NORMAL DUPLEX DOPPLER WAVEFORMS OF MAJOR ABDOMINAL BLOOD VESSELS IN DOGS: A REVIEW

The normal flow velocity profile and duplex Doppler waveform of the major abdominal blood vessels (aorta, caudal vena cava and the portal vein as well as their major branches) were examined by Doppler ultrasound. The flow velocity profile of an artery is largely determined by its diameter. The pulsatility of the waveform is related to the vascular impedance downstream to the point of measurement. Early systolic peak is present in the Doppler pattern of some vessels in some dogs. The waveform of the veins is mainly affected by the pressure conditions of the right atrium and the intrathoracic and intraabdominal pressure changes due to the respiration. Simultaneous electrocardiogram was used to reveal the effect of the heart beats on the Doppler patterns of the veins.     

SONOGRAPHIC EVALUATION OF CANINE TESTICULAR AND SCROTAL ABNORMALITIES: A REVIEW OF 26 CASE HISTORIES

The ultrasonographic and medical records of 26 dogs examined for testicular/scrotal abnormalities were reviewed. Fifteen dogs were diagnosed with testicular neoplasia that included one or more of the following tumor cell types: Sertoli cell, seminoma and interstitial cell. Ultrasound was highly sensitive to detection of testicular neoplasia including one nonpalpable tumor. Tumor type specificity was not readily apparent in this study, although the three nondescended Sertoli cell tumors displayed similar characteristic sonographic patterns. Six dogs were reviewed with nonneoplastic, noninfectious disorders that included: vascular compromise, atrophy, scrotal edema and intestinal hernia. Five dogs with infectious diseases were reviewed. Ultrasound was sensitive and relatively specific for the nonneoplastic conditions.     

CONTRAST ENHANCED SONOGRAPHIC ASSESSMENT OF FEEDING VESSELS AS A DISCRIMINATOR BETWEEN MALIGNANT VS. BENIGN FOCAL SPLENIC LESIONS

Contrast‐enhanced sonography was conducted in 17 confirmed focal splenic lesions (five malignant, 12 benign). Relative echogenicity changes were used for subjective interpretation of lesion perfusion. A rapid influx of contrast agent, resulting in an increased relative echogenicity of the lesion, followed by a rapid clearance of contrast agent was referred to as early washin/early washout. There were 6/12 benign, and 3/5 malignant lesions characterized by early washin/early washout. Therefore, sensitivity, specificity, and accuracy for this parameter in differentiating malignant from benign lesions was 60%, 50%, and 53%, respectively. There were 2/12 benign, and 2/5 malignant lesions with persistent hypoperfusion throughout all phases. Therefore, sensitivity, specificity, and accuracy for malignancy using this criterion were 40%, 83%, and 71%, respectively. However, none of the benign and all malignant lesions were characterized by tortuous and persistently visible feeding vessels. This suggests that interpretation of splenic lesions cannot be performed accurately on the basis of echogenicity or persistent hypoperfusion, but that assessment of vascular tortuosity may be helpful in discriminating between a malignant vs. benign focal splenic lesion.     

PATHOLOGIC CORRELATION OF RESISTIVE AND PULSATILITY INDICES IN CANINE ABDOMINAL LYMPH NODES

We assessed the ability of the resistive index (RI) and pulsatility index (PI) to allow differentiation between normal, reactive, and neoplastic lymph nodes. Forty-seven medial iliac and 54 mesenteric lymph nodes from 83 dogs were evaluated sonographically. A cytologic sample was obtained in each dog that allowed categorization into one of the categories defined above. We found a significant difference in the RI and PI in nonneoplastic vs. neoplastic medial iliac and mesenteric lymph nodes. Values higher than 0.67 for the RI and 1.02 for the PI in medial iliac lymph nodes and higher than 0.76 for the RI and 1.23 for the PI in mesenteric lymph nodes had a high sensitivity and specificity for differentiating benign from neoplastic lymph nodes.     

