HOW DOES MAGNETIC RESONANCE IMAGING REPRESENT HISTOLOGIC FINDINGS IN THE EQUINE DIGIT?

Magnetic resonance (MR) imaging is increasingly used in the diagnosis of equine foot pain, but improved understanding of how MR images represent tissue-level changes in the equine foot is required. We hypothesized that alterations in signal intensity and tissue contour would represent changes in tissue structure detected using histologic evaluation. The study objectives were to determine the significance of MR signal alterations in feet from horses with and without lameness, by comparison with histopathologic changes. Fifty-one cadaver feet from horses with a history of lameness improved by palmar digital analgesia (n = 32) or age-matched control horses with no history of lameness (n = 19) were stored frozen before undergoing MR imaging and subsequent histopathological examination at standard sites (deep digital flexor tendon, navicular bone, distal sesamoidean impar ligament, collateral sesamoidean ligament, and navicular bursa). Using MR images, signal intensity and homogeneity, size, definition of anatomic margins, and relationships with other structures were described. Alterations were graded as mild, moderate, or severe for each structure. For each anatomic site examined histologically the structures were described and scored as no changes, mild, moderate, or severe abnormalities, also taking into account adhesion formation within the navicular bursa detected on macroscopic examination. Alterations in MR signal intensity were related to changes at the tissue level detected by histologic examination. A sensitivity and specificity comparison of MR imaging with histologic examination was used to evaluate the significance of MR signal alterations for detection of moderate-to-severe lesions of the deep digital flexor tendon (DDFT), navicular bone, distal sesamoidean impar ligament (DSIL), collateral sesamoidean ligament (CSL) and navicular bursa. Agreement between the MR and histologic grading was assessed for each structure using a weighted kappa agreement. Direct comparison between histology and MR imaging for individual limbs revealed that signal alterations on MR imaging did represent tissue-level changes. These included structural damage, fibroplasia, fibrocartilaginous metaplasia, and hemosiderosis in ligaments and tendons; trabecular damage, osteonecrosis, fibroplasia, cortical defects, and increased vascularity in bone; and fibrocartilage defects. MR imaging had a high sensitivity and specificity for most structures. MR imaging had high specificity for lesions of the DDFT, CSL and navicular bursa, quite high specificity for lesions of the medulla of the navicular bone and its proximal aspect, with moderate specificity for the DSIL, and distal, dorsal and palmar aspects of the navicular bone, and was sensitive for detection of abnormalities in all structures except the dorsal aspect of the navicular bone. When MR and histologic grades alone were compared, there was good agreement between MR and histologic grades for the navicular bursa, DDFT, navicular bone medulla and CSL; moderate-to-good agreement in grades of the distal and palmar aspects of the navicular bone; fair to moderate in grades of the DSIL, and poor agreement for the dorsal and proximal aspects of the navicular bone. The results of this study support our hypothesis and indicate the potential use and limitations of MR imaging for visualization of structural changes within osseous and soft tissue structures of the equine foot.     

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.     

MAGNETIC RESONANCE IMAGING OF THE EQUINE FOOT

The purpose of this study was to assess the ability of magnetic resonance imaging to depict abnormalities of the equine foot. MRI was performed on isolated limbs which had lesions of the foot. These images were made in 3 perpendicular planes (sagittal, transverse and frontal) using a T1 weighted sequence and were 5mm thick. Images accurately depicted normal and pathologic structures in the foot and proved to be very precise for documenting degenerative joint disease, navicular disease and laminitis lesions. This preliminary study demonstrates the considerable potential of MRI in the diagnosis of locomotor problems in the horse.     

