Skip to main content
. Author manuscript; available in PMC: 2023 Oct 1.
Published in final edited form as: Circ Heart Fail. 2022 Aug 4;15(10):e009322. doi: 10.1161/CIRCHEARTFAILURE.121.009322

Table 2.

Summary of the commonly used imaging techniques for skeletal muscle evaluation.

Imaging modality Advantages Limitations Measurements Heart failure specific concerns
Computed tomography Gold standard. High accuracy. Measures muscle quantity and quality. Numerous indications allow opportunistic use. Relatively expensive. Requires high space. Low availability. High radiation risk. No cutoff values. Cross-sectional area of individual or group of muscles. Attenuation values. Commonly used L3 level is of low opportunistic utility in cardiac conditions. Metal artifact from cardiac implantable electronic devices.
Magnetic resonance imaging Gold standard. High accuracy. Best spatial resolution. Measures muscle quantity and quality. No radiation risk. Expensive. Requires high space. Low availability. Contraindications. No cutoff values. Long acquisition time. Cross-sectional area of individual or group of muscles. Fat content by Dixon imaging. Experimental advanced sequences. Provider concern for safety with cardiac implantable electronic devices.
Dual-energy x-ray absorptiometry Good accuracy. Cheap. Widely available. Low radiation risk. Cutoff values available. Low uniformity between protocols. No muscle quality data. Whole-body and appendicular lean mass. Confounded by edema and obesity.
Bioelectrical impedance analysis Cheap. Portable. Minimal maintenance. Immediate results. Measures muscle quantity and quality. Less accurate than gold standard methods. No muscle quality data. Fat mass and fat-free mass. Confounded by edema.
Ultrasound Cheap. Portable. Reliable. Measures muscle quantity and quality. Operator dependent. Low standardization. Cutoffs are population and device specific. Muscle thickness, cross-sectional area, and volume. Pennation angle. Fascicle length. Echo-intensity. Muscle stiffness. Contraction potential. Micro-circulation.
Anthropometric measures Cheap. Easy to perform. Minimal resources required. Inaccurate. No muscle quality data. Calf and mid-upper arm circumference. A Body Shape Index. Confounded by edema.