A REVIEW OF THE SONOGRAPHIC ASSESSMENT OF TUMOR METASTASES IN LIVER AND SUPERFICIAL LYMPH NODES

Diagnostic imaging techniques are an important part of the diagnostic workup and staging of cancer patients. Ultrasound is of particular interest in this respect. In so far as tumor metastases are concerned, ultrasonography of regional lymph nodes and of the liver can provide valuable information. In humans many criteria, some of them objective, have been evaluated as indicators of malignancy. The most diagnostically helpful of these include the short/long axis ratio of the lymph node, the pattern of distribution of the blood vessels within the lymph node, and to some extent the calculated values for resistive and pulsatility indices. Putative objective criteria to improve the specificity of ultrasound for metastases detection in the liver have also been evaluated. These include perfusion indices, primarily using analysis of Doppler frequencies (Doppler perfusion index) and hepatic venography using an ultrasound contrast agent. Contrast-enhanced ultrasonography is a new and promising area to help the initial diagnosis and characterization of malignancy, particularly for focal lesions in the liver. This review discusses the use of ultrasound for detection of metastases and presents material from four veterinary cases.     

A RETROSPECTIVE STUDY ON THE SONOGRAPHIC FINDINGS OF ABDOMINAL CARCINOMATOSIS IN 14 CATS

A retrospective review was performed on 14 cats with histology- or cytology-proven carcinomatosis. The mean age was 12.7 years with a median of 11 years. The diagnosis of carcinomatosis was made by histology in 11 cats and cytology in three cats. Twelve cats had cytologic examination of the peritoneal free fluid and seven cats (58.3%) had evidence of malignant cells. The primary tumor site was determined in 13 cats. The most common organ locations for the primary tumor were the liver (n = 5), pancreas (n = 3), and small intestine (n = 3). Other sites were stomach and spleen in one cat each. Epithelial cell neoplasia was the primary tumor type in 11 cats. Two cats had abdominal lymphomatosis and one cat had abdominal sarcomatosis secondary to metastatic hemangiosarcoma. Free peritoneal fluid and masses in the connecting peritoneum were found in all cats (100%). Additional findings included primary or metastatic masses in abdominal organs in 10 cats (71.4%), lymph node enlargement in five cats (35.7%), pleural effusion in three cats (21.4%), parietal peritoneal masses in two cats (14.3%), and visceral peritoneal masses in one cat (7.1%). Masses in the connecting peritoneal may be a very specific finding for carcinomatosis in cats, especially with a concurrent abdominal neoplastic mass. Parietal and visceral peritoneal masses, while uncommon in this series of cats, have not been reported for other diseases and seem to strongly support a diagnosis of carcinomatosis.     

INFLUENCE OF NORMOVOLEMIC ANEMIA ON DOPPLER-DERIVED BLOOD VELOCITY RATIOS OF ABDOMINAL SPLANCHNIC VESSELS IN CLINICALLY NORMAL DOGS

Doppler spectra of the abdominal aorta (AAo), cranial mesenteric artery (CMA), celiac artery (CA), and left renal artery (LRA) were obtained from 11 fasted, clinically healthy, conscious Beagles before and after inducing severe acute normovolemic anemia (mean±standard deviation hematocrit 16.0±0.77%). Peak systolic, end diastolic, and time-averaged mean velocities were measured. The different vessels were compared with each other. Peak systolic velocity ratio and time-averaged mean velocity ratio of splanchnic vessels to corresponding variables of the AAo were computed and compared between and within vessels during physiologic and anemic states. There was no difference between LRA and AAo, CMA or CA regarding time-averaged mean velocity, time-averaged mean velocity ratio, or end diastolic velocity during the physiological state. During the anemic state, LRA mean time-averaged mean velocity ( P ≤0.008) and mean end diastolic velocity ( P ≤0.041) were significantly lower than those of AAo, CMA, and CA. Mean time-averaged mean velocity ratio of the LRA was also significantly ( P ≤0.004) lower than the CMA and CA ratios, and significantly ( P =0.014) lower during anemic state than physiologic state of the same vessel. End diastolic and time-averaged mean velocities of the AAo, CMA, and CA increased proportionally during anemia, but there was a relatively less increase in the same variables of the LRA, suggesting less increase in blood flow. Doppler ratios allowed a noninvasive comparison between splanchnic and aortic hemodynamics. Velocity ratios might be useful for clinical detection of relative hemodynamic changes between different vessels.     

