ArticleEuropean journal of physical and rehabilitation medicine2025
Association between muscle strength and echogenicity using greyscale ultrasound software: a diagnostic accuracy study in kidney transplant candidates.
Article in European journal of physical and rehabilitation medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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10 authors.
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Abstract
backgroundAdvanced chronic kidney disease disrupts the delicate equilibrium between protein anabolism and catabolism, leading to alterations in muscle quantity, quality, and function. Musculoskeletal ultrasound emerges as a promising assessment tool due to its widespread availability and high reliability.
aimTo evaluate the efficacy of rectus femoris (RF) echogenicity, measured using greyscale software, in identifying diminished muscle quality and strength in candidates for kidney transplant.
designPost-hoc diagnostic accuracy study.
settingOutpatients in a multimodal prehabilitation program pre kidney transplantation (KT). POPULATION: Patients on the waiting list for KT.
methodsSensitivity, specificity, likelihood ratios and area under the curve (AUC) for diagnostic efficacy of echogenicity (index test) assessed with the ImageJ software greyscale as a potential marker of quadriceps muscle weakness (reference test) were calculated. Muscle weakness was considered as maximal voluntary isometric contraction of the quadriceps (Q-MVIC) <40% of body weight. Other variables included body composition parameters derived from multifrequency electrical bioimpedance, upper limb muscle strength (handgrip), and RF thickness assessed by ultrasound. Statistical tests: Chi-square, t-Student, Pearson correlation coefficients (r), bivariate and multivariate logistic regression models. Statistical significance level ≤0.05.
resultsOf 112 patients (mean age: 63.6, 76% male), 72 (63.7%) exhibited quadriceps weakness, while 80 (70.8%) had some degree of overhydration (extracellular water/total body water ratio >0.390). The echogenicity cut-off point of highest concordance with muscle weakness was 70, boasting a sensitivity of 83%, specificity of 57%, and AUC of 0.671 (CI 95% 0.570-0.772 [P=0.003]). Echogenicity >70 was associated with a 3.4-fold higher risk of muscle weakness (crude OR = 3.4 [CI95% 1.4 to 8.0]), which persisted after adjusting for age, height, weight and RF thickness.
conclusionsThe RF echogenicity exhibits fair validity in identifying muscle weakness among candidates for KT. However, it cannot be endorsed as a standalone diagnostic tool in this population. CLINICAL REHABILITATION IMPACT: Early identification of muscle weakness would advance efforts to mitigate morbidity and mortality through targeted measures.
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