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Qualitative and quantitative ultrasonographic assessment of muscle and its association with comprehensive geriatric assessment results among older patients scheduled for abdominal surgery Cover

Qualitative and quantitative ultrasonographic assessment of muscle and its association with comprehensive geriatric assessment results among older patients scheduled for abdominal surgery

Journal of Ultrasonography
Volume 25 (2025): Issue 103 (October 2025)
By: Apolonia Miążek,  Alicia del Carmen Yika,  Szymon Wróbel,  Zofia Łubniewska,  Wojciech Rudnicki and  Jakub Kenig  
Open Access
|Dec 2025

Figures & Tables

Fig. 1.

Example of ultrasound measurements of the rectus femoris (RF) muscle: A. the pennation angle (PA) was obtained in the long-axis view and measured between lines drawn along the deep muscle fascia and the muscle fascicle; b) RF thickness (MT) and cross-sectional area (CSA) were measured in the short-axis view, the former represented by the maximal vertical distance between the superficial and deep fascia layers, the latter calculated after outlining the muscle’s boundaries; C and D. echogenicity and gray-level co-occurrence matrix (GLCM) features were measured in the short-axis view: a square region of interest (ROI) was selected, and the following texture parameters were calculated using ImageJ software: mean pixel intensity, angular second moment (ASM), contrast, correlation, entropy, and inverse difference moment (IDM); C. muscle image from a patient in the “probable sarcopenia” group; D. muscle image from a patient in the “no probable sarcopenia” group
Example of ultrasound measurements of the rectus femoris (RF) muscle: A. the pennation angle (PA) was obtained in the long-axis view and measured between lines drawn along the deep muscle fascia and the muscle fascicle; b) RF thickness (MT) and cross-sectional area (CSA) were measured in the short-axis view, the former represented by the maximal vertical distance between the superficial and deep fascia layers, the latter calculated after outlining the muscle’s boundaries; C and D. echogenicity and gray-level co-occurrence matrix (GLCM) features were measured in the short-axis view: a square region of interest (ROI) was selected, and the following texture parameters were calculated using ImageJ software: mean pixel intensity, angular second moment (ASM), contrast, correlation, entropy, and inverse difference moment (IDM); C. muscle image from a patient in the “probable sarcopenia” group; D. muscle image from a patient in the “no probable sarcopenia” group

Fig. 2.

Comparison of ultrasonographic muscle measurements between the “probable sarcopenia“ and “no probable sarcopenia“ groups generated using R Statistical Software (v4.4.2; R Core Team 2024); Y-axis labels represent selected ultrasonographic measurements of the rectus femoris muscle; X-axis labels indicate comparison groups: patients without probable sarcopenia (“no”) and those with probable sarcopenia (“yes”). Effect sizes with 95% CI and statistical power (%) for comparisons between “probable sarcopenia“ and “no probable sarcopenia“ groups: A. 0.62 (0.16, 1.08), 78%; B. 0.52 (0.06, 0.98), 62%; C. 0.56 (0.10, 1.02), 65%; D. 0.35 (−0.11, 0.80), 31%; E. −0.16 (−0.62, 0.29), 10%; F. −0.27 (−0.72, 0.19), 20%; * p <0.05 (Mann–Whitney U test), adjusted for multiple comparisons using the false discovery rate (FDR) procedure. MT – rectus femoris muscle thickness (mm); CSA – rectus femoris muscle cross-sectional area (cm2); PA – pennation angle (°); EI – echogenicity: grayscale intensity of muscle tissue expressed in arbitrary units (AU), 0 – black, 255 – white, with higher values indicating poorer muscle quality
Comparison of ultrasonographic muscle measurements between the “probable sarcopenia“ and “no probable sarcopenia“ groups generated using R Statistical Software (v4.4.2; R Core Team 2024); Y-axis labels represent selected ultrasonographic measurements of the rectus femoris muscle; X-axis labels indicate comparison groups: patients without probable sarcopenia (“no”) and those with probable sarcopenia (“yes”). Effect sizes with 95% CI and statistical power (%) for comparisons between “probable sarcopenia“ and “no probable sarcopenia“ groups: A. 0.62 (0.16, 1.08), 78%; B. 0.52 (0.06, 0.98), 62%; C. 0.56 (0.10, 1.02), 65%; D. 0.35 (−0.11, 0.80), 31%; E. −0.16 (−0.62, 0.29), 10%; F. −0.27 (−0.72, 0.19), 20%; * p <0.05 (Mann–Whitney U test), adjusted for multiple comparisons using the false discovery rate (FDR) procedure. MT – rectus femoris muscle thickness (mm); CSA – rectus femoris muscle cross-sectional area (cm2); PA – pennation angle (°); EI – echogenicity: grayscale intensity of muscle tissue expressed in arbitrary units (AU), 0 – black, 255 – white, with higher values indicating poorer muscle quality

Fig. 3.

