Diagnostic value of acoustic radiation force impulse shear wave elastography in the early detection of non traumatic rhabdomyolysis

Diagnosis of non‑traumatic rhabdomyolysis presents a considerable diagnostic challenge due to its subtle clinical presentation. Existing laboratory methods – in particular, assessment of creatine phosphokinase (CPK) levels – do not allow for rapid point-of-care diagnosis. Therefore, evaluation of diagnostic value of shear wave elastography, a technique capable of promptly detecting muscle tissue damage, is of high relevance.

Aim: to evaluate the diagnostic value of shear wave elastography in detecting non‑traumatic rhabdomyolysis using 4–9 MHz and 5–18 MHz ultrasound probes.

Material and methods. A prospective case-control study compared shear-wave velocity (Vs) in the quadriceps femoris muscle between two groups: 45 patients with confirmed non-traumatic rhabdomyolysis (median age 81.0 [68.0; 90.0] years) and 82 healthy volunteers. All patients were  sequentially examined with the use of two expert ultrasound systems: Siemens Acuson S2000 (9L4 probe, 4.0–9.0 MHz) and Canon Aplio i800 (i18LX5 probe, 5.0–18.0 MHz). Correlation and ROC analyses were performed. The following factors influencing muscle tissue stiffness values were assessed: thickness of the muscle tissue and subcutaneous fat, age, and plasma concentrations of CPK and myoglobin.

Results. Vs was significantly lower in rhabdomyolysis patients (1.12 m/s and 1.08 m/s, respectively) than in controls (2.38 m/s and 2.48 m/s; p < 0.001). A moderate inverse correlation was found between Vs and creatine kinase level (rs from –0.370 to –0.481; p < 0.05). A threshold Vs < 1.3 m/s yielded high diagnostic accuracy (AUC 0.982–0.997; sensitivity 98%, specificity 99–100%) in rhabdomyolysis. Age, sex, subcutaneous fat thickness and muscle thickness did not significantly affect Vs.

Conclusion. SWE is a highly informative, reproducible, and non‑invasive method for non‑traumatic rhabdomyolysis diagnosis. A threshold  Vs < 1.3 m/s serves as a highly accurate diagnostic criterion, making the technique promising for use in intensive care units.

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