CHRONIC EXERTIONAL COMPARTMENT SYNDROME IN LOWER LEGS - LOCALIZATION AND FOLLOW-UP WITH TL-201 SPECT IMAGING

The purpose of this study was to ascertain whether Tl-201 SPECT imagin g of the leg is useful in precise localization of the ischemic compart ment involved in chronic exertional compartment syndrome (CECS). Metho ds: Imaging and quantitative analyses of postexercise Tl-201 SPECT leg examinations were retrospectively performed in nine patients with cli nically diagnosed CECS and eight control subjects. Imaging and quantit ative criteria for the ischemic compartment were decreased Tl-201 perf usion less than the lower limits of normal, which were defined as 2 s. d. below the mean percentage uptake of the control subjects. The SPECT imaging results were compared with those of quantitative analysis, po stoperative SPECT images and clinical diagnoses. Results: Postexercise normal legs had nonuniform Tl-201 distribution in both legs and in th e four compartments. Lower limits of normal mean percentage Tl-201 upt ake were about 60% for the anterior compartment and about 50% for the other three compartments. Redistribution was observed in 67% of normal compartments in the control subjects, The SPECT images demonstrated 1 6 ischemic compartments in eight of the nine patients. The SPECT resul ts were consistent with those of quantitative analysis. There were dis crepancies between the clinical and SPECT diagnoses in six legs (33% o f the 18 legs) of five patients. Postoperative SPECT demonstrated Tl-2 01 perfusion was improved in all involved compartments for that fascio tomy was performed, Conclusion: Thallium-201 SPECT imaging of the legs can easily provide precise localization of the ischemic compartment, which is demonstrated as decreased Tl-201 distribution on the stress i mage. This technique is promising for the screening and follow-up of C ECS.