Adding a noninvasive imaging technique to evaluate muscle changes in Duchenne patients can increase diagnostic certainty and follow-up applications without implementing any potential harm. Thus, we performed a systematic review and meta-analysis to assess the current evidence of sonography.

Duchenne muscular dystrophy (DMD) is a severe hereditary neuromuscular disease due to variation in the dystrophin gene. Diagnostic criteria rely mainly on clinical and laboratory examination along with genetic analysis. Some studies have recorded different sonographic parameters as a novel method to track disease change.

Through Web of Science, PubMed, Scopus, and Embase, we conducted a systematic review and meta-analysis of studies that compared sonographic muscle values between DMD patients and healthy controls. After setting the eligibility criteria, data extraction, and quality assessment of the identified studies, we performed statistical analysis using Revman 5.4 and Open Meta analyst.

As different sonographic parameters were recorded, twenty studies were included, with a total of 446 patients and 428 controls. DMD patients demonstrated significantly higher values in calibrated muscle backscatter (dB) with a mean difference (MD) of 4.83 and 4.47 for elbow flexors and rectus femoris, respectively. In addition, the grayscale echo intensity (EI) showed higher values with a MD of 24.70 and 31.05 for the biceps and quadriceps, respectively. However, the results of the cross-sectional muscle area, fascial muscle length, and muscle thickness of different muscle groups in DMD patients mostly yielded no potential difference.

We propose that sonographic application, combined with the standard clinical and serological assessment, adds value to the clinical practice by increasing diagnostic certainty and follow-up longitudinal evaluations.