CHARACTERISTICS OF CEREBROSPINAL FLUID FLOW IN CAVALIER KING CHARLES SPANIELS ANALYZED USING PHASE VELOCITY CINE MAGNETIC RESONANCE IMAGING

Syringomyelia is an important morbidity source in Cavalier King Charles Spaniels. Although abnormal cerebrospinal fluid (CSF) flow secondary to Chiari malformations is thought to cause syringomyelia in humans, this relationship is unknown in dogs. We used phase-contrast magnetic resonance (MR) imaging to evaluate CSF flow in dogs. Fifty-nine Cavalier King Charles Spaniels were assigned a neurologic grade reflecting their neurologic status. Five normal control dogs of other breeding were imaged for comparison. The presence of syringomyelia was noted from sagittal MR images. The pattern and velocity of CSF flow were assessed using phase-contrast cine MRI at the foramen magnum, C2–C3 disc space, and within syrinxes. Flow was measured most easily with the neck flexed to mimic standing. CSF flow velocity in the dorsal aspect of the subarachnoid space at the foramen magnum was significantly higher in control dogs than Cavalier King Charles Spaniels ( P =0.035). Flow was obstructed at the foramen magnum in 41 of 59 Cavalier King Charles Spaniels. Turbulent flow and jets were associated with syringomyelia presence and severity, and CSF flow velocity at C2/3 dorsally was inversely related to the presence of syringomyelia ( P =0.0197). Peak dorsal subarachnoid space CSF flow velocity at the foramen magnum and C2–C3 were together highly predictive of syringomyelia. CSF flow can be assessed in dogs using phase-contrast cine MRI. Obstruction to flow at the foramen magnum is common in Cavalier King Charles Spaniels and CSF flow pattern and velocity are related to the presence of syringomyelia.     

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.     

Evaluation of cerebrospinal fluid lactate and plasma lactate concentrations in anesthetized dogs with and without intracranial disease

The objectives of this study were to establish a reference interval for canine cerebrospinal fluid lactate (CSFL) and to compare CSFL and plasma lactate (PL) concentrations in anesthetized dogs with and without intracranial disease. Using a prospective study, canine blood and cerebrospinal fluid were collected for lactate analysis in 11 dogs with intracranial disease after undergoing magnetic resonance imaging (MRI) (Group ID-MRI), in 10 healthy dogs post-MRI (Group H-MRI), and in 39 healthy dogs after induction of anesthesia (Group H-Sx). Dogs were anesthetized for the procedures using different anesthetic protocols. Neurological scores (NS) and sedation scores (SS) were assessed pre-anesthesia in ID-MRI dogs. The CSFL reference interval [90% confidence interval (CI) for lower and upper limits] was 1.1 (1.0 to 1.2) to 2.0 (2.0 to 2.1) mmol/L. Mean ± SD CSFL concentrations were: ID-MRI, 2.1 ± 0.8; H-MRI, 1.6 ± 0.4; and H-Sx, 1.6 ± 0.2 mmol/L. There was a tendency for higher CSFL in dogs in the ID-MRI group than in those in the H-MRI or H-Sx groups (P = 0.12). There was agreement between CSFL and PL in ID-MRI dogs (P = 0.007), but not in dogs in H-MRI (P = 0.5) or H-Sx (P = 0.2). Of the ID-MRI dogs, those with worse NS had higher CSFL (r² = 0.44). The correlation between CSFL and PL in dogs with intracranial disease and between worse NS and higher CSFL warrants further investigation into the use of CSFL and PL for diagnostic and prognostic purposes.     

