High-voltage electric injury: assessment of muscle viability with MR imaging and Tc-99m pyrophosphate scintigraphy.
OBJECTIVE
To evaluate use of magnetic resonance (MR) imaging and technetium-99m pyrophosphate (PYP) scintigraphy in preoperative assessment of muscle viability after high-voltage electric injury.


METHODS
Twelve injured limbs were studied. Immediate, equilibrium, and delayed Tc-99m PYP scintigrams and gadolinium-enhanced and unenhanced MR images were obtained. Imaging results were compared with clinical findings.


RESULTS
Scintigraphy demonstrated nonperfusion in four limbs that were subsequently amputated, but MR imaging had poor sensitivity in nonperfused regions owing to lack of edema. Tc-99m PYP uptake increased at transition zones between normal and nonperfused regions. MR imaging allowed further characterization of these zones by demonstrating edema as enhancing (perfused) or nonenhancing (nonperfused). In all nonamputated limbs, edema showed enhancement.


CONCLUSIONS
In high-voltage electric injury, gadolinium-enhanced MR imaging appears able to demonstrate zones of potential viability within radionuclide-avid tissue but has poor perfusion sensitivity when used alone.
Fleckenstein
J L
JL
Department of Radiology, University of Texas Southwestern Medical Center, Dallas 75235-8896.
Chason
D P
DP
Bonte
F J
FJ
Parkey
R W
RW
Hunt
J L
JL
Purdue
G F
GF
Burns
D K
DK
D000671:Amputation, Surgical; D003287:Contrast Media; D004338:Drug Combinations; D004556:Electric Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D005121:Extremities / Q000293:injuries*; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging; D008536:Meglumine; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000293:injuries*; D009942:Organometallic Compounds; D004369:Pentetic Acid / Q000031:analogs & derivatives; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D016698:Technetium Tc 99m Pyrophosphate
D003287:Contrast Media; D004338:Drug Combinations; D009942:Organometallic Compounds; D016698:Technetium Tc 99m Pyrophosphate; D008536:Meglumine; D004369:Pentetic Acid; D019786:Gadolinium DTPA