CONTRAST‐ENHANCED ULTRASOUND OF THE FELINE KIDNEY

Contrast‐enhanced ultrasound offers a noninvasive means of subjectively and quantitatively evaluating renal perfusion in cats with renal disease, or in renal transplant patients. In this study, we characterized the pattern of ultrasonographic contrast enhancement in 16 normal feline kidneys in eight cats using contrast‐enhanced power Doppler and contrast‐enhanced harmonic ultrasound techniques. Mean time to peak contrast enhancement for the whole kidney was longer using contrast‐enhanced harmonic ultrasound (16.8s, SD 4.7s) than contrast‐enhanced power Doppler ultrasound (12.2s, SD 1.8s). The time to peak enhancement for the cortex alone in contrast‐enhanced harmonic ultrasound was 13s (SD 3.2s), and for the renal medulla was 25.5s (SD 8.7s). The half time for washout of contrast agent was 39s (SD 14.5s) for contrast‐enhanced harmonic ultrasound. The pattern of contrast enhancement in these normal feline kidneys can be used as normal reference values for the evaluation of clinical patients. Contrast‐enhanced harmonic ultrasound may allow the differentiation between cortical and medullary perfusion patterns.     

Renal perfusion parameters measured by contrast‐enhanced ultrasound in healthy dogs demonstrate a wide range of variability in the long‐term

Contrast‐enhanced ultrasound may be helpful for detecting early renal microvascular damage and dysfunction in dogs. However, before this noninvasive imaging method can be tested as an early‐stage screening tool in clinical patients, an improved understanding of long‐term variation in healthy animals is needed. In this prospective, secondary, longitudinal, serial measurements study, variability of contrast‐enhanced ultrasound renal perfusion parameters was described for eight healthy dogs, using seven time points and a period of 83 weeks. Dogs were sedated with butorphanol (0.4 mg/kg), and contrast‐enhanced ultrasound of each kidney was performed after an intravenous bolus injection of a microbubble contrast agent (0.04 mL/kg). Time‐intensity curves were created from regions‐of‐interest drawn in the renal cortex and medulla. Intensity‐related parameters representing blood volume and time‐related parameters representing blood velocity were determined. A random‐effects model using restricted maximum likelihood was used to estimate variance components. Within‐dog coefficient of variation was defined as the ratio of the standard deviation over the mean. Time‐related parameters such as time‐to‐peak, rise and fall time had lowest within‐dog variability. Intensity‐related parameters such as peak enhancement, wash‐in and wash‐out area under the curve, total area under the curve, and wash‐in and washout rates had high within‐dog variability (coefficient of variation > 45%). Authors therefore recommend the use of time‐related parameters for future studies of renal perfusion. Within‐dog variability for bilateral kidney measurements was extremely low, therefore contrast‐enhanced ultrasound may be particularly useful for detecting unilateral changes in renal perfusion. Future studies are needed to compare contrast‐enhanced ultrasound findings in healthy dogs versus dogs with renal disease.     

Doppler and Contrast‐Enhanced Ultrasonography of Testicles in Adult Domestic Felines

The objective was to characterize the vascular patterns of testicular blood flow of adult cats, measuring the systolic velocity (SV), diastolic velocity (DV), resistance index (RI), gate time (wash‐in) peak enhancement and output time (wash‐out) of the contrast and addition of tissue fill characteristics. Forty‐five adult cats were selected, and the echotexture, echogenicity, size, contours and margins of testicles were assessed via ultrasound. By Doppler were evaluated the blood flow and determined of vascular index in testicular artery (SV, DV and RI) and via contrast‐enhanced ultrasonography determine the time for phases: wash‐in, wash‐out and peak enhancement. Sonographic findings presented normal. Testicular artery was observed in the spermatic cord with tortuous patter and showed monophasic‐patterned waves and low vascular resistance and with systolic peak evident. Values of indices vascular were as follows: SV = 6.73 cm/s, DV = 2.8 cm/s and RI = 0.54 for left testicles; and SV = 6.23 cm/s, DV = 2.77 cm/s and RI = 0.53 for right testicles. Contrast filled the subcapsular vascular structures and after a few seconds, a homogeneous moderate enhancement of the parenchyma, with parenchymal vessels still distinguishable and after the peak phase, a rapid homogeneous decrease in echogenicity. Values of time for contrast‐enhanced ultrasonography were as follows: wash‐in = 8.78 s, peak enhancement = 21.62 s and wash‐out = 75.36 for left testicles; and wash‐in = 10.76 s, peak enhancement = 21.50 s and wash‐out = 81.81 for right testicles. Doppler and contrast‐enhanced ultrasonography of the testicles in healthy adult cats was easily implemented and may provide baseline data for this organ to allow the use of these techniques as a diagnostic tool for evaluating testicular abnormalities in sick cats.     

