INTRAOPERATIVE SPINAL ULTRASONOGRAPHY IN DOGS: NORMAL FINDINGS AND CASE-HISTORY REPORTS

Intraoperative spinal ultrasonography was performed in cervical and lumbar spine of 2 and 5 normal dogs, respectively, following ventral slot technique or dorsal or hemilamenectomy. The dura was hyperechoic, while the parenchyma was hypoechoic. The subarachnoid space was anechoic. An echogenic line was present in the center of the spinal cord, as seen in human. Pulsation of the spinal cord was noted during M-mode imaging. Clinical findings of one dog with thoracolumbar disk herniation and one with thoracic vertebral fracture/subluxation confirmed the usefulness of intraoperative spinal ultrasonography for real time evaluation of spinal canal spatial abnormalities (mass lesion and degree of spinal cord compression on scanning planes) and spinal cord motion. Follow-up ultrasound examinations were possible from 6 days postoperatively.     

IMAGING DIAGNOSIS—SPINAL CORD HISTIOCYTIC SARCOMA IN A DOG

A 12‐year‐old mixed breed dog was presented for evaluation of progressive paraparesis and ataxia. Magnetic resonance (MR) imaging was performed and identified multifocal intradural spinal cord mass lesions. The lesions were hyperintense in T2‐weighted sequences, isointense to mildly hyperintense in T1‐weighted sequences with strong contrast enhancement of the intradural lesions and spinal cord meninges. Spinal cord neoplasia was suspected. A diagnosis of intramedullary spinal cord histiocytic sarcoma, confined to the central nervous system, was confirmed histopathologically. Spinal cord histiocytic sarcoma is a rare neoplasm, but should be included in the differential diagnosis for dogs with clinical signs of myelopathy.     

METRIZAMIDE MYELOGRAPHY IN FIVE DOGS AND TWO CATS WITH SUSPECTED SPINAL CORD NEOPLASMS

Metrizamide myelography was used in five dogs and two cats with signs of spinal cord disease. The history, clinical signs, cerebrospinal fluid examination, and myelography supported a presumptive diagnosis of spinal cord neoplasia in all seven animals. Myelography demonstrated a deviation of the subarachnoid space in each of them. Five of the animals had an expansile intramedullary spinal cord lesion causing thinning and peripheral deviation of the subarachnoid space. Two had extramedullary lesions causing a central deviation of the subarachnoid space. Spinal cord tumors in six of the seven animals were confirmed by necropsy or surgical excision and histopathologic examination. In the seventh animal, a spinal cord fungal grapuloma was diagnosed by necropsy.     

RELATIONSHIP OF CERVICAL SPINAL CORD DIAMETER TO VERTEBRAL DIMENSIONS: A RADIOGRAPHIC STUDY OF NORMAL DOGS

Cervical spinal cord abnormalities are often unapparent on myelographic studies, because no normal values for cervical spinal cord diameter are currently available. The purpose of this study was to establish, myelographically, the normal sagittal diameter of the cervical spinal cord in large and small breed dogs and its relationship to the sagittal diameter of the vertebral canal and sagittal height/length of the corresponding vertebral bodies. Forty-one adult dogs underwent cervical radiography and myelography. Spinal cord and vertebral canal sagittal diameter, vertebral body height at C2 to 5, body length at C3 to 5, and dorsal spine length of C2 were measured on lateral views. Ratios of spinal cord:vertebral canal diameter, spinal cord:body height, and spinal cord:body length/spine were calculated, and a normal range was determined for small and large breed dogs. The spinal cord:vertebral canal ratios showed that small breeds have a higher cervical cord-to-canal ratio than large breeds. The mean values and ranges of 14 ratios are reported. The ratios of spinal cord:body length at C2 to 4 in small breeds and spinal cord:body height at C3 to 5 in large breeds were found to be the most accurate for assessing spinal cord sagittal diameter. These normal ranges would allow quantitative and objective evaluation of the cervical spinal cord by myelography and early identification of dogs with altered spinal cord diameter, which could be further evaluated by means of alternative imaging techniques.     