MAGNETIC RESONANCE IMAGING OF THE INITIAL ACTIVE STAGE OF EQUINE LAMINITIS AT 4.7 T

Equine laminitis is a severely debilitating disease. There is a poor understanding of the underlying pathophysiology, and traditional imaging modalities have limited diagnostic capacity. High field strength magnetic resonance (MR) imaging allows direct visualization of the laminae, which other modalities do not. This would prove useful both in assessment of clinical patients and in further investigation into the pathophysiology of the disease. The objective of this study was to characterize the anatomic changes within the equine foot associated with the initial active stage of laminitis. Images obtained using a 4.7 T magnet were compared with digital radiographs using histologic diagnosis as the reference standard. Objective measurements and subjective evaluation for both modalities were evaluated for the ability to predict the histologic diagnosis in horses with clinical signs of laminitis as well as in clinically normal horses and horses that were in a population at risk for developing laminitis. Signal intensity and architectural changes within the corium and laminae were readily seen at 4.7 T, and there was a strong association with the histologic diagnosis of active laminitis. Measurements obtained with MR imaging were more sensitive and specific predictors of laminitis than those obtained radiographically. Subjective evaluation with MR imaging was more sensitive than with radiography and should become more specific with greater understanding of normal anatomy.     

MAGNETIC RESONANCE IMAGING OF THE NORMAL EQUINE DIGIT AND METACARPOPHALANGEAL JOINT

Magnetic resonance (MR) images were made in sagittal and transverse planes through the metacarpophalangeal joint and digit of a horse. The images accurately depicted gross anatomic structures in the leg. Soft tissue structures were defined as separate entities on the images. Histologic varlation in tissues correlated with signal intensity differences on the MR images. Magnetic resonance imaging appears to be a promising imaging modality for evaluating musculoskeletal structures in equine limbs.     

MAGNETIC RESONANCE IMAGING FEATURES OF EQUINE NIGROPALLIDAL ENCEPHALOMALACIA

Magnetic resonance imaging (MR) was used to make a diagnosis of equine nigropallidal encephalomalacia in a horse. Equine nigropallidal encephalomalacia is a neurodegenerative disease that has many characteristics with Parkinson-like diseases in humans. Historically, horses were euthanized based on clinical signs and exposure to the toxic weed, yellow star thistle (Centaurea solstitialis). Previously, the disease has only been confirmed on necropsy. MR imaging can provide accurate and sensitive visualization of typical lesions seen in the brain of horses affected with equine nigropallidal encephalomalacia. Lesions were seen on T1-weighted, T2-weighted and proton density images. There was no contrast enhancement following Gd-DTPA administration. Lesions seen on MR were confirmed at necropsy. Using MR to confirm a diagnosis of equine nigropallidal encephalomalacia will prevent unnecessary suffering of horses and expense to owners that would otherwise incur, while further diagnostics are performed.     

LOW-FIELD MAGNETIC RESONANCE IMAGING OF THE EQUINE TARSUS: NORMAL ANATOMY

The objective of this study was to define the normal gross anatomic appearance of the adult equine tarsus on a low-field magnetic resonance (MR) image. Six radiographically normal, adult, equine tarsal cadavers were utilized. Using a scanner with a 0.064 Tesla magnet, images were acquired in the sagittal, transverse and dorsal planes for T1-weighted and the sagittal plane for T2-weighted imaging sequences. Anatomic structures on the MR images were identified and compared with cryosections of the imaged limbs. Optimal image planes were identified for the evaluation of articular cartilage, subchondral bone, flexor and extensor tendons, tarsal ligaments, and synovial structures. MR images provide a thorough evaluation of the anatomic relationships of the structures of the equine tarsus.     

MAGNETIC RESONANCE IMAGING OF THE EQUINE STIFLE

The purpose of this study was to define normal gross anatomic structures in the equine stifle with magnetic resonance images. Magnetic resonance (MR) images were made in sagittal, 15° supinated, transverse, and dorsal planes of two equine stifles. The MR images were scrutinized by comparing MR images to dissection specimens and frozen cross sections of stifle joints. Sagittal and 15° supinated images were the most valuable in assessing articular cartilage, subchondral bone, and soft tissue structures within the joint. Cranial and caudal cruciate ligaments, medial and lateral menisci, meniscotibial and meniscofemoral ligaments, long digital extensor tendon, and patellar ligaments were easily evaluated. MR images provided substantially more gross anatomical information than the currently available imaging modalities.     