Assessment of Vascular Perfusion Kinetics Using Contrast‐enhanced Ultrasound for the Diagnosis of Prostatic Disease in Dogs

Vascular perfusion was assessed in 10 dogs without prostatic abnormalities and 26 dogs with prostatic disease using contrast‐enhanced ultrasound. The time to reach peak contrast intensity (TTP) and peak perfusion intensity (PPI) were measured, and histological biopsies were collected from each dog. Biopsies confirmed normal prostate (n = 10), benign prostatic hyperplasia (n = 11), mixed benign pathology (n = 9), prostatitis (n = 1), prostatic malignancy [adenocarcinoma (n = 4); leiomyosarcoma (n = 1)]. In normal dogs, mean PPI was 16.8% ± 5.8 SD, and mean TTP was 33.6 ± 6.4 s. Benign conditions overall were not statistically different from normal dogs (p > 0.05); for benign prostatic hyperplasia, mean PPI was 16.9 ± 3.8%, and mean TTP was 26.2 ± 5.8 s; for mixed benign pathology mean PPI was 14.8 ± 7.8%, and mean TTP was 31.9 ± 9.7 s; for prostatitis, PPI was 14.2%, and TTP was 25.9 s. The malignant conditions overall had perfusion values that differed from the normal dogs (p < 0.05), although evaluation of the data for individual malignancies did not demonstrate a consistent trend; for adenocarcinomas, the PPI was numerically higher with a mean of 23.7 ± 1.9%, and the mean TTP was 26.9 ± 4.8 s, whilst for the dog with leiomyosarcoma values were numerically lower with a PPI of 14.1% and TTP of 41.3 s. Contrast‐enhanced ultrasound appears to offer some ability to document differences in perfusion that may differentiate between malignant and benign lesions, although studies with larger numbers of animals are required to confirm this contention.     

FEASIBILITY OF PERCUTANEOUS CONTRAST ULTRASOUND‐GUIDED CHOLECYSTOGRAPHY IN DOGS

Differentiating hepatocellular disease versus biliary obstruction can be challenging in dogs presented for icterus. The purpose of this prospective study was to determine the feasibility of percutaneous contrast ultrasound‐guided cholecystography in dogs. Ten normal dogs weighing 7.6–13.0 kg (median 9.8 kg) were recruited. All dogs were considered normal based on complete blood count, serum chemistry profile, ultrasound examination, and percutaneous radiographic cholecystography. Percutaneous contrast ultrasound‐guided cholecystography was performed using 0.5 ml of commercially available contrast agent and two conventional ultrasound machines for simultaneous scanning at two different locations. Two observers independently evaluated the time to initial detection of contrast in the proximal duodenum and duration of contrast enhancement via visual monitoring. Dynamic contrast enhancement was calculated using time‐intensity curves. Mean (±SD) and median (range) of time to initial detection were 8.60 s (± 3.35) and 8.0 s (2.0–11.0), respectively, and mean and median duration were 50.45 s (±23.24) and 53.0 s (20.0 – 70.0), respectively. Mean, median, and range of peak intensity were 114.1 mean pixel value (MPV) (SD ± 30.7), 109.2 MPV, and 79.7–166.7, respectively, and mean, median, and range of time to peak intensity were 26.1 s (SD ± 7.1 s), 24.0 s, and 19.0–41.0 s, respectively. Findings indicated that percutaneous contrast ultrasound‐guided cholecystography is a feasible technique for detecting and quantifying patency of the bile duct in normal dogs. Future studies are needed to assess the diagnostic utility of this technique for dogs with biliary obstruction.     

