Ultrasound imaging of the human medial gastrocnemius muscle: How to orient the transducer so that muscle fascicles lie in the image plane

The length and pennation of muscle fascicles are frequently measured using ultrasonography. Conventional ultrasonography imaging methods only provide two-dimensional images of muscles, but muscles have complex three-dimensional arrangements. The most accurate measurements will be obtained when the ultrasound transducer is oriented so that endpoints of a fascicle lie on the ultrasound image plane and the image plane is oriented perpendicular to the aponeurosis, but little is known about how to find this optimal transducer orientation in the frequently-studied medial gastrocnemius muscle. In the current study, we determined the optimal transducer orientation at 9 sites in the medial gastrocnemius muscle of 8 human subjects by calculating the angle of misalignment between three-dimensional muscle fascicles, reconstructed from diffusion tensor images, and the plane of a virtual ultrasound image. The misalignment angle was calculated for a range of tilts and rotations of the ultrasound transducer relative to a reference orientation that was perpendicular to the skin and parallel to the tibia. With the transducer in the reference orientation, the misalignment was substantial (mean across sites and subjects of 6.5°, range 1.4 to 20.2°). However for all sites and subjects a near-optimal alignment (on average 2.6°, range 0.5° to 6.0°) could be achieved by maintaining 0° tilt and applying a small rotation (typically less than 10°). On the basis of these data we recommend that ultrasonographic measurements of medial gastrocnemius muscle fascicle architecture be obtained, at least for relaxed muscles under static conditions, with the transducer oriented perpendicular to the skin and nearly parallel to the tibia.