Correlations between postoperative course, complication severity and components of the comprehensive geriatric assessment determined using R Statistical Software (v4.4.2; R Core Team 2024). Cell values represent Spearman’s rank correlation coefficients calculated using pairwise complete observations. Only correlations that remained statistically significant after adjustment for multiple comparisons using the false discovery rate (FDR) procedure are shown. ADL – activities of daily living; I-ADL – instrumental activities of daily living; CCI (0–37) – Charlson comorbidity index; ClavienD. (0–5) – Clavien-Dindo classification grade; CCI (0–100) – comprehensive complication index; LOH (days) – length of hospitalization; LOP (days) – length of postoperative stay
Correlations between postoperative course, complication severity and components of the comprehensive geriatric assessment determined using R Statistical Software (v4.4.2; R Core Team 2024). Cell values represent Spearman’s rank correlation coefficients calculated using pairwise complete observations. Only correlations that remained statistically significant after adjustment for multiple comparisons using the false discovery rate (FDR) procedure are shown. ADL – activities of daily living; I-ADL – instrumental activities of daily living; CCI (0–37) – Charlson comorbidity index; ClavienD. (0–5) – Clavien-Dindo classification grade; CCI (0–100) – comprehensive complication index; LOH (days) – length of hospitalization; LOP (days) – length of postoperative stay

Texture features extracted via gray-level co-occurrence matrix (GLCM) for tissue analysis

ParameterDefinitionClinical meaningInterpretation*
EntropyMeasures the randomness or complexity of pixel intensity distribution.Higher entropy indicates greater tissue heterogeneity (e.g., fibrosis, inflammation, or pathology).

  • High: Irregular/heterogeneous tissue

  • Low: Uniform/homogeneous tissue

Angular second moment (ASM)Measures textural uniformity; sum of squared elements in the GLCM.Reflects tissue homogeneity and structural regularity.

  • High: Regular, uniform structure

  • Low: Disorganized or heterogeneous tissue

ContrastMeasures local intensity variation; differences between neighboring pixels.Associated with edge sharpness or structural boundaries within tissue.

  • High: High local variation (possibly fibrotic or irregular tissue)

  • Low: Smooth texture or homogeneous regions

CorrelationMeasures the linear dependency of gray levels between neighboring pixels.Indicates the predictability of intensity relationships within a texture.

  • High: Strong linear relationship (similar gray levels of regions, high homogeneity)

  • Low: Weak or random relationships

Inverse difference moment (IDM)Measures the closeness of element distribution to the diagonal of the GLCM.Reflects uniformity and similarity among neighboring pixel intensities.

  • High: Uniform texture

  • Low: Coarse or variable tissue texture

Results of ultrasound muscle assessment; median values and ranges (minimal–maximal values) are presented

VariableWhole group (n = 84)Females (n = 44)Males (n = 40)p-value*Effect size (95% CI)†
median (range)
MT (mm)15.80 (8.60–30.20)14.64 (8.60–22.33)18.68 (9.20–30.20)0.002*0.87 (0.42–1.31)
Contracted MT (mm)18.97 (7.80–37.00)16.67 (7.80–26.53)21.03 (12.97–37.00)<0.001*1.07 (0.60–1.53)
CSA (cm2)6.16 (2.29–16.26)5.00 (2.29–12.04)7.49 (2.77–16.26)<0.001*1.01 (0.55–1.46)
Contracted CSA (cm2)5.63 (2.32–16.23)5.24 (2.49–12.73)7.51 (2.32–16.23)0.014*0.80 (0.33–1.25)
PA (°)9.00 (1.33–18.67)8.67 (1.33–16.67)10.00 (2.33–18.67)0.3370.29 (−0.14 – 0.73)
EI (AU)48.86 (9.10–105.90)50.14 (9.10–105.90)47.88 (18.27–71.68)0.234−0.37 (−0.80–0.06)
GLCM: ASM0.21 (0.00–0.76)0.10 (0.00–0.73)0.23 (0.00–0.76)0.7770.03 (−0.40–0.46)
GLCM: contrast400.17(8.55–2425.80)42.59 (8.55–2425.80)762.76 (13.41–2393.28)0.4190.04 (−0.39–0.47)
GLCM: correlation0.002 (0.000–0.009)0.002 (0.000–0.009)0.001 (0.000–0.004)0.227−0.53 (−0.96 – −0.09)
GLCM: IDM0.47 (0.20–0.94)0.43(0.24–0.94)0.48 (0.20–0.94)0.610−0.03 (−0.46–0.40)
GLCM: entropy5.31(0.99–7.64)5.75 (1.02–7.37)5.31(0.99–7.64)0.4190.04 (−0.39 – 0.47)

