Cited by 385Muscle Physiology and DisordersUltrasound Imaging and ElastographyUltrasound in Clinical Applications

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Skeletal muscle sonography: a correlative study of echogenicity and morphology

Reimers, K, Reimers, C D, Wagner, S, Paetzke, I, Pongratz, D E·1993·Journal of Ultrasound in Medicine

DOI 10.7863/jum.1993.12.2.73

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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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Diagnostic ultrasound: its use in the evaluation of muscle.
Hicks, J., Shawker, T. H., Jones, B. L., Linzer, M., & Gerber, L. H. (1984) · PubMed · Cited by 26
[Ultrasound imaging of the muscle in muscular dystrophy].
Nishimura, M., Nishimura, S., & YAMADA, S. (1989) · PubMed · Cited by 8

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Muscle echogenicity ratio can indicate severity of carpal tunnel syndrome
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“Further, MQ EI has been shown to be sensitive to intramuscular ﬁbrous tissue [14] and fat content [15], intramuscular glycogen content, and tissue hydration status [16–18].”
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Schwarz, T., Połtowicz, K., Nowak, J., Murawski, M., Małopolska, M. M., Andres, K., Wojtysiak, D., Jamieson, M., & Bartlewski, P. M. (2019) · Animals · doi:10.3390/ani9060306 · Cited by 10
“[20] reported greater echogenicity in the transverse compared with longitudinal scans of various skeletal muscles in humans.”
Background
Usefulness of a Qualitative Ultrasound Evaluation of the Gastrocnemius–Soleus Complex with the Heckmatt Scale for Clinical Practice in Cerebral Palsy
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Histopathological Basis of Muscle Imaging
Reimers, C. D., Fischer, P., & Pongratz, D. E. (1996) · Springer eBooks · doi:10.1007/978-1-4612-2314-6_12 · Cited by 10
Assessment of the upper limb muscles in patients with Fukuyama muscular dystrophy: Noninvasive assessment using visual ultrasound muscle analysis and shear wave elastography
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“In fact, an increase in muscle ultrasound intensity is associated with muscle fat replacement [32].”
Background
Effect of subcutaneous adipose tissue and muscle thicknesses on rectus femoris and vastus intermedius ultrasound echo intensities: a cadaver study
Akima, H., Yamamori, K., Taniguchi, K., Fujimiya, M., Katayose, M., Yoshiko, A., & Tanaka, N. (2022) · Journal of Ultrasound · doi:10.1007/s40477-022-00696-x · Cited by 9
Establishment and Validation of a Predictive Model for Sarcopenia Based on 2-D Ultrasound and Shear Wave Elastography in the Medial Gastrocnemius Muscle
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A Novel Exercise to Improve Suprahyoid Muscle Area and Intensity as Evaluated by Ultrasonography
Ogawa, N., Ohno, T., Kunieda, K., Watanabe, M., & Fujishima, I. (2024) · Dysphagia · doi:10.1007/s00455-024-10667-5 · Cited by 9
“Ultrasonography can also evaluate the quality of muscles indicated by intensity [33] because non-contractile tissues, such as fat tissues, show high intensity indicated as brightness in ultrasound images [34].”
Echogenicity Is Related to Skeletal Muscle Strength in Patients With Acute Respiratory Failure
Berry, M. J., Files, D. C., Campos, C. L., Bakhru, R. N., Skaggs, B. M., & Morris, P. E. (2019) · Journal of Cardiopulmonary Rehabilitation and Prevention · doi:10.1097/hcr.0000000000000403 · Cited by 9
Electromyographic amplitude versus torque relationships are different in young versus postmenopausal females and are related to muscle mass after controlling for bodyweight.
Banks, N. F., Rogers, E. M., & Jenkins, N. (2020) · European Journal of Applied Physiology · doi:10.1007/s00421-020-04532-0 · Cited by 4
Moving forward with the echo intensity mean analysis: Exploring echo intensity bands in different age groups
Pinto, R. S., & Pinto, M. D. (2020) · Experimental Gerontology · doi:10.1016/j.exger.2020.111179 · Cited by 9
Ultrasound Assessment of Changes in Muscle Architecture of the Brachialis Muscle After Stroke—A Prospective Study
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The sonographic quantitative assessment of the deltoid muscle to detect type 2 diabetes mellitus: a potential noninvasive and sensitive screening method?
