MAGNETIC RESONANCE IMAGING CONTRAST ENHANCEMENT OF THE TRIGEMINAL NERVE IN DOGS WITHOUT EVIDENCE OF TRIGEMINAL NEUROPATHY

Brain magnetic resonance images from 42 dogs imaged between 2002 and 2007 were reviewed retrospectively to establish the incidence of trigeminal nerve contrast enhancement. These dogs had otherwise normal MR images and no clinical evidence of trigeminal nerve disease. Contrast enhancement of the entire trigeminal nerve was seen in 39 dogs and in the region of the trigeminal ganglion in all 42 dogs. When contrast enhancement of the trigeminal nerve was observed, the intensity was subjectively less than or equal to that of the pituitary gland. Contrast enhancement of the trigeminal nerve was seen in 42 dogs with no clinical evidence of trigeminal nerve pathology.     

CONTRAST ENHANCEMENT OF EXTRADURAL COMPRESSIVE MATERIAL ON MAGNETIC RESONANCE IMAGING

Gadolinium‐enhancement of compressive extradural material is detected occasionally with magnetic resonance (MR) imaging in dogs. Our goal was to characterize contrast enhancement of extradural compressive material associated with intervertebral disc herniation, and to evaluate the association between enhancement and histopathologic findings and the onset of clinical signs. Ninety‐three dogs with a total of 99 lesions diagnosed as intervertebral disc herniation on MR imaging were assessed. Images were evaluated for lesion location, type of herniation, degree of compression, intramedullary T2‐weighted (T2W) intensities, and contrast enhancement. In 23 dogs, surgically removed compressive material was evaluated histopathologically for hemorrhage, inflammation, neovascularization, fibroplasia, fibrosis, mineralization, necrosis, and chronicity. Contrast enhancement of extradural compressive material, meninges, and both the compressive materials and meninges was present in 51.5%, 39.4%, and 17.2% of lesions, respectively. Extradural enhancement occurred more frequently in extrusions than protrusions (P=0.001). Meningeal enhancement and more severe neurologic deficits were significantly associated with a shorter duration of clinical signs (P=0.04 and 0.01, respectively). Intramedullary T2W hyperintensities, present with 44.4% of lesions, were associated with more severe neurologic deficits (P=0.001). Lesions with extradural enhancement were more often considered subacute to chronic in duration and more frequently associated with hemorrhage compared with nonenhancing material; however, no statistically significant association was established between contrast enhancement and histopathologic findings. Contrast enhancement of extradural compressive material and the meninges was found to be common with intervertebral disc herniation, and should not be interpreted as a specific sign of a mass lesion such as neoplasia.     

CONTRAST ENHANCEMENT IN MAGNETIC RESONANCE IMAGING USING INTRAVENOUS PARAMAGNETIC CONTRAST MEDIA: A REVIEW

Interest in magnetic resonance (MR) imaging as a major diagnostic tool in veterinary clinical medicine is increasing. Most MR studies are performed with the use of contrast enhancement via intravenous injection of paramagnetic gadolinium-containing contrast media. A vast number of publications are available regarding the use of contrast media in humans. The purpose of this paper is to assist practicing veterinary radiologists in understanding mechanisms of MR contrast enhancement. This paper reviews certain aspects of MR contrast enhancement, including physical, chemical and biologic characteristics of most common MR contrast media targeted primarily at the central nervous system (CNS). Authors also describe processes that explain changes in signal intensity on the MR images.     

MAGNETIC RESONANCE IMAGING OF OCULAR AND ORBITAL DISEASE IN 5 DOGS AND A CAT

Magnetic resonance (MR) images were acquired in five dogs and one cat with ocular and orbital disease. MR images were obtained in the dorsal or oblique dorsal, and oblique sagittal planes. Pathologic changes identified in MR images included inflammatory lesions, cystic structures, and neoplasms. All abnormalities were readily apparent in TI-weighted images. MR findings in affected animals were often similar in signal intensity, location, and growth pattern to those found in people with comparable diseases. Although no MR changes were considered pathognomonic for a given disease, MR imaging provided detailed information on the homogeneity, extent and invasiveness of the lesions.     

