A muscle ultrasound score in the diagnosis of amyotrophic lateral sclerosis.
The aims of this study are to elucidate the frequencies and distribution of fasciculations using muscle ultrasound in patients with amyotrophic lateral sclerosis (ALS) and those with other conditions mimicking ALS, and subsequently to develop a novel fasciculation score for the diagnosis of ALS.



Ultrasound of 21 muscles was performed to detect fasciculations in 36 consecutive patients suspected of having ALS. We developed a fasciculation ultrasound score that indicated the number of muscles with fasciculations in statistically selected muscles.



A total of 525 muscles in 25 ALS patients and 231 in 11 non-ALS patients were analysed. Using relative operating characteristic and multivariate logistic regression analysis, we selected the trapezius, deltoid, biceps brachii, abductor pollicis brevis, abdominal, vastus lateralis, vastus medialis, biceps femoris, and gastrocnemius muscles for the fasciculation ultrasound score. The mean scores were higher in the ALS group than those in the non-ALS group (5.3±0.5vs. 0.3±0.7) (mean±SD); p<0.001.



Two or more of the fasciculation ultrasound scores showed high sensitivity and specificity in differentiating ALS patients from non-ALS patients.



The fasciculation ultrasound score can be a simple and useful diagnostic marker of ALS.
Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Yukiko
Y
Tsuji
Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. Electronic address: y-noto@koto.kpu-m.ac.jp.
Yu-Ichi
YI
Noto
Department of Medical Education and Primary Care, Graduate School of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Kensuke
K
Shiga
Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Satoshi
S
Teramukai
North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Masanori
M
Nakagawa
Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Toshiki
T
Mizuno
D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D005207:Fasciculation / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods* / Q000592:standards
ALSFRS-R; Amyotrophic lateral sclerosis; Fasciculation; Muscle ultrasound; Revised ALS Functional Rating Scale; Ultrasonography