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“However, studies performed on patients with neuromuscular diseases, including muscular dystrophies, have shown that muscle echogenicity on US can actually decrease with excessive adipose muscle infiltration, likely secondary to decreased acoustic impedance [51, 52], which would actually decrease the muscle/bone ratio.”
Background
A Bibliometric Analysis of Citation Classics in the Journal of Ultrasound in Medicine
Balica, A. C., Kohut, A. Y., Tsai, T., Groszmann, Y. S., & Brandt, J. S. (2020) · Journal of Ultrasound in Medicine · doi:10.1002/jum.15220 · Cited by 9
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Bartley, J. M., & Studenski, S. A. (2017) · Journal of the American Geriatrics Society · doi:10.1111/jgs.15075 · Cited by 9
Techniques for in vivo assessment of myopathies in broiler chicken breasts using a biopsy as a support tool
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“These results corroborate the research of Reimers et al. (1993) and Pillen et al. (2009); the authors reported greater intensities of echogenicity according to increases in fibrosis and infiltration by adipose tissue.”
BackgroundResult
Relationship Between Muscle Quality or Stiffness Measured by Ultrasonography and Range of Motion in Hospitalized Older Adults
Nakagawa, K., Kataoka, H., Murata, C., Goto, K., Yamashita, J., Honda, Y., Sakamoto, J., Origuchi, T., & Okita, M. (2022) · Ultrasound in Medicine & Biology · doi:10.1016/j.ultrasmedbio.2022.05.016 · Cited by 8
Ultrasonography Assessment Based on Muscle Thickness and Echo Intensity in Post-Polio Patients
Angulo, Á. M., Salazar-Agulló, J. A., Roldán‐Jiménez, C., Trinidad‐Fernández, M., & Cuesta‐Vargas, A. (2022) · Diagnostics · doi:10.3390/diagnostics12112743 · Cited by 8
The Muscle Thickness Assessment Using Ultrasonography is a Useful Alternative to Skeletal Muscle Mass by Bioelectrical Impedance Analysis
Isaka, M., Sugimoto, K., Akasaka, H., Yasunobe, Y., Takahashi, T., Keyu, X., Onishi, Y., Yoshida, S., Minami, T., Yamamoto, K. I., et al. (2022) · Clinical Interventions in Aging · doi:10.2147/cia.s385469 · Cited by 12
“The higher numerical value of EI reflects more fat and fibrous tissue in the body.(29,30) The majority of reports on muscle US have used the quadriceps femoris muscle (QFM) for measurement purposes, but when performing QFM US in practice, it is necessary to expose and image the part above the knee, which makes it diff…”
Background
Validity and reliability of visual assessment of orofacial muscle ultrasound images using a modified Heckmatt scale
Lagarde, M., van den Engel-Hoek, L., Geurts, A. C. H., & van Alfen, N. (2023) · Muscle & Nerve · doi:10.1002/mus.27854 · Cited by 8
Point-of-care ultrasound use in COVID-19: a narrative review
Chua, M. T., Boon, Y., Yeoh, C. K., Li, Z., Goh, C. J. M., & Kuan, W. S. (2023) · Annals of Translational Medicine · doi:10.21037/atm-23-1403 · Cited by 8
“Echogenicity of other important respiratory muscles can be assessed by POCUS—low echogenicity is characterised by lean muscle tissue, whereas fat and connective tissue within the muscles constitute high echogenicity (140).”
Hyperechoic and Low Morphological Changes in the Prefemoral Fat Pad in Individuals with Knee Osteoarthritis Based on Ultrasonographic Findings
Shibata, K., Wakasa, M., Saito, A., Kimoto, M., Takahashi, Y., Sato, H., Kamada, T., Shinde, T., Takahashi, H., Kimura, Y., et al. (2021) · Journal of Medical Ultrasound · doi:10.4103/jmu.jmu_85_20 · Cited by 8
“The EI has been reported to be able to evaluate changes in intramuscular adipose tissue and muscle fibers, particularly those of the skeletal muscle.[12-14] Thus, changes in the EI have been recently evaluated.”
