CONTRAST-ENHANCED ULTRASONOGRAPHY FOR CHARACTERIZATION OF CANINE FOCAL LIVER LESIONS

In six normal beagles and 27 dogs with spontaneous focal or multifocal liver lesions, contrast-enhanced ultrasonography using Sonazoid^® was performed. Sonazoid^® is a newly developed second-generation contrast agent with the ability to be used for real-time contrast imaging along with parenchymal imaging. An appropriate protocol for the evaluation of all three phases (arterial, portal, and parenchymal) was established based on the results for normal beagles. By evaluation of the echogenicity of hepatic nodules during the arterial and parenchymal phases it was possible to differentiate malignant tumors from benign nodules with very high accuracy. In 15 of 16 dogs diagnosed as malignant tumors, nodules were clearly hypoechoic to the surrounding normal liver during the parenchymal phase. Additionally, malignant tumors had different echogenicity compared with the surrounding normal liver during the arterial phase in 14 of 15 dogs. In the portal phase, there were no characteristic findings. Contrast-enhanced ultrasonography with Sonazoid^® appears to improve the characterization of canine focal and multifocal hepatic lesions.     

HARMONIC ULTRASOUND: A REVIEW

Harmonic ultrasound is a technique based on the principle of transmitting at frequency f and receiving at frequency 2f (or 1/2f). This technology has become available through the development of wide-bandwidth transducers. Microbubble contrast media produce a large amount of harmonic signal. Contrast harmonic ultrasound provides the opportunity to image patterns of high flow vasculature and overall perfusion. Regions of poor perfusion, including necrosis or infarction, can be identified with contrast harmonic ultrasound. While proportionately lower, tissues also produce harmonic signals. Tissue harmonic ultrasound sequences often improve subjective image quality compared to fundamental ultrasound in echocardiographic and abdominal examinations. This review will discuss the physical principles of harmonic ultrasound signal generation, medical and animal research applications, and an overview of current veterinary experiences.     

QUANTITATIVE CONTRAST HARMONIC ULTRASOUND IMAGING OF NORMAL CANINE LIVER

Eight adult dogs with no evidence of liver disease, weighing between 8 and 25 kg were imaged after injection of a microbubble contrast medium using harmonic ultrasound imaging. All dogs received three separate bolus contrast injections, and six dogs also received three separate constant rate infusions each. Time/Mean Pixel Value curves were generated for selected regions of the liver. Upslope, downslope, baseline, peak, change, and time to peak were calculated. For bolus injection (averaging all subjects), upslope was 3.85 +/- 1.50 Mean Pixel Values/s, downslope was -0.71 +/- 0.30 Mean Pixel Values/s, baseline was 72.38 +/- 17.82 Mean Pixel Values, peak was 120.26 +/- 17.44 Mean Pixel Value, change from baseline to peak was 47.88 +/- 6.92 Mean Pixel Values, time to peak (from injection) was 22.88 +/- 6.79 s, and time to peak (from first upslope) was 13.88 +/- 1.55 s. Data acquisition and analysis from constant rate infusions was more cumbersome than for bolus, and results were less repeatable. There were significant differences (p < .005) in upslope, downslope, peak values, and time to peak between the two methods. These baseline data may prove useful in the evaluation of dogs with diffuse hepatic disease.     

