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Diagnostic Value of Temporal Muscle Ultrasound Parameters in the Assessment of Pediatric Malnutrition: A Prospective
Hüseyin Ayvaz1, Sevgi Demiröz Taşolar1, Emre Gök2
1Department of Radiology, Division of Pediatric Radiology, Inonu University Faculty of Medicine, Malatya, Turkey.
Insights
Temporal muscle (TM) thickness measured by B-mode ultrasound is a superior diagnostic tool for detecting malnutrition-induced muscle atrophy in children compared to shear wave elastography (SWE). This practical method offers high accuracy for clinical use.
Area of Science:
- Pediatric diagnostics
- Medical imaging
- Biomechanical analysis
Background:
- Malnutrition in children can lead to muscle atrophy, impacting growth and development.
- Accurate and accessible diagnostic tools are crucial for early detection and intervention.
- Temporal muscle (TM) assessment offers a potential non-invasive method for evaluating nutritional status.
Purpose of the Study:
- To compare the diagnostic accuracy of B-mode ultrasound and shear wave elastography (SWE) for assessing pediatric malnutrition.
- To establish practical cutoff values for TM ultrasound and SWE parameters in clinical settings.
- To identify the most effective ultrasonographic and biomechanical markers for malnutrition-induced muscle atrophy.
Main Methods:
- A prospective observational study involving 89 children (5-18 years) with 35 malnourished and 54 healthy controls.
- Measurements included TM thickness, total tissue thickness, tissue stiffness, and shear wave speed using high-frequency ultrasound and SWE.
- Data analysis employed multivariate logistic regression, Decision Curve Analysis (DCA), and receiver operating characteristic (ROC) curves.
Main Results:
- Malnourished children exhibited significantly lower TM thickness, tissue stiffness, and shear wave speed compared to controls (p < 0.001).
- TM thickness was the strongest independent predictor of malnutrition (OR = 0.428, p < 0.001), with the highest diagnostic accuracy (AUC = 0.887).
- A TM thickness cutoff of 11.15 mm achieved 82.9% sensitivity and 90.7% specificity, outperforming SWE parameters.
Conclusions:
- B-mode ultrasound measurement of TM thickness is a practical, reproducible, and accurate adjunctive parameter for detecting malnutrition-induced muscle atrophy in pediatric patients.
- TM thickness demonstrates superior diagnostic performance compared to SWE parameters for pediatric malnutrition assessment.
- Further multicenter validation is recommended prior to routine clinical implementation of TM thickness measurement.
Objectives:
The primary focus of this study was to compare the diagnostic accuracy of temporal muscle (TM) B-mode ultrasound and shear wave elastography (SWE) parameters in the assessment of pediatric and to establish practical cutoff values for clinical use.
Methods:
This prospective observational study included a total of 89 children aged 5-18 years, consisting of 35 primary malnourished patients and 54 healthy controls. TM thickness, total tissue thickness (muscle and subcutaneous fat), tissue stiffness, and shear wave speed were measured in the temporal fossae using a high-frequency linear transducer. For SWE quality standardization, Motion Stability (M-STB) and Reliability (RLB) indices were actively utilized. The obtained data were modeled using multivariate logistic regression, Decision Curve Analysis (DCA), and receiver operating characteristic (ROC) curves.
Results:
All investigated ultrasonographic and biomechanical values were significantly lower in the malnutrition group compared to controls (p < 0.001). In the multivariate logistic regression analysis, which was adjusted to resolve multicollinearity (VIF > 20) among the SWE parameters, TM thickness emerged as the strongest independent predictor of malnutrition (OR = 0.428, p < 0.001). ROC analyses demonstrated that TM thickness yielded the highest diagnostic accuracy (AUC = 0.887). A cut-off value of approximately 11.15 mm for this parameter provided a sensitivity of 82.9% and specificity of 90.7%. The DeLong test results confirmed that the discriminatory power of TM thickness was statistically superior to that of the elastography data.
Conclusions:
TM thickness measurement via B-mode ultrasound is a practical, reproducible, and promising adjunctive point-of-care parameter for detecting malnutrition-induced muscle atrophy in pediatric patients, demonstrating superiority over SWE parameters; however, external multicenter validation is warranted before routine clinical implementation.