VALUE OF A SINGLE-SHOT TURBO SPIN-ECHO PULSE SEQUENCE FOR ASSESSING THE ARCHITECTURE OF THE SUBARACHNOID SPACE AND THE CONSTITUTIVE NATURE OF CEREBROSPINAL FLUID

Three case history reports are presented to illustrate the value of the single-shot turbo spin-echo pulse sequence for assessment of the subarachnoid space. The use of the single-shot turbo spin-echo pulse sequence, which is a heavily T2-weighted sequence, allows for a rapid, noninvasive evaluation of the subarachnoid space by using the high signal from cerebrospinal fluid. This sequence can be completed in seconds rather than the several minutes required for a T2-fast spin-echo sequence. Unlike the standard T2-fast spin-echo sequence, a single-shot turbo spin-echo pulse sequence also provides qualitative information about the protein and the cellular content of the cerebrospinal fluid, such as in patients with inflammatory debris or hemorrhage in the cerebrospinal fluid. Although the resolution of the single-shot turbo spin-echo pulse sequence images is relatively poor compared with more conventional sequences, the qualitative information about the subarachnoid space and cerebrospinal fluid and the rapid acquisition time, make it a useful sequence to include in standard protocols of spinal magnetic resonance imaging.     

Age-related change in shear elastic modulus of the thoracolumbar multifidus muscle in healthy Beagle dogs using ultrasound shear wave elastography

BackgroundMultifidus muscle stiffness decreases in patients with lumbar intervertebral disk herniation; however, age-related changes in humans have not been reported.ObjectivesThe reliability of ultrasound shear wave elastography in dogs, and changes in the shear elastic modulus of the thoracolumbar multifidus muscle with aging in dogs, were investigated.MethodsTwelve beagle dogs were divided into 2 groups based on the age of onset of intervertebral disk herniation: young (aged not exceeding 2 years; 1.3 ± 0.6 years old, n = 5) and adult (4.9 ± 1.2 years old, n = 7). The shear elastic modulus of the multifidus muscle, from the thirteenth thoracic spine to the fourth lumbar spine, was measured using ultrasound shear wave elastography. The length, cross-sectional area and muscle to fat ratio of the multifidus muscle, and the grade of intervertebral disk degeneration, were assessed using radiographic and magnetic resonance imaging examinations.ResultsThe length and cross-sectional area of the multifidus muscle increased caudally. In the young group, the shear elastic modulus of the multifidus muscle of the thirteenth thoracic spine was less than that of the third lumbar spine. In the adult group, the shear elastic modulus of the multifidus muscle of first and third lumbar spine was lower than that of the same site in the young group.ConclusionsUltrasound can be used to measure shear wave elastography of the thoracolumbar multifidus in dogs. If the multifidus muscle stiffness decreases, we should consider age-related change.     

The effect of hypertonic saline solution on vasodilatation of the superior sagittal sinus using magnetic resonance imaging in normovolemic dogs

Several animal studies have demonstrated the beneficial effects of hypertonic saline (HSS) on cerebral blood flow, intracranial pressure and brain water content. This study aimed to investigate, using magnetic resonance imaging, whether a small volume of HSS is superior to dextran in vasodilatation of cerebral vessels and reduction of cerebrospinal fluids in dogs. HSS induced a significant expansion of the cross-section of the superior sagittal sinus in the axial transverse section of the pituitary and a decrease in cerebrospinal fluid area in the axial transverse section of the epencephalon more than dextran 40 did (p<0.001, respectively). However, the relative plasma volume in the dog which received dextran 40 was significantly higher after t=30min than in the HSS group (p<0.001). Therefore, it is suggested that HSS might be superior to colloid solutions in improving cerebral circulation, whereas dextran 40 is superior to HSS in enhancing systemic circulation in dogs.     