Background
Evaluation of rehabilitation exercise effects by using gradation-based skeletal muscle echo intensity in older individuals: a one-group before-and-after trial study
Yoshiko, A., Kaji, T., Kozuka, T., Sawazaki, T., & Akima, H. (2021) · BMC Geriatrics · doi:10.1186/s12877-021-02423-3 · Cited by 8
Association of mobility capacity with the masses and amounts of intramuscular non-contractile tissue of the trunk and lower extremity muscles in community-dwelling older adults
Masaki, M., Minakawa, K., Takeuchi, M., Kasahara, M., Inagaki, Y., Ogawa, Y., Sato, Y., Yokota, M., Maruyama, S., Usuki, R., et al. (2021) · Human Movement Science · doi:10.1016/j.humov.2021.102887 · Cited by 8
Muscular Echo-Intensity of the Quadriceps by Ultrasound Is More Related to Improvement of Gait Independence than Muscle Thickness in Older Inpatients
Akazawa, N., Kishi, M., Hino, T., Tsuji, R., Tamura, K., Hioka, A., & Moriyama, H. (2023) · The journal of nutrition health & aging · doi:10.1007/s12603-023-1880-6 · Cited by 8
“Considering that muscular echo-intensity by ultrasound mainly reflects intramuscular adipose tissue (4-6, 32), muscle composition changes of the quadriceps based on an improvement in gait independence in older inpatients may be more shown in intramuscular adipose tissue of the quadriceps than muscle mass.”
Background
Skeletal Muscle Compliance and Echogenicity in Resistance-Trained and Nontrained Women
Mongold, S. J., Ricci, A. W., Hahn, M. E., & Callahan, D. M. (2023) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000004669 · Cited by 7
“Recent studies have commonly cited an older, yet robust correlative study, relating muscle biopsy with US findings (35,39).”
Background
High-Frequency Ultrasound to Grade Disease Progression in Murine Models of Duchenne Muscular Dystrophy
Ahmad, N., Bygrave, M., Chhem, R. K., Hoffman, L., Welch, I. D., Grange, R. W., Fenster, A., Hill, D., & Lee, T. (2009) · Journal of Ultrasound in Medicine · doi:10.7863/jum.2009.28.6.707 · Cited by 8
Development and Testing of Biomarkers in Spinal Muscular Atrophy
Arnold, W. D., Simard, L. R., Rutkove, S. B., & Kolb, S. J. (2016) · Elsevier eBooks · doi:10.1016/b978-0-12-803685-3.00024-0 · Cited by 8
Efficacy of Quantitative Muscle Ultrasound Using Texture-Feature Parametric Imaging in Detecting Pompe Disease in Children
Chiou, H., Yeh, C., Hwang, H.-E., & Liao, Y. (2019) · Entropy · doi:10.3390/e21070714 · Cited by 8
“In contrast, muscles subjected to fat infiltration exhibit increased ultrasound beam reflections, and such reflections have a relatively bright appearance [15].”
Background
A Comparison Study of Conventional Ultrasound and Ultrasound Strain Elastography in the Evaluation of Myopathy
Teng, P. P. C., & Lo, Y. L. (2019) · Ultrasound Quarterly · doi:10.1097/ruq.0000000000000432 · Cited by 7
“In a study conducted on healthy subjects, USE had demonstrated the ability to detect differences in muscle stiffness before and after exercise.(14) Ultrasound strain elastography has also been used to assess the differences in muscle stiffness between healthy subjects and those with Parkinson disease.”
BackgroundMethod
Increased intramuscular adipose tissue of the quadriceps is related to decreased activities of daily living in patients who have had a stroke
Akazawa, N., Kishi, M., Hino, T., Tsuji, R., Tamura, K., Hioka, A., & Moriyama, H. (2021) · Nutrition · doi:10.1016/j.nut.2021.111277 · Cited by 7
The Role of Ultrasound Muscle Parameters for Myosteatosis and Myofibrosis Measurement in Young, Older, and Obese Subjects
Rossi, A. P., Babbanini, A., Monte, L. D., Vantini, G., Stabile, G., Urbani, S., Fantin, F., Zoico, E., Zamboni, M. M., & Mazzali, G. (2023) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2023.05.012 · Cited by 7
Muscle Quality as a Potential Diagnostic Marker of Advanced Liver Fibrosis in Patients with Non-alcoholic Fatty Liver Disease
Oshida, N., Oh, S., Kim, B., Miura, I., Hasegawa, N., Komine, S., Isobe, T., & Shoda, J. (2024) · Journal of Obesity & Metabolic Syndrome · doi:10.7570/jomes23072 · Cited by 7
“16 Furthermore, in our previous study, 17 leg muscle echo-intensity measured during ultrasonographic imaging and ex-tra-myocellular lipid content measured during MRS (both of which reflect myosteatosis and atrophy) positively correlated with urinary concentrations of titin-N fragment, a biomarker…”
Background
Ultrasonographic evaluation of gastrocnemius muscle in a rat model of N-methyl-N-nitrosourea-induced mammary tumor.
