An Early Detection of Acute Compartment Syndrome in Fastened Zip-Tie Rat Model Using Dynamic Phosphorous-31 Magnetic Resonance Spectroscopy at 9.4 Tesla

Abstract

IntroductionAcute compartment syndrome (ACS) leads to a series of health problems, limb salvage, disability, and even death. In vivo phosphorus-31 magnetic resonance spectroscopy (31P-MRS) provides a unique non-invasive method to assess skeletal muscle metabolisms such as inorganic phosphate (Pi), phosphocreatine (PCr), and adenosine triphosphate (ATP). The study aims to assess the ability of dynamic 31P-MRS in the early detection of muscular damage in ACS.Materials & MethodsThe study induced the fastened zip-tie model of ACS on normotensive Sprague-Dawley rats (n = 6). The spectra were acquired in Bruker 9.4-Tesla preclinical scanner using 1H/31P surface coil. 31P-MRS spectra and blood samples were obtained at time 0 (pre-ischemic phase) and every 15 minutes during the compression (120 minutes) and the reperfusion phase (90 minutes). 31P-MRS spectra findings were compared with plasma creatine phosphokinase (CPK).ResultsPCr/(Pi + PCr) ratio significantly decreased after muscle was compressed (P < 0.05). In contrast to this, CPK did not change significantly (P > 0.05). Both intracellular pH and arterial pH decreased over time. However, intracellular declined significantly (P < 0.05) at 60 minutes of ischemic state, and at 5 minutes and 60 minutes of reperfusion, while arterial pH slightly changed. After 30 minutes of ischemic, phosphomonoesters (PME) peak was detected, which was not seen at the pre-ischemic phase. It gradually increased and reached its highest peak at 120 minutes. At reperfusion state, 31P-MRS spectra and pH did not fully recover to their pre-ischemic state, and PME peak disappeared. There was a correlation between T2-weighted images and CPK from blood tests (R2 = 0.1996, P < 0.05).ConclusionsDynamic 31P-MRS technique is more clearly and rapidly detect the bioenergetic and mitochondrial functions change than blood test in a fastened zip-tie rat model of ACS. This technique is a promising non-invasive method to detect the early ischemic muscular damage in ACS.

Extremity compartment syndrome: A review with a focus on non-invasive methods of diagnosis

“…These results were further verified and the method seems suitable for diagnosing the chronic version of limb compartment syndrome ( Andreisek et al, 2009 ; Ringler et al, 2013 ). Dynamic magnetic resonance spectroscopy at 9.4 Tesla was capable of detecting ECS in an animal model ( Ohta et al, 2021 ), but the method is expensive and time-consuming, not allowing continuous monitoring in regular clinical practice. It could however be suitable for the chronic version of the syndrome, where the symptoms exacerbate after exercise and can therefore be planned.…”