CONTRAST AGENT Gd‐EOB‐DTPA (EOB·Primovist®) FOR LOW‐FIELD MAGNETIC RESONANCE IMAGING OF CANINE FOCAL LIVER LESIONS

Contrast‐enhanced magnetic resonance (MR) imaging with a new liver‐specific contrast agent gadolinium‐ethoxybenzyl‐diethylenetriamine penta‐acetic acid (Gd‐EOB‐DTPA; EOB·Primovist®) was studied in 14 normal beagles and 9 dogs with focal liver lesions. Gd‐EOB‐DTPA accumulates in normally functioning hepatocytes 20 min after injection. As with Gd‐DTPA, it is also possible to perform a dynamic multiphasic examination of the liver with Gd‐EOB‐DTPA, including an arterial phase and a portal venous phase. First, a reliable protocol was developed and the appropriate timings for the dynamic study and the parenchymal phase in normal dogs using Gd‐EOB‐DTPA were determined. Second, the patterns of these images were evaluated in patient dogs with hepatic masses. The optimal time of arterial imaging was from 15 s after injection, and the optimal time for portal venous imaging was from 40 s after injection. Meanwhile, the optimal time to observe changes during the hepatobiliary phase was from 20 min after injection. In patient dogs, 11 lesions were diagnosed as malignant tumors; all were hypointense to the surrounding normal liver parenchyma during the hepatobiliary phase. Even with a low‐field MR imaging unit, the sequences afforded images adequate to visualize the liver parenchyma and to detect tumors within an appropriate scan time. Contrast‐enhanced MR imaging with Gd‐EOB‐DTPA provides good demarcation on low‐field MR imaging for diagnosing canine focal liver lesions.     

COMPARISON OF TRANSCOLONIC 123I-IODOAMPHETAMINE AND PORTAL VEIN INJECTION OF 99mTc-MACROAGGREGATED ALBUMIN SHUNT FRACTION CALCU-LATIONS IN EXPERIMENTAL DOGS WITH ACQUIRED POR-TOSYSTEMIC SHUNTS

Shunt fraction was determined using transcolonic ¹²³I-iodoamphetamine (IMP) and portal vein injection of ^99mTc-macroaggregated albumin (MAA) in a group of eight dogs with chronic cirrhosis and acquired portosystemic shunts subsequent to total common bile duct ligation. Hepatic parenchymal damage was confirmed by alterations in liver function tests and liver histology. Seven of the eight dogs developed portal hypertension and had angiographic evidence of hepatofugal portal blood flow with multiple peripheral portosystemic anastomoses. Shunt fractions determined in the seven dogs with shunts varied from 39 to 100 using IMP and 45 to 93 using MAA. The remaining dog had normal portal pressure, a normal portal angiogram, and normal IMP and MAA scintigraphic studies. There was an excellent correlation between the two methods of shunt fraction calculation (R²= 0.98) and the line of regression was not significantly different from unity (IMP = 1.09 × MAA - 0.03).     

CHARACTERIZATION OF CANINE FOCAL LIVER LESIONS WITH CONTRAST-ENHANCED ULTRASOUND USING A NOVEL CONTRAST AGENT—SONAZOID

Contrast-enhanced ultrasound using Sonazoid, a novel contrast medium with a liver-specific Kupffer phase, was evaluated in canine focal liver lesions Twenty-five dogs with a liver mass were given intravenous Sonazoid, and the enhancement pattern in the arterial, portal, and parenchymal phase was characterized. An enhancement defect in the lesion in the parenchymal phase was observed in all malignant lesions, whereas only one of nine benign lesions had a filling defect. The diagnostic value of the presence of a filling defect for malignancy was statistically significant (100% sensitivity, 88.9% specificity, 94.1% positive predictive value, 100% negative predictive value), and was equal to that of hypoenhancement in the portal or delayed phase. The defect pattern (clear or irregular defect) was dependent ( P <0.05) on the types of malignancy (i.e., hepatocellular carcinoma and other types of malignancies). In the arterial phase, five of the six hepatocellular carcinomas had hypervascularity, whereas no other lesion was characterized by hypervascularity. In some dogs, additional lesions that could not be observed with conventional B-mode ultrasonography were detected in the parenchymal phase. The enhancement pattern of Sonazoid, especially in the parenchymal phase, has potential as a diagnostic tool for canine focal liver lesions.     