CEREBROSPINAL FLUID SIGNAL-VOID SIGN IN DOGS

The cerebrospinal fluid signal-void sign is an observable signal loss from cerebrospinal fluid (CSF), especially on T2-weighted magnetic resonance (MR) images. In people, this sign is attributed to rapid CSF flow or turbulence from arterial pulsations and occurs more frequently with reduced intracranial compliance. The purposes of this study were to describe the CSF signal-void sign, document whether a similar sign occurs in dogs and investigate associations between it and other conditions. The sample population consisted of 327 dogs admitted for neurocranium evaluation using a 0.2 T system. Review of the medical records and MR images was performed to characterize the presence and location of a CSF signal-void sign, ventricular size, syringomyelia, and other lesions. A CSF signal-void sign was detected in at least the mesencephalic aqueduct in 59/327 (18.0%) dogs, including some with no morphologic brain abnormality. The majority of these dogs (45/59% or 76%) weighed <15 kg. In two other dogs, a CSF signal-void sign was detected only in a cervical syrinx. In dogs weighing >15 kg, a CSF signal-void sign was seen with various conditions. In 137/327 (41.9%) dogs weighing <15 kg, the presence of a CSF signal-void sign in the aqueduct (45 dogs) was associated with syringomyelia ( P =0.0468) and increased ventricular size ( P =0.0054): syringomyelia also was associated with increased ventricular size ( P =0.0009). In conclusion, a CSF signal-void sign was seen in dogs with various conditions. In small-breed dogs, a CSF signal-void sign in the aqueduct was associated with ventricular enlargement and syringomyelia.     

Canine model of ischemic stroke with permanent middle cerebral artery occlusion: clinical and histopathological findings

The aim of the present study was to assess the clinical and histopathological findings in a canine model of ischemic stroke. Cerebral ischemic stroke was induced by middle cerebral artery occlusion in four healthy beagle dogs using silicone plugs. They showed neurological signs of forebrain dysfunction such as reduced responsiveness, head turning, circling, postural reaction deficits, perceptual deficits, and hemianopsia. These signs gradually regressed within 4 weeks without therapy. On magnetic resonance imaging, T2 hyperintensity and T1 hypointensity were found in the cerebral cortex and basal ganglia. These lesions were well-defined and sharply demarcated from adjacent brain parenchyma with a homogenous appearance. No abnormalities of the cerebrospinal fluid were observed. At necropsy, atrophic and necrotic lesions were observed in the cerebral cortex. The cerebral cortex, basal ganglia, and thalamus were partially unstained with triphenyl-tetrazolium chloride. Histopathologically, typical features of infarction were identified in cortical and thalamic lesions. This study demonstrates that our canine model resembles the conditions of real stroke patients.     

Cerebrospinal fluid flow on time‐spatial labeling inversion pulse images before and after treatment of congenital hydrocephalus in a dog

A 3‐month‐old male cross‐breed dog presented with signs of progressive diffuse brain disease. Noncommunicating congenital hydrocephalus concurrent with cervical syringomyelia was diagnosed on magnetic resonance images. On time‐spatial labeling inversion pulse (Time‐SLIP) images CSF flow through the mesencephalic aqueduct was poorly defined and there was flow into the syrinx across the craniocervical junction. After percutaneous ventricular drainage and ventriculoperitoneal shunting, CSF flow through the aqueduct was clearly detected and flow into the syrinx disappeared. In addition, CSF flow in the subarachnoid space at the pons and ventral aspect of the cervical subarachnoid space was restored. Signs of neurological dysfunction improved after ventriculoperitoneal shunting and the cerebral parenchyma was increased in thickness on 2‐year follow‐up computed tomography images. Patterns of CSF flow on Time‐SLIP images before and after CSF drainage or ventriculoperitoneal shunting aid in clarifying disease pathogenesis and confirm effects of CSF drainage.     

Effect of acetazolamide and subsequent ventriculo-peritoneal shunting on clinical signs and ventricular volumes in dogs with internal hydrocephalus

Background

Acetazolamide is recommended for the reduction of cerebrospinal fluid production in canine internal hydrocephalus. The efficacy of the drug in terms of alleviation of the clinical symptoms and the restoration of normal ventricular volume has not been documented. We hypothesize that acetazolamide inadequately improve clinical signs and has no effect on the ventricular volume. Six dogs with internal hydrocephalus underwent neurological examination and were examined by magnetic resonance imaging, on the day of the diagnosis, after treatment with acetazolamide directly before surgery, and 6 weeks after implantation of a vetriculo-peritoneal shunt due to lack of improvement after medical therapy with 10 mg/kg acetazolamide three times daily (TID). The ventricular volume in relation to the total brain volume was determined on each occasion. The changes in relative ventricular volume and of the neurological status were assessed and compared.

