Echo-intensity and fatty infiltration ultrasound imaging measurement of cervical multifidus and short rotators in healthy people: A reliability study

Juan Antonio Valera-Calero; José Luis Arias-Buría; César Fernández-de-Las-Peñas; Joshua A Cleland; Gracia María Gallego-Sendarrubias; Eduardo Cimadevilla-Fernández-Pola

doi:10.1016/j.msksp.2021.102335

Echo-intensity and fatty infiltration ultrasound imaging measurement of cervical multifidus and short rotators in healthy people: A reliability study

Musculoskelet Sci Pract. 2021 Jun:53:102335. doi: 10.1016/j.msksp.2021.102335. Epub 2021 Jan 23.

Authors

Juan Antonio Valera-Calero¹, José Luis Arias-Buría², César Fernández-de-Las-Peñas², Joshua A Cleland³, Gracia María Gallego-Sendarrubias⁴, Eduardo Cimadevilla-Fernández-Pola⁴

Affiliations

¹ Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de La Cañada, Madrid, Spain; International Doctoral School, Universidad Rey Juan Carlos, Alcorcón, Spain. Electronic address: javaleracalero@gmail.com.
² Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain; Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
³ Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Mass, USA.
⁴ Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de La Cañada, Madrid, Spain.

PMID: 33531271
DOI: 10.1016/j.msksp.2021.102335

Abstract

Background: In addition to muscle morphology, ultrasound imaging (US) could be a potential tool to determine muscle quality assessing the echo-intensity and using offline software to quantify the percentage of intramuscular fatty infiltration.

Objective: To investigate intra- and inter-rater image measurement reliability of morphological (i.e., cross-sectional area, perimeter) and echo intensity features (i.e., mean muscular echo intensity, fat echo intensity cut-offs, fatty infiltrates percentage estimation) of deep neck extensors in asymptomatic subjects.

Methods: Brightness-mode images of the cervical spine at C4/C5 were acquired in 25 asymptomatic subjects (40%women, age: 24 years) by an experienced examiner. Cross-sectional area, perimeter and echo-intensity measures of cervical multifidus and short rotators were measured on two separate days (one-week apart) in a randomized order by two assessors. Intra-class correlation coefficients (ICC), standard error of measurement, minimal detectable change, and mean, absolute and percent errors were calculated.

Results: Intra- (ICC_3,1 0.800-0.989) and inter- (ICC_3,2 0.841-0.948) examiner reliability of echo-intensity measures ranged from good to excellent. Women exhibited higher echo-intensity features than men. Intra-examiner reliability of morphological measures was excellent (ICC_3,1 0.917-0.974) for multifidus and good-excellent (ICC_3,1 0.868-0.987) for short rotators. Inter-examiner reliability of morphological measures also ranged from good to excellent (ICC_3,2 0.765-0.965). Men exhibited higher CSA and perimeter than women. No side-to-side differences were observed in any ultrasound measure.

Conclusion: This study found that intra- and inter-rater image analysis reliability of muscle morphology, mean echo intensity, and fatty infiltration quantification of cervical multifidus and short rotators at C4/C5 level was good-to-excellent in healthy subjects.

Keywords: Echo intensity; Fatty infiltration; Reliability; Ultrasound imaging.

MeSH terms

Adult
Cervical Vertebrae / diagnostic imaging
Female
Humans
Image Processing, Computer-Assisted*
Male
Paraspinal Muscles* / diagnostic imaging
Reproducibility of Results
Ultrasonography
Young Adult