Contrast-enhanced ultrasonography for characterization of focal splenic lesions in dogs

Background: Contrast‐enhanced ultrasonography with perflubutane microbubbles improves the diagnostic accuracy to differentiate benign and malignant focal liver lesions in dogs. Hypothesis: Perflubutane microbubbles‐enhanced ultrasonography is useful for differentiation of benign from malignant focal splenic lesions in dogs. Animals: Twenty‐nine clinical dogs with single or multiple focal splenic lesions detected by conventional ultrasonography. Methods: Prospective clinical observational study. Perflubutane microbubbles‐enhanced ultrasonography was performed in 29 dogs with focal splenic lesions. Qualitative assessment of the enhancement pattern was performed in the early vascular, late vascular, and parenchymal phases. Results: In the early vascular phase, a hypoechoic pattern was significantly associated with malignancy (P= .02) with sensitivity of 38% (95% confidence interval [CI], 25–38%) and specificity of 100% (95% CI, 84–100%). In the late vascular phase, a hypoechoic pattern was significantly associated with malignancy (P= .001) with sensitivity of 81% (95% CI, 66–90%) and specificity of 85% (95% CI, 65–95%). There was no significant difference between malignant and benign lesions during the parenchymal phase. Conclusions and Clinical Importance: Hypoechoic splenic nodules in the early and late vascular phases with perflubutane microbubbles‐enhanced ultrasonography are strongly suggestive of malignancy in dogs.     

QUANTITATIVE HEPATOBILIARY SCINTIGRAPHY USING 99mTC-DISIDA IN THE DOG

Quantitative hepatobiliary scintigraphy using ^99mTc-2,6 diisopropylphenylcarbamoylmethyl iminodiacetic acid (DISIDA) was performed in normal dogs. ^99mTc-DISIDA is excreted by the hepatocyte into the biliary tract. Hepatic blood flow from arterial and portal venous sources was measured as the hepatic perfusion index. The hepatic clearance of the radiopharmaceutical was used to assess hepatocyte function and parenchymal biliary transport. Biliary ejection was evaluated using synthetic cholecystokinin infusion. The procedure should be useful in evaluating dogs with hepatic and biliary disease.     

TRIPLE‐PHASE HELICAL COMPUTED TOMOGRAPHY IN DOGS WITH HEPATIC MASSES

The purpose of this study was to determine the utility of triple‐phase helical computed tomography (CT) for differentiating canine hepatic masses. Seventy dogs with hepatic masses underwent triple‐phase CT followed by surgical removal of the hepatic masses. Triple‐phase helical CT scans for each dog included precontrast, arterial phase, portal venous phase, and delayed phase studies. The removed hepatic masses were histopathologically classified as hepatocellular carcinoma (n = 47), nodular hyperplasia (n = 14), and hepatic metastatic tumors (n = 9) in dogs. Of the 47 hepatocellular carcinomas, the most common CT findings included a heterogeneous pattern with hyper‐, iso‐, and hypoenhancement in both the arterial and portal venous phases (40/47, 85.1%). Of the 14 nodular hyperplasias, the most common CT findings were a homogeneous pattern with hyper‐ and isoenhancement in both the portal venous and delayed phases (13/14, 92.9%). Of nine hepatic metastatic tumors, the most common CT findings included a homogeneous hypoenhancement pattern in both the arterial and portal venous phases (8/9, 88.9%). In addition, 5 (55.6%) showed homogeneous hypoenhancement patterns in the delayed phase. Findings from our study indicated that triple‐phase CT is a useful tool for preoperative differentiation of hepatocellular carcinoma, nodular hyperplasia, and hepatic metastatic tumors in dogs.     

Correlation of ultrasonographic and patho-morphological findings in canine hepatic diseases

Findings of hepatic ultrasonography were analysed in 22 dogs with liver disease and compared with the results of final morphological diagnoses. Ultrasonographic appearance of the liver demonstrated focal alterations in 11 dogs (50 per cent): multifocal lesions in hepatic neoplasia (six), hepatic cirrhosis (one), generalised mycosis (one) and unifocal lesions in haemangiosarcoma (one), nodular hyperplasia (one) and misdiagnosed intestinal invagination (one), Diffuse ultrasonographic alterations were found in 11 dogs (50 per cent): hyperechoic liver of normal/enlarged size in lymphosarcoma (four) and hepatic lipidosis (two); hyperechoic ‘bright’ but small liver in atrophic cirrhosis (two); hypoechoic to normal intensity liver of normal size in liver dystrophy (two) and hepatic venous distension (one). Gallbladder abnormalities were detected in 14 of 20 dogs (70 per cent). Correct ultrasonographic diagnoses were made in 11 dogs (50 per cent). The best results were achieved by combining the clinicolaboratory and ultrasonographic findings, providing a correct diagnosis in 17 dogs (77-3 per cent).     