SONOGRAPHIC CHARACTERISTICS OF INTRAABDOMINAL ABSCESSATION AND LYMPHADENOPATHY ATTRIBUTABLE TO RHODOCOCCUS EQUI INFECTIONS IN FOALS

The sonographic characteristics of intraabdominal abscesses in 11 foals and intraabdominal lymphadenitis in five foals with Rhodococcus equi infections are presented. Intraabdominal abscesses were usually present in the ventral abdomen adjacent to the ventral body wall, well‐marginated, and contained a mixed or complex echo pattern. Lymphadenitis appeared as singular or multiple clusters of lymph nodes of mixed echogenicity adjacent to any portion of the gastrointestinal tract or body wall. Sonographic findings were supported by necropsy examinations, but sonographic measurements consistently underestimated the size of abscess.     

SONOGRAPHIC APPLICATION IN THE DIAGNOSIS OF INTRAABDOMINAL ABSCESS IN THE DOG

The sonographic appearance of intraabdominal abscess, excluding prostatic abscess, is presented. The most common sonographic pattern identified for intraabdominal abscess is an irregularly defined, hypoechoic mass with minimal to no through transmission. Definitive diagnosis of intraabdominal abscess using only sonography is not possible, as variations of this common sonographic pattern are imaged. Sonography is best utilized to scan an animal when there is a high suspicion of intraabdominal abscess with no overt physical or radiographic evidence, and to better characterize intraabdominal masses. Sonography can be used to assist in percutaneous aspiration, catheterization, and intraoperative localization of abscessation.     

SONOGRAPHIC CHARACTERISTICS OF PRESUMPTIVELY NORMAL CANINE MEDIAL ILIAC AND SUPERFICIAL INGUINAL LYMPH NODES

The medial iliac and superficial inguinal lymph nodes are not routinely palpable in the dog, and ultrasound imaging provides an alternate noninvasive technique to assess these lymph nodes, as well as to guide needle aspiration. Herein we describe the ultrasound characteristics of the medial iliac and superficial inguinal lymph nodes in 50 healthy dogs, as well as frequency and ease of node detection. The relationship between the size of the lymph nodes and the following variables was assessed: age, gender, body weight, body condition score, body length, and thoracic height and width. Right and left medial iliac lymph nodes were detected in 50 (100%) dogs, right superficial inguinal lymph node(s) in 49 (98%) dogs, and left superficial inguinal lymph node(s) in 47 (96%) dogs. In >90% of both sets of lymph nodes, the echogenicity was hypoechoic or isoechoic to surrounding tissues, with a corticomedullary or homogenous echotexture, smooth, clearly defined margins, and a fusiform shape. Increasing weight, distance from the sternal manubrium to the ischium, and thoracic height and width were associated with increased lymph node size (P‐values<0.05). Average lymph node sizes and range of sizes provide preliminary reference values for the medial iliac and superficial inguinal lymph nodes in normal dogs.     

EFFECT OF SEVOFLURANE ANESTHESIA AND BLOOD DONATION ON THE SONOGRAPHIC APPEARANCE OF THE SPLEEN IN 60 HEALTHY CATS

The aims of this prospective study were to describe the normal sonographic size and appearance of the feline spleen, and to test effects of sevoflurane anesthesia and blood collection on sonographic characteristics. Sonographic evaluations were performed in 60 healthy blood donor cats prior to anesthesia and blood collection (baseline), after anesthesia induction, after completion of blood collection while under anesthesia, and 7–10 days after blood collection. Transverse sonographic images of the splenic mid‐body were made. Splenic height, width, cross‐sectional area, echogenicity relative to the left renal cortex, and echotexture were recorded. Height, width, and cross‐sectional area were compared across time periods using linear‐mixed effects models. Holm's method was applied to adjust for multiplicity and control the overall Type 1 error rate at α = 0.05. Normal transverse sonographic splenic measurements (mean ± standard deviation) at baseline were: height 8.2 ± 1.4 mm; width 26.7 ± 4.4 mm; and CSA 1.6 ± 0.5 cm². While there were statistically significant differences in splenic height, width, and cross‐sectional area after sevoflurane anesthesia and/or blood collection, differences were of low magnitude. The spleen was diffusely homogenous and subjectively isoechoic or mildly hyperechoic relative to the left renal cortex. In 77% of castrated male cats, the spleen was isoechoic to the left renal cortex. We conclude that sevoflurane anesthesia and blood donation do not subjectively alter splenic dimensions, echogenicity and echotexture in normal cats.     

