Muscles alive: ultrasound detects fibrillations.
OBJECTIVE
Muscle ultrasound is capable of visualizing muscle movements. Recent improvements in ultrasound technology have raised the question whether it is also possible to detect small-scale spontaneous muscle activity such as denervation. In this study we investigated the ability of dynamic muscle ultrasound to detect fibrillations.


METHODS
Eight patients with fibrillations were measured simultaneously by ultrasound and EMG to verify which movements on ultrasound examination corresponded to fibrillation potentials on EMG. The temperature dependency of ultrasound detected fibrillations and the observer agreement was assessed in five healthy subjects with focal denervation induced by botulinum toxin.


RESULTS
Fibrillations appeared on ultrasound examination as small, irregularly oscillating movements within the muscle while the overall shape of the muscle remains undisturbed. Visibility of fibrillations with ultrasound decreased with lower temperatures, with a 32% decrease at 30 degrees C compared to 39 degrees C. The interobserver agreement was substantial with a kappa of 0.65 for experienced observers.


CONCLUSIONS
Fibrillations could be visualized with ultrasound. Consistent results could be obtained from trained observers. Care has to be taken to ensure an optimal muscle temperature to avoid false negative results, especially in distal muscles.


CONCLUSIONS
Visualization of fibrillations by muscle ultrasound opens the way for a new diagnostic application of this technique.
Department of Clinical Neurophysiology, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. S.pillen@cukz.umcn.nl
Sigrid
S
Pillen
Mark
M
Nienhuis
Johannes P
JP
van Dijk
Ilse M P
IM
Arts
Nens
N
van Alfen
Machiel J
MJ
Zwarts
D000200:Action Potentials / Q000502:physiology; D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A; D003714:Denervation; D004576:Electromyography / Q000379:methods; D006801:Humans; D009119:Muscle Contraction / Q000502:physiology*; D018485:Muscle Fibers, Skeletal / Q000502:physiology; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D009135:Muscular Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D009465:Neuromuscular Agents; D011237:Predictive Value of Tests; D014463:Ultrasonography / Q000379:methods*
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A