Post-prandial serum bile acid concentrations and ammonia tolerance in Maltese dogs with and without hepatic vascular anomalies

SUMMARY: Post-prandial serum bile acid concentrations were measured in 200 Maltese dogs in an attempt to identify those with subclinical portosystemic shunts. Five of these were later shown to have hepatic pathology or abnormal liver function. In the other 195 Maltese bile acid concentrations ranged from 1 to 362 μmol.L^-1 (mean ± SD, 70 ±50 μmol.L^-1; median, 65.0 μmol.L^-1). Of these, 79% were above the reference range (0 to 31 μmol.L^-1) established from 23 mixed-breed control dogs. It was therefore not possible to determine the prevalence of subclinical portosystemic shunts on the basis of bile acid determinations.
Further investigation of liver function was performed to investigate why bile acid concentrations were increased in these dogs. Rectal ammonia tolerance tests were normal in 102 of 106 Maltese tested and liver samples (11 dogs) and plasma biochemistry profiles (9 dogs) demonstrated no significant hepatic disease or dysfunction.
Of 2 Maltese with hyperammonaemia after administration of ammonium chloride, one had a large congenital portosystemic shunt that was confirmed at surgery. In the other there were no macroscopic portosystemic communications, but a liver biopsy showed histological changes consistent with microscopic portovascular dysplasia.
Total serum bile acid concentrations were consistently lower when assessed by highperformance liquid chromatography than by an enzymatic spectrophotometric method. This discrepancy was substantially larger in Maltese than in control dogs, suggesting the presence of an additional reacting substance in the serum of Maltese dogs.     

QUANTITATIVE CONTRAST-ENHANCED ULTRASONOGRAPHY OF CANINE SPLEEN

Contrast-enhanced ultrasonography has an important role in the detection of tumors in humans. The second-generation contrast agent Sonazoid has the ability of real-time contrast imaging along with parenchymal imaging. The purposes of this study were to determine the effect and duration of Sonazoid on the changes in gray-scale enhancement of canine spleen and to establish an appropriate protocol for contrast-enhanced ultrasonography of canine spleen. Six healthy beagles were injected with an intravenous bolus of Sonazoid. In the spleen parenchyma, the enhancement was maintained up to 30 min after injection. Moreover, for 5–22 s after injection, gray-scale enhancement of splenic arteries afforded arterial imaging. Perfusion of the kidney may be investigated from 3.6 s to 3.5 min after injection of Sonazoid. These results suggest that Sonazoid is applicable to canine spleen parenchymal imaging and that the optimal time for the parenchymal imaging is 7–30 min after injection. The findings of this quantitative study should prove useful in the evaluation of diffuse or focal splenic and renal diseases in dogs.     

CONTRAST HARMONIC ULTRASOUND OF SPONTANEOUS LIVER NODULES IN 32 DOGS

Thirty-two dogs with spontaneous hepatic nodules were given intravenous ultrasound contrast medium (Definity or Sonovue) and imaged with contrast harmonic software on a conventional ultrasound machine system. Digital video images were initially reviewed to describe the perfusion pattern of malignant nodules. The images were reviewed again to test this pattern against all individual nodules. Subjectively, there was improved conspicuity of malignant nodules after contrast enhancement compared with conventional imaging and increased numbers of malignant nodules were often noted. There was decreased conspicuity of benign nodules and no additional nodules were seen after contrast enhancement. There was a highly significant (P < 0.0001) association of malignancy with a hypoechoic nodule at surrounding normal liver peak contrast enhancement. Benign nodules were isoechoic to the surrounding normal liver at peak contrast enhancement. Only one benign nodule (hepatoma) had regions of hypoechogenicity compared with the surrounding normal liver at peak liver contrast enhancement. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were highly significant (P < 0.0001) (100%, 94.1%, 93.8%, 100%, and 96.9%, respectively). No complications or morbidity was noted throughout the course of the study. Contrast harmonic ultrasound appears to be accurate at discriminating between naturally occurring benign and malignant nodules in the liver of dogs.     

