SCINTIGRAPHY OF THE SACROILIAC JOINT REGION IN ASYMPTOMATIC RIDING HORSES: SCINTIGRAPHIC APPEARANCE AND EVALUATION OF METHOD

The sacroiliac region in 33 clinically normal riding horses was examined with scintigraphy to determine the normal scintigraphic appearance, to evaluate a semiquantitative method used to calculate a sacroiliac joint (SI joint) ratio, and to identify factors that affect the scintigraphic appearance of the pelvis. The scintigraphic examination included dorsal views of each SI joint region and one lateral view of the urinary bladder. Two predefined areas (the SI joint and the area between the tuber sacrale and the SI joint) were evaluated subjectively by comparing the intensity in each area to the intensity in the tuber sacrale, and a semiquantitative method was applied on the images to calculate an SI joint ratio. The thickness of the muscle mass overlying each SI joint was measured by using ultrasound. A corrected ratio was calculated based on a corrected pixel count for each SI joint. Of 29 evaluated horses, 28 had normal radiotracer uptake in the SI joints and 10 horses had symmetric normal radiotracer uptake in the area between the tuber sacrale and the SI joint. The mean SI joint ratio was 0.53 on both the left and right sides, and the mean corrected SI joint ratio was 2.15 on the left side and 2.13 on the right side. Factors that affect the scintigraphic appearance of the pelvis were identified and included attenuation, radioactive urine, and muscle symmetry. The muscle thickness ranged from 8-11 cm, causing 71-82% attenuation. Radioactive urine in the urinary bladder was located ventral to the SI joint region in 16 horses, and four of these were excluded from further evaluation because of risk of misinterpretation. A visual assessment of symmetry of the horses' gluteal muscle mass was compared with the ultrasound measurements. Fourteen horses (14/33) were regarded symmetric by both techniques. Soft tissue attenuation was found to severely compromise the result and indicated that only lesions in the SI joint with severely increased radiotracer uptake can be detected with scintigraphy. Knowledge about presence of radioactive urine ventral to the SI joint region and assessment of muscle symmetry is essential for a correct subjective evaluation. Any situation with difference in muscle mass between the left and right side of the pelvis will give a false impression of increased radiotracer uptake on the side with lesser muscle mass.     

COMPARISON OF THORACIC ULTRASONOGRAPHY AND RADIOGRAPHY FOR THE DETECTION OF INDUCED SMALL VOLUME PNEUMOTHORAX IN THE HORSE

Small volume pneumothorax can be challenging to diagnose in horses. The current standard method for diagnosis is standing thoracic radiography. We hypothesized that thoracic ultrasonography would be more sensitive. Objectives of this prospective, experimental study were to describe a thoracic ultrasound method for detection of small volume pneumothorax in horses and to compare results of radiography and ultrasound in a sample of horses with induced small volume pneumothorax. Six mature healthy horses were recruited for this study. For each horse, five 50 ml air boluses were sequentially introduced via a teat cannula into the pleural space. Lateral thoracic radiographs and standardized ultrasound (2D and M‐mode) examinations of both hemithoraces were performed following administration of each 50 ml air bolus. Radiographs and ultrasound images/videos were analyzed for detection of pneumothorax by four independent investigators who were unaware of treatment status. Sensitivity, specificity, positive predictive values, negative predictive values, and agreement among investigators (Kappa test, κ) were calculated for radiography, 2D and M‐mode ultrasound. Comparisons were made using a chi‐squared exact test with significance set at P < 0.05. Two‐dimensional (84%) and M‐mode (80%) ultrasound were more sensitive than radiography (48%) for pneumothorax detection (P = 0.02 and P = 0.04, respectively). Specificity and positive predictive values were similar for all three imaging modalities (P = 1). Agreement between investigators for pneumothorax detection was excellent for 2D ultrasound (κ = 1), very good for M‐mode ultrasound (κ = 0.87), and good for radiography (κ = 0.79). Findings from this experimental study supported the use of thoracic ultrasonography as a diagnostic method for detecting pneumothorax in horses.     