THE EFFECT OF THE SAMPLE SIZE AND LOCATION ON CONTRAST ULTRASOUND MEASUREMENT OF PERFUSION PARAMETERS

Contrast‐enhanced ultrasound can be used to quantify tissue perfusion based on region of interest (ROI) analysis. The effect of the location and size of the ROI on the obtained perfusion parameters has been described in phantom, ex vivo and in vivo studies. We assessed the effects of location and size of the ROI on perfusion parameters in the renal cortex of 10 healthy, anesthetized cats using Definity^® contrast‐enhanced ultrasound to estimate the importance of the ROI on quantification of tissue perfusion with contrast‐enhanced ultrasound. Three separate sets of ROIs were placed in the renal cortex, varying in location, size or depth. There was a significant inverse association between increased depth or increased size of the ROI and peak intensity (P<0.05). There was no statistically significant difference in the peak intensity between the ROIs placed in a row in the near field cortex. There was no significant difference in the ROIs with regard to arrival time, time to peak intensity and wash‐in rate. When comparing two different ROIs in a patient with focal lesions, such as suspected neoplasia or infarction, the ROIs should always be placed at same depth and be as similar in size as possible.     

CONTRAST‐ENHANCED ULTRASONOGRAPHY OF THE NORMAL CANINE ADRENAL GLAND

Contrast‐enhanced ultrasonography is useful in differentiating adrenal gland adenomas from nonadenomatous lesions in human patients. The purposes of this study were to evaluate the feasibility and to describe contrast‐enhanced ultrasonography of the normal canine adrenal gland. Six healthy female Beagles were injected with an intravenous bolus of a lipid‐shelled contrast agent (SonoVue^®). The aorta enhanced immediately followed by the renal artery and then the adrenal gland. Adrenal gland enhancement was uniform, centrifugal, and rapid from the medulla to the cortex. When maximum enhancement was reached, a gradual homogeneous decrease in echogenicity of the adrenal gland began and simultaneously enhancement of the phrenicoabdominal vessels was observed. While enhancement kept decreasing in the adrenal parenchyma, the renal vein, caudal vena cava, and phrenicoabdominal vein were characterized by persistent enhancement until the end of the study. A second contrast enhancement was observed, corresponding to the refilling time. Objective measurements were performed storing the images for off‐line image analysis using Image J (ImageJ^©). The shape of the time–intensity curve reflecting adrenal perfusion was similar in all dogs. Ratios of the values of the cortex and the medulla to the values of the renal artery were characterized by significant differences from initial upslope to the peak allowing differentiation between the cortex and the medulla for both adrenal glands only in this time period. Contrast‐enhanced ultrasonography of the adrenal glands is feasible in dogs and the optimal time for adrenal imaging is between 5 and 90 s after injection.     

CONTRAST‐ENHANCED ULTRASONOGRAPHIC CHARACTERISTICS OF ADRENAL GLANDS IN DOGS WITH PITUITARY‐DEPENDENT HYPERADRENOCORTICISM

