Ultrasound imaging to assess skeletal muscle architecture during movements: A systematic review of methods, reliability, and challenges.

BACKGROUND: B-mode ultrasound is often used to quantify muscle architecture during movements. OBJECTIVES: 1) Systematically review the reliability of fascicle length (FL) and pennation angles (PA) measured using ultrasound during movements involving voluntary contractions, 2) systematically review the methods used in studies reporting reliability, discuss associated challenges, and provide recommendations to improve the reliability and validity of dynamic ultrasound measurements, 3) provide an overview of computational approaches for quantifying fascicle architecture, their validity, agreement with manual quantification of fascicle architecture, and advantages and drawbacks. METHODS: Three databases were searched until June 2019. Studies among healthy human individuals aged 17-85 years that investigated the reliability of FL or PA in lower extremity muscles during isoinertial movements and written in English were included. RESULTS: Thirty studies (n=340 participants) were included for reliability analyses. Between-session reliability as measured by coefficient of multiple correlations (CMC) and coefficient of variation (CV) was FL CMC: 0.89-0.96; CV: 8.3%, and PA CMC: 0.87-0.90; CV: 4.5-9.6%. Within-session reliability was FL CMC: 0.82-0.99; CV: 0.0-6.7%, and PA CMC: 0.91; CV: 0.0-15.0%. Manual analysis reliability was FL CMC: 0.89-0.96; CV: 0.0-15.9%; PA CMC: 0.84-0.90; CV: 2.0-9.8%. Computational analysis FL CMC was 0.82-0.99 and PA CV was 14.0-15.0%. Eighteen computational approaches were identified and these generally showed high agreement with manual analysis and high validity compared to phantoms or synthetic images. CONCLUSIONS: B-mode ultrasound is a reliable method to quantify fascicle architecture during movement. Additionally, computational approaches can provide a reliable and valid estimation of fascicle architecture.