SCINTIGRAPHIC EVALUATION OF SKELETAL DISEASE AND ITS APPLICATION TO THE HORSE

Bone scintigraphy is a valuable aid in the evaluation of lameness in horses. This review describes the principles of bone radiolabeling, scanning, and scan interpretation. Examples are used to illustrate how bone imaging can contribute significantly to a diagnosis after equivocal physical examination or radiographic findings.     

SCINTIGRAPHIC EVALUATION OF THE STIFLE IN NORMAL HORSES AND HORSES WITH FORELIMB LAMENESS

We tested the hypotheses that mature horses without lameness have a repeatable radiopharmaceutical uptake pattern in the stifle, which is bilaterally symmetric; immature horses have a different radiopharmaceutical uptake pattern; and forelimb lameness alters the radiopharmaceutical uptake pattern in the stifle. The objectives of the study were to describe the normal radiopharmaceutical uptake patterns using region of interest (ROI) analysis; to compare uptake patterns between left and right stifles of the same horse and between mature and immature horses; to compare radiopharmaceutical uptake in mature normal horses with those with forelimb lameness. Lateral scintigraphic images of the stifle from 51 horses aged 2-16 years were evaluated using seven ROIs and a reference site (midfemur). After subtraction of a background count, ratios between the mean counts per pixel for each ROI to the reference site were calculated. There was a repeatable radiopharmaceutical uptake pattern in mature normal horses that was bilaterally symmetrical. The caudoproximal aspect of the tibia and the patella had the highest ratios. Radiopharmaceutical uptake patterns in horses with forelimb lameness were not significantly different. Immature normal horses had a different symmetric pattern, with greatest radiopharmaceutical uptake ratios in the caudoproximal aspect of the tibia and the tibial crest. It was concluded that there are symmetric, repeatable radiopharmaceutical uptake patterns in both immature and mature horses, which are not altered by forelimb lameness.     

SCINTIGRAPHIC EVALUATION OF THE PROXIMAL METACARPAL AND METATARSAL REGIONS IN CLINICALLY SOUND HORSES

In recent years, pain arising from the proximal metacarpal and metatarsal regions has become well recognized as a cause of lameness and various disease entities have been identified. However, our knowledge of normal patterns of radiopharmaceutical uptake is limited, making interpretation of images problematic. It is therefore important to characterize normal patterns of radiopharmaceutical uptake at specific sites to ensure valid interpretation of images in clinical cases with subtle lesions. The purpose of this study was to describe the pattern of radiopharmaceutical uptake in the proximal metacarpal and proximal metatarsal regions in clinically sound horses. Scintigraphic images from 64 clinically normal horses were evaluated. All the images were assessed subjectively. The lateral, dorsal, and plantar scintigraphic images were assessed qualitatively using horizontal line profiles through the proximal metacarpal and proximal metatarsal regions. Mean ratios of radiopharmaceutical uptake were calculated from three regions of interest sited over the proximal metacarpal and proximal metatarsal regions and a reference site. In 78% of forelimbs the peak of radiopharmaceutical activity was at the dorsal to central portion of the proximal metacarpal region. Seventy-five per cent of the dorsal plane profiles of activity were symmetrical, with the highest peak over the medial to central portion of the proximal metacarpal region. In 80% of hindlimb lateral images the peak radiopharmaceutical activity was at the central to plantar aspect of the proximal metatarsal region. All (100%) plantar image profiles of activity were symmetrical, with the highest peak being over the lateral portion of the proximal metatarsal region. There was no significant left and right variation between sites for mean ratios on the lateral and dorsal images of the proximal metacarpal region. However, using lateral images the mean ratios from all regions of the right proximal metatarsal were greater than left (dorsal P = 0.003, plantar P < 0.0001 and whole proximal metatarsal, P = 0.0006). There was no significant variation in mean ratios between left and right on plantar images. However, the mean ratio for the lateral proximal metatarsal region was significantly greater than for the medial proximal metatarsal regions (P < 0.0001). There was no significant effect of age. Left/right symmetry of radiopharmaceutical uptake was shown in the proximal metacarpal region. However, there was a significant difference between left and right proximal metatarsal regions. There was higher radiopharmaceutical uptake in the right proximal metatarsal region than the left, which agrees with previous studies of the tarsal and metatarsophalangeal joints. There were differences in the pattern of radiopharmaceutical uptake between the forelimbs and hindlimbs. In the forelimbs maximum radiopharmaceutical uptake was located at the dorsal to central portion of the proximal metacarpal region in the lateral image, with peak activity over the medial to central portion of the proximal metacarpal region on dorsal images. In the hindlimbs the maximum radiopharmaceutical uptake was at the central to plantar aspect of the proximal metatarsal region in the lateral image, with peak activity over the lateral portion of proximal metatarsal region on plantar images. The results of this study support the hypothesis that there would be a standard pattern of radiopharmaceutical uptake across the proximal metacarpal and l metatarsal regions, but the pattern of uptake observed would be different in the proximal metacarpal region compared with the proximal metatarsal region. There was left/right symmetry of radiopharmaceutical uptake in the proximal metacarpal region. However, there was a significant difference between left and right proximal metatarsal regions, with higher radiopharmaceutical uptake in the right. There was no variation of radiopharmaceutical uptake pattern with age.     

