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

Chronic exertional compartment syndrome (CECS) is currently diagnosed using invasive pressure measurements. We report the use of Tc-99(m)-methoxyisobu tyl isonitrile (Tc-99(m)-MIBI) scintigraphy as a new noninvasive method of diagnosis. Forty-six patients with suspected chronic compartment syndrome u nderwent graded treadmill exercise to reproduce the presenting symptoms. At peak exercise, 300 MBq of Tc-99(m)-MIBI were injected intravenously. Subse quent 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 stron g clinical suspicion of CECS were considered for invasive pressure measurem ents. Statistical analysis of the results for investigation of CECS using T c-99(m)-MIBI versus pressure studies gave P = 0.06. A comparison of Tc-99(m )-MIBI versus outcome gave P < 0.0001. The sensitivity was 80% and the spec ificity 97% for Tc-99(m)-MIBI Studies based on outcome. The positive predic tive value was 89% and the negative predictive value 94%. Thus Tc-99(m) MIB I can detect compartment syndromes with,good positive and negative predicti ve values. It is relatively simple, cheap and less invasive than pressure m easurements. This technique shows promise in the diagnosis of CECS. ((C) 19 99 Lippincott Williams & Wilkins).