Faustino‐Rocha, A. I., Oliveira, P. A., Duarte, J. A., Ferreira, R. M., & Ginja, M. (2013) · PubMed · Cited by 7
Diagnostic evaluation in steroid-induced myopathy: case report suggesting clinical utility of quantitative muscle ultrasonography
Minetto, M. A., Caresio, C., D’Angelo, V., Lanfranco, F., Ghizzoni, L., Roatta, S., Arvat, E., & Kesari, S. (2018) · Endocrine Research · doi:10.1080/07435800.2018.1461904 · Cited by 7
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“75 showed poor, fair to good, and excellent reliability, respectively [16].”
Background
Objective physical activity level is associated with rectus femoris muscle echo‐intensity in patients with chronic obstructive pulmonary disease
Okura, K., Iwakura, M., Kawagoshi, A., Sugawara, K., Takahashi, H., & Shioya, T. (2022) · The Clinical Respiratory Journal · doi:10.1111/crj.13528 · Cited by 7
“EI has been reported to be associated with intramuscular fat content and fibrosis.(6,7) In patients with COPD, it has been reported that the EI was higher than that in healthy individuals and was associated with health-related quality of life.”
Background
Sonographic Quantification of Pronator Quadratus Activity During Gripping Effort
Shin, W.-J., Kim, J.-P., Kim, J.-S., & Park, H.-J. (2015) · Journal of Ultrasound in Medicine · doi:10.7863/ultra.15.02038 · Cited by 7
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“However, using echo intensity measurements, morphometry, and biochemical tests, Reimers et al. demonstrated that adipose tissue replacement correlated better with increased muscle echogenicity than with fibrosis [31].”
MethodResult
Changes in Muscle Quality Following Short-Term Resistance Training in Older Adults: A Comparison of Echo Intensity and Texture Analysis
Knowles, K. S., Pagan, J. I., Beausejour, J. P., Mongold, S. J., Anderson, A. W., Stout, J. R., & Stock, M. S. (2025) · Ultrasound in Medicine & Biology · doi:10.1016/j.ultrasmedbio.2024.12.012 · Cited by 6
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Background
Thigh muscle features in female patients with severe knee osteoarthritis: a cross-sectional study
Liu, T., Xie, H., Yan, S., Zeng, J., & Zhang, K. (2025) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-025-08361-0 · Cited by 6
“These muscular morphological changes are likely to result in the formation of new acoustic reflection planes within the RF of the symptomatic side, thereby contributing to an increase in EI [25].”
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Khanna, P., Anand, R. K., Ray, B. R., Parasuraman, V., & Shanmugam, R. (2025) · Indian Journal of Critical Care Medicine · doi:10.5005/jp-journals-10071-24966 · Cited by 6
Association of First-Trimester Echogenicity of the Puborectalis Muscle With Mode of Delivery
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“Higher echogenicity values are associated with increased amounts of either fat in muscle tissue or connective tissue.(16,17) The echogenicity provides us with structural information and in case of neuromuscular disease in children, it is also used as a diagnostic tool and monitoring tool for disease progression.”
Higher Body Mass Index in Hospitalized Older Patients Is Related to Higher Muscle Quality
Akazawa, N., Kishi, M., Hino, T., Tsuji, R., Tamura, K., Hioka, A., & Moriyama, H. (2022) · The journal of nutrition health & aging · doi:10.1007/s12603-022-1785-9 · Cited by 6
“…biopsy from patients with various neuromuscular diseases indicates that echo intensity is more strongly related to intramuscular adipose tissue than to fibrosis tissue (39); intramuscular adipose tissue in the quadriceps determined by MRI was significantly correlated with echo intensity (21, 22).”