MAGNETIC RESONANCE IMAGING OF THE NORMAL EQUINE BRAIN

The purpose of this investigation was to define the magnetic resonance (MR) imaging appearance of the brain and associated structures of the equine head. MR images were acquired in oblique dorsal (T2-weighted), sagittal (T1-weighted), and transverse planes (T2-weighted), using a magnet of 1.5 Tesla and a human body coil. Relevant anatomic structures were identified and labeled at each level. The resulting images provided excellent anatomic detail of the cranioencephalic structures. Annotated MR images from this study are intended as a reference for clinical imaging studies of the equine head, specially in the diagnosis of brain diseases in the horse.     

MAGNETIC RESONANCE IMAGING CHARACTERISTICS OF THE FOOT IN HORSES WITH PALMAR FOOT PAIN AND CONTROL HORSES

Palmar foot pain is a common cause of lameness. Magnetic resonance imaging (MRI) has the potential to detect damage in all tissues of the equine foot, but an understanding of the differences in magnetic resonance (MR) images between feet from horses with and without palmar foot pain is required. This study aimed to describe MR findings in feet from horses with no history of foot-related lameness, and to compare these with MR findings in horses with lameness improved by palmar digital local analgesia. Thirty-four limbs from horses euthanized with a clinical diagnosis of navicular syndrome (ameness >2 months duration, positive response to palmar digital nerve blocks and absence of other forelimb problems) (Group L), and 25 feet from age-matched horses with no history of foot pain (Group N) were examined. For each anatomic structure, MR signal intensity and homogeneity, size, definition of margins, and relationships with other structures were described. Alterations in MR signal intensity and homogeneity were graded as mild, moderate, or severe and compared between Groups L and N. Results revealed that there were significant differences in MR images between Groups N and L. Multiple moderate-severe MR signal changes were present in 91% of limbs from Group L and moderate (none were graded severe) in 27% of limbs from Group N. In most Group L limbs, more than three structures and frequently six to eight structures were abnormal. Concomitant abnormalities involved most frequently the deep digital flexor tendon, distal sesamoidean impar ligament, navicular bone, collateral sesamoidean ligament, and navicular bursa (with significant associations in severity grade between these structures), sometimes with involvement of the distal interphalangeal joint and/or its collateral ligaments. It was concluded that findings on MR images were different between horses with and without foot pain, and that pain localized to the foot was associated with MR changes in a variety of structures, indicating that damage to several structures may occur concurrently and that MR imaging was useful for evaluation of foot pain.     

MAGNETIC RESONANCE IMAGING OF THE EQUINE METACARPOPHALANGEAL JOINT: THREE-DIMENSIONAL RECONSTRUCTION AND ANATOMIC ANALYSIS

Magnetic resonance imaging was used to examine the equine metacarpophalangeal joint. Thirty-two saggital images generated by partial volume imaging were transferred to a computer for three dimensional reconstruction and analysis. All the tissues constituting the metacarpophalangeal joint were readily identified. The most significant increase finding regarded the soft tissues on the palmar aspect of the metacarpophalangeal joint and their interactions with the proximal sesamoid bones. the equine metacarpophalangeal joint has not previously been evaluated using 3-dimensional imaging software.     

MAGNETIC RESONANCE IMAGING FINDINGS OF DESMOPATHY OF THE COLLATERAL LIGAMENTS OF THE EQUINE DISTAL INTERPHALANGEAL JOINT

We report the use of a low-field magnetic resonance (MR) imaging system for the detection of desmopathy of the collateral ligament of the distal interphalangeal joint and the long-term outcome. Twenty horses were studied and their medical records and MR images were reviewed retrospectively. Long-term follow-up information was obtained by telephonic questionnaires of owners, trainers, or referring veterinarians. Desmopathy of the medial collateral ligament (80%) and enthesopathy of the affected collateral ligament (80%) were common MR imaging features. Treatment consisted of stall rest followed by a rehabilitation period. Additional treatments included shoeing, extracorporeal shock wave therapy, application of a half limb or foot cast, and medication of the distal interphalangeal joint. Twelve (60%) horses returned to their previous level of exercise and maintained their previous level, whereas eight horses had a poor outcome. Low-field MR imaging in the standing patient can be used to detect collateral ligament desmopathy of the distal interphalangeal joint without a need for general anesthesia.     