POSTOPERATIVE IRRADIATION OF SPINAL CORD TUMORS IN 9 DOGS

Between 1985 and 1993, nine dogs with spinal cord tumors were treated postoperatively with cobaltradiation at North Carolina State University-Veterinary Teaching Hospital. Total doses ranged between 33.3–48.0 Gy given in 10–12 fractions of 3–4 Gy over a four week period. Five dogs were euthanized due to recurrence of the tumor or neurologic signs and two dogs were euthanized due tounrelated problems. Two dogs were alive but lost to follow-up at 12 and 25 months. Survival time ranged from 6.5–70.0 months. Median survival time (95% confidence interval) was 17 (12–70) months. Results of this study suggest decompressive surgery followed by irradiation can be an effective treatment for dogs with spinal cord tumors.     

OCCIPITAL DYSPLASIA AND ASSOCIATED CRANIAL SPINAL CORD ABNORMALITIES IN TWO DOGS

Occipital dysplasia was found in association with cervical spinal cord abnormalities in two dogs. One dog presented for tetraparesis and cervical hyperesthesia, the other for historical cervical hyperesthesia and mild paraparesis. In dog 1, a midline cervical spinal cord defect consistent with a communicating syrinx was found. In the other dog, a presumptive syringo/hydromyelia of the cervical spinal cord was found on magnetic resonance imaging. While occipital dysplasia alone is not thought to cause any clinical abnormalities, the dogs of this report suggest that intramedullary central nervous system abnormalities may be present concurrently with occipital dysplasia and should be considered as a possible cause of the clinical signs. The relationship between occipital dysplasia and syringo/hydromyelia in these dogs remains unclear, however, similar associated abnormalities are occasionally found in humans with Chiari malformation.     

THE USE OF DIFFUSION TENSOR IMAGING TO EVALUATE THE SPINAL CORD IN NORMAL AND ABNORMAL DOGS

Diffusion tensor imaging (DTI) is a specialized magnetic resonance sequence to determine the direction of water molecule motion. Our hypothesis was that information derived from DTI will be significantly different in dogs with a spinal cord lesion compared with a normal dog. Eleven normal dogs and six dogs with a spinal cord lesions were imaged. DTI was performed along with standard T1‐ and T2‐weighted sequences in transverse and sagittal planes. Fractional anisotrophy and apparent diffusion coefficient (ADC) were obtained using regions of interests centered on the cranial aspect, middle cranial, middle caudal, and caudal aspects of the spinal cord. In normal dogs, the DTI sequence was characterized by normal fiber tracking with no statistical difference between the four sections of spinal cord (P>0.05). In the dogs with a spinal cord lesion, there was a significant difference in fractional anisotropy between the two groups (P=0.0003) and the ADC analysis statistical significance (P=0.048) at the caudal most site. Based on these findings, DTI is a potentially useful method to evaluate the spinal cord in dogs.     

COLOR DOPPLER AND DOPPLER SPECTRAL ANALYSIS IN THE SPINAL CORD OF NORMAL DOGS

Doppler ultrasonography of the spinal cord was performed in 34 normal, anesthetized dogs following hemilaminectomy. This study was part of an investigation to evaluate the efficacy of a 21-aminosteroid compound and high dose methylprednisolone for the treatment of spinal cord trauma. Grey-scale images of the canine spinal cord were similar to those described for the spinal cord of people. Doppler waveforms of intraparenchymal spinal arteries exhibited high end diastolic blood flow velocities, indicating low resistance to flow. Doppler values (mean ± SD) for arteries immediately ventrolateral to the central canal were: Peak Systolic Velocity = 5.78 ± 2.5 cm/sec, Minimum Diastolic Velocity = 3.5 ± 1.62 cm/sec, Mean Velocity = 4.45 ± 1.96 cm/sec, Minimum Diastolic Velocity = 3.5 ± 1.62 cm/sec, Mean Velocity = 4.45 ± 1.96 cm/sec, Systolic/Diastolic ratio = 169 ± 0.19, Pulsatility Index = 0.53 ± 0.09, and Resistance Index = 0.4 ± 0.06.     