CONTRAST MEDIA ENHANCEMENT OF INTRACRANIAL LESIONS IN MAGNETIC RESONANCE IMAGING DOES NOT REFLECT HISTOPATHOLOGIC FINDINGS CONSISTENTLY

Certain magnetic resonance (MR) enhancement patterns are often considered to be associated with a specific diagnosis but experience shows that this association is not always consistent. Therefore, it is not clear how reliably contrast enhancement patterns correlate with specific tissue changes. We investigated the detailed histomorphologic findings of intracranial lesions in relation to Gadodiamide contrast enhancement in 55 lesions from 55 patients, nine cats, and 46 dogs. Lesions were divided into areas according to their contrast enhancement; therefore 81 areas resulted from the 55 lesions which were directly compared with histopathology. In 40 of 55 lesions (73%), the histomorphologic features explained the contrast enhancement pattern. In particular, vascular proliferation and dilated vessels occurred significantly more often in areas with enhancement than in areas without enhancement (P=0.044). In 15 lesions, there was no association between MR images and histologic findings. In particular, contrast enhancement was found within necrotic areas (10 areas) and ring enhancement was seen in lesions without central necrosis (five lesions). These findings imply that necrosis cannot be differentiated reliably from viable tissue based on postcontrast images. Diffusion of contrast medium within lesions and time delays after contrast medium administration probably play important roles in the presence and patterns of contrast enhancement. Thus, histologic features of lesions cannot be predicted solely by contrast enhancement patterns.     

MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF CANINE INFLAMMATORY MYOPATHIES IN THREE DOGS

In humans affected with inflammatory myopathies, regions of altered signal intensity are found on magnetic resonance (MR) images of affected muscles. Although electromyography (EMG) is more practical for muscle disease evaluation, and a muscle biopsy is the only manner in which a definitive diagnosis can be made, MR imaging has proven useful if a specific anatomic localization is difficult to achieve. Three dogs with focal inflammatory myopathy diagnosed with the assistance of MR imaging are discussed and the findings are compared with those found in humans. MR images of the affected muscles in each dog were characterized by diffuse and poorly marginated abnormal signal on T1- and T2-weighted images. Marked enhancement was noted in these muscles after contrast medium administration. An inflammatory myopathy was confirmed histologically in all three dogs. A good association existed between the MR images and muscle inflammation identified histopathologically. MR imaging may be a useful adjunctive procedure for canine inflammatory myopathies.     

MAGNETIC RESONANCE IMAGING FEATURES OF ORBITAL INFLAMMATION WITH INTRACRANIAL EXTENSION IN FOUR DOGS

This retrospective study describes the clinical and magnetic resonance (MR) imaging features of chronic orbital inflammation with intracranial extension in four dogs (two Dachshunds, one Labrador, one Swiss Mountain). Intracranial extension was observed through the optic canal (n=1), the orbital fissure (n=4), and the alar canal (n=1). On T1-weighted images structures within the affected skull foramina could not be clearly differentiated, but were all collectively isointense to hypointense compared with the contralateral, unaffected side, or compared with gray matter. On T2-, short tau inversion recovery (STIR)-, or fluid-attenuated inversion recovery (FLAIR)-weighted images structures within the affected skull foramina appeared hyperintense compared with gray matter, and extended with increased signal into the rostral cranial fossa (n=1) and middle cranial fossa (n=4). Contrast enhancement at the level of the affected skul foramina as well as at the skull base in continuity with the orbital fissure was observed in all patients. Brain edema or definite meningeal enhancement could not be observed, but a close anatomic relationship of the abnormal tissue to the cavernous sinus was seen in two patients. Diagnosis was confirmed in three dogs (one cytology, two biopsy, one necropsy) and was presumptive in one based on clinical improvement after treatment. This study is limited by its small sample size, but provides evidence for a potential risk of intracranial extension of chronic orbital inflammation. This condition can be identified best by abnormal signal increase at the orbital fissure on transverse T2-weighted images, on dorsal STIR images, or on postcontrast transverse or dorsal images.     