EFFECT OF DEEP DIGITAL FLEXOR TENDON ORIENTATION ON MAGNETIC RESONANCE IMAGING SIGNAL INTENSITY IN ISOLATED EQUINE LIMBS—THE MAGIC ANGLE EFFECT

Ten normal equine isolated limbs were imaged using a knee coil in a 1.5 Tesla magnetic field, with short echo time sequences (TE < 15 ms). Magnetic resonance imaging was performed on each isolated limb in different positions, with and without extension of the metacarpophalangeal joint. Deep digital flexor tendon orientation ranged from 20 to 60 degrees in relation to the static magnetic field. Increased intratendinous signal intensity was observed when the angle between the deep digital flexor tendon and the constant magnetic field approached 55 degrees ("magic angle"). The increased signal intensity was independent from extension of the metacarpophalangeal joint. Recognition of the magic angle phenomenon is essential for proper evaluation of magnetic resonance imaging studies of the equine foot.     

A TECHNIQUE FOR MAGNETIC RESONANCE IMAGING OF EQUINE CADAVER SPECIMENS

We tested an adaptation of a technique for performing magnetic resonance (MR) imaging of human cadaver limbs in the horse. The forelimbs from a normal horse were collected, frozen, and sealed with a paraffin-polymer combination prior to imaging with either a high- or midfield magnetic resonance scanner. Each forelimb was defrosted, scanned, and refrozen on two separate occasions. A five-point scale was used to evaluate the quality of each set of sagittal and transverse, T1-weighted images of each digit. There was no difference in image quality between first and second scans of either specimen (p > 0.05). We conclude that this technique allows investigators to bank tissue specimens for future magnetic resonance imaging without significant loss of image quality.     

EX VIVO MAGNETIC RESONANCE IMAGING OF THE DISTAL ROW OF EQUINE CARPAL BONES: ASSESSMENT OF BONE SCLEROSIS AND CARTILAGE DAMAGE

The distal row of carpal bones (C2, C3, and C4) from eight left intercarpal joints--four from Standardbred Trotters and four from Swedish Warmblood horses--were used to assess the potential of magnetic resonance (MR) imaging to detect cartilage and bone lesions. The joints used in the study were classified by macroscopic and radiographic examinations as having normal, mild, moderate, or severe articular cartilage lesions and bone sclerosis. Those classifications correlated well with the appearance of the MR images. Bone sclerosis in the MR images was observed as regions of decreased signal intensity. Upon quantitative analysis of the MR images there was a significant difference (p < 0.0001) in the MR signal intensity from areas where radiographic bone sclerosis was observed compared to areas of radiographic nonsclerotic bone. In addition, the MR images were used to pilot the location of histology slices through areas of interest that were then examined microscopically; hence, the lesions found from the MR imaging examination were verified microscopically. It was concluded that cartilage lesions and cartilage loss are related to the sclerotic state of the underlying bone. The MR protocols developed in this study were applied on five intact cadaveric carpal joints, and it was concluded that MR imaging could successfully be used in the intact joint to detect minor cartilage and bone lesions not visualized by either radiography or macroscopic examination. Hence, MR imaging can be used to delineate interactions between articular cartilage and subchondral bone over time and in vivo.     

CORRELATION OF ARTICULAR CARTILAGE THICKNESS MEASUREMENTS MADE WITH MAGNETIC RESONANCE IMAGING,MAGNETIC RESONANCE ARTHROGRAPHY,AND COMPUTED TOMOGRAPHIC ARTHROGRAPHY WITH GROSS ARTICULAR CARTILAGE THICKNESS IN THE EQUINE METACARPOPHALANGEAL JOINT

