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Updated: Jan 12, 2026
Diaphragmatic Ultrasound in Adults: Image Acquisition and Interpretation
Published on: January 31, 2025
Diaphragm ultrasound for muscle strength assessment: A systematic literature review
Joao Leote1,2, Margarida Monteiro3, Cláudia Rocha4
1Lisbon School of Health Technology, Polytechnic of Lisbon, Lisbon, Portugal.
Objective:
To assess if diaphragmatic ultrasound (DU) reflects diaphragmatic muscle strenght when compared to respiratory tests and neurophysiological studies.
Methods:
A systematic literature review was conducted on adults undergoing DU, compared to any respiratory or neurophysiological technique. The search strategy was applied in PubMed, Scopus, and Web of Science, and the analysis was conducted using the PRISMA methodology. Three eligibility assessment stages were performed: title, abstract, and full-text reading. The risk of bias was evaluated using the RoB 2.0, ROBINS-I, and Newcastle-Ottawa Scale tools.
Results:
Out of 155 identified articles, 25 were selected for full-text review (14 non-randomised studies, 8 case-control studies, and 3 randomised studies). The overall risk of bias was moderate, with the main biases related to population selection and intervention assessment.Twenty-three articles used maximal inspiratory pressure measurement as a comparator which showed a weak-to-moderate correlation, significant in 10 studies, with diaphragmatic excursion. Three studies reported a weak association between diaphragmatic thickening and sniff pressure.Five articles reported a concordant correlation between diaphragmatic thickening and compound muscle action potential amplitude, significant only in one study.
Conclusion:
The variability of results obtained across different pathologies does not support the use of DU alone to predict diaphragmatic muscle strength.
