153646 20260227124019.0 doi 10.3390/jcm14092902 sideral 143729 ART-2025-143729 eng Asadi, Borhan Universidad de Zaragoza Improving the Reliability of Muscle Tissue Characterization Post-Stroke: A Secondary Statistical Analysis of Echotexture Features 2025 Access copy available to the general public Unrestricted Background/Objectives: Ultrasound (US) imaging and echotexture analysis are emerging techniques for assessing muscle tissue quality in the post-stroke population. Clinical studies suggest that echovariation (EV) and echointensity (EI) serve as objective indicators of muscle impairment, although methodological limitations hinder their clinical translation. This secondary analysis aimed to refine the assessment of echotexture by using robust statistical techniques. Methods: A total of 130 regions of interest (ROIs) extracted from the gastrocnemius medialis of 22 post-stroke individuals were analyzed. First, inter-examiner reliability between two physiotherapists was assessed by using Cohen’s kappa for muscle impairment classification (low/high) for each echotexture feature. For each examiner, the correlation between the classification of the degree of impairment and the modified Heckmatt scale for each feature was analyzed. The dataset was then reduced to 44 ROIs (one image per leg per patient) and assessed by three physiotherapists to analyze inter-examiner reliability by using Light´s kappa and correlation between both assessment methods globally. Statistical differences in 21 echotexture features were evaluated according to the degree of muscle impairment. A binary logistic regression model was developed by using features with a Cohen’s kappa value greater than 0.9 as predictors. Results: A strong and significant degree of agreement was observed among the three examiners regarding the degree of muscle impairment (Kappalight = 0.85, p < 0.001), with nine of the 21 features showing excellent inter-examiner reliability. The correlation between muscle impairment classification with the modified Heckmatt scale was very high and significant both globally and for each echotexture feature. Significant differences (<0.05) were found for EV, EI, dissimilarity, energy, contrast, maximum likelihood, skewness, and the modified Heckmatt scale. Logistic regression highlighted dissimilarity, entropy, EV, Gray-Level Uniformity (GLU), and EI as the main predictors of muscle tissue impairment. The EV and EI models showed high explanatory power (Nagelkerke’s pseudo-R2 = 0.74 and 0.76) and robust classification performance (AUC = 94.20% and 95.45%). Conclusions: This secondary analysis confirms echotexture analysis as a reliable tool for post-stroke muscle assessment, validating EV and EI as key indicators while identifying dissimilarity, entropy, and GLU as additional relevant features. info:eu-repo/semantics/openAccess by https://creativecommons.org/licenses/by/4.0/deed.es info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Cuenca-Zaldívar, Juan Nicolás Carcasona-Otal, Alberto Universidad de Zaragoza (orcid)0009-0003-8000-7084 Herrero, Pablo Universidad de Zaragoza (orcid)0000-0002-9201-0120 Lapuente-Hernández, Diego Universidad de Zaragoza (orcid)0000-0002-6506-6081 1006 245 Universidad de Zaragoza Dpto. Fisiatría y Enfermería Área Educación Física y Depor. 1006 413 Universidad de Zaragoza Dpto. Fisiatría y Enfermería Área Fisioterapia 14, 9 (2025), 2902 [12 pp.] J. clin.med. Journal of Clinical Medicine 2077-0383 403724 http://zaguan.unizar.es/record/153646/files/texto_completo.pdf Versión publicada 2805386 http://zaguan.unizar.es/record/153646/files/texto_completo.jpg?subformat=icon icon Versión publicada oai:zaguan.unizar.es:153646 articulos driver 2026-02-27-12:39:20 ARTICLE