COMPARISON OF TRANSVERSE COMPUTED TOMOGRAPHIC EXCRETORY UROGRAPHY IMAGES AND MAXIMUM INTENSITY PROJECTION IMAGES FOR DIAGNOSING ECTOPIC URETERS IN DOGS

Computed tomographic maximum intensity projection (MIP) images have been shown to improve reader confidence in their diagnoses and to improve detection of vascular structures and pulmonary nodules. The objectives of this method comparison study were to compare transverse source computed tomographic excretory urography (CTEU) images to two, five, and 10 slab thick MIP images for diagnosing canine ectopic ureters, compare reader confidence, and evaluate interobserver agreement. Two board‐certified veterinary radiologists and a board‐certified small animal internist blindly reviewed transverse source CTEU and two, five, and 10 slab thick MIP images of 24 dogs enrolled in the study. Inclusion criteria included a diagnostic CTEU and either cystoscopic or surgical confirmation of the presence or absence of ureteral ectopia. Eleven dogs were confirmed to have 17 ectopic ureters at surgery and/or cystoscopically. There was no significant difference in reader diagnoses between viewing methods or between viewing methods and the surgical/cystoscopic findings (P < 0.001). Reader confidence was significantly greater on two (P = 0.0080) and five (P = 0.0009) slab thick MIP images with significant interobserver agreement between readers for all viewing methods (P values ranging between 0.0363 and <0.001). In addition, the diagnostic accuracy of MIP images was similar to or better than transverse source CTEU images, when assessed by a radiologist. The study results suggest that CTEU is a reliable imaging technique for diagnosing canine ectopic ureters among specialists of varied experience. In addition, thin slice reconstructed MIP images improve reader confidence and potentially diagnostic accuracy, and thus their use should be considered, especially in more challenging cases.     

EVALUATION OF THE URETER AND URETEROVESICULAR JUNCTION USING HELICAL COMPUTED TOMOGRAPHIC EXCRETORY UROGRAPHY IN HEALTHY DOGS

Abdominal computed tomography (CT) using a protocol designed for evaluation of the ureters was performed on six normal purpose-bred research dogs. After noncontrast CT, a postcontrast scan was performed 3 min post midpoint of injection of 400 mgI/kg body weight of diatrizoate meglumine/sodium. Ureteral and ureterovesicular junction anatomy were readily assessed with minimal patient preparation. The ureters were similar in size to reported values and the renal pelvis, ureter, and ureterovesicular junction were easily identified on both noncontrast and contrast-enhanced scans. There was a significant relationship between bladder volume and interureterovesicular junction distance but not between bladder volume and ureterovesicular junction to internal urethral orifice distance. A reliable bony landmark for the identification of the internal urethral orifice could not be determined. The results of this preliminary study of normal anatomy should facilitate the clinical use of CT in the evaluation of ureteral disease (e.g., ureteral ectopia).     

EFFECT OF DELAYED ACQUISITION TIMES ON GADOLINIUM‐ENHANCED MAGNETIC RESONANCE IMAGING OF THE PRESUMABLY NORMAL CANINE BRAIN

A delay in imaging following intravenous contrast medium administration has been recommended to reduce misdiagnoses. However, the normal variation of contrast enhancement in dogs following a delay has not been characterized. Contrast‐enhanced MR imaging of 22 dogs was assessed, in terms of identification of normal anatomic structures, to investigate the variation associated with 10‐min delay between contrast medium administration and imaging. All dogs had a normal brain MR imaging study and unremarkable cerebrospinal fluid. Specific regions of interest were assessed both objectively, using computer software, and subjectively using three observers. Mean contrast enhancement >10% was seen in the pituitary gland, choroid plexus, meninges, temporal muscle, trigeminal nerve, and the trigeminal nerve root. Structures with an active blood–brain barrier had minimal contrast enhancement (<6%). Enhancing structures had significantly more contrast enhancement at t=1 min vs. t=10 min, except in temporal muscle, the trigeminal nerve and the trigeminal nerve root. Interobserver agreement was moderate to good in favor of the initial postcontrast T1‐weighted (T1w) sequence. The observers found either no difference or poor agreement in identification of the nonvascular structures. Intraobserver agreement was very good with all vascular structures and most nonvascular structures. A degree of meningeal enhancement was a consistent finding. The initial acquisition had higher enhancement characteristics and observer agreement for some structures; however, contrast‐to‐noise was comparable in the delayed phase or not significantly different. We provide baseline references and suggest that the initial T1w postcontrast sequence is preferable but not essential should a delayed postcontrast T1w sequence be performed.     

