Search

Chronic exertional compartment syndrome (CECS) is currently diagnosed using invasive pressure measurements. We report the use of 99Tcm-methoxyisobutyl isonitrile (99Tcm-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 99Tcm-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 99Tcm-MIBI versus pressure studies gave P= 0.06. A comparison of 99Tcm-MIBI versus outcome gave P< 0.0001. The sensitivity was 80 and the specificity 97 for 99Tcm-MIBI studies based on outcome. The positive predictive value was 89 and the negative predictive value 94. Thus 99Tcm-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.

Renal parenchymal transit time measurements are used in the diagnosis of obstructive nephropathy but parenchyma) regions are usually drawn by hand with or without the aid of a functional image. This paper describes three computerized methods for derivation of parenchymal regions from a mean time functional image and compares them with the manual method by processing renogram data from 82 normal, 19 obstructed and 11 dilated nonobstructed kidneys using all four techniques. Receiver-operator characteristic analysis demonstrated the computer methods to be superior to manually drawn regions. The optimum computer method had a sensitivity of 95 and specificity 95 for distinguishing obstructed kidneys from dilated nonobstructed kidneys. The computer method could be readily incorporated into routine renogram analysis programs.

A technique for using 99Tcmmethoxyisobutylisonitrile MIBI to evaluate leg muscle perfusion in the assessment of peripheral vascular disease PVD is described and evaluated. The uptake of MIBI in muscle groups is quantified and normalized to whole body activity. Eleven patients with PVD undergoing angiography and nine controls were studied. there was a significant difference in MIBI uptake in the calf P<0.000 01 and thigh P<0.0001 between the two groups on exercise. The technique has a sensitivity of 91 and specificity of 94 for the diagnosis of PVD. The technique can also effectively evaluate the severity of disease as shown by significant correlations between exercise calf flow and angiographic severity P<0.05 and Doppler anklearm pressure measurements P<0.0005. Single photon emission tomography SPET of the calves was also performed in five controls and five patients with PVD. Uptake was significantly reduced in all muscle areas in patients with PVD and, amongst those with PVD, uptake was lower in muscle groups by occluded arteries. The potential role of 99TcmMIBI in the assessment of PVD and its advantages over other methods of assessment are discussed.