Ultrasound Is Reliable in the Assessment of Muscle Echogenicity in Patients with Rheumatic Diseases: Results of a Multicenter International Web-based Study

Andrea Di Matteo¹, Erica Moscioni², Maria Giovanna Lommano¹, Edoardo Cipolletta¹, Gianluca Smerilli¹, Sonia Farah¹, Carla Airoldi³, Sibel Aydin⁴, Becciolini Andrea⁵, Karina Bonfiglioli⁶, Marina Carotti⁷, Greta Carrara⁸, Tomas Cazenave⁹, Davide Corradini¹⁰, Micaela Ana Cosatti¹¹, Juan Josè de Agustin¹², Giulia Maria Destro Castaniti¹³, Marco Di Carlo¹, Eleonora Di Donato⁵, Luca Di geso¹⁴, Ashley Elliott¹⁵, Daniela Fodor¹⁶, Francesca Francioso¹, Alessandra Gabba¹⁷, Cristina Hernández-Díaz¹⁸, Rudolf Horvath¹⁹, Jana Hurnakova¹⁹, Diogo Jesus²⁰, Josefina Marin²¹, Maria Victoria Martire²², Riccardo Mashadi-Mirza²³, Marco Massarotti²⁴, Alice Andreea Musca²⁵, Jagdish Nair²⁶, Tadashi Okano²⁷, Ioannis Papalopoulos²⁸, Javier Eduardo Rosa²¹, Marcos Rosemffet²⁹, João Rovisco³⁰, Davide Rozza⁸, Fausto Salaffi¹, Crescenzio Scioscia³¹, Carlo Alberto Scirè⁸, Maria-Magdalena Tamas³², Shun Tanimura³³, Lucio Ventura-Rios¹⁸, Catalina Villota-Eraso³⁴, Orlando Villota³⁵, Paraksevi V Voulgari³⁶, Florentin Ananu Vreju³⁷, Gentiana Vukatana³⁷, Johana Zacariaz Hereter²¹, Anna Zanetti⁸, Walter Grassi¹ and Emilio Filippucci¹, ¹Polytechnic University of Marche, Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Jesi, Italy, ²Polytechnic University of Marche, Jesi, Italy, ³Hospital Provincial, Rosario, Argentina, ⁴University of Ottawa, Rheumatology, Ottawa, Canada, Ottawa, ON, Canada, ⁵Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero Universitaria di Parma, Parma, Italy, ⁶Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, ⁷Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy, ⁸Epidemiology Unit, Italian Society of Rheumatology, Milano, Italy, ⁹Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina, ¹⁰Rheumatology Unit, University Clinic AOU Cagliari, Cagliari, Italy, ¹¹CEMIC, Centro de educación médica e investigaciones médicas "Norberto Quirno", Buenos Aires, Argentina, ¹²Vall D'hebron University Hospital, Barcelona, Spain, ¹³Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology section, University of Palermo, Palermo, Italy, ¹⁴Ospedale Madonna del Soccorso, Department of Internal Medicine, San Benedetto del Tronto, Italy, ¹⁵Centre for Experimental Medicine, Queen's University, Belfast, Northern Ireland, United Kingdom, ¹⁶2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania, ¹⁷Local Health Unit (ASL), Oristano, Italy, ¹⁸Division de Reumatologia. Instituto Nacional de Rehabilitacion "Luis Guillermo Ibarra Ibarra", Ciudad de México, Mexico, ¹⁹Department of Paediatric and Adult Rheumatology, University Hospital Motol, Prague, Czech Republic, ²⁰Rheumatology Department, Centro Hospitalar de Leiria, Leira, Portugal, ²¹Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, ²²San Roque Hospital, La Plata, Buenos Aires, Argentina, ²³Radiology Department, A.O. Ospedali Riuniti Marche Nord, Pesaro, Italy, ²⁴Department of Rheumatology, University Hospitals Dorset NHS Foundation Trust, Christchurch Hospital, Christchurch, United Kingdom, ²⁵Department of Rheumatology - Colentina Clinical Hospital, Bucharest, Romania, ²⁶Rheumatology, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom, ²⁷Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan, ²⁸Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Heraklion, Greece, ²⁹Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Capital Federal, Argentina, ³⁰Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal, ³¹Department of Emergency and Organ Transplantations-Rheumatology Unit, University of Bari "Aldo Moro", Bari, Italy, ³²Department of Rheumatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania, ³³Rheumatology Department, Hokkaido Medical Center for Rheumatic Diseases, Sapporo, Japan, ³⁴IPS Servicio integral de reumatología e inmunología Dr Orlando Villota, Pasto, Colombia, ³⁵Division of Rheumatology, Fundación Hospital San Pedro, Pasto, Colombia, ³⁶Department of Rheumatology, School of Health Science, Faculty of Medicine, University of Ioannina, Ioannina, Greece, ³⁷Rheumatology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania, ³⁷Rheumatology Unit; IRCCS Policlinico S. Orsola Malpighi, Bologna, Italy