CONTRAST-ENHANCED ULTRASONOGRAPHY IN NORMAL CANINE LIVER. EVALUATION OF IMAGING AND SAFETY PARAMETERS

Contrast-enhanced ultrasonography, a new imaging modality in veterinary medicine, can provide data on tissue perfusion. The objective of this study was to use the ultrasonographic contrast agent SonoVue to evaluate various transit time indices in the normal canine liver, to examine the effect of anesthesia on these parameters, and to evaluate the safety of this agent in dogs. The liver of 11 healthy dogs was studied by ultrasound during an intravenous bolus injection of SonoVue. Each dog underwent the examination twice, first with and later without the use of anesthesia. A time-intensity curve was generated from a selected region of interest within the liver from each scanning session. Ratios derived from peak enhancement, time to peak enhancement, up-slope and full-width half-maximum (FWHM) of the curve were calculated from the time-intensity curves, and are reported. There were no statistically significant differences (P > 0.05) in peak enhancement, up-slope and FWHM between dogs that were anesthetized and dogs that were not. Time to peak enhancement, however, was significantly shorter when the dogs were anesthetized than when they were nonanesthetized (P < 0.05). There were no biologically significant changes in clinical laboratory findings. This study indicates that contrast-enhanced ultrasound using SonoVue gives reproducible liver perfusion data, and appears to be a safe and well-tolerated agent for use in dogs. When considering normal values, the use of anesthetic drugs has to be considered.     

CHARACTERIZATION OF CANINE FOCAL LIVER LESIONS WITH CONTRAST-ENHANCED ULTRASOUND USING A NOVEL CONTRAST AGENT—SONAZOID

Contrast-enhanced ultrasound using Sonazoid, a novel contrast medium with a liver-specific Kupffer phase, was evaluated in canine focal liver lesions Twenty-five dogs with a liver mass were given intravenous Sonazoid, and the enhancement pattern in the arterial, portal, and parenchymal phase was characterized. An enhancement defect in the lesion in the parenchymal phase was observed in all malignant lesions, whereas only one of nine benign lesions had a filling defect. The diagnostic value of the presence of a filling defect for malignancy was statistically significant (100% sensitivity, 88.9% specificity, 94.1% positive predictive value, 100% negative predictive value), and was equal to that of hypoenhancement in the portal or delayed phase. The defect pattern (clear or irregular defect) was dependent ( P <0.05) on the types of malignancy (i.e., hepatocellular carcinoma and other types of malignancies). In the arterial phase, five of the six hepatocellular carcinomas had hypervascularity, whereas no other lesion was characterized by hypervascularity. In some dogs, additional lesions that could not be observed with conventional B-mode ultrasonography were detected in the parenchymal phase. The enhancement pattern of Sonazoid, especially in the parenchymal phase, has potential as a diagnostic tool for canine focal liver lesions.     

A REVIEW OF IMAGING TECHNIQUES FOR CANINE CAUDA EQUINA SYNDROME

There are many imaging modalities available for evaluating the canine lumbosacral region. These include conventional radiography, stress radiography, myelography, epidurography, transosseous and intravenous venography, discography, linear tomography, computed tomography, and magnetic resonance imaging. Myelography, epidurography and discography are commonly used, but often lack sensitivity. Myelography is of little value when evaluating the cauda equina because the dural sac is elevated from the vertebral canal floor and frequently ends before the lumbosacral junction. Epidurography will identify a ventrally located compressive lesion and discography can delineate the dorsal extent of the diseased disc; however, both are sometimes difficult to interpret. Therefore, more than one of these imaging techniques must be used in order to make a diagnosis. Computed tomography and magnetic resonance imaging have become valuable in evaluating the lumbosacral region in dogs. These modalities have proven to be both sensitive and specific for determining cauda equina compression in both humans and in dogs.     

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.     

MAGNETIC RESONANCE IMAGING AND ULTRASONOGRAPHY IN THE DIAGNOSIS OF A MALIGNANT PERIPHERAL NERVE SHEATH TUMOR IN A DOG

A 9-year-old male neutered mixed breed dog had a two-month history of progressive left thoracic limb lameness. There was electromyographic evidence of denervation potentials in all muscles of this limb. In magnetic resonance images a multilobulated, hyperintense mass was visible caudal to the middiaphysis of the left humerus on T-2 weighted images. The mass, which was isointense with surrounding tissue on T1 weighted images, extended proximally towards the brachial plexus. The mass was also visible as a fusiform structure of mixed echogenicity sonographically, although fine-needle aspiration performed at this time was nondiagnostic. A malignant peripheral nerve sheath tumor was diagnosed histopathologically.