Occurrence and severity of postoperative complications between different CGA classes; number of patients with a given characteristic or median values with ranges (minimal–maximal values) are presented

VariableNon frail (n = 36)Frail (n = 48)p-value *Effect size (95% CI)†
n or median (% or range)

  • Unplanned ICU

  • No

  • 1 (2.8)

  • 35 (97.2)

  • 3 (6.3)

  • 45 (93.8)

0.206

  • 2.31

  • (0.18–125.85)

  • Unplanned reoperation

  • No

  • 1 (2.8)

  • 35 (97.2)

  • 4 (8.3)

  • 44 (91.7)

0.386

  • 3.14

  • (0.29–160.96)

  • Any complication

  • No

  • 10 (27.8)

  • 26 (72.2)

  • 23 (47.9)

  • 25 (52.1)

0.135

  • 2.37

  • (0.87–6.78)

  • Any severe complication

  • No

  • 2 (5.6)

  • 34 (94.4)

  • 7 (14.6)

  • 41 (85.4)

0.243

  • 2.94

  • (0.51–30.84)

  • Any surgical complication

  • No

  • 5 (13.9)

  • 31 (86.1)

  • 12 (31.6)

  • 36 (68.4)

0.304

  • 2.04

  • (0.59–8.28)

  • Any medical complication

  • No

  • 8 (22.2)

  • 28 (77.8)

  • 20 (41.7)

  • 28 (58.3)

0.135

  • 2.47

  • (0.86–7.64)

  • Postoperative death

  • No

  • 1 (2.8)

  • 35 (97.2)

  • 4 (8.3)

  • 44 (91.7)

0.135

  • 3.14

  • (0.29–160.96)

CCI0.00 (0.00–100.00)8.70 (0.00–100.00)0.135−0.44 (−0.88 – −0.00)

Comparison of ultrasonographic muscle measurements between different CGA classes; median values and ranges (minimal – maximal values) are presented

VariableNon frail (n = 36)Frail (n = 48)p-value *Effect size (95% CI)†
median (range)
MT [mm]18.74 (8.60–29.47)15.54 (8.87–30.20)0.0690.57 (0.12–1.02)
Contracted MT (mm)20.23 (7.80–37.00)17.32 (8.10–29.23)0.047*0.61 (0.16–1.07)
CSA (cm2)7.45 (3.04–16.26)5.57 (2.29–12.53)0.047*0.69 (0.24–1.15)
Contracted CSA (cm2)6.69 (2.8 –16.23)4.93 (2.32–12.73)0.047*0.59 (0.14–1.04)
PA (°)9.17 (2.33–17.67)8.50 (1.33–18.67)0.7240.16 (−0.28–0.60)
EI (AU)45.05 (9.10–69.97)51.71 (24.63–105.90)0.047*−0.76 (−1.21 – −0.30)
GLCM: ASM0.234 (0.001–0.761)0.007 (0.001–0.732)0.6010.13 (−0.32–0.57)
GLCM: contrast762.76 (11.66–2425.80)47.98 (8.55–2393.28)0.5750.08 (−0.36–0.53)
GLCM: correlation0.002 (0.000–0.009)0.002 (0.000–0.007)0.420−0.21 (−0.66–0.23)
GLCM: IDM0.49 (0.25–0.94)0.38 (0.20–0.94)0.6010.12 (−0.33–0.56)
GLCM: entropy5.14 (0.98–7.46)6.25 (1.02–7.64)0.724−0.10 (−0.55–0.34)