A noninvasive method for quantifying adrenal gland vascular patterns could be helpful for improving detection of adrenal gland disease in dogs. The purpose of this retrospective study was to compare the contrast‐enhanced ultrasound (CEUS) characteristics of adrenal glands in 18 dogs with pituitary‐dependent hyperadrenocorticism (PDH) vs. four clinically healthy dogs. Each dog received a bolus of the contrast agent (SonoVue®, 0.03 ml/kg of body weight) into the cephalic vein, immediately followed by a 5 ml saline flush. Dynamic contrast enhancement was analyzed using time–intensity curves in two regions of interest drawn manually in the caudal part of the adrenal cortex and medulla, respectively. In healthy dogs, contrast enhancement distribution was homogeneous and exhibited increased intensity from the medulla to the cortex. In the washout phase, there was a gradual and homogeneous decrease of enhancement of the adrenal gland. For all dogs with PDH, there was rapid, chaotic, and simultaneous contrast enhancement in both the medulla and cortex. Three distinct perfusion patterns were observed. Peak perfusion intensity was approximately twice as high (P < 0.05) in dogs with PDH compared with that of healthy dogs (28.90 ± 10.36 vs. 48.47 ± 15.28, respectively). In dogs with PDH, adrenal blood flow and blood volume values were approximately two‐ to fourfold (P < 0.05) greater than those of controls. Findings from the present study support the use of CEUS as a clinical tool for characterizing canine adrenal gland disease based on changes in vascular patterns.     

EFFECT OF SEDATION ON CONTRAST‐ENHANCED ULTRASONOGRAPHY OF THE SPLEEN IN HEALTHY DOGS

Contrast‐enhanced ultrasound of the spleen enables the dynamic assessment of the perfusion of this organ, however, both subjective and quantitative evaluation can be strongly influenced by sedative agent administration. The purpose of this prospective, experimental study was to test effects of two sedative agents on splenic perfusion during contrast‐enhanced ultrasound of the spleen in a sample of healthy dogs. Contrast‐enhanced ultrasound of the spleen was repeated in six healthy Beagles following a cross‐over study design comparing three protocols: awake, butorphanol 0.2 mg/Kg intramuscular (IM), and dexmedetomidine 500 μg/m² IM. After intravenous injection of a phospholipid stabilized sulfur hexafluoride microbubble solution (SonoVue®, Bracco Imaging, Milano, Italy), the enhancement intensity and perfusion pattern of the splenic parenchyma were assessed and perfusion parameters were calculated. Normal spleen was slightly heterogeneous in the early phase, but the parenchyma was homogeneous at a later phase. Sedation with butorphanol did not modify perfusion of the spleen. Dexmedetomidine significantly reduced splenic enhancement, providing diffuse parenchymal hypoechogenicity during the entire examination. Measured parameters were significantly modified, with increased arrival time (AT; (< 0.0001) and time to peak (TTP; P < 0.0001), and decreased peak intensity (PI; P = 0.0108), wash‐in (P = 0.0014), and area under the curve (AUC; P = 0.0421). Findings supported the use of butorphanol and contraindicated the use of dexmedetomidine as sedatives for splenic contrast ultrasound procedures in dogs. Short‐term and diffuse heterogeneity of the spleen in the early venous phase was determined to be a normal finding.     

INTRAOPERATIVE CONTRAST‐ENHANCED ULTRASONOGRAPHY OF NORMAL CANINE JEJUNUM

Nine normal juvenile dogs were evaluated with direct jejunal contrast‐enhanced ultrasonography via midline celiotomy. Three different doses of ultrasound contrast medium (Definity^®) were injected through a peripheral venous catheter. Time‐intensity curves were used to calculate baseline, time to initial rise, inflow slope, time‐to‐peak, peak intensity (PI), and outflow slope for each administered dose. PI was directly proportional to dose. Outflow slope was similar for all patients, independent of dose. The most favorable images were acquired with a dose of 0.030 ml/kg given as a rapid intravenous manual bolus. The technique and normal jejunal perfusion pattern described herein may provide useful data for evaluation of intestinal vascular, inflammatory, and neoplastic disease in the dog.     