Structural and passive mechanical properties of the medial gastrocnemius muscle in ambulatory individuals with chronic stroke
Huang, M., Miller, T., Fu, S. N., Ying, M. T. C., & Pang, M. Y. C. (2022) · Clinical Biomechanics · doi:10.1016/j.clinbiomech.2022.105672 · Cited by 7
Effects of plyometric- and cycle-based high-intensity interval training on body composition, aerobic capacity, and muscle function in young females: a field-based group fitness assessment
Holmes, A. J., Stratton, M. T., Bailly, A. R., Gottschall, J. S., Feito, Y., Ha, P. L., Lavigne, A., Persaud, K., Gagnon, H. L., Krueger, A., et al. (2023) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2022-0465 · Cited by 13
Influence of Inward Pressure of the Transducer on Thickness and Echo Intensity of the Rectus Femoris Muscle During Ultrasonography
Ishida, H., Suehiro, T., & Watanabe, S. (2016) · Middle East Journal of Rehabilitation and Health Studies · doi:10.17795/mejrh-36059 · Cited by 6
“Muscle composition can also be evaluated using US, whereby enhanced echo intensity represents changes caused by increased intramuscular fibrous and adipose tissue (4, 5).”
Background
Quantitative ultrasound imaging over the ischial tuberosity: An exploratory study to inform tissue health
Gabison, S., Mathur, S., Verrier, M. C., Nussbaum, E. L., Popović, M. R., & Gagnon, D. H. (2018) · Journal of Tissue Viability · doi:10.1016/j.jtv.2018.04.002 · Cited by 6
Quantitative ultrasound imaging of intrinsic hand muscles after traumatic cervical spinal cord injury
Klein, C. S., Liu, H., Zhao, C. N., & Yang, X. (2021) · Spinal Cord · doi:10.1038/s41393-021-00653-1 · Cited by 6
Unique Characteristics of Quadriceps Muscle Morphology and Function in Older Tennis Players
Yoshiko, A., Beppu, M., Chosa, N., & Watanabe, K. (2021) · Journal of Aging and Physical Activity · doi:10.1123/japa.2021-0074 · Cited by 6
Sonographische Untersuchung des Bewegungsapparats beim Rind
Kofler, J. (2011) · Tierärztliche Praxis Ausgabe G Großtiere / Nutztiere · doi:10.1055/s-0038-1623075 · Cited by 6
Is there a place for ultrasound in diagnosing sarcopenia?
Rondaij, T., Kozjek, N. R., Jerele, C., & Jordan, T. (2025) · Radiology and Oncology · doi:10.2478/raon-2025-0035 · Cited by 6
“71 Increased EI is an indicator of muscle degeneration, which presents as an increase in the proportion of intramuscular fatty and connective tissue.”
Ultrasonographic findings in long COVID: A cross-sectional study of 312 patients
Imamura, M., Uchyiama, S. S. T., Naves, G. S., Abicalaf, C. A. R. P., Mirisola, A. R., dos Santos, A. C. A., Battistella, L. R., & HCFMUSP COVID-19 Study Group (2023) · Frontiers in Medicine · doi:10.3389/fmed.2022.1051389 · Cited by 7
Association between quadriceps muscle thickness or echo intensity, malnutrition, and activities of daily living in an integrated medical and long-term care facility: A cross-sectional study
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Relationship between echogenicity of deep cervical muscles and pain laterality in subjects suffering from cervicogenic headache
Abaspour, O., & Akbari, M. (2021) · CRANIO® · doi:10.1080/08869634.2020.1866922 · Cited by 5
“Theoretically, in diagnostic studies, loss of normal function and muscle structure and fatty infiltration in the muscle-weakening conditions will lead to the greater return of ultrasound waves and increased echogenicity [12].”
Background
The effect of limb position on measured values of vastus lateralis muscle morphology using B Mode ultrasound
Jacob, I., Jones, G., Francis, P. R., & Johnson, M. I. (2021) · Translational Sports Medicine · doi:10.1002/tsm2.271 · Cited by 5
Comparison of the mass and amount of intramuscular non-contractile tissue of the trunk and lower extremity muscles between patients with Parkinson’s disease and community-dwelling older adults
Masaki, M., Kasahara, M., Takeuchi, M., Minakawa, K., Inagaki, Y., Ogawa, Y., Sato, Y., Yokota, M., Maruyama, S., Usuki, R., et al. (2022) · Neurological Sciences · doi:10.1007/s10072-021-05828-5 · Cited by 5
“Muscle echo intensities, which represent the amounts of intramuscular non-contractile tissue such as fibrous and adipose tissues, measured using the ultrasound imaging device, can also be used to assess muscle quality [17, 18].”
