A new non-invasive test for the detection of compartment syndromes

SUMMARYChronic exertional compartment syndrome (CECS) is currently diagnosed using invasive pressure measurements. We report the use of Tc-methoxyisobutyl isonitrile (Tc-MIBI) scintigraphy as a new noninvasive method of diagnosis. Forty-six patients with suspected chronic compartment syndrome underwent graded treadmill exercise to reproduce the presenting symptoms. At peak exercise, 300 MBq of Tc-MIBI were injected intravenously. Subsequent cross-sectional imaging provided by emission tomography demonstrated regional abnormalities in muscle perfusion in the calf. A repeat study was performed at rest the following day. All patients in whom there was a strong clinical suspicion of CECS were considered for invasive pressure measurements. Statistical analysis of the results for investigation of CECS using Tc-MIBI versus pressure studies gave P = 0.06. A comparison of Tc-MIBI versus outcome gave P < 0.0001. The sensitivity was 80% and the specificity 97% for Tc-MIBI studies based on outcome. The positive predictive value was 89% and the negative predictive value 94%. Thus Tc-MIBI can detect compartment syndromes with good positive and negative predictive values. It is relatively simple, cheap and less invasive than pressure measurements. This technique shows promise in the diagnosis of CECS.