MAGNETIC RESONANCE IMAGING FEATURES OF DISCOSPONDYLITIS IN DOGS

The diagnosis of discospondylitis is based mainly on diagnostic imaging and laboratory results. Herein, we describe the magnetic resonance imaging (MRI) findings in 13 dogs with confirmed discospondylitis. In total there were 17 sites of discospondylitis. Eleven (81.1%) of the dogs had spinal pain for >3 weeks and a variable degree of neurologic signs. Two dogs had spinal pain and ataxia for 4 days. Radiographs were available in nine of the dogs. In MR images there was always involvement of two adjacent vertebral endplates and the associated disk. The involved endplates and adjacent marrow were T1‐hypointense with hyperintensity in short tau inversion recovery (STIR) images in all dogs, and all dogs also had contrast enhancement of endplates and paravertebral tissues. The intervertebral disks were hyperintense in T2W and STIR images and characterized by contrast enhancement in 15 sites (88.2%). Endplate erosion was present in 15 sites (88.2%) and was associated with T2‐hypointense bone marrow adjacent to it. In two sites (11.8%) endplate erosion was not MR images or radiographically. The vertebral bone marrow in these sites was T2‐hyperintense. Epidural extension was conspicuous in postcontrast images at 15 sites (88.2%). Spinal cord compression was present at 15 sites (88.2%), and all affected dogs had neurologic signs. Subluxation was present in two sites (11.8%). MRI shows characteristic features of discospondylitis, and it allows the recognition of the exact location and extension (to the epidural space and paravertebral soft tissues) of the infection. Furthermore, MRI increases lesion conspicuity in early discospondylitis that may not be visualized by radiography.     

MENINGEAL ENHANCEMENT ON MAGNETIC RESONANCE IMAGING IN 15 DOGS AND 3 CATS

A retrospective study of 15 dogs and three cats was done to characterize the appearance of meningeal enhancement on magnetic resonance (MR) images of the brain, and to correlate this appearance with its underlying cause. Two patterns of meningeal enhancement (pial and dural) were identified. Enhancement of the pia mater was evident in four dogs and one cat, while enhancement of the dura mater was seen in 11 dogs and 2 cats. A variety of causes of meningeal enhancement were identified, including bacterial and cryptococcal meningitis, plasmacytic meningitis with associated subdural fluid accumulation, granulomatous meningoencephalomyelitis, inflammation secondary to otitis interna, feline infectious peritonitis, and neoplasia. The present study confirms that pial or dural meningeal enhancement may be present on MR images of the brain of dogs or cats in association with a variety of central nervous system diseases. A larger prospective study is required to further establish the incidence of specific patterns of meningeal enhancement seen in association with specific diseases.     

CLINICAL AND MAGNETIC RESONANCE IMAGING FEATURES OF IDIOPATHIC OCULOMOTOR NEUROPATHY IN 14 DOGS

Ophthalmoplegia/ophthalmoparesis (internal, external, or both) has been reported in dogs secondary to neoplasia affecting the oculomotor nerve and is usually given a poor prognosis. The purpose of this retrospective study was to describe the clinical findings, magnetic resonance imaging (MRI) findings, management, outcome, and follow‐up in a group of canine cases with idiopathic oculomotor neuropathy. Inclusion criteria included cases with ophthalmoplegia/ophthalmoparesis (internal, external or both) as sole neuroophthalmologic signs, complete ophthalmic and neurologic examination, head MRI, and a minimum follow‐up period of 1 year. Dogs with progressive neurological signs not related to oculomotor neuropathy were excluded. Fourteen cases met the inclusion criteria. All cases were unilaterally affected. Magnetic resonance imaging showed equivocal enlargement of the oculomotor nerve in three cases, mild enlargement in five, and marked enlargement in six. Contrast enhancement was present in 12 cases, being marked in six. When present, the contrast enhancement was focal in eight cases and diffuse in four. The median follow‐up time was 25 months. External ophthalmoparesis improved in seven cases, five cases under no treatment and two under systemic corticosteroid therapy. The clinical signs in the other seven cases remained unchanged. Idiopathic oculomotor neuropathy should be included as a differential diagnosis in dogs presenting with unilateral ophthalmoplegia/ophthalmoparesis (internal, external, or both) with the absence of other neurologic and ophthalmic signs, and with the MRI findings restricted to the oculomotor nerve. Idiopathic oculomotor neuropathy has a good prognosis as the clinical signs do not deteriorate and they can improve without treatment.     