METRIZAMIDE MYELOGRAPHY OF THE EQUINE CERVICAL SPINE

Case histories of 14 horses with pelvic limb ataxia requiring myelography were reviewed. Because differential diagnosis requires radiography, comparisons of lesion location, radiographic techniques, and lesion patterns were studied. Survey radiography and myelography were performed under general anesthesia, with recumbent-lateral and flexed-lateral views of the carnial and caudal cervical spine. Metrizamide was the myelographic contrast medium. Assessment of radiography as a diagnostic aid for cervical vertebral instability and cervical stenotic myelopathy was made through the comparison of survey radiographs and myleograms, in nonflexed and flexed positions, using these criteria: width of dorsal and ventral columns of contrast medium, compression of intervertebral disc spaces, presence or absence of bone proliferation at articular facets, remodeling secondary to vertebral instability. Radiography was an adequate diagnostic aid for cervical vertebral instability and cervical stenotic myelopathy. Distribution of lesions showed C_3–4 most common, with C_2–3 and C_4–5 following.     

SCINTIGRAPHIC EVALUATION OF THE DISTAL TARSAL REGION IN HORSES WITH DISTAL TARSAL PAIN

Distal tarsal pain is a common reason for hind limb lameness, but diagnosis cannot always be made on radiographic examination. Scintigraphy may allow detection of subtle changes undetected by other diagnostic methods. We hypothesized that (1) distal tarsal pain would be associated with a loss of the expected pattern of radiopharmaceutical uptake (RU) detected in normal horses, (2) distal tarsal RU would be greater in limbs with tarsal pain than without pain, (3) RU in painful tarsi with radiographic evidence of osteoarthritis (OA) would be greater than in distal tarsal pain with no radiographic evidence of OA. The study aimed to describe radiopharmaceutical distribution in the distal tarsal region of horses with distal tarsal pain, and to compare this with the contralateral limb and results from horses without tarsal pain. Retrospective evaluation of scintigraphic images of the distal tarsal region was performed for 52 horses with distal tarsal pain: 15 with no radiographic evidence of OA (Group 1) and 37 with radiographic evidence (Group 2). The images were assessed using vertical and horizontal profile analysis across the distal tarsal region and regions of interest comparisons between the distal tarsal region and tibia within each horse (RU ratio). Painful limbs in unilaterally lame horses from Groups 1 and 2 had a significantly greater RU ratio than the respective contralateral limbs, and were significantly greater than the RU ratio in normal horses. On plantar images, mean region of interest counts were greater in the lame than the contralateral limb in Group 2 but not in Group 1. Although there was a positive correlation between lame and contralateral limb RU ratio in group 1, this was lost in group 2 horses. In lame limbs, the normal vertical activity profile was lost in 85% of group 1 and all of group 2, and the normal horizontal activity profile was lost in all of group 1 and 96% of group 2. There was a significant effect of lameness, but not of group on sites of peak activity on all profiles. The results of this study indicate that distal tarsal pain is associated with loss of the expected pattern of RU detected in normal horses. The findings also suggest that distal tarsal RU in lame limbs is greater than in limbs without pain, and that painful limbs with radiographic evidence of OA have a greater RU than painful limbs without radiographic evidence of OA.     

