Diagnosis of chronic exertional compartment syndrome by post-exercise MRI

OBJECTIVE: Chronic exertional compartment syndrome (CECS) is the cause of 27% of anterior leg pain in athletes. The source of pain in this condition is still debated. Measurement of intracompartmental pressure is the gold standard diagnosis, albeit an invasive study. The development and interpretation of new MRI sequences has provided a non-invasive alternative to CECS diagnosis. Post-exercise MRI is an attractive option, which is currently undergoing its validation process. METHODS: 22 patients with a clinical diagnosis of CECS were included, with a median follow-up of 5 years (1-10 years). All the patients were evaluated by clinical examination, pre- and post-exercise MRI and pre-and post-exercise intracompartmental pressure measurement. Pressure was measured with Whitesides technique, and diagnosis was carried out by Pedowitz criteria. RESULTS: Out of the total 22 patients, 19 had positive intracompartmental measurement (15 male, 4 female) and 3 had negative measurement. All the patients had a normal MRI at rest. The three patients who had negative intracompartmental measurement had a normal post-stress MRI. Out of the remaining 19 patients, the MRI detected hyperintense signal in T2 and STIR weighted in 15 of them (78,95%). CONCLUSIONS: MRI could be relevant for diagnosis, for which case the sensitivity of this method should be improved. Nevertheless, pre- and post-stress intracompartmental measurement continues to be the gold standard.