Aging Clinical and Experimental Research

, Volume 30, Issue 12, pp 1437–1443 | Cite as

Assessing sarcopenia with vastus lateralis muscle ultrasound: an operative protocol

  • Andrea TicinesiEmail author
  • Marco V. Narici
  • Fulvio Lauretani
  • Antonio Nouvenne
  • Elena Colizzi
  • Marco Mantovani
  • Andrea Corsonello
  • Francesco Landi
  • Tiziana Meschi
  • Marcello Maggio
Original Article



Muscle ultrasound (MUS) has so far not been implemented for sarcopenia assessment in clinical geriatric practice due to allegedly low reproducibility of results in the absence of standardization of procedures. However, rigorous and standardized application of this technique yields highly reproducible results. Its application, especially if integrated with clinical evaluation and comprehensive geriatric assessment, proofs very useful for rapidly obtaining information on muscle mass and architecture.


Here, we present a standardized protocol for performing right vastus lateralis (RVL) MUS and measuring parameters of muscle size and architecture.


RVL muscle thickness (MT), fascicle length (FL), pennation angle (PA), echo-intensity (EI) and cross-sectional area (CSA) can be assessed with this protocol. A portable instrument equipped with a 5-cm long 3–11 mHz linear probe should be used with both B-mode real-time and extended-field-of-view (EFOV) techniques. Longitudinal B-mode and transverse EFOV images should be acquired during each exam, and analyzed with NIH-ImageJ software.


This operative protocol represents a good compromise between the feasibility of MUS in clinical settings and the need of obtaining precise measurements of muscle parameters. Future studies should verify the reproducibility of the proposed technique, and its correlation with appendicular lean mass and parameters of muscle function.


Ultrasonography Skeletal muscle mass Sarcopenia Physical frailty Myopenia 



The ultrasonographic images of right vastus lateralis muscle were obtained using a portable ultrasound (MyLab Gamma™) by Esaote (Genova, Italy) equipped with an extended-field-of-view software (VPAN™). The operative protocol detailed in this paper has been elaborated in the context of an advanced training course on muscle ultrasound that Professor Marco V. Narici held at the University of Parma in November 2016 and January 2017. The authors wish to thank all the participants to the course and their tutors: Lara Bianchi, Prof. Stefano Volpato (University of Ferrara); Cesare Caliari, Stefano Gattazzo, Prof. Andrea Rossi (University of Verona); Anna Maria Dalise, Prof. Giuseppe Paolisso (University of Campania “Luigi Vanvitelli”, Naples); Christian Ferro, Prof. Francesco Corica (University of Messina); Alessandra Pratesi, Prof. Mauro Di Bari (University of Florence); Aurelio Lo Buglio, Lucia Barbera, Prof. Gaetano Serviddio, Prof Gianluigi Vendemmiale (University of Foggia); Costantino Caroselli, Prof. Antonio Cherubini, Prof. Fabrizia Lattanzio (Italian National Research Center on Aging, Ancona); Anna Maria Martone (Catholic University of the Sacred Heart, Rome); Giulia Mori, Nicoletta Cerundolo, Giacomo Bussolati, Erika Ciarrocchi, Chiara Guareschi, Alberto Fisichella, Prof. Gian Paolo Ceda (University of Parma). The authors also wish to thank Dr. Chiara Sidoli for assistance in literature review.


This study has been supported by a grant from the Cariparma Foundation ( for implementation of muscle ultrasound techniques in the Geriatric-Rehabilitation Department of Parma University-Hospital.

Compliance with ethical standards

Conflict of interest

All the authors have no conflict of interest to declare.

Ethical approval

This paper does not contain data from human subjects, so Ethics Committee approval is not necessary.

Informed consent

For this kind of study, formal consent is not required.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Andrea Ticinesi
    • 1
    • 2
    Email author
  • Marco V. Narici
    • 3
  • Fulvio Lauretani
    • 1
    • 2
  • Antonio Nouvenne
    • 1
    • 2
  • Elena Colizzi
    • 1
  • Marco Mantovani
    • 1
  • Andrea Corsonello
    • 4
  • Francesco Landi
    • 5
  • Tiziana Meschi
    • 1
    • 2
  • Marcello Maggio
    • 1
    • 2
  1. 1.Department of Medicine and SurgeryUniversity of ParmaParmaItaly
  2. 2.Geriatric-Rehabilitation DepartmentParma University HospitalParmaItaly
  3. 3.Institute of Physiology, Department of Biomedical SciencesUniversity of PadovaPaduaItaly
  4. 4.Unit of Geriatric PharmacoepidemiologyItalian National Research Center on Aging (INRCA)CosenzaItaly
  5. 5.Department of Geriatrics, Neurosciences and Orthopedics, Center for Geriatric Medicine (CEMI), Institute of Internal Medicine and GeriatricsCatholic University of the Sacred HeartRomeItaly

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