title: Time-dependent diffusion in skeletal muscle with the random permeable barrier model (RPBM): application to normal controls and chronic exertional compartment syndrome patients.
abstract: The purpose of this work was to carry out diffusion tensor imaging (DTI) at multiple diffusion times Td in skeletal muscle in normal subjects and chronic exertional compartment syndrome (CECS) patients and analyze the data with the random permeable barrier model (RPBM) for biophysical specificity. Using an institutional review board approved HIPAA-compliant protocol, seven patients with clinical suspicion of CECS and eight healthy volunteers underwent DTI of the calf muscle in a Siemens MAGNETOM Verio 3 T scanner at rest and after treadmill exertion at four different T(d) values. Radial diffusion values λ(rad) were computed for each of seven different muscle compartments and analyzed with RPBM to produce estimates of free diffusivity D(0), fiber diameter a, and permeability κ. Fiber diameter estimates were compared with measurements from literature autopsy reference for several compartments. Response factors (post/pre-exercise ratios) were computed and compared between normal controls and CECS patients using a mixed-model two-way analysis of variance. All subjects and muscle compartments showed nearly time-independent diffusion along and strongly time-dependent diffusion transverse to the muscle fibers. RPBM estimates of fiber diameter correlated well with corresponding autopsy reference. D(0) showed significant (p < 0.05) increases with exercise for volunteers, and a increased significantly (p < 0.05) in volunteers. At the group level, response factors of all three parameters showed trends differentiating controls from CECS patients, with patients showing smaller diameter changes (p = 0.07), and larger permeability increases (p = 0.07) than controls. Time-dependent diffusion measurements combined with appropriate tissue modeling can provide enhanced microstructural specificity for in vivo tissue characterization. In CECS patients, our results suggest that high-pressure interfiber edema elevates free diffusion and restricts exercise-induced fiber dilation. Such specificity may be useful in differentiating CECS from other disorders or in predicting its response to either physical therapy or fasciotomy.
authors.affiliation: Department of Radiology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Eric E
authors.initials: EE
authors.lastname: Sigmund
authors.forename: Dmitry S
authors.initials: DS
authors.lastname: Novikov
authors.forename: Dabang
authors.initials: D
authors.lastname: Sui
authors.forename: Obehi
authors.initials: O
authors.lastname: Ukpebor
authors.forename: Steven
authors.initials: S
authors.lastname: Baete
authors.forename: James S
authors.initials: JS
authors.lastname: Babb
authors.forename: Kecheng
authors.initials: K
authors.lastname: Liu
authors.forename: Thorsten
authors.initials: T
authors.lastname: Feiweier
authors.forename: Jane
authors.initials: J
authors.lastname: Kwon
authors.forename: Kellyanne
authors.initials: K
authors.lastname: McGorty
authors.forename: Jenny
authors.initials: J
authors.lastname: Bencardino
authors.forename: Els
authors.initials: E
authors.lastname: Fieremans
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002908:Chronic Disease; D003161:Compartment Syndromes / Q000473:pathology*; D004058:Diffusion; D005260:Female; D006801:Humans; D008297:Male; D008954:Models, Biological; D018482:Muscle, Skeletal / Q000473:pathology*; D010539:Permeability; D019047:Phantoms, Imaging; D005082:Physical Exertion; D059629:Signal-To-Noise Ratio; D013997:Time Factors; D055815:Young Adult
keywords: DTI; chronic exertional compartment syndrome; exercise; random permeable barrier model; skeletal muscle; stimulated echo; time-dependent diffusion