Use of Contrast‐Enhanced Ultrasonography in Chronic Pathologic Canine Testes

Contrast‐enhanced ultrasound with sulphur hexafluoride microbubbles was performed in seven healthy dogs without a history of reproductive pathology and with histologically confirmed normal testes and in 42 dogs with chronic scrotal anomalies. All dogs underwent orchiectomy and histological examination. Enhancement patterns and perfusion parameters (peak intensity and regional blood flow) of testes of healthy dogs and testes with chronic lesions were compared. Fourteen non‐pathologic and 60 pathologic testes were considered. Forty testes were neoplastic (24 interstitial cell tumours, 9 seminomas, 7 Sertoli cell tumours), 20 were non‐neoplastic (16 testicular degenerations, 2 chronic orchitis, 1 testicular atrophy, 1 interstitial cell hyperplasia). In healthy dogs, the contrast medium flow had a rapid homogeneous wash‐in and wash‐out, with a short peak phase. With contrast ultrasound, testes that were inhomogeneous with a hyperenhancing pattern were associated with neoplasia (sensitivity: 87.5%, specificity: 100%). Lesions with persistent inner vessels and a hypo‐to‐isoechoic background were significantly associated with seminomas (sensitivity: 77.8%, specificity: 100%). Testes with non‐neoplastic lesions were characterized by a scant/moderate homogeneous enhancement. Perfusion parameters were higher in neoplastic lesions. Contrast ultrasound was a feasible diagnostic tool in the assessment of testicular lesions, with hyperenhancement being an important feature in the diagnosis of malignancy.     

Accuracy of four ultrasonography techniques in predicting histopathological classification of canine mammary carcinomas

Due to the importance of presurgical, noninvasive, and accurate diagnostic tools in mammary carcinoma characterization, this prospective secondary observational cohort study was designed to evaluate and compare the diagnostic accuracy of B‐mode, Doppler, contrast enhancement ultrasonography, or acoustic radiation force impulse–elastography in identifying mammary carcinomas types with high degree of malignancy. A total of 246 mammary carcinomas from 141 female dogs were analyzed using B‐mode, Doppler, contrast enhancement ultrasonography, and acoustic radiation force impulse ultrasonography prior to their histopathological classification according to types (simple, complex, or special) and grade (I, II, or III). Qualitative and quantitative variables were compared between carcinoma types and grades by Fisher's or analysis of variance. Diagnostic performance was estimated by receiver‐operating characteristic analysis, using histopathological classification as a reference. Deformability (acoustic radiation force impulse) had a diagnostic specificity of 100% and sensitivity of 12% in identifying special carcinomas. A width:length ratio greater than 0.53 can be suggestive of special carcinoma, with 80% sensitivity and 76% specificity. Contrast wash‐in and peak enhancement times lower than 7.5 and 13.5 s, respectively, were indicative of complex carcinoma at 62% sensitivity and 60% specificity. Contrast wash‐in, peak enhancement, and wash‐out times greater than 6.5, 12.5, and 64.5 s, respectively; were indicative of grade II and III carcinoma at 68% sensitivity and 62% specificity. In conclusion, B‐mode ultrasonography, contrast enhancement ultrasonography, and acoustic radiation force impulse–elastography enabled the identification of some of the characteristics of high‐grade mammary carcinoma types and grades in female dogs with limited accuracy. The findings from this study may contribute to oncology research and clinical management canine patients.     

CONTRAST‐ENHANCED ULTRASONOGRAPHY OF THE PANCREAS IN HEALTHY DOGS AND IN DOGS WITH ACUTE PANCREATITIS

Pancreatitis is the most frequent disease affecting the exocrine pancreas in dogs and reliable diagnostic techniques for predicting fatal complications are lacking. Contrast‐enhanced ultrasound (CEUS) improves detection of tissue perfusion as well as organ lesion vascular pattern. Objectives of this prospective case control study were to compare perfusion characteristics and enhancement patterns of the pancreas in healthy dogs and dogs with pancreatitis using CEUS. Ten healthy dogs and eight dogs with pancreatitis were selected based on physical examination, abdominal ultrasound, and blood analysis findings. A CEUS study of the pancreas was performed for each dog and two observers who were aware of clinical status used advanced ultrasound quantification software to analyze time‐intensity curves. Perfusion patterns were compared between healthy and affected dogs. In dogs with acute pancreatitis, mean pixel and peak intensity of the pancreatic parenchyma was significantly higher than that of normal dogs (P = 0.05) in between 6 and 60 s (P = <0.0001–0.046). This corresponds to a 311% increase in mean pixel intensity in dogs with acute pancreatitis compared to healthy dogs. Wash‐in rates were greater and had a consistently steeper slope to peak in dogs with pancreatitis as opposed to healthy dogs. All dogs with pancreatitis showed a decrease in pixel intensity 10–15 days after the initial examination (P = 0.011) and their times to peak values were prolonged compared to the initial exam. Findings from the current study supported the use of CEUS for diagnosing pancreatitis, pancreatic necrosis, and disease monitoring following therapy in dogs.     

