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).