EFFECTS OF GADOXETATE DISODIUM (EOVIST®) CONTRAST ON MAGNETIC RESONANCE IMAGING CHARACTERISTICS OF THE LIVER IN CLINICALLY HEALTHY DOGS

Gadoxetate disodium (Gd‐EOB‐DTPA; gadolinium‐ethoxybenzyl‐diethylene triamine penta‐acetic acid) is a newly developed paramagnetic contrast agent reported to have a high specificity for the hepatobiliary system in humans. The purpose of this prospective study was to describe effects of Gd‐EOB‐DTPA contrast administration on MRI characteristics of the liver in eight clinically healthy dogs. Precontrast dorsal and transverse T1‐weighted spin echo, T2‐weighted fast spin echo, and transverse T1‐weighted 3D gradient echo (VIBE; volume‐interpolated body examination) pulse sequences were acquired for each dog. Dogs were assigned to four groups based on contrast dose administered (0.0125 mmol/kg or 0.025 mmol/kg), and pulse sequences acquired after contrast administration (T1‐weighted spin echo and T1‐weighted 3D gradient echo). Liver signal intensity ratios were calculated and compared between the two contrast dose groups and two postcontrast pulse sequence groups using ANOVA. No adverse effects of contrast administration were observed. All dogs exhibited homogeneous contrast enhancement of the liver with no statistical difference in enhancement between the two different contrast doses. Contrast enhancement in all dogs peaked between 1 and 10 min after intravenous injection. There was a significant difference in mean signal intensity ratios between sequences (P = 0.035) but not between doses (P = 0.421). Postcontrast signal intensities of the liver parenchyma were significantly higher for the T1‐weighted 3D gradient echo images when compared to the T1‐weighted spin echo sequences. Findings indicated that Gd‐EOB‐DTPA contrast administration is safe in healthy dogs and causes homogeneous enhancement of the liver that is more pronounced in T1‐weighted 3D gradient echo MRI pulse sequences.     

MAGNETIC RESONANCE IMAGING FEATURES OF EMPTY SELLA IN DOGS

In humans, the empty sella is defined as herniation of the subarachnoidal space into the sella turcica with invisible (total empty sella) or reduced (partial empty sella) hypophyseal size. An empty sella can be associated with endocrine disturbances. The purpose of this study was to determine if the empty sella exists in dogs or cats and whether it is associated with endocrinopathy or hydrocephalus. Archived magnetic resonance images of the head of 370 dogs and 77 cats were re-evaluated specifically for the presence or absence of the pituitary gland. Hypophyseal tissue filling more than 50% of the sella was considered normal, between 30% and 50% was defined as partial empty sella and less than 30% was defined as total empty sella. In patients with an empty sella, and in all other imaged dogs of the affected breeds, the ventricle to brain ratio was measured. In patients with an empty sella, the medical record was searched for evidence of endocrinopathy. No cat had an empty sella but 11 dogs (3%) had a small or missing hypophysis. Seven of these dogs had a ventricle to brain ratio greater than 15%. Only small dogs (mean weight of 6.7 kg) were affected. One dog with an empty sella had signs of central hyperadrenocorticism while the other 10 had no sign of endocrinopathy. We conclude that the empty sella exists in dogs but is not generally associated with endocrinopathy.     