Patient characteristics

VariableWhole group (n = 84)Females (n = 44)Males (n = 40)p-value*
n or median (% or range)
Age71.00 (65.00–90.00)72.00 (65.00–89.00)71.00 (65.00–88.00)0.585
Indication for surgeryoncologic disease55 (65.5)29 (65.9)26 (65.0)0.930
non-oncologic disease29 (34.5)15 (34.1)14 (35.0)
Type of surgerycolorectal17 (20.2)7 (15.9)10 (25.0)0.536
gastric and esophageal8 (9.5)3 (6.8)5 (12.5)
periampullary area16 (19.1)13 (29.6)3 (7.5)
hepatic3 (3.6)1 (2.3)2 (5.0)
palliative procedures5 (6.0)2 (4.6)3 (7.5)
other oncological8 (9.5)6 (13.6)2 (5.0)
non-oncological24 (28.6)10 (22.7)14 (35.0)
open biopsy3 (3.6)2 (4.6)1 (2.5)
Charlson comorbidity index5.00 (2.00–12.00)5.00 (3.00–11.00)5.00 (2.00–12.00)0.398
Number of drugs5.00 (0.00–16.00)6.00 (1.00–14.00)4.50 (0.00–16.00)0.698
ADL6.00 (1.00–6.00)6.00 (1.00–6.00)6.00 (2.00–6.00)0.398
  impaired2 (2.4)1 (2.3)1 (2.5)1.000
I-ADL8.00 (2.00 – 8.00)8.00 (2.00 – 8.00)8.00 (4.00 – 8.00)0.852
  impaired13 (15.5)6 (13.6)7 (17.5)0.994
Self-assessment6.00 (2.00 – 10.00)6.00 (2.00 – 10.00)6.50 (4.00 – 10.00)0.641
NRS069 (82.1)36 (81.8)33 (82.5)0.931
18 (9.5)5 (11.4)3 (7.5)
21 (1.2)0 (0.0)1 (2.5)
36 (7.1)3 (6.8)3 (7.5)
BOMC2.50 (0.00–28.00)2.00 (0.00–28.00)4.50 (0.00–28.00)0.585
  impaired12 (14.3)3 (6.8)9 (22.5)0.722
CDT6.00 (0.00–7.00)5.00 (0.00–7.00)6.00 (0.00–7.00)0.585
  impaired31 (36.9)18 (40.9)13 (32.5)0.750
BFI2.00 (0.00–9.00)3.00 (0.00–9.00)2.00 (0.00–8.00)0.698
  impaired36 (42.9)21 (47.7)15 (37.5)0.750
GDS0.00 (0.00–4.00)0.00 (0.00–2.00)0.00 (0.00–4.00)0.585
  depression37 (44.1)20 (45.5)17 (42.5)0.994
SSQ23.00 (11.00–25.00)24.00 (12.00–25.00)23.00 (11.00–25.00)0.585
  impaired16 (19.1)6 (13.6)10 (25.0)0.750
Number of falls0.00 (0.00–4.00)0.00 (0.00–4.00)0.00 (0.00–2.00)0.930
DASI37.45 (0.00–52.95)35.96 (0.00–52.95)39.20 (7.20–52.95)0.742
HGS (kg)28.00 (0.00 – 70.00)20.00 (0.00 – 50.00)35.00 (20.00 – 70.00)<0.001*
  impaired12 (14.3)8 (18.2)4 (10.0)0.750
FTSST (s)12.24 (6.19–25.00)12.56 (6.6–20.00)12.00 (6.19–25.00)0.585
  impaired27 (32.1)17 (38.6)10 (25.0)0.750
TUG (s)8.64 (5.47–33.00)8.64 (5.47–19.25)8.38 (5.54–33.00)0.641
  impaired21 (25.0)12 (27.3)9 (22.5)0.750
Gait speed (m/s)0.95 (0.00–2.00)0.90 (0.00–2.00)0.99 (0.25–1.86)0.585
  impaired27 (32.1)16 (36.4)11 (27.5)0.750
Frailty syndromeyes48 (57.1)31 (70.5)17 (42.5)0.102
no36 (42.9)13 (29.5)23 (57.5)
Probable sarcopeniayes33 (39.3)20 (45.5)13 (32.5)0.585
no51 (60.7)24 (54.5)17 (67.5)
DOI: https://doi.org/10.15557/jou.2025.0039 | Journal eISSN: 2451-070X | Journal ISSN: 2084-8404
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Language: English
Submitted on: May 17, 2025
|
Accepted on: Nov 17, 2025
|
Published on: Dec 31, 2025
Published by: MEDICAL COMMUNICATIONS Sp. z o.o.
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
musculoskeletal ultrasound,
sarcopenia,
preoperative assessment,
frailty,
comprehensive geriatric assessment
Related subjects:
Medicine,
Basic medical science,
Basic medical science, other

© 2025 Apolonia Miążek, Alicia del Carmen Yika, Szymon Wróbel, Zofia Łubniewska, Wojciech Rudnicki, Jakub Kenig, published by MEDICAL COMMUNICATIONS Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

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