MAGNETIC RESONANCE IMAGING FINDINGS IN SPINAL CORD INFARCTION IN THREE SMALL BREED DOGS

Fibrocartilaginous embolization (FCE) of the spinal cord is a common disease in large breed dogs. There are only a few reports about this entity in small breed dogs and it has never been reported in chondrodystrophic breed. For definitive diagnosis histopathologic examination is necessary. Magnetic resonance imaging (MRI) as a potential diagnostic tool for intravitam diagnosis of FCE has been mentioned before, but results have not been reported so far. This report describes the neurological findings and MRI results in three small breed dogs, including a Pekingese dog, with FCE of the spinal cord. The disease was suspected in two animals based upon clinical and MRI-appearance and confirmed in the third by histopathological examination. In all three cases, similar focal intramedullary lesions, consisting of hyperintensive signals on T2-weighted images, were detected. Based on these findings, high-field MRI may be used as an antemortem tool for the diagnosis of FCE. It is also shown that FCE can occur in chondrodystrophic dogs.     

TRUNCATION ARTIFACT IN MAGNETIC RESONANCE IMAGES OF THE CANINE SPINAL CORD

The truncation artifact in magnetic resonance (MR) images is a line of abnormal signal intensity that occurs parallel to an interface between tissues of markedly different signal intensity. In order to demonstrate the truncation artifact in sagittal images of the canine spinal cord and the effect of changing spatial resolution, we conducted an experimental in vitro study. A section of fixed canine spinal cord was imaged using a 1.5T magnet. Spatial resolution was increased by increasing the acquisition matrix and reconstruction matrix, producing series of T2‐weighted (T2w) images with the following pixel sizes: A, 1.6 (vertical) × 2.2 mm² (horizontal); B, 1.2 × 1.7 mm²; C, 0.8 × 1.1 mm²; D, 0.4 × 0. 6 mm². Plots of mean pixel value across the cord showed variations in signal intensity compatible with truncation artifact, which appeared as a single, wide central hyperintense zone in low‐resolution images and as multiple narrower zones in high spatial resolution images. Even in images obtained using the highest spatial resolution available for the MR system, the edge of the spinal cord was not accurately defined and the central canal was not visible. The experiment was repeated using an unfixed spinal cord specimen with focal compression applied to mimic a pathologic lesion. Slight hyperintensity was observed within the spinal cord at the site of compression although the cord was normal histologically. Results of this study suggest that caution should be applied when interpreting hyperintensity affecting the spinal cord in T2w sagittal images of clinical patients because of the possibility that the abnormal signal could represent a truncation artifact.     

SPINAL SUB ARACHNOID CYSTS IN 13 DOGS

Thirteen dogs, including 6 Rottweiler dogs, exhibiting clinical signs of spinal cord dysfunction and myelographically confirmed subarachnoid space enlargement were investigated. To characterize the lesions and to get a better understanding of their pathogenesis, different imaging techniques were used in association with explorative surgical procedures (12 dogs) and histopathologic techniques (5 dogs). All subjects underwent preoperative myelography, five of which were examined by computed tomography (CT) scanning and one by magnetic resonance imaging (MRI) as well as cerebrospinal fluid (CSF) flow measurement (velocimetry). Most animals were <12 months old (7/13 dogs) and Rottweilers were over-represented (6/13 dogs). The lesions were mainly located dorsally with respect to the spinal cord (10/13 dogs) and in the cranial cervical area (8/13 dogs). MRI suggested spinal cord deviation with signs of ventral leptomeningeal adhesion opposite the enlarged space. In one dog, velocimetry confirmed that the "cyst" was freely communicating with the surrounding CSF space. Surgical investigation confirmed leptomeninges-induced ventral adhesion in 4/5 dogs. Follow-up studies, carried out from 6 months to 2.5 years postoperatively, showed there was full recovery in 8/13 dogs. This study suggests that the compression of the spinal cord is possibly not caused by a cyst. Adhesion resulting from a combination of microtrauma and chronic inflammatory processes induces a secondary enlargement of the subarachnoid space and may be a significant causative factor in spinal cord compression and dysfunction. The over-representation of Rottweilers and the young age of the animals in the study suggest a possible genetic predisposition and an inherited etiology.     

