Exploring ultrasonography changes in calf muscle myopathy due to chronic venous disease: Correlation with histopathology in a cohort of 200 patients.

PurposeChronic venous disease (CVD) of lower extremities is a common disease having considerable morbidity and mortality in affected patients. Myopathy in venous insufficiency affects mainly the calf muscles. Undiagnosed and untreated patients experience persistent symptoms even after surgery for CVD. Conventionally, muscle biopsy is considered as the gold standard diagnostic investigation for myopathy. Ultrasonography has excellent spatial resolution and soft tissue contrast, making it a potentially useful initial, non-invasive imaging investigation for this condition.AimTo identify the ultrasonography features of calf muscle myopathy in chronic venous disease and to establish their correlation with histopathological findings.Material and MethodsThis article employed a descriptive study design. Written and informed consent was obtained from all participants prior to inclusion in the study. After history taking and clinical examination, all the participants underwent comprehensive lower limb ultrasonography evaluation with venous Duplex ultrasound (DUS) imaging using high frequency linear transducers. The study population included a selective cohort of 200 patients suffering from CVD of lower limbs and having abnormal ultrasonography appearance of calf muscles on B mode ultrasound. The study population was categorized into three grades on the basis of echogenicity, fibrillary architecture and size of gastrocnemius muscle as seen on ultrasonography. Later, ultrasound guided biopsies of gastrocnemius muscle were performed in all the patients. This was a blinded study as the radiologist was blinded to histopathology findings and the pathologist was blinded to the ultrasonography report. The ultrasonography findings were later correlated with histopathology features to determine association.ResultsThe demographic analysis showed obvious female preponderance (67% females vs 33% males). The mean age of study population was 50.3 (±11.25) years. Increased prevalence was noted in higher BMI (mean ± SD = 25.8 ± 4.0 kg/m2) patients and occupations involving long standing hours. According to CEAP classification, 'C2' clinical class of disease was the most common among study participants (30.5%). Highest number of patients were recorded having Grade 2 myopathy (53.5%) followed by Grade 1 (25%) and Grade 3 (21.5%) disease. The most commonly involved muscle was gastrocnemius (100%) followed by tibialis anterior, tibialis posterior, deep flexors and extensors. It was observed that with longer duration and higher 'C' class of the disease, increased number of muscles showed changes of myopathy and correspondingly higher grades of myopathy were noted. Based on correlation analysis using cross tabulation, a Spearman rank correlation coefficient (rho = 0.73; p value <0.001), Chi square test (x2 = 170.5, p < 0.001) and Cramer's V (V = 0.65) were computed. These statistics revealed presence of significant association between the ultrasonography and histopathology findings.ConclusionChronic venous disease associated myopathy is a progressive phenomenon which impacts disease prognosis and patient treatment. This article explores the potential use of ultrasonography as an initial, non-invasive imaging investigation in CVD associated myopathy, due to its strong positive correlation with the severity of histopathological changes in a selected cohort of patients suffering from CVD associated calf muscle myopathy. In addition, the ultrasound grading system proposed in the article aims to standardise reporting of CVD associated myopathy in order to give the clinician a better understanding of disease severity and its temporal progression.