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Echo intensity as an indicator of skeletal muscle quality: applications, methodology, and future directions

Abstract

Purpose

This narrative review provides an overview of the current knowledge of B-mode ultrasound-derived echo intensity (EI) as an indicator of skeletal muscle quality.

Method

PubMed and Google Scholar were used to search the literature. Advanced search functions were used to find original studies with the terms ‘echo intensity’ and/or ‘muscle quality’ in the title and/or abstract. Publications that conceptually described muscle quality but did not include measurement of EI were not a focus of the review.

Result

Importantly, the foundational premise of EI remains unclear. While it is likely that EI reflects intramuscular adiposity, data suggesting that these measurements are influenced by fibrous tissue is limited to diseased muscle and animal models. EI appears to show particular promise in studying muscular aging. Studies have consistently reported an association between EI and muscle function, though not all chronic interventions have demonstrated improvements. Based on the existing literature, it is unclear if EI can be used as a marker of muscle glycogen following exercise and nutritional interventions, or if EI is influenced by hydration status. Inconsistent methodological approaches used across laboratories have made comparing EI studies challenging. Image depth, rest duration, participant positioning, probe tilt, and the decision to correct for subcutaneous adipose tissue thickness are all critical considerations when interpreting the literature and planning studies.

Conclusion

While some areas show conflicting evidence, EI shows promise as a novel tool for studying muscle quality. Collaborative efforts focused on methodology are necessary to enhance the consistency and quality of the EI literature.

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Abbreviations

EI:

Echo intensity

MRI:

Magnetic resonance imaging

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Authors

Contributions

Both authors contributed equally to all aspects of this review.

Corresponding author

Correspondence to Matt S. Stock.

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The authors declare no conflicts of interest in the reporting of this research.

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Communicated by Michael Lindinger.

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Stock, M.S., Thompson, B.J. Echo intensity as an indicator of skeletal muscle quality: applications, methodology, and future directions. Eur J Appl Physiol 121, 369–380 (2021). https://doi.org/10.1007/s00421-020-04556-6

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  • DOI: https://doi.org/10.1007/s00421-020-04556-6

Keywords

  • Muscle quality
  • Body composition
  • Resistance training
  • Aging
  • Ultrasound
  • MRI
  • CT
  • Obesity
  • Exercise