European Radiology

, Volume 29, Issue 1, pp 3–12 | Cite as

Speed of sound ultrasound: a pilot study on a novel technique to identify sarcopenia in seniors

  • Sergio J. Sanabria
  • Katharina Martini
  • Gregor Freystätter
  • Lisa Ruby
  • Orcun Goksel
  • Thomas Frauenfelder
  • Marga B. RomingerEmail author



To measure speed of sound (SoS) with a novel hand-held ultrasound technique as a quantitative indicator for muscle loss and fatty muscular degeneration.


Both calf muscles of 11 healthy, young females (mean age 29 years), and 10 elderly females (mean age 82 years) were prospectively examined with a standard ultrasound machine. A flat Plexiglas® reflector, on the opposite side of the probe with the calf in between, was used as timing reference for SoS (m/s) and ΔSoS (variation of SoS, m/s). Handgrip strength (kPA), Tegner activity scores, and 5-point comfort score (1 = comfortable to 5 = never again) were also assessed. Ultrasound parameters (muscle/adipose thickness, echo intensity) were measured for comparison.


Both calves were assessed in less than two minutes. All measurements were successful. The elderly females showed significantly lower SoS (1516 m/s, SD17) compared to the young adults (1545 m/s, SD10; p < 0.01). The ΔSoS of elderly females was significantly higher (12.2 m/s, SD3.6) than for young females (6.4 m/s, SD1.5; p < 0.01). Significant correlations of SoS with hand grip strength (r = 0.644) and Tegner activity score (rs = 0.709) were found, of similar magnitude as the correlation of hand grip strength with Tegner activity score (rs = 0.794). The average comfort score of the elderly was 1.1 and for the young adults 1.4. SoS senior/young classification (AUC = 0.936) was superior to conventional US parameters.


There were significant differences of SoS and ΔSoS between young and elderly females. Measurements were fast and well tolerated. The novel technique shows potential for sarcopenia quantification using a standard ultrasound machine.

Key Points

• Speed of sound ultrasound: a novel technique to identify sarcopenia in seniors.

• Measurements were fast and well tolerated using a standard ultrasound machine.

• The novel technique shows potential for sarcopenia quantification.


Skeletal muscle Ultrasonography Aging Sarcopenia Adipose tissue 







American College of Radiology


Area under curve


Body mass index


Computed tomography


Magnetic resonance imaging


Receiver operating characteristic


Speed of sound





This study has received funding by USZ Foundation and an ETH Zurich & ETH Zurich Foundation Pioneer Fellowship. This project has been generously supported by a donation from Dr. Hans-Peter Wild to the USZ Foundation.

Compliance with ethical standards


The scientific guarantor of this publication is Marga Rominger.

Conflict of interest

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.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• Prospective

