{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T12:07:47Z","timestamp":1779797267511,"version":"3.53.1"},"reference-count":18,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Spasticity is a common and disabling symptom of multiple sclerosis (MS), yet its assessment remains challenging. Clinical scales such as the Ashworth Scale (AS) evaluate resistance to passive movement, whereas neurophysiological measures (e.g., H-reflex, F-wave) provide objective indices of \u03b1-motoneuron excitability but correlate inconsistently with clinical severity. Real-time ultrasound elastography (RTE) enables semi-quantitative, in vivo assessment of muscle stiffness, while the recently introduced Muscle Elastography Multiple Sclerosis Score (MEMSs) aims to classify muscle spasticity in MS. Objective: To evaluate the utility of RTE using MEMSs for the objective assessment of muscle status in MS patients with spasticity, and to compare elastographic findings with clinical and neurophysiological measures. Methods: In this single-center study, 26 MS patients (diagnosed according to the 2017 McDonald criteria) and age- and sex-matched healthy controls (n = 27) were enrolled. Spasticity was graded using the AS. All participants underwent bilateral RTE of the gastrocnemius muscle, with images independently scored by two blinded neurologists using the 5-point MEMSs scale. Neurophysiological assessment included the soleus H-reflex, with calculation of H\/M ratios. Correlations were analyzed using Pearson\u2019s coefficient, and inter-observer reliability was assessed. Results: No consistent or statistically robust associations were found between clinical spasticity severity (AS scores) and either neurophysiological or elastographic parameters. Several MEMSs did not correlate reliably with AS grades, and neurophysiological measures showed limited discriminatory ability between MS patients and healthy controls. Correlations between neurophysiological and elastography parameters were weak to moderate (\u03c1 ranging from \u22120.49 to 0.45). Inter-observer reliability of MEMSs scoring ranged from poor to moderate across the examined muscle groups, with Cohen\u2019s \u03ba values ranging from \u22120.02 to 0.54. Conclusions: RTE using MEMSs did not demonstrate sufficient validity or reproducibility for assessing muscle spasticity in MS, showing poor agreement with both clinical and neurophysiological measures.<\/jats:p>","DOI":"10.3390\/jcm15114095","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T11:02:51Z","timestamp":1779793371000},"page":"4095","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-Time Ultrasound Elastography in Multiple Sclerosis Spasticity: Comparison with Clinical and Neurophysiological Measures"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7002-9795","authenticated-orcid":false,"given":"Eleni","family":"Bakola","sequence":"first","affiliation":[{"name":"Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0163-7455","authenticated-orcid":false,"given":"Marianna","family":"Papadopoulou","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, 12462 Athens, Greece"},{"name":"Department of Physiotherapy, University of West Attica, 12243 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2305-6627","authenticated-orcid":false,"given":"Maria-Ioanna","family":"Stefanou","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7496-1195","authenticated-orcid":false,"given":"Athanasios K.","family":"Chasiotis","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, 12462 Athens, Greece"},{"name":"Department of Physiotherapy, University of West Attica, 12243 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3496-7543","authenticated-orcid":false,"given":"Stella","family":"Fanouraki","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2865-048X","authenticated-orcid":false,"given":"Angeliki-Erato","family":"Sterpi","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0722-9329","authenticated-orcid":false,"given":"Dimitrios","family":"Kitsos","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0640-3797","authenticated-orcid":false,"given":"Georgios","family":"Tsivgoulis","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1177\/016173469101300201","article-title":"Elastography: A quantitative method for imaging the elasticity of biological tissues","volume":"13","author":"Ophir","year":"1991","journal-title":"Ultrason. Imaging"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.diii.2013.01.022","article-title":"Ultrasound elastography: Principles and techniques","volume":"94","author":"Gennisson","year":"2013","journal-title":"Diagn. Interv. Imaging"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1148\/radiol.2391041676","article-title":"Breast disease: Clinical application of US elastography for diagnosis","volume":"239","author":"Itoh","year":"2006","journal-title":"Radiology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1111\/j.1464-410X.2007.06851.x","article-title":"Real-time elastography for detecting prostate cancer: Preliminary experience","volume":"100","author":"Pallwein","year":"2007","journal-title":"BJU Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1016\/j.crad.2009.08.006","article-title":"Real-time ultrasound elastography of the normal Achilles tendon: Reproducibility and pattern description","volume":"64","author":"Drakonaki","year":"2009","journal-title":"Clin. Radiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1055\/s-0030-1254521","article-title":"Is sonoelastography of value in assessing tendons?","volume":"14","author":"Klauser","year":"2010","journal-title":"Semin. Musculoskelet. Radiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s11910-019-0991-2","article-title":"Assessment and Measurement of Spasticity in MS: State of the Evidence","volume":"19","author":"Hugos","year":"2019","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1111\/j.1748-1716.2006.01652.x","article-title":"The spinal pathophysiology of spasticity\u2014From a basic science point of view","volume":"189","author":"Nielsen","year":"2007","journal-title":"Acta Physiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1080\/09638280400014576","article-title":"Spasticity: Clinical perceptions, neurological realities and meaningful measurement","volume":"27","author":"Pandyan","year":"2005","journal-title":"Disabil. Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1007\/s10072-016-2780-x","article-title":"Muscle elastography: A new imaging technique for multiple sclerosis spasticity measurement","volume":"38","author":"Illomei","year":"2017","journal-title":"Neurol. Sci."},{"key":"ref_11","unstructured":"Harb, A., Margetis, K., and Kishner, S. (2025). Modified Ashworth Scale. StatPearls, StatPearls Publishing."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1080\/09638280400014600","article-title":"Neurophysiological methods for the assessment of spasticity: The Hoffmann reflex, the tendon reflex, and the stretch reflex","volume":"27","author":"Voerman","year":"2005","journal-title":"Disabil. Rehabil."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/S1474-4422(17)30470-2","article-title":"Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria","volume":"17","author":"Thompson","year":"2018","journal-title":"Lancet Neurol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1177\/0269215508101747","article-title":"Spasticity, an impairment that is poorly defined and poorly measured","volume":"23","author":"Malhotra","year":"2009","journal-title":"Clin. Rehabil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1093\/ptj\/67.2.206","article-title":"Interrater reliability of a modified Ashworth scale of muscle spasticity","volume":"67","author":"Bohannon","year":"1987","journal-title":"Phys. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"He, J., Luo, A., Yu, J., Qian, C., Liu, D., Hou, M., and Ma, Y. (2023). Quantitative assessment of spasticity: A narrative review of novel approaches and technologies. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1121323"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1259\/bjr\/93042867","article-title":"Ultrasound elastography for musculoskeletal applications","volume":"85","author":"Drakonaki","year":"2012","journal-title":"Br. J. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.jclinepi.2010.03.002","article-title":"Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed","volume":"64","author":"Kottner","year":"2011","journal-title":"J. Clin. Epidemiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4095\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T11:30:23Z","timestamp":1779795023000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4095"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":18,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15114095"],"URL":"https:\/\/doi.org\/10.3390\/jcm15114095","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,26]]}}}