USE OF COMPUTED TOMOGRAPHY RENAL ANGIOGRAPHY FOR SCREENING FELINE RENAL TRANSPLANT DONORS

Preoperative knowledge of the renal vascular anatomy is important for selection of the appropriate feline renal donor. Intravenous urograms (IVUs) have been performed routinely to screen potential donors at the Veterinary Hospital of the University of Pennsylvania (VHUP), but the vascular phase views lack sufficient detail of the renal vascular anatomy. Computed tomography angiography (CTA), which requires a helical computed tomography (CT) scanner, has been found to provide superior renal vascular anatomic information of prospective human renal donors. The specific aims of this study were as follows: 1) develop the CTA technique for the feline patient; and 2) obtain preliminary information on feline renal vessel anatomy in potential renal donors. Ten healthy, potential feline renal donors were anesthetized and imaged using a third-generation helical CT scanner. The time delay between i.v. contrast medium injection and image acquisition, and other parameters of slice collimation, slice interval, pitch, exposure settings, and reconstruction algorithms were varied to maximize contrast medium opacification of the renal vascular anatomy. Optimal CTA acquisition parameters were determined to be: 1) 10-sec delay post-i.v. bolus of iodinated contrast medium; 2) two serially acquired (corresponding to arterial and venous phases) helical scans through the renal vasculature; 3) pitch of 2 (4 mm/sec patient translation, 2 mm slice collimation); and 4) 120-kVp, 160-mA, and 1-sec exposure settings. Retrospective reconstructed CTA transverse images obtained at a 2-mm slice width and a 1-mm slice interval in combination with two-dimensional reformatted images and three-dimensional reconstructed images were qualitatively evaluated for vascular anatomy; vascular anatomy was confirmed at surgery. Four cats had single renal arteries and veins bilaterally; four cats had double renal veins. One cat had a small accessory artery supplying the caudal pole of the left kidney. One cat had a left renal artery originating from the aorta at a 90 degrees angle with the cranial mesenteric artery. CTA of the feline renal vascular anatomy is feasible, and reconstruction techniques provide excellent anatomic vascular detail. CTA is now used routinely at VHUP to screen all potential feline renal donors.     

Multidetector row computed tomography evaluation of the micropig kidney as a potential renal donor

Multidetector row computed tomography (MDCT) provides anatomical information about the kidney and other internal organs. Presently, the suitability of 64-channel MDCT to assess the kidney of healthy micropigs was evaluated. Morphological evaluations of the kidney and the major renal vessels of six healthy micropigs were carried out using MDCT, recording kidney volume and the diameter and length of renal arteries and veins. The mean diameters and lengths of the renal artery were 0.44 ± 0.05 and 4.51 ± 0.55 cm on the right side and 0.46 ± 0.06 and 3.36 ± 0.27 cm on the left side, respectively. The mean diameters and lengths of the renal vein were 1.44 ± 0.52 and 4.22 ± 1.29 cm on the right side and 1.38 ± 0.17 and 5.15 ± 0.87 cm on the left side, respectively. The mean volume of the right kidney was 79.3 ± 14.5 mL and of the left kidney was 78.0 ± 13.9 mL. The data presented in this study suggest that the MDCT offers a noninvasive, rapid, and accurate method for the evaluation of the renal anatomy in living kidney donors. It also provides sufficient information about extra-renal anatomy important for donor surgery and determination of organ suitability.     

Use of computed tomography angiography for the evaluation of a cutaneous haemangioma in a Standardbred horse