• Case-control study

• Performed at one institution


  1. 1.
    Buford TW, Lott DJ, Marzetti E et al (2012) Age-related differences in lower extremity tissue compartments and associations with physical function in older adults. Exp Gerontol 47:38–44CrossRefGoogle Scholar
  2. 2.
    Shen Y, Hao Q, Zhou J, Dong B (2017) The impact of frailty and sarcopenia on postoperative outcomes in older patients undergoing gastrectomy surgery: a systematic review and meta-analysis. BMC Geriatr 17:188CrossRefGoogle Scholar
  3. 3.
    van Vugt JLA, Alferink LJM, Buettner S et al (2018) A model including sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant candidates. J Hepatol 68:707–714CrossRefGoogle Scholar
  4. 4.
    van Vugt JLA, Buettner S, Levolger S et al (2017) Low skeletal muscle mass is associated with increased hospital expenditure in patients undergoing cancer surgery of the alimentary tract. PLoS One 12:e0186547CrossRefGoogle Scholar
  5. 5.
    Boer BC, de Graaff F, Brusse-Keizer M et al (2016) Skeletal muscle mass and quality as risk factors for postoperative outcome after open colon resection for cancer. Int J Colorectal Dis 31:1117–1124CrossRefGoogle Scholar
  6. 6.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing 39:412–423CrossRefGoogle Scholar
  7. 7.
    Fielding RA, Vellas B, Evans WJ et al (2011) Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc 12:249–256CrossRefGoogle Scholar
  8. 8.
    Dawson-Hughes B, Bischoff-Ferrari H (2016) Considerations concerning the definition of sarcopenia. Osteoporos Int 27:3139–3144CrossRefGoogle Scholar
  9. 9.
    Bischoff-Ferrari HA, Orav JE, Kanis JA et al (2015) Comparative performance of current definitions of sarcopenia against the prospective incidence of falls among community-dwelling seniors age 65 and older. Osteoporos Int 26:2793–2802CrossRefGoogle Scholar
  10. 10.
    Janssen I, Shepard DS, Katzmarzyk PT, Roubenoff R (2004) The healthcare costs of sarcopenia in the United States. J Am Geriatr Soc 52:80–85CrossRefGoogle Scholar
  11. 11.
    Boutin RD, Yao L, Canter RJ, Lenchik L (2015) Sarcopenia: current concepts and imaging implications. AJR Am J Roentgenol 205:W255–W266CrossRefGoogle Scholar
  12. 12.
    Duric N, Boyd N, Littrup P et al (2013) Breast density measurements with ultrasound tomography: a comparison with film and digital mammography. Med Phys 40:013501CrossRefGoogle Scholar
  13. 13.
    Duric N, Littrup P, Poulo L et al (2007) Detection of breast cancer with ultrasound tomography: first results with the computed ultrasound risk evaluation (CURE) prototype. Med Phys 34:773–785CrossRefGoogle Scholar
  14. 14.
    Glide C, Duric N, Littrup P (2007) Novel approach to evaluating breast density utilizing ultrasound tomography. Med Phys 34:744–753CrossRefGoogle Scholar
  15. 15.
    Glide-Hurst CK, Duric N, Littrup P (2008) Volumetric breast density evaluation from ultrasound tomography images. Med Phys 35:3988–3997CrossRefGoogle Scholar
  16. 16.
    Khodr ZG, Sak MA, Pfeiffer RM et al (2015) Determinants of the reliability of ultrasound tomography sound speed estimates as a surrogate for volumetric breast density. Med Phys 42:5671–5678CrossRefGoogle Scholar
  17. 17.
    O'Flynn EA, Fromageau J, Ledger AE et al (2017) Ultrasound tomography evaluation of breast density: a comparison with noncontrast magnetic resonance imaging. Invest Radiol 52:343–348CrossRefGoogle Scholar
  18. 18.
    Sak M, Duric N, Littrup P et al (2017) Using speed of sound imaging to characterize breast density. Ultrasound Med Biol 43:91–103CrossRefGoogle Scholar
  19. 19.
    Sak M, Duric N, Littrup P et al (2014) Comparison of sound speed measurements on two different ultrasound tomography devices. Proc SPIE Int Soc Opt Eng 9040:90400sPubMedPubMedCentralGoogle Scholar
  20. 20.
    Sak M, Duric N, Littrup P et al (2013) Breast density measurements using ultrasound tomography for patients undergoing tamoxifen treatment. Proc SPIE Int Soc Opt Eng 8675:86751ePubMedPubMedCentralGoogle Scholar