TISSUE HARMONIC ULTRASOUND FOR IMAGING NORMAL ABDOMINAL ORGANS IN DOGS AND CATS

Normal cats (n = 38) and dogs (n = 40) were imaged with fundamental ultrasound and tissue harmonic ultrasound. Images of the liver, gall bladder, spleen, left kidney, urinary bladder, and jejunum were collected in all animals. Images of the left adrenal gland were collected in all dogs. All normal cats and dogs had improved imaging with tissue harmonic ultrasound. The number of organs with improved conspicuity ranged from one to all organs imaged. The most common organ to have improved conspicuity was the jejunum (100% of dogs and 89% of cats). Significant improvement by tissue harmonic ultrasound was seen in images of gall bladder (p = .05) and left adrenal gland (p = .02) in dogs, and spleen, urinary bladder, and intestinal images (p = .01) in cats. Significant improvement was seen in tissue harmonic ultrasound images of the gall bladder in dogs weighing greater than 16 kilograms (p = .03) and in the images of the urinary bladder of dogs weighing less than 16 kilograms (p = .02). These data suggest that image quality improvement of normal organs using tissue harmonic ultrasound is consistent but not predictable. The exception was the jejunum, where improvement was seen in all dogs. Sonographers should be cognizant of the potential benefits of tissue harmonic ultrasound.     

SONOGRAPHIC RENAL FINDINGS IN 20 DOGS WITH LEPTOSPIROSIS

Abdominal ultrasound examinations of 20 dogs with confirmed leptospirosis were reviewed retrospectively for renal abnormalities. Three dogs had a normal ultrasound examination. The remaining 17 dogs had sonographic abnormalities of the kidneys. These abnormalities, seen either alone or in combination, included renalmegaly (n=10), pyelectasia (n=9), increased cortical echogenicity (n=15), perinephric effusion (n=5), and a medullary band of increased echogenicity (n=6). At our institution, the medullary band of increased echogencity has only been seen in dogs with leptospirosis and may therefore be a specific sonographic sign for this disease.     

ULTRASONOGRAPHIC EXAMINATION OF ABDOMINAL LYMPH NODES IN THE DOG

Ultrasonography is a valuable diagnostic tool for examination of the abdomen. Normal lymph nodes are often indistinct during routine abdominal ultrasonographic examination. Lymph nodes altered by infiltrative or inflammatory processes may become sonographically visible due to enlargement and/or altered echogeńicity. A working knowledge of the anatomic distribution of lymph nodes and the scheme of lymphatic drainage is important for increasing the sensitivity and specificity of abdominal lymph node assessment during ultrasonographic examination.     

B-MODE AND DOPPLER ULTRASOUND IMAGING OF THE SPLEEN WITH CANINE SPLENIC TORSION: A RETROSPECTIVE EVALUATION

The ultrasonographic appearance of splenic torsion has been described; the splenic parenchyma can be normal, hypoechoic or anechoic with interspersed linear echoes (coarse/"lacy" appearance). The ultrasonographic parenchymal appearance of 15 dogs in this report with splenic torsion varied: mottled hypoechoic regions (n=2), diffusely hypoechoic (n=11) and normal (n=2). Because splenic torsion causes vascular congestion due to splenic vein compression and eventual thrombosis, visible splenic vein intraluminal echogenicities compatible with thrombi were seen in 13 dogs using B-mode. Using spectral Doppler and color Doppler imaging of the splenic veins, no measurable flow velocities were detected in any of the 15 dogs. The varied B-mode ultrasonographic appearance of the splenic veins for intraluminal echoes and spectral or color Doppler evaluation for absent velocity flow.     

