Diagnostic Value of Muscle Ultrasound for Myopathies and Myositis

Jemima Albayda, Nens van Alfen, Jemima Albayda, Nens van Alfen

Abstract

Purpose of review: The purpose of this review is to critically discuss the use of ultrasound in the evaluation of muscle disorders with a particular focus on the emerging use in inflammatory myopathies.

Recent findings: In myopathies, pathologic muscle shows an increase in echogenicity. Muscle echogenicity can be assessed visually, semi-quantitatively, or quantitatively using grayscale analysis. The involvement of specific muscle groups and the pattern of increase in echogenicity can further point to specific diseases. In pediatric neuromuscular disorders, the value of muscle ultrasound for screening and diagnosis is well-established. It has also been found to be a responsive measure of disease change in muscular dystrophies. In chronic forms of myositis like inclusion body myositis, ultrasound is very suitable for detecting markedly increased echogenicity and atrophy in affected muscles. Acute cases of muscle edema show only a mild increase in echogenicity, which can also reverse with successful treatment. Muscle ultrasound is an important imaging modality that is highly adaptable to study various muscle conditions. Although its diagnostic value for neuromuscular disorders is high, the evidence in myositis has only begun to accrue in earnest. Further systematic studies are needed, especially in its role for detecting muscle edema.

Keywords: Diagnostic test; Muscle echogenicity; Muscle ultrasound; Myopathies; Myositis.

Conflict of interest statement

Nens van Alfen acts as a muscle ultrasound consultant for Dynacure, with fee payment to employer.

Figures

Fig. 1
Fig. 1
A normal vastus lateralis (A, B) and tibialis anterior (C, D) in transverse and longitudinal views. SC, subcutaneous tissue; VL, vastus lateralis; VI, vastus intermedius; TA, tibialis anterior; EDL, extensor digitorum longus; IM, interosseous membrane
Fig. 2
Fig. 2
Heckmatt scoring using vastus lateralis muscle (disease examples from established myositis patients); grade 1 is normal; grade 2 shows a slight increase in echogenicity without architecture loss or attenuation. Grade 3 shows clearly increased muscle echogenicity, loss of muscle architecture, and some attenuation causing less visibility of deeper structures. Grade 4 shows a completely white muscle with loss of recognizable features and strong attenuation of the ultrasound signal so no deep structures can be discerned beyond the superficial layer of muscle. VL, vastus lateralis
Fig. 3
Fig. 3
Quantitative grayscale analysis in a healthy (A) and diseased muscle (B). The mean echogenicity (EI) can be read from the histogram output using Image J (https://imagej.nih.gov/ij/). In (B), the muscle can be seen as having an increase in echogenicity compared with overlying subcutaneous tissue and normal muscle in (A). Mean grayscale level in the normal vastus lateralis is 91 (A) versus 130 in the diseased (B). VL, vastus lateralis; VI, vastus intermedius
Fig. 4
Fig. 4
Increased echogenicity in a “ground glass” pattern (A), and a “moth-eaten” pattern (B)
Fig. 5
Fig. 5
Dermatomyositis showing increased echogenicity in the subcutaneous tissue, focally altered and “see-through” echogenicity within the muscle (A), as well as calcinosis (*) causing posterior shadowing (B). SC, subcutaneous tissue; Br, brachialis; Hum, humerus; VI, vastus intermedius; Fem, femur
Fig. 6
Fig. 6
Affected flexor digitorum profundus FDP (B) and gastrocnemius (D) muscles in IBM showing markedly increase echogenicity and atrophy, in comparison with normal (A, C). fdp, flexor digitorum profundus; fcu, flexor carpi ulnaris; SC, subcutaneous tissue

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