  21. 21.
    Sanabria SJ, Goksel O (2016) Hand-held sound-speed mammography based on ultrasound reflector tracking. In: Ourselin S et al (eds) Medical Image Computing and Computer-Assisted Intervention - MICCAI 2016, Part I, LNCS, 9900, 567–576Google Scholar
  22. 22.
    Sanabria SJ, Goksel O (2016) Hand-held medical ultrasound apparatus and system for determining a tomographic image. PCT/EP2016/070321 (patent pending)Google Scholar
  23. 23.
    Sanabria SJ, Goksel O, Martini K et al (2018) Breast-density assessment with hand-held ultrasound: a novel biomarker to assess breast cancer risk and to tailor screening? Eur Radiol.
  24. 24.
    Szabo T (2004) Diagnostic ultrasound imaging: inside out, 1st edn. Academic Press, BurlingtonGoogle Scholar
  25. 25.
    Thorngren KG, Werner CO (1979) Normal grip strength. Acta Orthop Scand 50:255–259CrossRefGoogle Scholar
  26. 26.
    Desrosiers J, Bravo G, Hébert R, Dutil E (1995) Normative data for grip strength of elderly men and women. Am J Occup Ther 49:637–644CrossRefGoogle Scholar
  27. 27.
    Fortbildungen für orthopädische Medizin und manuelle Therapie (FOMT) Report (2013) TAS − Tegner activity scale.
  28. 28.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310CrossRefGoogle Scholar
  29. 29.
    Stewart A (2010) Basic statistics and epidemiology: a practical guide, 3rd edn. Radcliffe Pub, AbingdonGoogle Scholar
  30. 30.
    Ticinesi A, Meschi T, Narici MV, Lauretani F, Maggio M (2017) Muscle ultrasound and sarcopenia in older individuals: a clinical perspective. J Am Med Dir Assoc 18:290–300CrossRefGoogle Scholar
  31. 31.
    Muscaritoli M, Anker SD, Argilés J et al (2010) Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by special interest groups (SIG) “cachexia-anorexia in chronic wasting diseases” and “nutrition in geriatrics”. Clin Nutr 29:154–159CrossRefGoogle Scholar
  32. 32.
    Sergi G, Trevisan C, Veronese N, Lucato P, Manzato E (2016) Imaging of sarcopenia. Eur J Radiol 85:1519–1524CrossRefGoogle Scholar
  33. 33.
    Harris-Love MO, Monfaredi R, Ismail C, Blackman MR, Cleary K (2014) Quantitative ultrasound: measurement considerations for the assessment of muscular dystrophy and sarcopenia. Front Aging Neurosci 6:172CrossRefGoogle Scholar
  34. 34.
    Narici MV, Maganaris CN, Reeves ND, Capodaglio P (2003) Effect of aging on human muscle architecture. J Appl Physiol (1985) 95:2229–2234Google Scholar
  35. 35.
    Morse CI, Thom JM, Reeves ND, Birch KM, Narici MV (2005) In vivo physiological cross-sectional area and specific force are reduced in the gastrocnemius of elderly men. J Appl Physiol (1985) 99:1050–1055Google Scholar
  36. 36.
    Takai Y, Ohta M, Akagi R et al (2014) Applicability of ultrasound muscle thickness measurements for predicting fat-free mass in elderly population. J Nutr Health Aging 18:579–585CrossRefGoogle Scholar
  37. 37.
    Abe T, Patterson KM, Stover CD et al (2014) Site-specific thigh muscle loss as an independent phenomenon for age-related muscle loss in middle-aged and older men and women. Age (Dordr) 36:9634CrossRefGoogle Scholar
  38. 38.
    Berger J, Bunout D, Barrera G et al (2015) Rectus femoris (RF) ultrasound for the assessment of muscle mass in older people. Arch Gerontol Geriatr 61:33–38CrossRefGoogle Scholar
  39. 39.
    Ismail C, Zabal J, Hernandez HJ et al (2015) Diagnostic ultrasound estimates of muscle mass and muscle quality discriminate between women with and without sarcopenia. Front Physiol 6:302CrossRefGoogle Scholar
  40. 40.
    Minetto MA, Caresio C, Menapace T et al (2016) Ultrasound-based detection of low muscle mass for diagnosis of sarcopenia in older adults. PM R 8:453–462CrossRefGoogle Scholar
  41. 41.
    Kuyumcu ME, Halil M, Kara Ö et al (2016) Ultrasonographic evaluation of the calf muscle mass and architecture in elderly patients with and without sarcopenia. Arch Gerontol Geriatr 65:218–224CrossRefGoogle Scholar
  42. 42.