Contrast harmonic imaging of canine hepatic tumors

Six adult healthy Beagles were used to investigate the hepatic perfusion dynamics of Levovist, a contrast agent used in contrast harmonic imaging (CHI). In addition, 8 dogs with hepatocellular carcinoma (HCC) and 2 dogs with metastatic hepatic hemangiosarcoma (HSA) were used to characterize both the CHI findings with Levovist. In the Beagles, the start of intravenously injected Levovist into the aorta between the cranial mesenteric and renal arteries and the portal vein at the hepatic hilum were 5.47 +/- 1.52 sec and 16.03 +/- 3.39 sec, respectively. As a characteristic CHI finding in the 8 dogs with HCC, the early arterial phase showed a fine network of blood flow enhanced at the surrounding region and within the tumor in all the 8 dogs (100%), and the post vascular phase demonstrated a defect in the whole tumor and an enhancement of the surrounding hepatic tissues in 7 dogs (87.5%). In the 2 dogs with HSA, characteristic finding in which the early arterial and late vascular phases showed a rim contrast enhancement pattern, and the post vascular phase revealed that the whole tumor lacked contrast enhancement and the surrounding hepatic tissues was clearly enhanced. In dogs, the start of the early arterial and late vascular phases, and the characterizations of the CHI findings in HCC and HSA were suggested to be similar to those in humans. Therefore, CHI is thought to be useful for the diagnosis of HCC and metastatic hepatic HSA in dogs as well as in humans.     

DOPPLER MEASUREMENT OF HEPATIC ARTERIAL FLOW IN DOGS: TECHNIQUE AND PRELIMINARY FINDINGS

The common hepatic artery in 10 healthy adult beagles, 20 healthy pups (13 Deerhounds and seven Irish Wolfhounds), and seven dogs with either a congenital or acquired hepatic disorder was examined by duplex-Doppler ultrasonography. Peak systolic velocity (Vs), resistive index (RI), pulse rate, angle of insonation, and sample volume depth were recorded. Measurements in Beagles were made after a 24 h fast and repeated 2 h after feeding. The mean Vs and RI in fasted Beagles were 1.5 m/s (range 1.1-2.3 m/s) and 0.68 (range 0.62-0.74), respectively. Postprandially, there were no significant differences in any of these variables. Mean Vs and RI were lower in pups: 1.0 m/s (range 0.8-1.3 m/s) and 0.59 (range 0.46-0.65), respectively (P < .001). Two dogs with congenital arterioportal fistula had higher mean Vs (P < .001) and lower mean RI (P < .05) than normal pups. No significant differences were detected between normal Beagles, three dogs with portal vein thrombosis, and two dogs with acquired hepatic insufficiency. Differences in measured hepatic blood flow in dogs of different age or breed will complicate diagnostic use of hepatic arterial Doppler measurements.     

DIAGNOSIS OF CEREBRAL VENTRICULOMEGALY IN NORMAL ADULT BEAGLES USING QUANTITATIVE MRI

The brain of 17 asymptomatic normal adult beagles was evaluated with magnetic resonance imaging. Lateral ventricular size was quantified using computer algorithms. In beagles with large ventricles, contrast medium was introduced into the cerebellomedullary cistern to determine whether obstructive hydrocephalus was present. Total lateral ventricular volume ranged from 73^mm3. to 11, 726 ^mm3. Based on Gd-DTPA diffusion, the csf flow pattern was considered normal neural morphology was seen using electron microscopy. Results Suggest a high incidence of clinically asymptomatic vetriculomegaly in normal adult beagles.     

COMPARISON OF PER-RECTAL PORTAL SCINTIGRAPHY USING 99mTECHNETIUM PERTECHNETATE TO MESENTERIC INJECTION OF RADIOACTIVE MICROSPHERES FOR QUANTIFICATION OF PORTOSYSTEMIC SHUNTS IN AN EXPERIMENTAL DOG MODEL

Per-rectal portal scintigraphy using tech-netium-99m pertechnetate (^99mTcO₄^-) was performed in 8 normal dogs before and after surgical creation of a portacaval shunt. Shunt fractions were calculated by computer assisted analysis of dynamic images (IMG) and compared to shunt fractions determined by mesenteric venous injection of radioactive microspheres (MIC). The mean pre-operative shunt fraction was 1.59% using IMG and 3.00% using MCI. The mean postoperative shunt fraction was 64.56% using IMG and 69.56% using MIC. There was excellent correlation between both methods (r² 0.94). Per-rectal portal scintigraphy is an easily performed, inexpensive method to diagnose and quantify portosystemic shunts in dogs.     