IDENTIFICATION OF AN OSSICLE ASSOCIATED WITH THE PALMAR ASPECT OF THE CARPUS IN THE HORSE

An ossicle associated with the palmar aspect of the carpus is described in five horses. The size of the ossicle varied from 3 x 4 mm to approximately 12 x 10 mm. The ossicles were located at the junction of the proximal and distal rows of carpal bones, between the palmaromedial aspect of the fourth carpal bone and the ulnar carpal bone. In 3 horses they were bilateral, in one horse unilateral, and only one limb was examined in the remaining horse. In all horses it was an incidental finding and not regarded to be a pathologic entity.     

DETECTION OF A RADIOGRAPHICALLY OCCULT FRACTURE OF THE LATERAL PALMAR PROCESS OF THE DISTAL PHALANX IN A HORSE USING COMPUTED TOMOGRAPHY

A horse with a suspected injury of the distal phalanx was examined using radiography at day two and 19 after the onset of the lameness, with no definite diagnosis. Using computed tomography an incomplete fracture of the lateral wing of the distal phalanx was diagnosed at day 25. Based on computed tomography it was determined that the fracture probably did not enter the joint or involve the palmar cortex throughout its length which were of prognostic importance. The day following the CT examination a new oblique radiographic projection was made. In this radiography which was based on, and never would have been attempted without, the information about the geometric pattern of the fracture achieved by CT examination, a radiolucent area indicative of a wing fracture was seen. This report emphasizes the value of computed tomography in diagnosing a geometric complicated nonarticular oblique fracture of the palmar process of the pedal bone in a horse.     

EVALUATION OF MAGNETIC RESONANCE IMAGING TECHNIQUES IN THE EQUINE DIGIT

An anatomic study of the equine digit using magnetic resonance imaging (MRI) was performed. Seventeen isolated forelimbs and one hindleg of nine warmblood horses were imaged in transverse, sagittal, and dorsal planes with a 1.5 Tesla magnet using T1-, T2- proton density-weighted spin echo sequences as well as T2 gradient echo sequences. One scan plane in each horse was compared with corresponding anatomic and histologic sections. The best imaging planes to visualize various anatomic structures were determined. Fibrocartilage was visualized in the insertion of the deep digital flexor tendon and the suspensory ligament as well as in the distal sesamoidean ligaments. The correlation of MRI images with anatomic and histologic sections confirmed that all of the anatomic structures in the equine digit could be evaluated in PD and T2 studies.     

