. Scientific Frontline: New tool for diagnosing and evaluating the severity of sarcopenia

Monday, March 13, 2023

New tool for diagnosing and evaluating the severity of sarcopenia

From left to right, researchers from the Faculty of Medicine and Welfare of WITH (Campus Bellvige) Maribel Miguel, Ingrid Mötller and Joan Basi.
Photo Credit: Courtesy of University of Barcelona

Sarcopenia is a degenerative disease characterized by a pathological decrease in muscle strength that especially affects older people. Researchers at the University of Barcelona have developed a new tool to assess the presence and severity of this muscle failure. The study, published in the journal RMD Open, provides a muscle quality scoring system based on musculoskeletal ultrasound, which has been validated with anatomical and histological samples of patients. It is the first imaging method that assesses muscle quality, an essential factor in the disease. According to researchers, these results could be useful "not only for diagnostic purposes, but also for monitoring patients in clinical practice and also in clinical trials.".

Researchers from the Human Anatomy and Embryology Unit and the Histology Unit of the Department of Pathology and Experimental Therapeutic Therapeutic Tepell de la Faculty of Medicine and Health Sciences (Campus Bellvige) of the UB. Also, experts from the Puigvert Foundation, the University of Genoa, the University of Oslo and the University of Copenhagen have been trained.

A harmless, low-cost technique

A key feature of sarcopenia is the deterioration in muscle quantity and quality, which worsens the quality of life and is associated with cardiorespiratory diseases and with an increased risk and prolongation of hospital admission. There is currently a wide variety of tests and tools to characterize the disease in practice and in research. “In most cases, diagnosis and evolution are measured by functional test or patient surveys on aspects such as falls, feeling of weakness, slow walking, difficulty getting up from a chair or weight loss, that allow to know the condition of the patient”, explains Ingrid Mötller, researcher at the UB and the Poal Institute of Reimatology and first signatory of the article.

In this context, imaging techniques play a critical role in the objective assessment of patients with sarcopenia; however, most, such as dual-energy X-ray absorbers (DXA), magnetic resonance imaging (MRI), or computed tomography (TC), focus on muscle quantity. "These techniques make clear the amount of muscle, but muscle quality, which is a relatively new term, is more important, as the amount is highly variable depending on different factors, such as age or height," the researcher.

There is currently no universal consensus on appropriate methods for assessing muscle quality in common clinical practice. In this situation, the researchers propose the use of musculoskeletal ultrasound, as it is a technique capable of showing muscle texture and changes in microscopic and macroscopic aspects of the architecture and muscle composition that causes sarcopenia. In addition, unlike other imaging techniques, it is a low-cost, portable, harmless test because it does not emit ionizing radiation.

Validated method with clinical measurements

To confirm the diagnostic validity of this new tool, in the study a muscle of the lower extremity (the femoral rectum) and another of the upper extremity (the brachial biceps) of ten donor corpses were evaluated. between 68 and 91 years. To this end, two researchers rated and qualitatively punctuated the severity of muscle degeneration from ultrasound images and subsequently compared the results with anatomical and histological evaluation of the corpses.

The evaluation was done blindly with respect to the other evaluator and was repeated half an hour later for each of the researchers. In addition, the evaluation of an experienced histologist, under the same methodological conditions, was added. According to researchers, this methodology is one of the "strengths of the study, as it allows direct comparison between images and clinical measurements of muscle quality.".

The challenge of clinical application: clinical trial with patients

The next challenge for researchers is to verify the patient scoring system and test the added value of the tool in the long-term follow-up of patients with sarcopenia, as well as its application in related clinical trials. In this regard, according to the researcher, the team at the University of Copenhagen that has participated in this work should apply the new tool in a cohort of patients to see how it works in prognostic value. “We believe it works very well on diagnoses, but, both in this case and in its prognostic value, it needs to be corroborated with longitudinal studies with patients,” explains Ingrid Mötller.

A potential tool to apply to other diseases

Muscle quality is an important factor in other muscle diseases, apart from sarcopenia. This way, for researchers, musculoskeletal ultrasound could also be applied to other disorders or, even, in the rehabilitation of athletes, as it will allow to deepen in the knowledge of the muscle quality, in their variations in different immune diseases, degenerative and metabolic and in the monitoring of treatments. "It is the starting point in an area where there is no similar evidence, so we believe it is a tool that will spread in this and other diseases," the researcher concludes.

Published in journalRMD Open

Source/CreditUniversity of Barcelona

Reference Number: med031323_01

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