Method
The anatomy and function of the equine thoracolumbar Longissimus dorsi muscle
von Scheven, C. (2010) · Cited by 5
Ultrasound and Electromyography as Guidance Tools for the Botulinum Toxin Therapy in Cervical Dystonia
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Rectus Femoris Muscle Segmentation on Ultrasound Images of Older Adults Using Automatic Segment Anything Model, nnU-Net and U-Net—A Prospective Study of Hong Kong Community Cohort
Zhang, D., Kang, H., Sun, Y., Liu, J. Y. W., Lee, K.-S., Song, Z. G., Khaw, J., Yeung, J., Peng, T., Lam, S., et al. (2024) · Bioengineering · doi:10.3390/bioengineering11121291 · Cited by 4
Respiratory muscle ultrasound echo characteristics and weaning outcomes in mechanically ventilated patients with sepsis: A prospective observational study
Sun, C., Zhan, M., Yu, L., Li, T., Zhao, H., Gu, Q., Zhou, G., & Guo, F. (2025) · The American Journal of the Medical Sciences · doi:10.1016/j.amjms.2025.05.002 · Cited by 4
Age-related changes in the passive properties of the plantarflexors: Influence of tissue size and quality
Giuliani, H. K., Gerstner, G. R., Mota, J. A., & Ryan, E. D. (2019) · Clinical Biomechanics · doi:10.1016/j.clinbiomech.2019.05.027 · Cited by 4
Relationship between Echo Intensity of Vastus Lateralis and Knee Extension Strength in Patients with Type 2 Diabetes Mellitus
Hirasawa, Y., Matsuki, R., & Tanina, H. (2022) · Physical Therapy Research · doi:10.1298/ptr.e10172 · Cited by 4
Association of activities of daily living, mobility and balance ability, and symptoms of Parkinson’s disease with the masses and amounts of intramuscular non-contractile tissue of the trunk and lower extremity muscles in patients with Parkinson’s disease
Masaki, M., Takeuchi, M., Kasahara, M., Minakawa, K., Inagaki, Y., Ogawa, Y., Sato, Y., Yokota, M., Maruyama, S., & Obinata, S. (2023) · Journal of Medical Ultrasonics · doi:10.1007/s10396-023-01356-1 · Cited by 4
Contractile properties and magnetic resonance imaging‐assessed fat replacement of muscles in myotonia congenita
Jacobsen, L. N., Stemmerik, M. P. G., Skriver, S. V., Pedersen, J. J., Løkken, N., & Vissing, J. (2024) · European Journal of Neurology · doi:10.1111/ene.16207 · Cited by 4
“However, although elevated echo intensities on ultrasound of muscles can signify elevated fat content and/or inflammation [27, 28], they are not specific for those changes in muscle tissue.”
Background
The Effect of Self-Myofascial Release on the Pennation Angle of the Vastus Medialis Oblique and the Vastus Lateralis in Athletic Male Individuals: An Ultrasound Investigation
Torrente, Q. M., Killingback, A., Adds, P. J., & Robertson, C. (2022) · International Journal of Sports Physical Therapy · doi:10.26603/001c.35591 · Cited by 5
Comparison of Quantitative Ultrasound Methods to Classify Dystrophic and Obese Models of Skeletal Muscle
Goryachev, I., Pigula, A., Ely, G., Chrzanowski, S. M., Nagy, J. A., Rutkove, S. B., & Anthony, B. (2022) · Ultrasound in Medicine & Biology · doi:10.1016/j.ultrasmedbio.2022.05.022 · Cited by 4
Treatment of Focal Muscle Stiffness with Hyaluronidase Injections
Raghavan, P., Gordon, A., Roemmich, R. T., & Stecco, A. (2022) · Springer eBooks · doi:10.1007/978-3-030-96900-4_13 · Cited by 4
Skeletal Muscle Ultrasonography and Muscle Fitness Relationships: Effects of Scanning Plane and Echogenicity Correction
Voskuil, C. C., Dudar, M. D., Zhang, Y., & Carr, J. C. (2023) · Muscles · doi:10.3390/muscles2020010 · Cited by 4
“Muscle biopsy work demonstrates intramuscular lipid content has a strong to moderate positive relationship with echo intensity, suggesting that this measure may be utilized as a cost-effective and non-invasive method to examine body composition [6,45].”