Cutaneous haeangiomas are benign vascular neoplasms that arise from endothelial cells of blood vessels. Haemangiomas account for 0.6%–4% of all equine cutaneous neoplasms and the fetlock is the most commonly affected site. We describe the use of computed tomography angiography (CTA) for the evaluation of a cutaneous haemangioma located on the plantarolateral aspect of the left hindlimb fetlock of a 9-month-old Standardbred colt. Computed tomography angiography of the affected fetlock was performed under general anaesthesia. The medial plantar artery was catheterised and a total volume of 50 ml of iodinated non-ionic contrast medium (Iopamidol, 300 mg I/ml, Bracco Imaging Canada) was injected at a rate of 2 ml/s. Following contrast medium administration, the dorsal metatarsal artery and branches including the lateral and medial digital arteries were well demarcated. Two smaller lateral and medial arteries were also identified, forming the vascular network of the metatarsophalangeal joint. At the level of the haemangioma, two tortuous arteries arising from the lateral digital artery were identified, in addition to multiple small branches from nearby cutaneous arteries. These vessels supplied the homogeneously strongly contrast-enhancing cutaneous mass. The initial goal of the CTA study was to map the vascular anatomy for arterial embolisation in conjunction with pharmacological therapy. Considering the involvement of multiple small arterial branches, complete surgical excision along with ligation of the two main supplying arteries was alternatively elected, resulting in a successful long-term outcome.     

STRUCTURAL AND FUNCTIONAL CHANGES RELEVANT TO MAXILLARY ARTERIAL FLOW OBSERVED DURING COMPUTED TOMOGRAPHY AND NONSELECTIVE DIGITAL SUBTRACTION ANGIOGRAPHY IN CATS WITH THE MOUTH CLOSED AND OPENED

Some cats develop blindness during procedures with mouth gags, which possibly relates to maxillary arterial occlusion by opening the mouth. Our first aim was to use computed tomography (CT) to describe how vascular compression is possible based on morphologic differences between mouth positions. Our second aim was to use nonselective digital subtraction angiography to assess whether opening the mouth induces collateral circulation. Six healthy cats were examined. During CT, the maxillary artery coursed between the angular process of the mandible and the rostrolateral wall of the tympanic bulla. The median distance between these structures was shorter when the mouth was opened (left, 4.3 mm; right, 3.6 mm) vs. closed (left, 6.9 mm; right, 7.1 mm). Additionally, the distance was shorter on the side ipsilateral to the gag (P = 0.03). During nonselective angiography, with the mouth closed, there was strong sequential opacification of the external carotid arteries, maxillary arteries, maxillary retia mirabilia, cerebral arterial circle, and basilar artery. Additionally, there was uniform opacification of the cerebrum and cerebellum. With the mouth opened, opacification of the maxillary arteries (rostral to the angular processes) was reduced in all cats, the cerebral arterial circle and basilar artery had simultaneous opacification in four of six (67%) cats, and the cerebrum had reduced opacification compared to the cerebellum in four of six (67%). In conclusion, the maxillary arteries are situated such that they can be compressed when opening the mouth. Opening the mouth did not consistently induce collateral circulation sufficient to produce comparable cerebral opacification as when the mouth was closed.     

TIME-RESOLVED RENAL CONTRAST-ENHANCED MRA IN NORMAL DOGS

In humans, contrast-enhanced magnetic resonance angiography (CE-MRA) is a documented method to quantitatively and qualitatively evaluate renal vessels. It offers a safer alternative to computed tomography angiography. The aim of this study was to establish a renal MRA protocol in dogs using a 3D multiphase Fast Spoiled Gradient Recalled echo CE-MRA sequence (3D FSPGR CE-MRA). We used an elliptical centric ordering of k -space to acquire the contrast-sensitive data faster. Four to five consecutive 3D dorsal slabs, encompassing both kidneys, could be acquired in 40–65 s. The renal arterial and venous phases were obtained separately during phases 1 or 2, and 2 or 3, respectively without the need for any contrast medium bolus timing. The renal arteries and veins were clearly visualized. In conclusion, multiphase FSPGR 3D CE-MRA with an elliptical centric k -space ordering allows distinguishing renal arterial and venous phases in dogs, and can be used as a noninvasive diagnostic imaging alternative to map renal vessels in this species. Potential applications include the screening of renal donors in renal transplantation programs, and the pretreatment evaluation of animals with invasive renal neoplasia or renal vascular anomalies when surgery or embolization are contemplated.     