RADIOGRAPHIC QUANTIFICATION OF TRACHEAL DIMENSIONS OF THE NORMAL THOROUGHBRED HORSE

Radiographic measurement of tracheal dimensions in the horse may be useful in evaluating upper and lower respiratory tract conditions due to the gradient of pressure changes between these areas. Lateral radiographs of the trachea of 15 normal sedated Thoroughbred horses were made at inspiration and expiration and magnification-corrected mean airway heights measured were, respectively: larynx: 5.89 and 5.86 cm; trachea at the third cervical vertebra (C3): 4.17 and 4.04 cm; at the fifth cervical vertebra (C5): 3.62 and 3.59 cm; at the first thoracic vertebra (T1): 3.4 and 3.23 cm; and carina: 3.85 and 4.12 cm. The ratio of airway height to nearby vertebral body lengths, at inspiration and expiration were, respectively: laryngeal height at C3: 0.56 and 0.56; tracheal height at C3: 0.4 and 0.39; at C5: 0.37 and 0.37; at T1: 0.59 and 0.59; and carina height: 0.91 and 0.94. The ratio of tracheal height to the thoracic inlet at inspiration and expiration was, respectively, 0.15 and 0.15. There was not a statistically significant association between airway diameter and phase of respiration. No association was found between tracheal height and body mass or height at the withers. Radiographic tracheal height can be measured independent of respiratory phase in sedated horses. It is suggested that the ratio of tracheal height to an adjacent bony landmark is more reliable for comparison between horses and tracheal height measurement should be made at C5, due to a lower standard deviation. If only thoracic radiographs are made, measurements of tracheal height at the thoracic inlet may be valuable.     

ULTRASONOGRAPHIC, GROSS, AND HISTOLOGIC EVALUATION OF A TENDINITIS DISEASE MODEL IN THE HORSE

Collagenase-induced lesions of the superficial digital flexor tendon were monitored using diagnostic ultrasound and subsequently compared with gross and microscopic findings. The postinjury sonograms demonstrated hypoechoic or anechoic areas corresponding to areas of hemorrhage and necrosis. The size of the lesion increased and the echogenicity decreased with increasing units of collagenase injected into the tendon. As postinjury time increased, echogenicity increased, which corresponded to fibrous-tissue invasion and collagen deposition. The extent of tendon injury produced correlated with the amount of collagenase injected into the tendon. Diagnostic ultrasound is useful in evaluating injury and healing in collagenase— induced tendinitis.     

SCINTIGRAPHIC CHARACTERIZATION OF DISTAL RADIAL PHYSEAL CLOSURE IN YOUNG STANDARDBRED RACEHORSES

A longitudinal scintigraphic and radiographic study of distal radial physeal activity in 14 Standardbred trotters was conducted to quantify and visually evaluate physeal uptake around the time of physeal closure. Initial intense 99mTc-HDP uptake was seen, followed by a rapid decrease of activity starting at a mean age of 20 months. Mean physeal to distal diaphyseal ROI and line profile ratios compared to ratios of mature horses decreased from 2.8 to 1.4 at the time of radiographic closure at 24-32 months. Ratios then gradually decreased until values of mature horses were reached at the end of the study (mean age 42 months). Visually discernible distal radial physeal activity was present with declining frequency throughout the study. This study indicates that, in the normal Standardbred trotter, there is mild distal radial physeal uptake present after radiographic evidence of physeal closure. This uptake is not likely to confound evaluation of pathologic conditions of the physeal or carpal regions.     

OSTEOCHONDROSIS IN THE LATERAL FEMORAL CONDYLES OF A HORSE

Osteochondrosis of the lateral femoral condyles was diagnosed radiographically in an 8-month-old, female Arabian horse, which had been presented with a hindlimb lameness. The diagnosis was confirmed by gross and microscopic pathology. The location of the lesions was considered unusual for osteochondrosis in the horse.     