Triple‐phased mesenteric CT angiography using a test bolus technique for evaluation of the mesenteric vasculature and small intestinal wall contrast enhancement in dogs

Computed tomography angiography is widely used for the assessment of various mesenteric vascular and bowel diseases in humans. However, there are only few studies that describe CT angiography application to mesenteric vessels in dogs. In this prospective, experimental, exploratory study, the mesenteric vasculature and enhancement pattern of the intestinal wall were evaluated on triple‐phase CT angiography, and improvement of the visibility of vasculature was assessed on multiplanar reformation, maximum intensity projection, and volume rendering technique. After test bolus scanning at the level of the cranial mesenteric artery arising from the aorta, mesenteric CT angiography was performed in 10 healthy, male, Beagle dogs. Scan delay was set based on time‐to‐attenuation curves, drawn by placing the regions of interest over the aorta, intestinal wall, and cranial mesenteric vein. Visualization and enhancement of mesenteric arteries and veins were evaluated with multiplanar reformation, maximum intensity projection, and volume rendering techniques. The degree of intestinal wall enhancement was assessed on the transverse images in precontrast, arterial, intestinal, and venous phases. Pure arterial images were obtained in the arterial phase. Venous phase images allowed good portal vascular mapping. All CT angiography images were of high quality, allowing for excellent visualization of the anatomy of mesenteric vasculature including the small branches, particularly on maximum intensity projection and volume rendering technique. Distinct contrast enhancement of the intestinal wall was observed in both intestinal and venous phases. Findings indicated that this technique is feasible for the evaluation of mesenteric circulation in dogs.     

CONTRAST VIDEOFLUOROSCOPIC ASSESSMENT OF DYSPHAGIC CATS

The diagnostic utility of contrast‐enhanced videofluoroscopic esophagography in dysphagic cats has been rarely studied relative to dogs. Current literature regarding feline dysphagia typically consists of individual case reports or small case series. This retrospective study analyzed the imaging findings in 11 cats undergoing 15 videofluoroscopic swallow studies. Hiatal hernia (n = 5), esophageal stricture (n = 3), and esophageal dysmotility (n = 7) were the most common diagnoses (some cats having more than 1 diagnosis) in dysphagic cats that underwent videofluoroscopic swallow studies. Esophageal dysmotility appeared to be associated with a higher percentage of swallows from which no peristaltic waves were generated. Oropharyngeal and cricopharyngeal causes of dysphagia were not identified in any cat and quantitative assessment of the swallowing reflex (pharyngeal constriction ratio = 0.17 ± 0.09; time to maximum pharyngeal contraction = 0.13 ± 0.02 s; time to proximal esophageal sphincter opening = 0.07 ± 0.02 s; time to proximal esophageal sphincter closed = 0.23 ± 0.05 s; time to opening of the epiglottis = 0.27 ± 0.04 s) was similar to quantitative swallowing parameters previously reported in healthy dogs. In conclusion, videofluoroscopy is a diagnostic tool that can identify esophageal abnormalities that are not readily apparent on survey radiographs. Limitations include the potential need for multiple studies, and the possibility of poor compliance in the feline patient. Results of this study are intended to help veterinarians define a prioritized differential diagnosis list for dysphagic cats.     