Hepatic lymphangiomatosis in a young dog

A 9-month-old intact male American cocker spaniel was referred because of hepatomegaly and ascites. Ultrasonographic evaluation of the liver revealed congestion and increased parenchymal echogenicity with focal and more hyperechoic nodules. Histopathology of the hepatic lesion revealed diffuse, ill-defined vascular proliferation. A single layer of endothelial cells, which showed signs of minimal cellular atypia, lined the irregular vessels. On immunohistochemistry, the proliferative endothelial cells lining the irregular vessels were positive for an antiserum to factor VIII related antigen. Based on these findings, the dog was diagnosed with hepatic lymphangiomatosis.     

Ultrasonographic features of testicular neoplasia in dogs: 16 cases (1980-1988)

For 16 dogs with testicular neoplasia (n = 19 tumors), ultrasonography was performed to determine whether a correlation exists between ultrasonographic features of testicular tumors and cell type. The echogenicity of the tumors varied depending on the size of the tumor and whether the tumor had focal or diffuse distribution within the testis. The ultrasonographic characteristics of Sertoli cell tumors were variable, with no predominant pattern. This variation may be related to tumor size, because 6 of 7 Sertoli cell tumors were greater than 5 cm in diameter. Focal seminomas and interstitial cell tumors less than 3 cm in diameter had hypoechoic texture. Focal seminomas and interstitial cell tumors greater than 3 cm in diameter had mixed echogenicity. Tumors of multiple cell types were greater than 5 cm in diameter and had mixed echogenicity. In valuable breeding dogs with a small (less than 3 cm) focal intrascrotal lesion, testicular ultrasonography would be of benefit for localization of the mass to the testis or epididymis for subsequent biopsy. In dogs with intraabdominal neoplastic testes, ultrasonography may be of benefit in determining intra-abdominal metastases and invasion of contiguous structures.     

Ultrasonographic evaluation of renal parenchymal diseases in dogs: 32 cases (1981-1986)

The medical records of 32 dogs with microscopically proven renal parenchymal disease were evaluated to characterize the associated ultrasonographic patterns and to assess the contribution of ultrasonography to the diagnosis and management in each case. Ultrasonography provided additional information on internal renal architecture in 18 dogs with radiographic evidence of structural abnormality. Ultrasonography determined the renal origin of 2 abdominal masses, defined the extent and distribution of neoplastic disease in 6 dogs, and identified kidneys not seen on survey radiographs or excretory urograms in 5 dogs because of decreased abdominal contrast or poor function. The ultrasonographic patterns were most specific for focal and multifocal or diffuse neoplasia. Ultrasonographic findings were least specific for diffuse parenchymal disease without architectural disruption such as glomerulo/interstitial nephritis, renal tubular necrosis, and nephrocalcinosis. In these cases, biopsy was recommended. Six interpretive errors were made. Four of these errors were related to the overestimation of renal pelvic and diverticular size because of confusion with medullary papilla. Two errors occurred in the diagnosis of renal lymphosarcoma, one of which was interpreted to be pyelonephritis. The other was an interpretive dilemma because of absence of hypoechoic multifocal nodules. Renal tubular necrosis was confirmed in this case.     

CT characteristics of primary hepatic mass lesions in dogs

Little information is available on the relationship between computed tomography (CT) imaging findings and the pathologic diagnosis of canine hepatic tumors. Our purpose was to clarify the characteristic features of CT findings in liver tumors in dogs. Data from 33 dogs with either a hepatocellular carcinoma, n = 14, hepatocellular adenoma, n = 14, or nodular hyperplasia, n = 5 were summarized from medical records. CT features for each histologic diagnosis were characterized and analyzed statistically. Common findings in hepatocellular carcinoma included central (79%, P = 0.0030) and marginal enhancement (93%, P = 0.00043) in the arterial phase, cyst-like lesions (93%), capsule formation (93%), and hypoattenuation in the portal (86%), and equilibrium phases (93%). Hepatic adenoma was characterized by a characteristic diffuse enhancement pattern during the arterial phase (57%, P = 0.013), which was also found in nodular hyperplasia (60%), but never in hepatocellular carcinoma. Nodular hyperplasia was less likely to have a capsule structure (20%, P = 0.0087). Mass size was significantly smaller in nodular hyperplasia than in hepatocellular carcinoma and hepatic adenoma (P = 0.0033 and 0.038, respectively). Hyperattenuation in the arterial and the portal phase i.e. contrast retention, was more frequent in hepatic adenoma than in the other groups (P = 0.037 and 0.037, respectively). Nodular hyperplasia was more frequently isoattenuating in the equilibrium phase (P = 0.043).