Osteoarthritis of the metacarpophalangeal joint is common cause of lameness in equine athletes, and is hallmarked by articular cartilage damage. An accurate, noninvasive method for measuring cartilage thickness would be beneficial to screen for cartilage injury and allow for prompt initiation of interventional therapy. The objective of this methods comparison study was to compare computed tomographic arthrography (CTA), magnetic resonance imaging (MRI), and magnetic resonance arthrography (MRA) measurements of articular cartilage thickness with gross measurements in the metacarpophalangeal joint of Thoroughbred horses. Fourteen cadaveric, equine thoracic limbs were included. Limbs were excluded from the study if pathology of the metacarpophalangeal articular cartilage was observed with any imaging modality. Articular cartilage thickness was measured in nine regions of the third metacarpal bone and proximal phalanx on sagittal plane MRI sequences. After intra‐articular contrast administration, the measurements were repeated on sagittal plane MRA and sagittal CTA reformations. In an effort to increase cartilage conspicuity, the volume of intra‐articular contrast was increased from 14.5 ml, to maximal distention for the second set of seven limbs. Mean and standard deviation values were calculated, and linear regression analysis was used to determine correlations between gross and imaging measurements of cartilage thickness. This study failed to identify one imaging test that consistently yielded measurements correlating with gross cartilage thickness. Even with the use of intra‐articular contrast, cartilage surfaces were difficult to differentiate in regions where the cartilage surfaces of the proximal phalanx and third metacarpal bone were in close contact with each other.     

RADIOGRAPHIC AND MAGNETIC RESONANCE IMAGING OF THE STIFLE JOINT IN EXPERIMENTAL OSTEOARTHRITIS OF DOGS

Radiography and magnetic resonance imaging were used to evaluate osteoarthritis at 2, 6, and 12 weeks following transection of the cranial cruciate ligament of the stifle (femorotibial) joint of 6 dogs. A quantitative radiographic scoring system was used to assess the progression of hard and soft tissue changes of osteoarthritis. Mediolateral (flexed joint) and oblique (extended joint) radiographic projections enabled identification of small osteophytes on the femoral trochlear ridges, which were detected at an earlier stage of development than was previously reported. Magnetic resonance imaging was useful in detecting changes in cartilage thickness, osteophytosis and intraarticular loose bodies. Radiography and magnetic resonance imaging were complementary in the assessment of pathologic changes of osteoarthritis.     

MAGNETIC RESONANCE IMAGING ANATOMY OF THE NORMAL EQUINE LARYNX AND PHARYNX

The purpose of the present study was to describe normal magnetic resonance (MR) imaging anatomy of the equine larynx and pharynx and to present the optimal protocol, sequences, and possible limitations of this examination technique. Using a 0.3 T unit, the laryngeal and pharyngeal regions was imaged in two horses. The protocol consisted of sagittal and transverse T2-weighted (T2w) fast spin echo, transverse T1-weighted (T1w) spin echo, and dorsal high-resolution T1w gradient echo (both pre- and postcontrast enhancement) sequences. Euthanasia was performed at the end of the imaging procedure. Macroscopic anatomy of the cadaver sections were compared with the MR images in transverse, midsagittal, and parasagittal planes. There was good differentiation of anatomic structures, including soft tissues. The laryngeal cartilages, hyoid apparatus, and upper airway muscle groups with their attachments could be clearly identified. However, it was not always possible to delineate individual muscles in each plane. Most useful were both T2w and T1w transverse sequences. Intravenous application of contrast medium was helpful to identify blood vessels. The MR images corresponded with the macroscopic anatomy of cadaver sections.     

MAGNETIC RESONANCE IMAGING OF THE BRAIN OF NORMAL NEONATAL FOALS

Magnetic resonance imaging (MRI) was performed on gthe brain of 5 normal, anesthetized, neonatal (age 3-to-6 days) Quarter Horse foals. The objectives of the study were to develop a technique for imaging the brain of neonatal foals, and to ascertain their normal brain anatomy. Interavenous propofol was administered for induction and maintenance of general anesthesia. Using spin echo MR techniques, T1 weighted sagittal and transverse views, and spin density and T2 weighted transverse views were successfully made of each foal. MR images provided excellent visualization of many anatomic struictures of the brain and head. MRI of the bgrain is feasible for selected neonantal equine patients.