USE OF INTRAOPERATIVE ULTRASONOGRAPHY IN CANINE SPINAL CORD LESIONS

The purpose of this retrospective study was to describe the intraoperative appearance of various spinal cord conditions, and to investigate how intraoperative ultrasonography assisted in modification of surgical and postoperative treatment plans. Intraoperative ultrasonography (B-mode, and power Doppler mode) was used in 25 dogs undergoing spinal surgery. The neurologic conditions included cervical spondylomyelopathy, intervertebral disc (IVD) protrusion, IVD extrusion, spinal tumors, nerve sheath mass, granulomatous myelitis, and discospondylitis. All of these diagnoses were supported by histopathologic and/or cytologic evaluation. It was possible to visualize the spinal cord and the abnormal spinal tissue in all of the patients. Power Doppler imaging allowed assessment of the spinal cord microcirculation, and assisted in judgment of the degree of decompression. Ultrasound imaging directly impacted the surgical and the medical treatment plans in four patients. Owing to the intraoperative imaging, two hemilaminectomies were extended cranially and caudally, and additional disc spaces were fenestrated, one hemilaminectomy site was extended dorsally to retrieve the disc material from the opposite side, and one intramedullary cervical spinal cord lesion was discovered, aspirated, and consequently diagnosed as granulomatous inflammation, which altered the long-term medication protocol in that dog. This study suggests that intraoperative sonographic spinal cord imaging is a useful and viable technique.     

MAGNETIC RESONANCE IMAGING FEATURES OF TUMORS OF THE SPINE AND SPINAL CORD IN DOGS

Twenty-one dogs with confirmed tumors of the spinal cord or paraspinal tissues were imaged with magnetic resonance (MR) imaging. Anatomical location, location in relation to the dura and the medulla (spinal cord), and bone infiltration were assessed on the MR images and compared to findings at surgery or necropsy. Localization of tumors in the intradural-extramedullary compartment was not always possible. Bone infiltration was correctly assessed in all but one dog, and the anatomical locations involved were accurately determined in all dogs. Sagittal T2-weighted images were helpful to determine the anatomical location. Transverse T1-weighted images pre and post Gd-DTPA administration were helpful for additional localization and definition of tumor extension.     

B-MODE AND DOPPLER ULTRASOUND IMAGING OF THE SPLEEN WITH CANINE SPLENIC TORSION: A RETROSPECTIVE EVALUATION

The ultrasonographic appearance of splenic torsion has been described; the splenic parenchyma can be normal, hypoechoic or anechoic with interspersed linear echoes (coarse/"lacy" appearance). The ultrasonographic parenchymal appearance of 15 dogs in this report with splenic torsion varied: mottled hypoechoic regions (n=2), diffusely hypoechoic (n=11) and normal (n=2). Because splenic torsion causes vascular congestion due to splenic vein compression and eventual thrombosis, visible splenic vein intraluminal echogenicities compatible with thrombi were seen in 13 dogs using B-mode. Using spectral Doppler and color Doppler imaging of the splenic veins, no measurable flow velocities were detected in any of the 15 dogs. The varied B-mode ultrasonographic appearance of the splenic veins for intraluminal echoes and spectral or color Doppler evaluation for absent velocity flow.     

MAGNETIC RESONANCE IMAGING FEATURES OF CERVICAL SPINAL CORD MENINGIOMAS

The records of four dogs with cervical spinal cord meningiomas were retrospectively reviewed. Signalment, history, laboratory findings, neurological examination, and histopathological findings were evaluated. Magnetic resonance imaging (MRI) was performed using a 1.0-T superconducting magnet and T2-weighted (W) and noncontrast and postcontrast T1-W spin echo pulse sequences. Meningiomas were located at the level of the second, third, and fifth cervical vertebrae and the C2-3 intervertebral space. All meningiomas appeared as focal masses that were hyperintense to the spinal cord on T2-W images and iso- to hypointense on the T1-W images. They could be identified as intradural and extramedullary in origin based on a broad-based dural margin seen on at least one of the imaging planes and a gradual expansion of the subarachnoid space cranial and caudal to the mass, best noted on the transverse and dorsal plane images. On dorsal plane T2-W images in three dogs, expansion of the subarachnoid space adjacent to the mass appeared similar to the myelographic "golf tee" sign. All meningiomas exhibited moderate, well-defined contrast enhancement with dural tails seen in three of the four dogs. One dog had extension into the intervertebral foramen along the nerve and ipsilateral atrophy of the muscles of the neck. By differentiating the meningiomas from intramedullary tumors and by clearly depicting the extent of the masses, MRI provided valuable information about treatment options and prognosis.     

