European Radiology

, Volume 25, Issue 2, pp 290–298 | Cite as

Cross-sectional area measurements versus volumetric assessment of the quadriceps femoris muscle in patients with anterior cruciate ligament reconstructions

  • Magda Marcon
  • Bernhard Ciritsis
  • Christoph Laux
  • Daniel Nanz
  • Thi Dan Linh Nguyen-Kim
  • Michael A. Fischer
  • Gustav Andreisek
  • Erika J. UlbrichEmail author



Our aim was to validate the use of cross-sectional area (CSA) measurements at multiple quadriceps muscle levels for estimating the total muscle volume (TMV), and to define the best correlating measurement level.


Prospective institutional review board (IRB)-approved study with written informed patient consent. Thighs of thirty-four consecutive patients with ACL-reconstructions (men, 22; women, 12) were imaged at 1.5-T using three-dimensional (3D) spoiled dual gradient-echo sequences. CSA was measured at three levels: 15, 20, and 25 cm above the knee joint line. TMV was determined using dedicated volumetry software with semiautomatic segmentation. Pearson’s correlation and regression analysis (including standard error of the estimate, SEE) was used to compare CSA and TMV.


The mean ± standard deviation (SD) for the CSA was 60.6 ± 12.8 cm2 (range, 35.6–93.4 cm2), 71.1 ± 15.1 cm2 (range, 42.5–108.9 cm2) and 74.2 ± 17.1 cm2 (range, 40.9–115.9 cm2) for CSA-15, CSA-20 and CSA-25, respectively. The mean ± SD quadriceps’ TMV was 1949 ± 533.7 cm3 (range, 964.0–3283.0 cm3). Pearson correlation coefficient was r = 0.835 (p < 0.01), r = 0.906 (p < 0.01), and r = 0.956 (p < 0.01) for CSA-15, CSA-20 and CSA-25, respectively. Corresponding SEE, expressed as percentage of the TMV, were 15.2 %, 11.6 % and 8.1 %, respectively.


The best correlation coefficient between quadriceps CSA and TMV was found for CSA-25, but its clinical application to estimate the TMV is limited by a relatively large SEE.

Key points

Cross-sectional area was used to estimate QFM size in patients with ACL-reconstruction

A high correlation coefficient exists between quadriceps CSA and volume

Best correlation was seen 25 cm above the knee joint line

A relatively large standard error of the estimate limits CSA application


Knee injuries Quadriceps muscle Anterior cruciate ligament reconstruction Magnetic resonance imaging Three dimensional imaging 



Cross-sectional area


Total muscle volume


Anterior cruciate ligament


Quadriceps femoris muscle



The scientific guarantor of this publication is Erika Ulbrich. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been included in another substudy (not published yet) focusing on the vastus medialis muscle atrophy in patients after ACL reconstruction. Methodology: prospective, cross sectional study / experimental, performed at one institution.


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Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Magda Marcon
    • 1
    • 2
  • Bernhard Ciritsis
    • 3
  • Christoph Laux
    • 3
  • Daniel Nanz
    • 1
  • Thi Dan Linh Nguyen-Kim
    • 1
  • Michael A. Fischer
    • 1
  • Gustav Andreisek
    • 1
  • Erika J. Ulbrich
    • 1
    Email author
  1. 1.Department of RadiologyUniversity Hospital ZurichZurichSwitzerland
  2. 2.Department of RadiologyUniversity Hospital UdineUdineItaly
  3. 3.Department of TraumatologyUniversity Hospital ZurichZurichSwitzerland

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