Meeting: ACR Convergence 2022

Keywords: Comorbidity, Imaging, Muscle Function, Myopathies, Ultrasound

Session Information

Date: Sunday, November 13, 2022

Title: Imaging of Rheumatic Diseases Poster

Session Type: Poster Session C

Session Time: 1:00PM-3:00PM

Background/Purpose: Studies have showed that an increased ultrasound (US) muscle echogenicity indicating fatty replacement/fibrosis of muscle tissue may represent an early indicator of muscle involvement associated with sarcopenia in patients with rheumatic diseases. The lack of a standardized approach for the US evaluation of muscle echogenicity, and the little evidence supporting its reliability, represent the main limitations to the application of this US method in the assessment of muscle involvement in patients with rheumatic diseases. In a recent study, our research group has developed a visual semi-quantitative scale for the evaluation of muscle echogenicity (Figure 1), which showed the ability to discriminate between healthy subjects and SLE patients and to potentially identify patients with a clinically relevant muscle involvement (i.e. patients with impaired physical performance and reduced grip strength). The objectives of this study were to explore, in a large group of physicians who routinely perform musculoskeletal US, the reliability of the visual US semi-quantitative scale for muscle echogenicity which was recently developed by our research group. In addition, to investigate the reliability of a quantitative visual scale for muscle echogenicity (from 0 to 100, ‘VAS echogenicity’). Finally, to study the correlation between the semi-quantitative scale and VAS echogenicity, and their correlation with a software for the analysis of images echo-intensity (ImageJ).

Methods: Forty-two rheumatologists and 2 radiologists from 13 countries participated in this web-based exercise. Participants were asked to assess quadriceps muscle echogenicity in 80 static images and 20 clips according to the visual semi-quantitative scale (0=normal, 1=mild, 2=moderate, 3=severe) and a continuous quantitative measurement (‘VAS echogenicity’; 0=black to 100=white). Images were acquired in 64 consecutive patients with different rheumatic diseases and 8 healthy controls. The same assessment was repeated (at least >8 weeks after the first evaluation) to calculate the intra-observer reliability. Muscle echogenicity was also calculated by a research assistant using ImageJ blind to the participant’s evaluations.
Inter and intra reliability were assessed by means of Light’s Kappa and correlations through Kendall’s Tau and Pearson’s Rho coefficients, as appropriate.

Results: As shown in Table 1, the semi-quantitative scale showed a moderate inter-reliability [Light’s kappa=0.57 (0.56-0.58), PABAK=0.58 (0.57-0.59) and a substantial intra-reliability [Cohen’s kappa=0.70 (0.67-0.72), PABAK=0.71 (0.68-0.73)]. Lower reliability results were obtained for the single grades of the scale. The reliability of ‘VAS echogenicity’ was high both in the inter-reliability and intra-reliability assessment [ICC=0.80 (0.75-0.85) and ICC=0.88 (0.88-0.89), respectively]. A significant correlation was found between the semi-quantitative scale and VAS echogenicity (Tau=0.86), and between these two visual scales and imageJ analysis (Tau=0.76 and Rho=0.89, respectively).

Conclusion: US muscle echogenicity should be regarded as a reliable tool for the evaluation of muscle involvement in patients with rheumatic diseases.