Results

McNemar’s test revealed no significant differences in clinical symptoms before and after medical treatment (P > 0.05). However, clinical symptoms changed significantly after surgical treatment (P = 0.001). The ventricle-brain ratio was not significantly changed after therapy with acetazolamide (P > 0.05); however, after subsequent shunt implantation, it was significantly reduced (P = 0.001).

Conclusion

Acetazolamide (10 mg/kg TID) showed no effects on clinical signs or ventricular volume in dogs with internal hydrocephalus. After subsequent ventriculo-peritoneal shunting, the dogs had a significantly reduced cerebral ventricular volume and five out of six dogs had no abnormal findings in neurological examination.     

Syringohydromyelia in Cavalier King Charles spaniels

Syringohydromyelia secondary to foramen magnum overcrowding is described in seven Cavalier King Charles spaniels. Clinical signs were consistent with a central spinal cord lesion. The most common signs were persistent scratching at the shoulder region with apparent neck, thoracic limb, or ear pain and thoracic limb lower motor neuron deficits. The diagnosis was made by magnetic resonance imaging. The syringohydromyelia is postulated to be a consequence of an occipital bone malformation resulting in a small caudal fossa and cerebellar herniation. Clinical signs improved but did not completely resolve when the dogs received treatment with corticosteroids or nonsteroidal anti-inflammatory drugs.     

Evaluation of left ventricular function with cardiac magnetic resonance imaging and echocardiography after administration of dobutamine and esmolol in healthy beagle dogs

Unlike echocardiography, cardiac magnetic resonance imaging (cardiac MRI) results in a near-exact assessment of cardiac structures and function. However, most veterinary studies have focused on dogs with normal cardiac function. We hypothesized that there would be significant differences in cardiac measurements between cardiac MRI and echocardiography when left ventricular (LV) function was abnormal. This study was undertaken to compare measurements of LV function produced by cardiac MRI and echocardiography in dogs whose LV function was altered by pharmacological agents. This study was conducted with six healthy beagle dogs. We increased left ventricular contractility by administration of dobutamine; we decreased cardiac contractility with esmolol. Stroke volume measurements were made by using both cardiac MRI and echocardiography under seven different conditions with general anesthesia: control, three doses of esmolol (100, 200, and 500 µg/kg/min), and three doses of dobutamine (10, 20, and 50 µg/kg/min). Experiments involving each condition were conducted at least 1 week apart. When LV contractility was normal, ejection fraction (EF) and stroke volume (SV), as measured by echocardiography and cardiac MRI, were not significantly different. However, when contractility was changed by pharmacological agents, EF and SV were overestimated by echocardiography, compared to MRI. Evaluation of cardiac function in patients treated with pharmacological agents should be conducted carefully because EF and SV measured by echocardiography can be overestimated, compared with EF and SV obtained by cardiac MRI.     