DOPPLER SONOGRAPHIC EVALUATION OF THE DIGITAL BLOOD FLOW IN HORSES WITH LAMINITIS OR SEPTIC PODODERMATITIS

The aim of this study was to evaluate the use of Doppler ultrasonography to monitor vascular blood flow dynamics in defined diseases of the equine digit in a noninvasive way. Doppler sonography was used to evaluate medial digital artery blood flow in eight horses with septic pododermatitis and four horses with laminitis in comparison with 10 horses of a control group. Doppler sonographic measurement and lameness examinations were performed in lame horses before treatment (day 0) and at 3, 6, and 9 days following treatment. Before treatment, blood flow velocities, arterial diameter, and flow volume were significantly higher in the lame horses, while pulsatility indices (PIs) were significantly lower (P < 0.05). Compared with the control group, there was no significant difference of resistive indices (RI) in the septic pododermatitis group, but these indices were significantly lower in the laminitis group. No significant difference between the two lame groups was recorded. After treatment, blood flow velocities and flow volume decreased significantly and PIs increased significantly in both lame groups, while RI and arterial diameter did not change. No correlation between Doppler parameters and the degree of lameness was found. Doppler sonography can be used to monitor vascular blood flow dynamics in horses suffering from septic pododermatitis and laminitis, while blood flow velocities and PI can serve as parameters for monitoring the course of the disease.     

ESTIMATION OF PORTAL BLOOD FLOW USING DUPLEX REAL-TIME AND PULSED DOPPLER ULTRASOUND IMAGING IN THE DOG

A duplex ultrasound system incorporating a pulsed wave Doppler ultrasound probe with conventional B-mode real-time imaging was used to evaluate portal vein blood flow in eight normal dogs. Adequate visualization of the cranial abdominal vessels was obtained from the right lateral 11th or 12th intercostal space. Doppler spectral analysis showed non-pulsatile flow with a wide range of linear flow velocities across the vessel lumen typical of laminar blood flow. Results for portal vein blood flows were 49.8 ± 13.5 ml/min/kg body weight (mean ± SD) with a range of 37.8 - 76.8 ml/min/kg body weight. These values overestimate portal blood flow by approximately 2 times when compared with published studies using invasive techniques. This overestimation is primarily due to the use of the maximal flow velocity in the blood flow calculations.     

PRENATAL SONOGRAPHIC DIAGNOSIS OF FETAL DEATH AND HYDRANENCEPHALY IN TWO CHIHUAHUA FETUSES

Hydranencephaly and fetal death was diagnosed in two of three fetuses during the abdominal sonographic examination of a 2.5-year-old, intact female Chihuahua that had clinical signs of dystocia 63 days after mating. A cesarean section was performed and one live normal puppy was present. Two dead puppies, each with a markedly enlarged and fluid filled skull were removed.     

A REVIEW OF EQUINE RENAL IMAGING TECHNIQUES

Radiography has a limited role in the evaluation of the kidneys in foals and adult horses. Ultrasonography is the current method of choice for structural evaluation of the kidneys in horses as it provides additional information to standard serum chemistry and urinalysis evaluation. A variety of structural abnormalities have been identified in diseased equine kidneys with the use of ultrasound. Ultrasound guided renal biopsy is the preferred method for performing renal biopsy in the horse. The use of Duplex Doppler ultrasound may allow for the characterization of regional hemodynamics of the equine kidneys, but is currently an untapped method for evaluation of equine renal hemodynamics.
Radionuclide methods including scintigraphy and quantitative renal function measurement can be used to provide further information about equine renal function. Scintigraphy can provide structural and possibly functional information. Quantitative methods using radiopharmaceuticals can provide precise measurement of glomerular filtration rate and effective renal blood flow. This method is especially helpful in identifying acute renal failure and in guiding response to treatment.
All equine renal imaging techniques should be a supplement to the physical examination and standard laboratory tests. Additional diagnostic aids such as urinary tract endoscopy should also be considered in horses with hematuria, hydroureter, and suspected calculi. Taken together, all these modalities provide a through evaluation of the equine renal system and provide a basis for the clinician to select treatment options and provide prognostic information to the owner.