Figure 1. Ultrasound visual semi-quantitative scale for the assessment of muscle echogenicity
Legend. Grade 0=normal (i.e., normal hypoechoic muscle); Grade 1=mild (i.e., increased echogenicity in less than 1/3 of muscle tissue); Grade 2=moderate (i.e., increased echogenicity in more than 1/3 but less than 2/3 of muscle tissue); Grade 3=severe (i.e., increased echogenicity in more than 2/3 of muscle tissue). f: femur; rf: rectus femoris muscle; vi: vastus intermedius muscle. See for reference: Di Matteo A, Smerilli G, Cipolletta E, et al. Muscle involvement in systemic lupus erythematosus: multimodal ultrasound assessment and relationship with physical performance. Rheumatology (Oxford). 2022;25:keac196.

Table 1. Reliability results of the visual semi-quantitative scale for muscle echogenicity.
Legend. AA: absolute agreement.

Disclosures: A. Di Matteo, None; E. Moscioni, None; M. Lommano, None; E. Cipolletta, None; G. Smerilli, None; S. Farah, None; C. Airoldi, None; S. Aydin, None; B. Andrea, Amgen, Galapagos; K. Bonfiglioli, None; M. Carotti, None; G. Carrara, None; T. Cazenave, None; D. Corradini, None; M. Cosatti, None; J. de Agustin, None; G. Destro Castaniti, None; M. Di Carlo, None; E. Di Donato, None; L. Di geso, None; A. Elliott, None; D. Fodor, None; F. Francioso, None; A. Gabba, None; C. Hernández-Díaz, None; R. Horvath, None; J. Hurnakova, None; D. Jesus, None; J. Marin, AbbVie/Abbott, UCB, Janssen, Novartis; M. Martire, None; R. Mashadi-Mirza, None; M. Massarotti, None; A. Musca, None; J. Nair, None; T. Okano, None; I. Papalopoulos, None; J. Rosa, Eli Lilly, AbbVie/Abbott, Bristol-Myers Squibb(BMS), Amgen, Novartis, Pfizer; M. Rosemffet, AbbVie/Abbott, Novartis, Sandoz, Bristol-Myers Squibb(BMS), Pfizer, Raffo; J. Rovisco, None; D. Rozza, None; F. Salaffi, None; C. Scioscia, None; C. Scirè, None; M. Tamas, None; S. Tanimura, None; L. Ventura-Rios, None; C. Villota-Eraso, None; O. Villota, None; P. Voulgari, None; F. Vreju, None; G. Vukatana, None; J. Zacariaz Hereter, None; A. Zanetti, None; W. Grassi, None; E. Filippucci, None.

To cite this abstract in AMA style:

Di Matteo A, Moscioni E, Lommano M, Cipolletta E, Smerilli G, Farah S, Airoldi C, Aydin S, Andrea B, Bonfiglioli K, Carotti M, Carrara G, Cazenave T, Corradini D, Cosatti M, de Agustin J, Destro Castaniti G, Di Carlo M, Di Donato E, Di geso L, Elliott A, Fodor D, Francioso F, Gabba A, Hernández-Díaz C, Horvath R, Hurnakova J, Jesus D, Marin J, Martire M, Mashadi-Mirza R, Massarotti M, Musca A, Nair J, Okano T, Papalopoulos I, Rosa J, Rosemffet M, Rovisco J, Rozza D, Salaffi F, Scioscia C, Scirè C, Tamas M, Tanimura S, Ventura-Rios L, Villota-Eraso C, Villota O, Voulgari P, Vreju F, Vukatana G, Zacariaz Hereter J, Zanetti A, Grassi W, Filippucci E. Ultrasound Is Reliable in the Assessment of Muscle Echogenicity in Patients with Rheumatic Diseases: Results of a Multicenter International Web-based Study [abstract]. Arthritis Rheumatol. 2022; 74 (suppl 9). https://acrabstracts.org/abstract/ultrasound-is-reliable-in-the-assessment-of-muscle-echogenicity-in-patients-with-rheumatic-diseases-results-of-a-multicenter-international-web-based-study/. Accessed .

« Back to ACR Convergence 2022

ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasound-is-reliable-in-the-assessment-of-muscle-echogenicity-in-patients-with-rheumatic-diseases-results-of-a-multicenter-international-web-based-study/