Method
Reliability of ultrasound measurements of muscle thickness and echointensity in older adults with type 2 diabetes
Bell, K. E., Paris, M. T., Samuel, M., & Mourtzakis, M. (2024) · WFUMB Ultrasound Open · doi:10.1016/j.wfumbo.2023.100032 · Cited by 6
Muskelsonographie bei neuromuskulären Erkrankungen
Reimers, C. D., & Kele, H. (2002) · Der Orthopäde · doi:10.1007/s00132-001-0240-6 · Cited by 4
Apport du scanner, de l’échographie et de l’IRM dans la pathologie musculaire de l’adulte
Mattei, J., D’Agostino, M. A., Fur, Y. L., Guis, S., Cozzone, P. J., & Bendahan, D. (2008) · Revue du Rhumatisme · doi:10.1016/j.rhum.2007.11.007 · Cited by 4
La creatinina como indicador del tejido muscular esquelético y el estado nutricional
Méndez, R. E. B. (2015) · Revista Cubana de Alimentación y Nutrición · Cited by 4
Commentary: Selective Fiber Degeneration in the Peripheral Nerve of a Patient With Severe Complex Regional Pain Syndrome
Vas, L. (2019) · Frontiers in Neuroscience · doi:10.3389/fnins.2019.00019 · Cited by 2
Analysis of Masseter Muscle Structure in Patients with Mandibular Asymmetry Using Ultrasonic Diagnostic Equipment
Umehara, A., Haga, S., Takakaze, M., Kobayashi, R., Akatsuka, K., Yamashiro, M., Tatsuta, S., & Nakano, H. (2025) · Bioengineering · doi:10.3390/bioengineering12111159 · Cited by 3
“Previous studies have shown that echo intensity correlates with the proportion of fat or fibrous tissue in muscle [10,11].”
Pilot study: Differences in echo intensity ratios between ulnar and median innervated muscles in ulnar neuropathy
Choi, H., Choi, J. H., Kang, S., Yoon, J. S., & Son, S. (2019) · Muscle & Nerve · doi:10.1002/mus.26631 · Cited by 3
Determinants of Maximal Dorsiflexion Range of Motion: Multi-Perspective Comparison Using Mechanical, Neural, Morphological, and Muscle Quality Factors
Mizuno, T., Yoshiko, A., Yamashita, N., Harada, K., Takeuchi, K., Matsuo, S., & Nakamura, M. (2024) · Journal of Functional Morphology and Kinesiology · doi:10.3390/jfmk9040257 · Cited by 3
“Echo intensity is significantly associated with non-contractile elements such as intramuscular fat and/or connective tissue [11–13].”
Intérêt de l’échographie thoracique et musculaire en kinésithérapie de réanimation
Neindre, A. L., & Fossat, G. (2017) · Médecine Intensive Réanimation · doi:10.1007/s13546-017-1305-9 · Cited by 3
Feasibility Validation on Healthy Adults of a Novel Active Vibrational Sensing Based Ankle Band for Ankle Flexion Angle Estimation
Kang, P., Jiang, S., Shull, P. B., & Lo, B. P. L. (2021) · IEEE Open Journal of Engineering in Medicine and Biology · doi:10.1109/ojemb.2021.3130206 · Cited by 3
“However, this phenomenon can be attributed to many factors, including morphological muscle deformation, skeleton deformation, and even the change of contact condition [23].”
Background
Precision technologies for predictive diagnosis and study of the allometric growth of broiler chickens with breast myopathies
de Castilho, V. A. R., Komiyama, C. M., Burbarelli, M. F. D. C., Fernandes, A. M., Garcia, R. G., Seno, L. D. O., Barbosa, D. K., Przybulinski, B. B., & Serpa, F. C. (2022) · British Poultry Science · doi:10.1080/00071668.2022.2128989 · Cited by 3
“Previous studies have shown a strong correlation between muscle biopsy and the intensity of echogenicity, since the infiltration of fat and fibrous tissue are responsible for an increase in wave reflection, resulting in higher intensities (Reimers et al. 1993; Pillen et al. 2009).”
