Assessing spinal muscular atrophy with quantitative ultrasound
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To the Editor: We read the article by Wu et al.1 with interest. The authors report a new quantitative method for muscle ultrasound (US) in spinal muscular atrophy (SMA).
Previous studies reported that quantitative US is a reliable, noninvasive technique for evaluating neuromuscular disorders.2 New quantitative methods less influenced by US hardware and settings would be welcome. The authors present a novel method of quantifying muscle echogenicity. Establishing normal values via internal references as proposed would eliminate the present need to convert normal values from one US device to another, which is quite time-consuming. However, there are several limitations to this approach.
Many variables will affect the proposed echo intensity (referred to as luminosity) ratio (LR). Each machine, even by the same manufacturer, will have varying ultrasonic properties that will not result in uniform echogenicity of muscle and subcutaneous fat. This technique assumes these properties will vary proportionally and as a result the ratio will remain fixed. This assumption is untested …
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