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Manual Muscle Testing: A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients
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Reference Methods for Measuring Skeletal Muscle Mass: A Critical Perspective.

Steven B Heymsfield1, Houchun H Hu2, Edvin Johanssen3

  • 1Pennington Biomedical Research Center, LSU System, Baton Rouge, Louisiana, USA.

Journal of Cachexia, Sarcopenia and Muscle
|January 20, 2026
PubMed
Summary
This summary is machine-generated.

There is no single gold standard for measuring human skeletal muscle (SM) mass. This review highlights the need for standardized protocols and precise terminology in in vivo methods for accurate SM quantification.

Keywords:
body compositioncachexiafrailtymalnutritionnutritional assessmentobesitysarcopenia

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Area of Science:

  • Physiology
  • Biomedical Engineering
  • Medical Imaging

Background:

  • Skeletal muscle (SM) plays a crucial role in health and disease.
  • Quantifying human SM mass lacks a universally accepted gold standard method.
  • Current methods are broadly categorized into in vitro and in vivo approaches.

Purpose of the Study:

  • To critically review existing in vivo methods for quantifying human skeletal muscle mass and composition.
  • To identify limitations in current reference methods and their impact on derived techniques.
  • To propose recommendations for improving the accuracy, reproducibility, and clarity of SM measurements.

Main Methods:

  • Systematic review of in vitro and in vivo methods for skeletal muscle quantification.
  • Categorization of in vivo methods into reference (upper tier) and secondary (lower tier) approaches.
  • Critical analysis of protocols, terminology, and validation procedures for reference methods (CT, MRI, DXA).

Main Results:

  • In vitro methods are rarely reported and not suitable for current clinical use.
  • Three in vivo methods (CT, MRI, DXA) are considered reference standards but lack standardized protocols and terminology.
  • Lower-tier methods require calibration against reference methods, propagating any inaccuracies.
  • Significant variability exists in acquisition protocols and image analysis for reference methods.

Conclusions:

  • No definitive gold standard exists for in vivo skeletal muscle mass quantification.
  • Standardized protocols and precise terminology are essential for CT, MRI, and DXA in SM measurement.
  • Future expert consensus is needed to establish optimal guidelines for muscle mass and composition analysis.