Feline platelet counting with prostaglandin E1 on the Sysmex XT‐2000iV

Background: The large size of many feline platelets and the high frequency of platelet aggregation often results in falsely low platelet counts in this species. A combination of optical platelet counting to detect even large platelets and the use of prostaglandin E1 (PGE1) to inhibit platelet clumping may increase the accuracy of feline platelet counting. Objective: The objective of this study was to compare platelet counts in feline whole blood samples with and without the addition of PGE1 and using different analytical methods in a clinical setting. Methods: Platelet counts were determined in 10 feline patients in a referral veterinary hospital using 2 sample types (EDTA, EDTA with PGE1) and 2 methods of analysis (optical counting [PLT‐O] and impedance counting [PLT‐I]) on the Sysmex XT 2000 iV analyzer. Results: All PGE1–PLT‐O samples had platelet counts of >200 × 10⁹/L. Mean platelet count using PGE1–PLT‐O (410,256±178 × 10⁹/L) was significantly higher (P<.03) compared with PGE1–PLT‐I (256±113 × 10⁹/L), EDTA–PLT‐O (238±107 × 10⁹/L), and EDTA–PLT‐I (142±84 × 10⁹/L) methods. Depending on the method, platelet counts in 2 to 7 of 10 cats were <200 × 10⁹/L when PGE1‐PLT‐O was not used. A slightly increased platelet count in response to treatment of a feline patient with thrombocytopenia would have been missed without use of PGE1–PLT‐O. Conclusions: Using PLT‐O analysis on EDTA samples containing PGE1 provides higher, and therefore likely more accurate, feline platelet counts in a clinical setting.     

In vitro validation of a technique for assessment of canine and feline elbow joint collateral ligament integrity and description of a new method for collateral ligament prosthetic replacement

Objective— To assess the ability of an operator to differentiate intact from transected canine and feline elbow joint collateral ligaments (CL) using a reported manipulative test (Campbell's test) and to determine the potential for elbow joint luxation in canine and feline elbows with intact, transected, and surgically stabilized CL. Study Design— In vitro biomechanical study. Sample Population— Canine (n=6) and feline cadavers (n=3). Methods— Thoracic limb specimens were mounted on a custom‐built jig with the elbows and carpi fixed in 90° of flexion. Angles of pronation and supination were recorded after applying rotational forces to the manus. Attempts were made to manually luxate each elbow with intact CL. Constructs were re‐evaluated after sequential sectioning of the medial (MCL) and lateral (LCL) collateral ligaments and after insertion of a new CL prosthesis. Results— Mean (±SD) angles of rotation in dogs increased from 27.3±8° (range, 16.7–41.3°) in pronation to 58.9±9.2° (range, 38–88.3°) after sectioning the MCL and from 45.5±10.8° (range, 30.7–67.3°) in supination to 68.9±17.2° (range, 45–94°) after sectioning the LCL. Angles of pronation and supination were subject to significant interanimal variability, with a strong correlation between increasing animal weight and smaller angles of rotation. Elbow luxation in dogs was not possible unless at least the LCL was transected. In cats, mean angles of rotation increased from 49.8±14.9° (range, 30.7–70°) in pronation to 99.1±17.6° (range, 79–111.7°) after sectioning the MCL and from 128.7±18.8° (range, 108.3–151.7°) in supination to 166.7±13.1° (range, 157.3–181.7°) after sectioning the LCL. Luxation in cats was not possible unless both CL were cut. Use of the ligament prosthesis without primary CL repair reliably prevented reluxation in all canine and feline elbows. Conclusions— Campbell's test allowed reliable differentiation of intact, transected and surgically stabilized canine and feline elbow joint CL in a cadaveric model. Luxation could not be performed by application of rotational forces to specimens with intact CL. Clinical Relevance— Clinical examination findings, specifically Campbell's test, can be used to determine elbow CL integrity in dogs and cats. The contralateral elbow should be used as a control, because of interanimal variability in angles of rotation.     