MRI CHARACTERISTICS OF FOURTH VENTRICLE ARACHNOID DIVERTICULA IN FIVE DOGS

Intracranial arachnoid diverticula (cysts) are rare accumulations of cerebrospinal fluid (CSF) within the arachnoid membrane. The purpose of this retrospective study was to describe magnetic resonance imaging (MRI) characteristics of fourth ventricle arachnoid diverticula in a group of dogs. The hospital's medical records were searched for dogs with MRI studies of the brain and a diagnosis of fourth ventricle arachnoid diverticulum. Clinical characteristics were recorded from medical records and MRI studies were reinterpreted by a board‐certified veterinary radiologist. Five pediatric dogs fulfilled inclusion criteria. Clinical signs included cervical hyperaesthesia, obtundation, tetraparesis, and/or central vestibular syndrome. In all five dogs, MRI findings were consistent with obstructive hydrocephalus, based on dilation of all ventricles and compression of the cerebellum and brainstem. All five dogs also had cervical syringohydromyelia, with T2‐weighted hyperintensity of the gray matter of the cord adjacent to the syringohydromyelia. A signal void, interpreted as flow disturbance, was observed at the mesencephalic aqueduct in all dogs. Four dogs underwent surgical treatment with occipitalectomy and durotomy. A cystic lesion emerging from the fourth ventricle was detected in all four dogs during surgery and histopathology confirmed the diagnosis of arachnoid diverticula. Three dogs made excellent recovery but deteriorated shortly after surgery and were euthanized. Repeat MRI in two dogs revealed improved hydrocephalus but worsening of the syringohydromyelia. Findings from the current study supported theories that fourth ventricle arachnoid diverticula are secondary to partial obstruction of the central canal or lateral apertures and that arachnoid diverticula are developmental lesions in dogs.     

Ultrasonographic appearance of the craniocervical junction in normal brachycephalic dogs and dogs with caudal occipital (Chiari-like) malformation

Ultrasonographic evaluation of the spine, especially of the spinal cord, has been rarely reported in dogs. The atlanto-occipital junction provides a small acoustic window through which examination of the craniocervical transition can be performed. Normal sonographic findings of this region in 10 normal brachycephalic dogs are presented and compared with sonographic findings from 25 Cavalier King Charles Spaniels with the caudal occipital malformation syndrome. Sonographic findings were compared with magnetic resonance imaging findings to determine the extent of cerebellar herniation and syringohydromyelia. Cerebellar displacement into the foramen magnum was clearly identified sonographically; however, syringohydromyelia was not discernable due to bone overlay.     

ASSOCIATIONS BETWEEN CARDIOPULMONARY VARIABLES AND THE CEREBROSPINAL FLUID SIGNAL-VOID SIGN IN SMALL-BREED DOGS

The cerebrospinal fluid (CSF) signal-void sign is a CSF signal loss, especially on T2-weighted magnetic resonance (MR) images. The CSF signal-void sign is often seen in small dogs with hydrocephalus and syringomyelia. In people, this sign is attributed to high velocity or turbulent CSF flow resulting from normal arterial pulsations, but is more pronounced in hydrocephalic patients with reduced intracranial compliance. If dogs are similar, then detection of this sign might be influenced by cardiovascular variables affected by anesthesia or related to intracranial compliance (e.g., blood pressure) or that affect CSF flow (e.g., heart rate). Therefore, the purpose of this study was to investigate whether the CSF signal-void sign is associated with these cardiovascular variables. The sample population consisted of 53 small-breed (<15 kg) anesthetized dogs undergoing spin echo, T2-weighted MR imaging of the neurocranium. Heart rate, blood pressure (systolic, mean, diastolic, pulse), and end-tidal CO₂ were recorded and dogs were grouped as having a CSF signal-void sign in the mesencephalic aqueduct (19/53) or not (34/53). Normality was confirmed and t -tests used. No statistical difference was detected between groups for any of the cardiovascular variables. However, the sample size was too small to accept the null hypothesis that no difference existed between groups for any of the variables assessed. Therefore, although it is uncertain whether the investigated variables alter the frequency of detecting a CSF signal-void sign, any possible relationship does not appear strong.     

Cerebellar cortical degeneration with selective granule cell loss in Bavarian mountain dogs

Three Bavarian mountain dogs aged between 18 and 20 months, not related to each other, were presented with chronic signs of cerebellar dysfunction. On sagittal T2-weighted magnetic resonance imaging brain images, the tentative diagnosis of cerebellar hypoplasia was established based on an enlarged cerebrospinal fluid space around the cerebellum and an increased cerebrospinal fluid signal between the folia. Post-mortem examination was performed in one dog and did show an overall reduction of cerebellar size. On histopathologic examination, a selective loss of cerebellar granule cells with sparing of Purkinje cells was evident. Therefore, the Bavarian mountain dog is a breed where cerebellar cortical degeneration caused by the rather exceptional selective granule cell loss can be seen as cause of chronic, slowly progressive cerebellar dysfunction starting at an age of several months.     

