:10.1016/j.nmd.2009.06.369 · Cited by 44 · see citing works
“Fibrosis and fatty infiltration as for example detected in abundance in muscular dystrophies are thought to account for the increased echo signal detected by muscle ultrasound [12,14,17,18].”
Yoshiko, A., Kaji, T., Sugiyama, H., Koike, T., Oshida, Y., & Akima, H. (2018) · European Journal of Applied Physiology · doi:10.1007/s00421-018-3870-7 · Cited by 43 · see citing works
Fukumoto, Y., Yamada, Y., Ikezoe, T., Watanabe, Y., Taniguchi, M., Sawano, S., Minami, S., Asai, T., Kimura, M., & Ichihashi, N. (2018) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00317.2018 · Cited by 42 · see citing works
Quantitative ultrasonography in focal neuropathies as compared to clinical and EMG findings
Bargfrede, M., Schwennicke, A., Tumani, H., & Reimers, C. D. (1999) · European Journal of Ultrasound · doi:10.1016/s0929-8266(99)00040-3 · Cited by 42 · see citing works
Nodera, H., Takamatsu, N., Matsui, N., Mori, A., Terasawa, Y., Shimatani, Y., Osaki, Y., Maruyama, K., Izumi, Y., & Kaji, R. (2015) · European Journal of Neurology · doi:10.1111/ene.12899 · Cited by 40 · see citing works
“Sonography has been reported to be correlated with clinical severity in diseases including spinal muscular atrophy, juvenile dermatomyositis, and muscular dystrophy, and to be correlated with findings of other diagnostic modalities such as MRI and muscle biopsy [11-14].”
BackgroundDiaphragm echodensity in mechanically ventilated patients: a description of technique and outcomes
Coiffard, B., Riegler, S., Sklar, M. C., Dres, M., Vorona, S., Reid, W. D., Brochard, L. J., Ferguson, N. D., & Goligher, E. C. (2021) · Critical Care · doi:10.1186/s13054-021-03494-9 · Cited by 39 · see citing works
“In neurodegenerative diseases, muscle fibrosis and dystrophy assessed by histology strongly correlated with increased echodensity [5, 26].”
BackgroundConsistency of novel ultrasound equations for estimating percent intramuscular fat
Burton, A. M., & Stock, M. S. (2018) · Clinical Physiology and Functional Imaging · doi:10.1111/cpf.12532 · Cited by 39 · see citing works
“Although work in both humans and animals suggest that echo intensity may reflect intramuscular adiposity and fibrous tissue content (Reimers et al., 1993; Pillen et al., 2009; Young et al., 2015; Ryan et al., 2016), the exact explanation for what it represents is somewhat unclear (Jenkins, 2016).”
Background
- Authors
- Reimers, K., Reimers, C. D., Wagner, S., Paetzke, I., & Pongratz, D. E.
- Affiliations
- Ludwig-Maximilians-Universität München (DE)
- Venue
- Journal of Ultrasound in Medicine
- Publisher
- Wiley
- Published
- 1993-02
- Volume
- 12
- Issue
- 2
- Pages
- 73-77
- ISSN
- 0278-4297 (ISSN-L)
- OpenAlex
- W2228483624
- Cited by
- 385
- References
- 2
- Citations by year
- 2026: 6 · 2025: 16 · 2024: 26 · 2023: 21 · 2022: 39 · 2021: 42 · 2020: 32 · 2019: 32 · 2018: 35 · 2017: 16 · 2016: 16 · 2015: 23 · 2014: 14 · 2013: 5 · 2012: 9
- FWCI
- 0.90
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Ultrasound in Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Muscle Physiology and Disorders
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Ultrasound Imaging and Elastography
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Ultrasound in Clinical Applications
- Keywords
- muscle echogenicity, intramuscular fat, muscle morphology, subcutaneous fat thickness, muscle biopsy, fat replacement, connective tissue
- MeSH terms
- Adipose Tissue, Adolescent, Adult, Aged, Biopsy, Child, Female, Humans, Male, Middle Aged, Muscles, Neuromuscular Diseases, Ultrasonography
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