    Seymour JM, Ward K, Sidhu PS et al (2009) Ultrasound measurement of rectus femoris cross-sectional area and the relationship with quadriceps strength in COPD. Thorax 64:418–423CrossRefGoogle Scholar
  43. 43.
    Can B, Kara M, Kara Ö, Ülger Z, Frontera WR, Özçakar L (2017) The value of musculoskeletal ultrasound in geriatric care and rehabilitation. Int J Rehabil Res 40:285–296Google Scholar
  44. 44.
    Reeves N, Maganaris C, Narici M (2004) Ultrasonographic assessment of human skeletal muscle size. Eur J Appl Physiol 91:116–118CrossRefGoogle Scholar
  45. 45.
    Strasser E, Draskovits T, Praschak M, Quittan M, Graf A (2013) Association between ultrasound measurements of muscle thickness, pennation angle, echogenicity and skeletal muscle strength in the elderly. Age (Dodr) 35:2377–1388Google Scholar
  46. 46.
    da Silva Pereira Júnior N, da Matta TT, Alvarenga AV, de Albuquerque Pereira WC, de Oliveira LF (2017) Reliability of ultrasound texture measures of biceps brachialis and gastrocnemius Lateralis muscles’ images. Clin Physiol Funct Imaging 37:84–88Google Scholar
  47. 47.
    Hans D, Baim S (2017) Quantitative ultrasound (QUS) in the Management of Osteoporosis and assessment of fracture risk. J Clin Densitom 20:323–333Google Scholar
  48. 48.
    Krieg MA, Barkmann R, Gonnelli S et al (2008) Quantitative ultrasound in the management of osteoporosis: the 2007 ISCD official positions. J Clin Densitom 11:163–187CrossRefGoogle Scholar
  49. 49.
    Brandenburg JE, Eby SF, Song P et al (2014) Ultrasound elastography: the new frontier in direct measurement of muscle stiffness. Arch Phys Med Rehabil 95:2207–2219CrossRefGoogle Scholar
  50. 50.
    Gennisson JL, Deffieux T, Macé E, Montaldo G, Fink M, Tanter M (2010) Viscoelastic and anisotropic mechanical properties of in vivo muscle tissue assessed by supersonic shear imaging. Ultrasound Med Biol 36:789–801CrossRefGoogle Scholar
  51. 51.
    Kot BC, Zhang ZJ, Lee AW, Leung VY, Fu SN (2012) Elastic modulus of muscle and tendon with shear wave ultrasound elastography: variations with different technical settings. PLoS One 7:e44348CrossRefGoogle Scholar
  52. 52.
    Nordez A, Hug F (2010) Muscle shear elastic modulus measured using supersonic shear imaging is highly related to muscle activity level. J Appl Physiol (1985) 108:1389–1394Google Scholar
  53. 53.
    Marsh RL (2016) Speed of sound in muscle for use in sonomicrometry. J Biomech 49:4138.4141CrossRefGoogle Scholar
  54. 54.
    Topp KA, O’Brien WD (1998) Anisotropy of ultrasonic parameters in fresh rat skeletal muscle in vitro. In: Schneider SC, Levy M, McAvoy BR (eds) IEEE Ultrasonics Symposium, Sendai, Japan, pp 1369–1372Google Scholar
  55. 55.
    Park B, Whittaker AD, Miller RK, Hale DS (1994) Predicting intramuscular fat in beef longissimus muscle from speed of sound. J Anim Sci 72:109–116CrossRefGoogle Scholar
  56. 56.
    Qu X, Azuma T, Lin H et al (2017) Limb muscle sound speed estimation by ultrasound computed tomography excluding receivers in bone shadow. In: N Duric, B Heyde (eds) Proceedings of the SPIE, Volume 10139, id. 101391B 8 ppGoogle Scholar
  57. 57.
    Janssen I, Heymsfield SB, Wang ZM, Ross R (2000) Skeletal muscle mass and distribution in 468 men and women aged 18-88 yr. J Appl Physiol (1985) 89:81–88CrossRefGoogle Scholar
  58. 58.
    Narici MV, Maffulli N (2010) Sarcopenia: characteristics, mechanisms and functional significance. Br Med Bull 95:139–159CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Sergio J. Sanabria
    • 1
  • Katharina Martini
    • 2
  • Gregor Freystätter
    • 3
  • Lisa Ruby
    • 2
  • Orcun Goksel
    • 1
  • Thomas Frauenfelder
    • 2
  • Marga B. Rominger
    • 2
    Email author
  1. 1.Computer Assisted Applications in MedicineETH ZurichZurichSwitzerland
  2. 2.Institute of Diagnostic and Interventional RadiologyUniversity Hospital ZurichZurichSwitzerland
  3. 3.Department of Geriatrics and Aging ResearchUniversity Hospital ZurichZurichSwitzerland

Personalised recommendations