Contrast-enhanced ultrasonography for evaluation of the blood perfusion of sciatic nerves in healthy dogs

Blood supply to the peripheral nerves is essential for fulfilling their structural and functional requirements. This prospective, experimental, exploratory study aimed to assess the feasibility of contrast-enhanced ultrasonography (CEUS) for evaluating blood perfusion of the sciatic nerve in normal dogs. Contrast-enhanced ultrasonography examinations were performed on the bilateral sciatic nerves after bolus injection of Sonazoid™ (0.015 mL/kg) in 12 healthy Beagles for 150 s. Then, qualitative assessment of the wash-in timing, degree and enhancement patterns, and quantitative measurement of the peak intensity and time to peak intensity were performed from the sciatic nerve. The results were compared to those obtained from the adductor muscle around the nerve and caudal gluteal artery. After contrast agent injection, the sciatic nerve was enhanced at approximately 13–14 s, immediately after wash-in of the caudal gluteal artery. The peak intensity of the sciatic nerve was significantly lower than that of the caudal gluteal artery and higher than that of the adductor muscle. The time to peak intensity was significantly slower than that of the caudal gluteal artery; but was not significantly different from that of the adductor muscle. There were no significant differences in the peak intensity and time to peak intensity between the left and right sciatic nerves. These results demonstrate the feasibility of CEUS to assess blood perfusion of the sciatic nerve in healthy dogs qualitatively and quantitatively. This result from healthy dogs could serve as a reference for further studies that evaluate the sciatic nerve under pathological conditions.     

Morphological assessment of cat kidneys using computed tomography

There are numerous publications about feline renal imaging information; however, none have established reference values for kidney size using computed tomography (CT). This study aimed to determine renal size and shape as well as the morphology of renal‐related structures in clinically normal cats (Felis catus) that underwent CT. Twenty‐seven healthy cats underwent pre‐ and post‐iodinated contrast‐enhanced CT. Most cat (59%) kidneys were located at the same level. The average pre‐contrast dimensions of the left kidney included a width of 2.46 ± 0.28 cm, a length of 3.52 ± 0.44 cm and a height 2.19 ± 0.31 cm, whereas those of the right kidneys were 2.45 ± 0.27 cm, 3.54 ± 0.46 cm and 2.05 ± 0.23 cm, respectively. After contrast enhancement, kidneys were slightly enlarged though not significantly. Additionally, renal length (LK or RK) was compared with second lumbar vertebra (L2) length and abdominal aorta diameter (AO). AO was significantly larger in male cats whereas L2 length appeared longer in male cats, but was not statistically different from the female cats. The LK/L2 and RK/L2 ratios were 2.29 ± 0.23 and 2.36 ± 0.20, respectively, and the LK/AO and RK/AO were 11.72 ± 1.37 and 12.05 ± 1.47, respectively. Renal vessels were examined. The renal vein was obviously larger than the renal artery, and paired renal veins were observed periodically. This study provides CT information about the feline kidney, which may help to establish reference values and information regarding renal structure prior to surgery in practice.     

Contrast‐Enhanced Ultrasound Examination for the Assessment of Renal Perfusion in Cats with Chronic Kidney Disease

Background

Contrast‐enhanced ultrasound examination (CEUS) is a functional imaging technique allowing noninvasive assessment of tissue perfusion. Studies in humans show that the technique holds great potential to be used in the diagnosis of chronic kidney disease (CKD). However, data in veterinary medicine are currently lacking.

Objectives

To evaluate renal perfusion using CEUS in cats with CKD.

Animals

Fourteen client‐owned cats with CKD and 43 healthy control cats.

Methods

Prospective case‐controlled clinical trial using CEUS to evaluate renal perfusion in cats with CKD compared to healthy control cats. Time‐intensity curves were created, and perfusion parameters were calculated using off‐line software. A linear mixed model was used to examine differences between perfusion parameters of cats with CKD and healthy cats.

Results

In cats with CKD, longer time to peak and shorter mean transit times were observed for the renal cortex. In contrast, a shorter time to peak and rise time were seen for the renal medulla. The findings for the renal cortex indicate decreased blood velocity and shorter total duration of enhancement, likely caused by increased vascular resistance in CKD. Increased blood velocity in the renal medulla has not been described before and may be because of a different response to regulatory factors in cortex and medulla.

Conclusions and Clinical Importance

Contrast‐enhanced ultrasound examination was capable of detecting perfusion changes in cats with CKD. Further research is warranted to assess the diagnostic capabilities of CEUS in early stage of the disease process.