Clinical Sciences/Health Conditions
Zahira Cecilia Aguilar-Mancilla, MD
other
Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra
México, Distrito Federal, Mexico
Roberto Coronado-Zarco, MD
Medical specialist
Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra
México, Distrito Federal, Mexico
Jimena Quinzaños, MD, PhD (she/her/hers)
Head of Neurologic Rehabilitation Department
instituto nacional de rehabilitación
mexico city, Distrito Federal, Mexico
Rafael Zepeda-Mora, MD, PhD
Head of Neurologic Rehabilitation Department
instituto nacional de rehabilitación
mexico city, Distrito Federal, Mexico
Andrea Olascoaga-Gómez de León, MD, PhD
Head of Neurologic Rehabilitation Department
instituto nacional de rehabilitación
mexico city, Distrito Federal, Mexico
To evaluate the diagnostic accuracy, reliability and standardization of ultrasound for the detection of primary sarcopenia, using the available evidence from systematic reviews.
Design:
An umbrella review of systematic reviews was conducted and registered in PROSPERO (CRD420251003631). Searches were performed in PubMed, Scopus and the Cochrane Library from 2000 to the present. Study selection and data extraction were carried out independently and in duplicate. The methodological quality of the included reviews was assessed using the ROBIS tool, and overlap among primary studies was quantified through a citation matrix and calculation of the Corrected Covered Area (CCA). Evidence synthesis was performed narratively and complemented with an adapted GRADE approach.
Results:
Three systematic reviews were included (out of 27 records; overlap CCA = 7.9%). Overall, ultrasound (US) showed moderate-to-good diagnostic performance for sarcopenia: AUC 0.76–0.87, sensitivity ~82%, and specificity ~72%, with better performance under AWGS criteria. At the muscle level, the most consistent cut-off values were found for the medial gastrocnemius (1.5–1.71 cm) and the rectus femoris (1.5 cm; sex-specific alternative: 0.9 cm for women / 0.7 cm for men), measured in the transverse plane and without compression. Quadriceps measurements showed heterogeneity across sites and planes and lower accuracy (AUC 0.66–0.74). Compared with reference standards, US showed a moderate correlation with DXA (r=0.69); BIA had high specificity (~95%, AUC 0.88), and MRI showed the highest agreement with DXA (r=0.96).
Conclusion:
When applied according to standardized protocols, ultrasound can identify sarcopenia with good performance in GM and RF and offers a practical, economical, complementary alternative to DXA/MRI for clinical decision-making. Further validation of cut-off values and methodological harmonization will help establish its role as a first-line diagnostic tool in resource-limited settings.
