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Diagnostic value of shear wave elastography in snake venom-induced compartment syndrome: a prospective study
Yan Ren1,2, Xiaoyan Xian1, Xi Xiang3
1Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China.
Objective:
To evaluate the diagnostic utility of shear wave elastography in snake venom-induced compartment syndrome and to assess its consistency with traditional intra-compartmental pressure monitoring.
Methods:
This prospective single-center study was conducted on snakebite patients evaluated in the emergency department. Based on the intra-compartmental pressure, patients were divided into the low-pressure group and the high-pressure group. Shear wave elastography was used to measure Young's modulus and shear wave propagation velocity in both the affected and contralateral limbs. Clinical symptoms, laboratory findings, and imaging data were analyzed for correlations with intra-compartmental pressure severity. Statistical analyses included t-tests, logistic regression, and receiver operating characteristic analysis.
Results:
The present study included 108 snakebite patients. The median Young's modulus of the medial calf muscle group on the affected side 15.15 kPa (IQR: 12.77-20.60 kPa) in the high-pressure group was significantly greater than that on the contralateral healthy side 9.05 kPa (IQR: 7.08-14.62 kPa). The ratio of elastic modulus between the affected and healthy sides in the high-pressure group (1.56) was significantly greater than that in the low-pressure group (1.05) (P <0.05). Notably, the elastic modulus ratio in the medial leg muscle group showed a positive correlation with intra-compartmental pressure measurements (OR = 3.2, 95% CI: 1.1-9.1; P = 0.025). Furthermore, the area under the receiver operating characteristic curve was 0.735 (P = 0.011), with a diagnostic sensitivity of 71.4% and a specificity of 68.6%.
Conclusions:
Shear wave elastography shows promising diagnostic utility for non-invasive assessment of compartment hardness in snake venom-induced compartment syndrome, with demonstrated reliability in early detection and longitudinal monitoring. Nevertheless, further multicenter studies are warranted to establish standardized shear wave elastography protocols and validate their broader clinical use.