Cerebellar vascular hamartoma in a British Shorthair cat

Cerebellar vascular hamartoma was diagnosed in a 16-month-old cat following magnetic resonance imaging and incisional biopsy. The clinical features were consistent with the cerebellar site of the lesion accompanied by signs attributable to cerebellar herniation through the foramen magnum and increased intra-cranial pressure. A lesion of this type represents a previously unreported differential diagnosis for central nervous system lesions in young cats.     

Comparison of magnetic resonance imaging sequences in dogs with multi-focal intracranial disease

OBJECTIVES: To compare the value of different magnetic resonance sequences in the detection of brain lesions in dogs with multi-focal intracranial neurolocalised lesions and abnormal cisternal cerebrospinal fluid analysis. METHODS: T2-weighted, T1-weighted, T1-weighted-Gd, FLAIR (fluid attenuated inversion recovery) images of 73 dogs with multi-focal intracranial localised lesions were reviewed retrospectively. Control dogs (19) were selected on the basis of normal neurological examination, magnetic resonance images and cerebrospinal fluid analysis. Two board-certified radiologists blindly reviewed the magnetic resonance images. Magnetic resonance sequence sensitivities were compared using the chi-squared test and logistic regression, accounting for clustering at the patient level. Statistical significance was set at the 5 per cent level. RESULTS: The FLAIR sequence was found to have the highest sensitivity (84 per cent, 61 of 73), followed by T2-weighted (63 per cent, 46 of 73), T1-weighted postcontrast (62 per cent, 45 of 73) and T1-weighted (23 per cent, 17 of 73) (P<0.001). FLAIR images were 106.1 times (95 per cent confidence interval 25.2 to 447.5) more likely to correctly identify cerebrospinal fluid-positive patients than T1-weighted, 6.4 times (95 per cent confidence interval 2.2 to 18.2) than T1-weighted postcontrast and 5.8 times (95 per cent confidence interval 2.0 to 16.4) than T2-weighted. FLAIR identified 14 per cent of cases that were classified as normal based on the three others sequences. CLINICAL SIGNIFICANCE: Routine use of FLAIR sequence should be encouraged in dogs undergoing a brain magnetic resonance imaging and probably more specifically in cases of suspected inflammatory brain disease.     

IMAGING DIAGNOSIS—CANINE MENINGIOANGIOMATOSIS

Meningioangiomatosis is a rare proliferative disorder of the central nervous system. It occurs sporadically in dogs and is characterized by a leptomeningeal plaque that extends from the subarachnoid space along the perivascular spaces into the adjacent parenchyma. We describe the clinical presentation, magnetic resonance (MR) imaging and neuropathologic characteristics of two additional dogs with meningioangiomatosis, and document involvement of the thoracolumbar spinal cord, a site not previously described for this condition. MR imaging findings were different from those previously described, most likely reflecting the degree of vascularity and collagen deposition. The MR imaging features of meningioangiomatosis are not specific.     

The relationship between clinical signs and brain herniation associated with rostrotentorial mass lesions in the dog

Retrospective analysis of magnetic resonance imaging and clinical findings in a referral population of dogs was used to determine the relationship between rostrotentorial space-occupying lesions and the development of secondary neurological signs. Brain herniation was detected in 54/153 cases of uni-focal rostrotentorial space-occupying lesions; of these 30 had caudal transtentorial herniation (CTH) and 24 had both transtentorial and foramen magnum herniation (CTH/FMH). Masses associated with herniation were larger and situated more dorsally and caudally within the cranial vault. Clinical signs classically associated with CTH, e.g., oculomotor nerve palsy, were seen in only one case of isolated CTH and seven (14%) of all herniation cases. Deficits in caudal cranial nerve function were detectable in 39% of cases with FMH. We conclude that severe shifts in brain parenchyma can exist in the absence of detectable localising signs.