Ultrasound and shear wave elastography assessment of diaphragm thickness and stiffness in malnourished pediatric patients

Our objective was to obtain information about diaphragm muscle mass, strength, and quality using conventional US and US-based imaging method shear wave elastography (SWE) in pediatric patients with primary malnutrition. We also sought to evaluate the usability of SWE in the diagnosis and follow-up of sarcopenia. We evaluated the diaphragm thickness and stiffness of patients diagnosed with primary malnutrition in the pediatrics and pediatric gastroenterology outpatient clinic using US and US-based SWE. The data were compared with those of an age- and gender-matched healthy control group. The study included 115 volunteers. Of the cases included, 53 were healthy controls and 62 (54%) were patients with primary malnutrition. There was no significant difference between the groups in terms of age and gender (p = 0.891 and p = 0.923, respectively). The malnourished patient group had significantly lower diaphragm thickness and stiffness. There is a significant positive correlation between anthropometric measurement Z scores and diaphragm thickness and stiffness.

Conclusion: Our study indicated that there was a reduction in the thickness of the diaphragm and a decline in its stiffness, which could be an indirect indicator of the quality and strength of the diaphragm muscle. These findings suggest that US and SWE evaluation of the diaphragm muscle may have the potential for use in the diagnosis and follow-up of sarcopenia. However, further comprehensive randomized controlled studies are needed to confirm this.

What is known: • Magnetic resonance imaging, computed tomography, and dual-energy x-ray absorptiometry are commonly used in the evaluation of sarcopenia. • The psoas and paraspinal muscles are commonly used in the evaluation of sarcopenia.

What is new: • Ultrasound and shear wave elastography can be used in the evaluation of pediatric sarcopenia. • Diaphragm muscle can be used in the evaluation of pediatric sarcopenia.