ULTRASOUND‐GUIDED CERVICAL CENTESIS TO OBTAIN CEREBROSPINAL FLUID IN THE STANDING HORSE

Horses with intracranial lesions and severe ataxia are not good anesthesia candidates; however, only one method to obtain cerebrospinal fluid (CSF) from the cervical region in a standing horse has been reported. This method is not performed routinely due to the difficulty for sample acquisition. Our hypothesis is that standing cervical centesis can be performed in horses without complication. Ultrasound‐guided centesis of the CSF between C1 and C2 in 11 clinically normal horses and two horses with neurologic signs were performed. Horses were sedated and ultrasound was used to identify the subarachnoid space and spinal cord between C1 and C2. With ultrasound guidance, a needle was introduced into the dorsal aspect of the subarachnoid space using a lateral approach. Ten milliliters of CSF was obtained and analyzed. Two normal horses in this study had moderate red blood cell contamination in the CSF (940 and 612 RBC/μl). One horse had 11 RBC/μl and the remaining horses had <4 RBC/μl. The total procedure time was approximately 2 min. No reaction was observed and no complications were detected up to 48 h after the procedure. Ultrasound‐guided centesis between C1 and C2 is a rapid procedure that causes minimal to no reaction in standing, sedated horses used in this study. The use of ultrasound to guide a standing C1–2 centesis of the subarachnoid space provides an additional route to obtain CSF for analysis in the equine patient.     

DUPLEX-ULTRASONOGRAPHIC EVALUATION OF THE COMMON CAROTID ARTERY IN THE RESTING, SEDATED AND ANESTHETIZED HORSE

The aim of this study was to determine the blood flow in the carotid artery during halothane anaesthesia by means of duplex-sonography. Seventeen warm blood horses were evaluated in dorsal and lateral recumbency and the results were compared with the values of the same horses resting and under sedation. The cross sectional area of the vessels, the time-averaged maximal blood velocity, time-averaged maximal blood flow and the resistance index were determined and the flow profile was evaluated. During halothane anesthesia the total blood flow shows a significant increase which is not dependent on the positioning of the horse. Mean blood velocity is decreased by sedation and significantly increased during anesthesia. Reduced peripheral resistance is expressed by a decline of the resistance index. After sedation and during recumbency there is an increase in diameter of the carotid artery.     

PULSED WAVE-DOPPLER ULTRASONOGRAPHIC EVALUATION OF THE COMMON CAROTID ARTERY IN THE RESTING HORSE: PHYSIOLOGIC DATA

A pulsed wave-Doppler ultrasonographic evaluation of common carotid arterial blood flow was carried out on 63 healthy Italian Saddlebred horses. Vessel diameter and tracing morphology were evaluated were evaluated and blood flow parameters (systolic, diastolic and mean velocity, acceleration and deceleration of the systolic wave, cartid pulse volume) were calculated and correlated with class variables (sex, age and body weight). On the basis of the presence of an incisure in the ascending branch of the systolic curve, subjects were divided in two groups: one with a bifid systolic curve and the other with a monophasic aspect. Correlations between: 1) diameter of the vessel and body weight and 2) carotid pulse volume and flow velocity (systolic, diastolic and mean) were found. A greater systolic pulse volume was found in male subjects, in subjects with greater body weight and in those which had a monophasic systolic wave.     

SCINTIGRAPHIC EVALUATION OF SOLID-PHASE GASTRIC EMPTYING IN THE DOG

A technique for scintigraphically quantitating solid-phase gastric emptying in the dog was developed in a Beagle model. The test meal was determined to empty in a linear fashion, indicating a solid-phase label. The evaluation was performed on a group of dogs presented for gastrointestinal signs that were judged to have normal liquid barium sulfate fluoroscopic and radiographic studies. The results of this study indicate that this technique is valuable for identifying those patients with surgically correctable pyloric obstruction that exhibit normal gastric emptying of liquid barium.     

ULTRASONOGRAPHY OF PERIPHERAL NERVES IN THE NORMAL ADULT HORSE

A study of the ultrasonographic appearance and size of the sciatic, tibial, peroneal, suprascapular, radial, median, and ulnar nerves and a comparison with the anatomic size and location of these nerves in the normal adult horse is reported. Cadavers and live horses were studied. Landmarks for localization and techniques for nerve identification are described. The depth and diameter of each nerve at various locations and the success rate in imaging each nerve are reported. Statistically significant correlations were found between anatomically and ultrasonographically measured nerve depths and diameters. The success rate in identifying nerves was 70% in the live horses and 49% in cadavers, with the deep peroneal nerve being the easiest to identify. Some applications of this technique in horses are discussed.