MAGNETIC RESONANCE IMAGING OF SUBARTICULAR BONE MARROW LESIONS IN DOGS WITH STIFLE LAMENESS

A bone bruise is a magnetic resonance (MR) imaging sign thought to signify acute traumatic microfracture of trabecular bone with hemorrhage and edema in the marrow that may occur without grossly visible disruption of the adjacent cortices or overlying cartilage. In approximately 75% of people with acute anterior-cruciate ligament tears, bone bruises are detected in characteristic locations within the femur and tibia and are best seen as high-signal lesions using fat-suppression sequences. We questioned whether this is a component of naturally acquired stifle lameness in dogs and obtained short-tau inversion recovery (STIR) images of six dogs with stifle lameness. High-signal STIR lesions were detected in five of six (83%) dogs and eight of 12 (67%) limbs. We observed these lesions deep to the intercondylar fossa of the femur and intercondylar eminence of the tibia, which are atypical locations in people. High-signal STIR lesions were detected in dogs with only synovitis, partial tear of the cranial cruciate ligament (CCL) and complete tear of the CCL. One of these lesions was seen in the lateral tibial condyle, a typical location in humans with acute anterior cruciate ligament tear. As the MR imaging appearance of stress fractures and bone bruises are similar, and the high-signal STIR lesions are at attachment sites of the CCL, this finding may be due to stress disease or other unknown causes, rather than bone bruising. High-signal STIR lesions may be a common sign in naturally acquired canine stifle disease, but the pathogenesis, prognostic and diagnostic values need further investigation.     

MAGNETIC RESONANCE IMAGING OF THE CERVICAL SPINE IN 27 DOGS

The cervical spine of 27 dogs with cervical pain or cervical myelopathy was evaluated using magnetic resonance imaging (MRI). Spin echo T1, T2, and post-contrast T1 weighted imaging sequences were obtained with a 0.5 Tesla magnet in 5 dogs and a 1.5 Tesla magnet in the remaining 22 dogs. MRI provided for visualization of the entire cervical spine including the vertebral bodies, intervertebral discs, vertebral canal, and spinal cord. Disorders noted included intervertebral disc degeneration and/or protrusion (12 dogs), intradural extramedullary mass lesions (3 dogs), intradural and extradural nerve root tumors (3 dogs), hydromyelia/syringomyelia (1 dog), intramedullary ring enhancing lesions (1 dog), extradural synovial cysts (1 dog), and extradural compressive lesions (3 dogs). The MRI findings were consistent with surgical findings in 18 dogs that underwent surgery. Magnetic resonance imaging provided a safe, useful non-invasive method of evaluating the cervical spinal cord.     

MAGNETIC RESONANCE IMAGING FINDINGS IN THE SPINE OF SIX DOGS DIAGNOSED WITH LYMPHOMA

Lymphoma is one of the most common neoplasms in the dog. Despite its prevalence and the increasing use of advanced diagnostic imaging in veterinary patients only few reports of magnetic resonance imaging (MRI) findings in spinal lymphoma have been published to date. The purpose of this retrospective case series study was to describe the MRI findings in dogs with confirmed lymphoma affecting the spine and/or paraspinal soft tissues. Medical records were searched for patients that had MRI of the spine and a diagnosis of lymphoma during the period of 2005–2015. Data recorded from retrieved MRI studies were presence of focal or multifocal disease, structures involved, and signal characteristics on T2‐W, short tau inversion recovery (STIR), and T1‐W sequences prior to and following intravenous contrast medium administration. Six dogs met the inclusion criteria. Common findings included multifocal disease (4/6), vertebral involvement (5/6), spinal cord compression (4/6), and involvement of more than one spinal compartment (medullary cavity, vertebral canal, paraspinal soft tissues) (6/6). Vertebral changes were confined to the medullary cavity without evidence of cortical osteolysis. There was questionable involvement of the spinal cord in one case. All spinal and paraspinal lesions identified were T2‐W isointense to hyperintense, STIR hyperintense, T1‐W hypointense to isointense, and showed variable moderate to strong contrast enhancement. Additional lesions identified were enlarged intraabdominal lymph nodes, hepatomegaly, splenomegaly, and a splenic nodule. The STIR and T1‐W postcontrast sequences were subjectively the most useful in identification of the spinal and paraspinal lesions.     

MAGNETIC RESONANCE IMAGING FINDINGS IN SMALL RUMINANTS WITH BRAIN DISEASE

Brain disease is an important cause of neurologic deficits in small ruminants, however few MRI features have been described. The aim of this retrospective, case series study was to describe MRI characteristics in a group of small ruminants with confirmed brain disease. A total of nine small ruminants (six sheep and three goats) met inclusion criteria. All had neurologic disorders localized to the brain and histopathologic confirmation. In animals with toxic‐metabolic diseases, there were bilaterally symmetric MRI lesions affecting either the gray matter (one animal with polioencephalomalacia) or the white matter (two animals with enterotoxemia). In animals with suppurative inflammation, asymmetric focal brainstem lesions were present (two animals with listeric encephalitis), or lesions typical of an intra‐axial (one animal) or dural abscess (one animal), respectively. No MRI lesions were detected in one animal with suspected viral cerebellitis and one animal with parasitic migration tracts. No neoplastic or vascular lesions were identified in this case series. Findings from the current study supported the use of MRI for diagnosing brain diseases in small ruminants.     