Background
Serum Adiponectin and Leptin Is Not Related to Skeletal Muscle Morphology and Function in Young Women
Yoshiko, A., Ohta, M., Kuramochi, R., & Mitsuyama, H. (2023) · Journal of the Endocrine Society · doi:10.1210/jendso/bvad032 · Cited by 3
Relationship of serial muscle ultrasound of rectus femoris and ambulatory recovery in patients with acute incomplete spinal cord injury: A prospective observational study
Tay, M. R. J., & Kong, K. H. (2024) · Journal of Spinal Cord Medicine · doi:10.1080/10790268.2024.2344317 · Cited by 3
Muscle oxidative capacity but not specific force is greater in aerobic versus resistance trained young adults
Perlet, M. R., Batman, G. B., Ransom, K. V., Bailey, M. D., & Keller, J. L. (2025) · European Journal of Applied Physiology · doi:10.1007/s00421-025-05771-9 · Cited by 3
“Related to another index, it has been suggested that echo intensity (EI) may also be used as a measure of skeletal muscle quality (Stock and Thompson 2021; Knowles et al. 2025), and this measure is at least partially affected by intramuscular fat (Reimers et al. 1993; Young et al. 2015).”
Quantitative assessment of changes in skeletal muscle injury by computer‐aided analysis based on two‐dimensional ultrasonography combined with contrast‐enhanced ultrasonography and estimated by a modified semi‐quantitative scoring system: An experimental study in a contusion model
Zhao, J., Huang, H., Xu, Q., Pan, Q., & Guo, J. (2022) · International Journal of Experimental Pathology · doi:10.1111/iep.12447 · Cited by 3
“13 After that, the injured muscle fibres undergo necrosis and then induce inflammatory cells to secrete cytokines at the inflammatory stage.”
Background
Lumbar mechanics from ultrasound imaging
Desmoulin, G. T., & Milner, T. E. (2007) · Canadian acoustics · Cited by 3
Correlations among Ultrasonographic, Physicochemical and Sensory Characteristics of Pectoralis Major Muscles in Turkeys Reared in a Sustainable Farming System
Schwarz, T., Węglarz, A., Andres, K., Wojtysiak, D., Murawski, M., Ahmadi, B., Bartlewski, P. M., & Ahmadi, B. (2021) · Animals · doi:10.3390/ani12010005 · Cited by 4
“Higher numerical pixel values of ultrasonograms reflect the occurrence of harder and more compact tissue fragments [50,51].”
Background
Ultrasound Basic Anatomy
Sartoris, R., & Silvestri, E. (2014) · Springer eBooks · doi:10.1007/978-3-319-09480-9_4 · Cited by 3
Frailty, sarcopenia and immunesenescence: shared mechanisms and clinical insights
Wilson, D. V. (2018) · University of Birmingham Institutional Research Archive (University of Birmingham) · Cited by 3
Usefulness of Muscle Stiffness Evaluated by Ultrasonography for Detecting Muscle Change Related to Contracture in Frail Older Adults
Nakagawa, K., Kataoka, H., Inoue, R., Goto, K., Yamashita, J., Nishi, Y., Honda, Y., Sakamoto, J., Origuchi, T., & Okita, M. (2025) · Canadian Geriatrics Journal · doi:10.5770/cgj.28.827 · Cited by 2
“(13) Accordingly, it is difficult to evaluate muscle fibrosis indirectly using EI.”
Sex-Related Differences of Weight Bearing and Non-Weight Bearing Muscle Properties
Nabavizadeh, O., & Herda, A. A. (2023) · Muscles · doi:10.3390/muscles2040031 · Cited by 2
“Reimers et al. [21], examined 86 muscle biopsies and measured EI and intramuscular fat content and concluded that increases in EI occurred due to the amount of intramuscular fat within the muscle, changing the acoustics of the ultrasound waves.”
Background
Novel approaches to the treatment of cervical dystonia. The concept of dual navigation control
Коваленко, А. П., Zalyalova, Z. A., & Ivolgin, A. F. (2021) · Neurology neuropsychiatry Psychosomatics · doi:10.14412/2074-2711-2021-6-124-131 · Cited by 2

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)
DOI: 10.7863/jum.1993.12.2.73
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
Licence: doi.wiley.com/10.1002/tdm_license_1 (tdm)
onlinelibrary.wiley.com/termsAndConditions (vor)
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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Skeletal muscle sonography: a correlative study of echogenicity and morphology

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