European Journal of Trauma and Emergency Surgery

, Volume 40, Issue 5, pp 535–539 | Cite as

Contrast enhanced ultrasound (CEUS) reliably detects critical perfusion changes in compartmental muscle: a model in healthy volunteers

  • R. M. SelleiEmail author
  • A. Waehling
  • C. D. Weber
  • S. Jeromin
  • F. Zimmermann
  • P. A. McCann
  • F. Hildebrand
  • H.-C. Pape
Original Article



The purpose of this study was to assess the utility of contrast enhanced ultrasound (CEUS) in the differentiation between physiological and simulated pathophysiological lower limb muscle perfusion pressures in healthy volunteers.


The lower limb muscle perfusion pressures in eight healthy volunteers were assessed in the supine position (as a control) and then subsequently in an elevated position with a thigh tourniquet applied to induce venous stasis. An intravenous bolus injection of 2.5 ml contrast agent was given to create a perfusion signal, which was measured with a multiple-frequency probe. Semiquantitative analysis was performed using specific software to create a perfusion curve which allowed measurement of six parameters: the time to arrival (TTA) starting from bolus application (s); peak of signal intensity (%); time to peak (TTP) maximum (seconds); regional blood volume (RBV), regional blood flow (RBF), and mean transit time (MTT) in seconds. Statistical analysis was performed using the Mann–Whitney U test as a non-parametric test (IBM SPSS statistics, version 21, USA).


The group of simulated hypoperfusion showed significant higher values for TTA (39.8 ± 5.1 s) (p = 0.028), TTP (43.8 ± 13.6 s) (p = 0.003), RBV (8,424 ± 5,405) (p = 0.028), and MTT (262 ± 90.6 s) (p = 0.005). In contrast, the parameter of regional blood flow (32.1 ± 10.9) was significantly lower (p = 0.038). The peak signal intensity (25.8 ± 8.2 %) was lower, but this was not significant (p = 0.083).


CEUS provides a reliable non-invasive imaging modality for the assessment of lower limb muscle perfusion pressures. This may be of clinical use in the assessment of a developing compartment syndrome. Further clinical studies are required to further define its accuracy and reproducibility.


Compartment syndrome CEUS TIC Time to peak Regional blood flow 



This investigation and research project was supported by the START-Program of the faculty of medicine, RWTH Aachen University, Germany. The authors thank ESAOTE, Germany, supporting this project by supplying the ultrasound probe for the period of investigation.

Conflict of interest

The authors disclose all possible conflicts of interest in the manuscript, including financial, consultant, institutional and other relationships that might lead to bias or a conflict of interest. Richard Martin Sellei, Anna Waehling, Christian David Weber, Sabine Jeromin, Frauke Zimmermann, Philip Andrew McCann, Frank Hildebrand, and Hans-Christoph Pape declare that they have no conflict of interest.

Ethical standards

This study has been approved by the appropriate ethics committee of the local university and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. The authors gave their informed consent prior to their inclusion in the study.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • R. M. Sellei
    • 1
    • 2
    Email author
  • A. Waehling
    • 1
  • C. D. Weber
    • 1
  • S. Jeromin
    • 4
  • F. Zimmermann
    • 4
  • P. A. McCann
    • 3
  • F. Hildebrand
    • 1
  • H.-C. Pape
    • 1
  1. 1.Department of Orthopaedic Trauma at Aachen UniversityAachenGermany
  2. 2.Department of Orthopaedic TraumaSana Klinikum OffenbachOffenbachGermany
  3. 3.Department of Orthopaedics and TraumaBristol Royal InfirmaryBristolUK
  4. 4.Helmholtz-Institute for Biomedical Engineering, Chair of Medical EngineeringRWTH Aachen UniversityAachenGermany

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