Imaging-based quantification of myosteatosis: a narrative review of main principles, techniques, and clinical applications.
- 1Université Paris-Saclay, CNRS, Inerm, CEA, Laboratoire d'Imagerie Biomédicale Multimodale (BioMaps), Service Hospitalier Frédéric Joliot, Orsay, France.
Abstract
Intramuscular fat infiltration, commonly referred to as myosteatosis, has emerged as an important biomarker of skeletal muscle quality and is increasingly associated with aging, sarcopenia, metabolic disorders, neuromuscular diseases, and reduced functional outcomes. As interest in muscle composition grows, imaging techniques capable of quantifying intramuscular fat have become essential for both clinical assessment and research applications. Magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound (US) each provide distinct approaches for evaluating muscle fat content, relying on different physical principles, biomarkers, and quantitative frameworks. This article provides an overview of the principal imaging modalities currently used for intramuscular fat quantification, with emphasis on their physical foundations, quantitative biomarkers, methodological developments, and clinical applicability. We conducted a literature search on Google Scholar and PubMed using the following keywords: "myosteatosis", "muscle fat", "CT", "MRI" and "ultrasound", as well as more specific topics regarding corresponding modalities, methods, or limitations encountered: "muscle attenuation", "material decomposition", "PDFF", "Dixon", "echo intensity", "echo attenuation", "speed of sound". The included papers focus on the measurements of muscle fat content using CT, MRI, or US. This paper reviews the three main imaging modalities to assess muscle fat content: CT, MRI, and US. It details the working physical principles, and introduces the existing methods applied to assess fat content inside the muscles. While some methods are already used in clinical practice, there remain limitations that are detailed and discussed to improve the myosteatosis assessment. While significant progress has been made in imaging-based quantification of intramuscular fat, no single modality currently satisfies all clinical and research requirements. A nuanced understanding of each technique's strengths and limitations is essential to guide their appropriate use, and continued methodological advancements will be key to improving their reliability.
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BibTeX
@article{leriche2026imagingbased,
title = {{Imaging-based quantification of myosteatosis: a narrative review of main principles, techniques, and clinical applications.}},
author = {Maxime Leriche and Angéline Nemeth and Jean-Luc Gennisson},
journal = {Quantitative imaging in medicine and surgery},
year = {2026},
month = sep,
doi = {10.21037/qims-2026-1262},
url = {https://europepmc.org/article/MED/42997952},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Imaging-based quantification of myosteatosis: a narrative review of main principles, techniques, and clinical applications.
AU - Maxime Leriche
AU - Angéline Nemeth
AU - Jean-Luc Gennisson
PY - 2026
DA - 2026/09/29
JO - Quantitative imaging in medicine and surgery
DO - 10.21037/qims-2026-1262
UR - https://europepmc.org/article/MED/42997952
AB - Intramuscular fat infiltration, commonly referred to as myosteatosis, has emerged as an important biomarker of skeletal muscle quality and is increasingly associated with aging, sarcopenia, metabolic disorders, neuromuscular diseases, and reduced functional outcomes. As interest in muscle composition grows, imaging techniques capable of quantifying intramuscular fat have become essential for both clinical assessment and research applications. Magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound (US) each provide distinct approaches for evaluating muscle fat content, relying on different physical principles, biomarkers, and quantitative frameworks. This article provides an overview of the principal imaging modalities currently used for intramuscular fat quantification, with emphasis on their physical foundations, quantitative biomarkers, methodological developments, and clinical applicability. We conducted a literature search on Google Scholar and PubMed using the following keywords: "myosteatosis", "muscle fat", "CT", "MRI" and "ultrasound", as well as more specific topics regarding corresponding modalities, methods, or limitations encountered: "muscle attenuation", "material decomposition", "PDFF", "Dixon", "echo intensity", "echo attenuation", "speed of sound". The included papers focus on the measurements of muscle fat content using CT, MRI, or US. This paper reviews the three main imaging modalities to assess muscle fat content: CT, MRI, and US. It details the working physical principles, and introduces the existing methods applied to assess fat content inside the muscles. While some methods are already used in clinical practice, there remain limitations that are detailed and discussed to improve the myosteatosis assessment. While significant progress has been made in imaging-based quantification of intramuscular fat, no single modality currently satisfies all clinical and research requirements. A nuanced understanding of each technique's strengths and limitations is essential to guide their appropriate use, and continued methodological advancements will be key to improving their reliability.
SN - 2223-4292
SN - 2223-4306
ER -