MAGNETIC RESONANCE IMAGING APPEARANCE OF SUSPECTED ISCHEMIC MYELOPATHY IN DOGS

Ischemia and infarction of the spinal cord is a known cause of acute spinal injury in dogs. Currently, the diagnosis of spinal cord infarction in small animals is based on history, clinical signs, and the exclusion of other differentials with radiography and myelography. It is a diagnosis only confirmed through necropsy examination of the spinal cord. The aim of this paper is to describe the Magnetic resonance imaging (MRI) findings of the spinal cord of dogs with suspected spinal cord infarcts to utilize this technology for antemortem support of this diagnosis. This retrospective study evaluated the spinal MR examinations of 11 dogs with acute onset of asymmetric nonpainful myelopathies. All patients except one (imaged at 2 months) were imaged within 1 week of clinical signs and managed conservatively with minimal medical and no surgical intervention. They were followed clinically for a minimum of 4 months after discharge. MR findings in all dogs were characterized by focal, intramedullary, hyperintense lesions on T2-weighted images with variable contrast enhancement similar to what is reported in humans. Though it could not be used to diagnose spinal cord infarction definitively, MRI was useful in excluding extramedullary spinal lesions and supporting intramedullary infarction as a cause of the acute neurologic signs. Together with the history and clinical examination findings, MRI is supportive of a diagnosis of spinal cord infarction.     

DYNAMIC CONTRAST‐ENHANCED MAGNETIC RESONANCE IMAGING OF CANINE BRAIN TUMORS

We evaluated dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) in canine brain tumors. Magnetic resonance data sets were collected on seven canine intracranial tumors with a 3 T magnet using a T1‐weighted fast spin echo fluid attenuated inversion recovery sequence after an IV bolus injection (0.2 mmol/kg) of Gd‐DTPA. The tumors were confirmed histopathologically as adenocarcinoma (n=1), ependymoma (n=1), meningioma (n=3), oligodendroglioma (n=1), and pituitary macroadenoma (n=1) The data were analyzed using a two‐compartment pharmacokinetic model for estimation of three enhancement parameters, E_R (rate of enhancement), K_el (rate of elimination), and K_ep (rate constant), and a model‐free phenomenologic parameter initial area under the Gd concentration curve (IAUGC) defined over the first 90 s postenhancement. Pearson's correlations were calculated between parameters of the two methods. The IAUGC has a relatively strong association with the rate of enhancement E_R, with r ranges from 0.4 to 0.9, but it was weakly associated with K_ep and K_el. To determine whether any two tumors differed significantly, the Kolmogorov–Smirnov test was used. The results showed that there were statistical differences (P<0.05) between distributions of the enhancement pattern of each tumor. These kinetic parameters may characterize the perfusion and vascular permeability of the tumors and the IAUGC may reflect blood flow, vascular permeability, and the fraction of interstitial space. The kinetic parameters and the IAUGC derived from DCE‐MRI present complementary information and they may be appropriate to noninvasively differentiate canine brain tumors although a larger prospective study is necessary.     

MAGNETIC RESONANCE IMAGING FEATURES OF MULTILOBULAR OSTEOCHONDROSARCOMA IN 3 DOGS

Three dogs with multilobular osteochondrosarcoma of the skull were evaluated using magnetic resonance (MR) imaging. Spin echo T1, T2, proton weighted and post contrast T1W images were obtained with a 1.5 Tesla magnet. The MR imaging findings were similar in all three dogs with mixed signal intensities in the T1W, T2W and proton weighted images and fairly large areas of contrast enhancement in the post contrast T1W images. The extent of brain and soft tissue involvement were well delineated and provided useful information concerning surgical planning. MR imaging provided a useful method of evaluating dogs with skull tumors.