Developing an in-vivo physiological porcine model of inducing acute atraumatic compartment syndrome towards a non-invasive diagnosis using shear wave elastography

Jong Woo Kang,Jong Woong Park,Tae Hyun Lim,Song Joo Lee,Keun Tae Kim

doi:10.1038/s41598-021-01405-0

Abstract

Compartment syndrome (CS) is a pathological event caused by elevated intracompartmental pressure (ICP); however, changes from the onset of inducing atraumatic CS remained unclear. The study aimed to investigate the physiological changes in a newly developed in vivo porcine acute atraumatic CS model. CS was induced by ischemia–reperfusion injury in the left hind leg of fourteen pigs divided into an echogenicity group (EG) and a shear wave elastography group (SEG). Echogenicity was measured in EG, and shear elastic modulus (SEM) was measured in SEG seven times before, at the onset of inducing CS, and every 30 min after the onset over eight hours. Simultaneously, ICP, blood pressure, and muscle perfusion pressure (MPP) were also measured in both groups. Our results indicate that SEM of the experimental leg in SEG significantly increased as CS developed compared to the control leg (p = 0.027), but no statistical difference in the echogenicity in EG was found between the experimental leg and control leg. There were also significant correlations between SEM and ICP (p < 0.001) and ICP and MPP (p < 0.001). Our method and findings can be a basis to develop a non-invasive diagnostic tool using a shear wave elastography for atraumatic CS.

Highlights

Compartment syndrome (CS) is a pathological event caused by elevated intracompartmental pressure (ICP); changes from the onset of inducing atraumatic CS remained unclear
Wilcoxon rank-sum tests revealed that there were no significant differences in the ICP and perfusion pressure of the experimental legs between the Echogniecity Group (EG) and Shear wave elastography group (SEG) at each time point
Analysis revealed that there was a significant correlation between the elastography and the ICP (p < 0.001, ρ = 0.458) and the perfusion pressure and the ICP (p < 0.001, ρ = − 0.477); no correlation between the elastography and perfusion pressure. This is the first study to investigate comprehensive measurements related to detecting CS using an in vivo porcine acute atraumatic CS leg model

Summary

Introduction

Compartment syndrome (CS) is a pathological event caused by elevated intracompartmental pressure (ICP); changes from the onset of inducing atraumatic CS remained unclear. A recent study demonstrated that there is a significant correlation between the ICP and shear modulus obtained from shear wave elastography (SWE) among healthy individuals[24], there are no comprehensive studies simultaneously investigating echogenicity, muscle elasticity, and arterial blood flow in an in vivo acute atraumatic CS model. Understanding comprehensive physiological changes associated with CS can be further possible by measuring these values simultaneously since there can be a significant relationship between the muscle perfusion pressure associated with blood pressure and ICP. The authors devised a physiologic porcine leg model for acute atraumatic CS and intended to investigate the correlations of ICP and changes in muscle echogenicity, elasticity, and arterial blood flow velocity on ultrasound during acute CS. Our findings and methods in this study can be used to further develop a new non-invasive sonographic technique that is safe, accurate, and reproducible in measuring and monitoring ICP in the future

Methods

Results

Conclusion