Standardizing shear wave elastography for sarcopenia assessment: A necessary step forward

We read with great interest the recent systematic review by Gutiu et al. in Geriatrics & Gerontology International, titled “Muscle elasticity variations in assessing age-related changes in adults”.¹ The authors are to be commended for their excellent work in synthesizing the complex and often contradictory literature on the use of shear wave elastography (SWE) to assess age-related muscle changes.

The most cautionary conclusion of the review is the authors' inability to carry out a meta-analysis due to “substantial variability in methodologies” across studies.¹ This is not a limitation of the review, but a powerful statement on the current state of the field. This finding highlights a systemic issue: methodological inconsistency has become a primary barrier to translating SWE from a research tool to a clinical application, creating a critical “translational gap.” Without standardization, large-scale validation studies are impossible; without validation, SWE cannot be integrated into clinical guidelines, such as those defined by the European Working Group on Sarcopenia in Older People,² for the diagnosis and monitoring of sarcopenia. This is not an isolated problem; other reviews have similarly noted a “striking lack of consensus” and a “pressing need for developing standardized, validated scanning protocols” in musculoskeletal SWE research.³

Therefore, we support and echo the conclusion of Gutiu et al. that “refining standardized SWE protocols” is an urgent priority.¹ We further propose the formation of an international working group composed of experts in geriatrics, radiology, rehabilitation medicine and biomedical engineering/physics. This cross-disciplinary collaboration is crucial, as the solution requires not only clinical consensus, but also the deep understanding of the underlying physics of SWE technology that physicists and engineers can provide, thereby bridging the gap between clinical needs and technical reality. The success of similar consensus-building initiatives in establishing standardized guidelines for liver elastography⁹ and the broader push for structured reporting in radiology¹⁰ underscore the feasibility and importance of such an endeavor.

Only through such rigorous standardization can we facilitate multicenter studies and meta-analyses, establish reliable normative reference values, and ultimately validate the full potential of SWE as a non-invasive, accessible biomarker in the diagnosis and management of sarcopenia and age-related muscle decline.

The authors received no specific funding for this work.

The authors declare no conflict of interest.

Y-CC conceived the study, carried out the literature search and drafted the manuscript. C-CH provided critical revision, supervised the project and is the guarantor. Both authors have read and approved the final manuscript.

This article is a commentary on a previously published study and does not involve human participants or animals. Therefore, institutional review board approval was not required.