Objective  To evaluate the muscle mass, elasticity, hardness, and blood flow perfusion of skeletal muscles in elderly patients using multimodal ultrasound, and analyse the diagnostic value of multimodal ultrasound for sarcopenia.

Methods  Patients over 60 years old with sarcopenia and healthy elderly individuals were selected as the sarcopenia group and control group. Musculoskeletal ultrasound, virtual touch tissue imaging quantification, and power Doppler ultrasound were used to measure and score the muscle thickness, cross-sectional area, shear wave velocity, and blood flow energy signals of bilateral biceps and rectus femoris muscles, respectively. The diagnostic values of multimodal ultrasound parameters for sarcopenia were analyzed based on the relative skeletal muscle mass index results obtained by dual energy X-ray absorptiometry (DEXA).

Results  A total of 73 study subjects were included, including 36 cases in the sarcopenia group and 37 cases in the control group. The age, biceps, and rectus femoris shear wave velocity of the sarcopenia group were significantly higher than those of the control group (P<0.05). The thickness, cross-sectional area, and blood flow energy signal scores of the biceps brachii and rectus femoris muscles were significantly lower than those of the control group (P<0.05). Among various multimodal ultrasound parameters, muscle shear wave velocity has the best diagnostic efficiency. The area under curve (AUC) of the receiver operating characteristic curve for shear wave velocity of biceps brachii was 0.96[95%CI (0.87, 0.98)], and the sensitivity and specificity for diagnosing muscle atrophy were 86.50% and 98.89%, respectively. The AUC of shear wave velocity of rectus femoris muscle was 0.91[95%CI (0.84, 0.95)], with sensitivity and specificity of 81.08% and 90.38%, respectively. The thickness, cross-sectional area, and blood flow energy signal score of the biceps brachii and rectus femoris muscles were positively correlated with DEXA results, while shear wave velocity was negatively correlated with DEXA results.

Conclusion  Multimodal ultrasound technology can evaluate the morphological structure, biomechanics, and microcirculation status of skeletal muscles in the limbs of elderly people. It has good diagnostic value for sarcopenia, providing objective and multidimensional quantitative diagnostic indicators for early screening of  sarcopenia.

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