SPATIAL ACCURACY OF FRACTIONATED IMRT DELIVERY STUDIES IN CANINE PARASPINAL IRRADIATION

Intensity modulated radiation therapy (IMRT) theoretically allows detailed tailoring of the dose distribution in tissue. The goal of this study was to determine if a method of dynamic IMRT could be used to deliver a high dose of radiation to a concave shaped target around the cervical spinal cord. Fifteen young adult dogs from our laboratory population were randomly divided into two groups. A radiation dose of 84 Gy in 4 Gy fractions was delivered with a conventional 4 field technique for Group A dogs, and with dynamic IMRT for Group B dogs to a "C-shaped" target close to the cervical spinal cord. Neurologic status, magnetic resonance imaging results and histopathologic changes were compared among dogs in the two groups. Group A dogs developed myelomalacia with a latency period of 65 +/- 9 days. Group B dogs did not have any histologic changes to the cervical spinal cord when euthanasia was performed 12 months after irradiation. The results demonstrate that this IMRT technique can be safely and precisely delivered to a patient in a clinical situation.     

RESULTS OF MYELOGRAPHY IN SEVEN DOGS WITH MYELOMALACIA

Myelomalacia is a hemorrhagic infarction of the spinal cord that can occur as a sequel to acute spinal cord injury. Myelomalacia may be focal or diffuse; the diffuse form is typically associated with cranial migration of neurologic signs ("ascending syndrome") and is often fatal. In a retrospective study of seven affected dogs, diffuse myelomalacia was associated with intervertebral disc extrusion in five dogs, focal myelomalacia was associated with fibrocartilagenous embolus in one dog, and had no apparent cause in one dog. The myelographic signs included a variable degree of contrast medium infiltration into the spinal cord in six dogs (86%) and/or spinal cord swelling in six dogs (86%). In one dog with focal myelomalacia, the only myelographic sign was spinal cord swelling.     

INTRAOPERATIVE SPINAL ULTRASONOGRAPHY IN TWO DOGS WITH SPINAL DISEASE

Ultrasonography was performed during spinal surgery on two dogs that were suspected of having intramedullary lesions by myelography and magnetic resonance imaging. Ultrasonographically, the pathologic conditions of the spinal canal or cord were adequately imaged during surgery in both dogs. On the basis of ultrasonographic findings, a biopsy was obtained in Patient 1 and removal of the lesion was accomplished in Patient 2. Histopathologic diagnosis was myelomalacia in Patient 1 and spinal nephroblastoma in Patient 2. Intraoperative ultrasonography was demonstrated to be suitable for detecting intradural conditions, and, thus, is valuable for increasing the accuracy of biopsies or completeness of resections of intramedullary lesions.     

COMPARISON OF FAST SPIN-ECHO AND CONVENTIONAL SPIN-ECHO MAGNETIC RESONANCE SPINAL IMAGING TECHNIQUES IN FOUR NORMAL DOGS

Various magnetic resonance (MR) imaging techniques have been used to assess lumbar spinal abnormalities in people. Four, young adult, clinically normal dogs were used to compare images of the spinal cord acquired using conventional spin-echo and rapid acquisition relaxation-enhanced (RARE), commonly called fast spin-echo (FSE), magnetic resonance imaging techniques. Lateral myelograms were made as an anatomic control. The T2-weighted FSE technique was characterized by better image quality than the T2-weighted conventional spin-echo technique. The short acquisition time with the FSE technique allowed increases in the matrix size and number of excitations, thus improving resolution and signal-to-noise ratio. In canine lumbar spinal MR imaging, use of a FSE technique is recommended to reduce the overall time for imaging and to improve image quality.     

THE USE OF HYPOTHERMIA IN SPINAL CORD DECOMPRESSION

In 1970 and in 1972 we reported on the use of local hypothermia as an aid in spinal surgery of the dog (Lumb and Brasmer, J.A.V.M.A., Aug. 1, 1970 and Brasmer and Lumb, Am. J. Vet. Res., March, 1972). These reports developed from a purely research project which involved extensive manipulation of the lumbar spinal cord. Preliminary studies had led us to expect a long period of postoperative paraparesis or paraplegia. We were aware of the work of Negin, Albin, White and others which indicated that hypothermia, both general and local, reduced the sensitivity of the spinal cord to trauma. In fact, their work strongly indicated that cooling even after trauma was highly desirable.