Computed tomography features of bronchial and non-bronchial collateral arterial circulation development in a dog diagnosed with multiple chronic pulmonary thrombi

A 5 year-old female Lhasa Apso was diagnosed with a large right pulmonary artery thrombus, multiple smaller pulmonary thrombi, and pulmonary hypertension. In addition, thoracic computed tomography angiography revealed numerous periesophageal arterial vessels, tortuous and dilated bronchial arteries, and an enlarged tortuous left phrenic artery, consistent with systemic bronchial and non-bronchial collateral arterial circulation development. These features of chronic pulmonary arterial thrombi have not been described in dogs but are recognized in people. One year after the diagnosis, the dog was still alive and there were no clinical signs reported.     

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.     

双峰驼肾动脉分布

应用大体解剖学和血管铸型方法,研究了12峰双峰驼肾动脉的分支分布。结果显示,肾脏的肾动脉在进入肾门之前均分成一背干和一腹干,在肾窦内,背干分为一前支,再由前、后支分别发出背部贤脏的各肾段动脉。腹干不分前、后支,而由主干直接发出腹部肾脏的各肾段动脉。不仅各肾段动脉之间未见吻合,背干及其分支与腹干及其分支之间也无吻合。左肾肾段动脉共13条,右肾肾段动脉12条。表明,双峰驼不仅左、右肾的肾动脉与肾段动脉不尽相同,各肾的背部和腹部的动脉供应也存在差异。肾动脉的背干和腹干是相对独立的。     

Role of computed tomography angiography in the differentiation of feline truncus arteriosus communis from pulmonary atresia with ventricular septal defect

Two domestic shorthair cats, a 6-month-old castrated male and a 7-month-old intact female, were diagnosed with complex congenital heart disease. Transthoracic echocardiography in both cats revealed a dilated arterial trunk overriding the interventricular septum with a large ventricular septal defect. The pulmonary trunk and branch pulmonary arteries were not visible using standard echocardiographic views in either cat. The differential diagnosis for both cats included truncus arteriosus communis vs. pulmonary atresia with ventricular septal defect. Each cat underwent computed tomography angiography to determine the origin and extent of the pulmonary blood supply and to better define extra-cardiac anatomy. Computed tomography angiography led to a diagnosis of truncus arteriosus communis with unrestricted pulmonary blood flow in one cat, whereas the other cat was diagnosed with pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals serving as the primary source of pulmonary blood flow. Computed tomography angiography allowed for the ante mortem differentiation of truncus arteriosus communis from pulmonary atresia with ventricular septal defect in these two cats, leading to an accurate diagnosis and providing valuable information to therapeutic decision-making for each case.     

Ultrasonographic evaluation of renal dimension and resistive index in clinically healthy Korean domestic short-hair cats

Renal length, height, width, resistive index (RI), size of cortex, and medulla were determined by renal ultrasonography in 50 healthy Korean domestic short-hair cats. In the sagittal plane, the renal length was 3.83 ± 0.51 cm (mean ± SD) in the left kidney and 3.96 ± 0.48 cm in the right kidney, whereas the renal height was 2.42 ± 0.27 cm in the left kidney and 2.36 ± 0.28 cm in the right kidney. In the transverse plane, the renal height was 2.42 ± 0.28 cm in the left kidney and 2.38 ± 0.27 cm in the right kidney, whereas the renal width was: 2.65 ± 0.35 cm in the left kidney and 2.63 ± 0.31 cm in the right kidney. In the dorsal plane, the renal length was 3.84 ± 0.53 cm in the left kidney and 3.97 ± 0.54 cm in the right kidney, whereas the renal width was 2.65 ± 0.34 cm in the left kidney and 2.66 ± 0.33 cm in the right kidney. There were no significant differences (p > 0.05) among the same structure sizes measured in different planes. In the sagittal plane, the size of the renal cortex was 0.47 ± 0.08 cm in the left kidney and 0.47 ± 0.08 cm in the right kidney, whereas of the size of the renal medulla was 0.55 ± 0.30 cm in the left kidney and 0.50 ± 0.07 cm in the right kidney. RI evaluated by pulsed wave Doppler sonography was 0.52 ± 0.05 in the left kidney and 0.55 ± 0.05 in the right kidney. The actual renal dimensions determined by gross examination were not statistically different from those determined by ultrasonography. Furthermore the renal dimensions and RI were statistically correlated to the body weight of cats.