3 Tesla magnetic resonance imaging study of the normal canine femoral and sciatic nerves

Understanding the normal course and optimizing visualization of the canine peripheral nerves of the lumbar plexus, in particular the sciatic and the femoral nerves, is essential when interpreting images of patients with suspected peripheral neuropathies such as inflammatory or neoplastic conditions. The purpose of this prospective, anatomic study was to describe the magnetic resonance imaging (MRI) anatomy of the normal canine femoral and sciatic nerves and to define the sequences in which the nerves are best depicted. A preliminary postmortem cadaver study was performed to determine optimal sequences and imaging protocol. In a second step the optimized technique was implemented on 10 healthy Beagle dogs, included in the study. The applied protocol included the following sequences: T1‐weighted, T2‐weighted, T2‐Spectral Attenuated Inversion Recovery, T1‐weighted postcontrast and T1‐Spectral Presaturated Inversion Recovery postcontrast. All sequences had satisfactory signal‐to‐noise ratio and contrast resolution in all patients. The sciatic and femoral nerves were seen in all images. They were symmetric and of homogeneous signal intensity, being iso‐ to mildly hyperintense to muscle on T2‐weighted, mildly hyperintense in T2‐Spectral Attenuated Inversion Recovery, and iso‐ to mildly hypointense in T1‐weighted images. No evidence of contrast enhancement in T1‐weighted and T1‐Spectral Presaturated Inversion Recovery postcontrast sequences was observed. The anatomic landmarks helpful to identify the course of the femoral and sciatic nerves are described in detail. This study may be used as an anatomical reference, depicting the normal canine femoral and sciatic nerves at 3 Tesla MRI.     

EVALUATION OF THE GASTROINTESTINAL TRACT IN DOGS USING COMPUTED TOMOGRAPHY

Abdominal computed tomography (CT) studies of 19 dogs with no history or clinical signs of gastrointestinal disease, and two dogs with a histological diagnosis of gastrointestinal neoplasia were examined retrospectively. Gastrointestinal segments were evaluated subjectively for conspicuity, contrast enhancement, and wall layering after contrast medium administration. In dogs without gastrointestinal disease, there were 62.8% of gastrointestinal segments (serosa to serosa) and 77.7% of gastrointestinal walls (serosa to mucosa) visualized. Wall layering on postcontrast images was seen in 21.8% of gastrointestinal segments. There was significant association between gastrointestinal diameter and wall thickness. There was significant association between weight and gastrointestinal wall thickness in the following regions: gastric fundus, gastric body, gastric pylorus, gastric pyloric antrum, duodenal cranial flexure, jejunum and ascending colon, and between patient weight and gastrointestinal diameter in cranial duodenal flexure, descending duodenum, transverse duodenum, ascending duodenum, and jejunum. Measurements acquired from CT studies correlated well with previously published normal reference ranges for radiographic and ultrasonographic studies. Gastrointestinal neoplasia, diagnosed in two dogs, had a gastrointestinal wall thickness greater than the range of the dogs without gastrointestinal disease. Computed tomography offers identification of the gastrointestinal tract segments in dogs, allows for evaluation of gastrointestinal diameter and aids in investigation of gastrointestinal wall thickness.     

Effect of partial ureteral obstruction on results of renal scintigraphy in dogs

OBJECTIVE: To use scintigraphy to determine the effects of partial ureteral obstruction on renal transit time and induction of diuresis in dogs. ANIMALS: 8 adult dogs. PROCEDURE: Scintigraphy was performed, using technetium Tc 99m diethylenetriaminepentacetic acid (Tc 99m-DTPA), before and within 2 weeks after surgical induction of unilateral partial ureteral obstruction. Time of peak (TOP) for the parenchyma (pTOP) and whole kidney (wTOP) and mean-transit time (MTT) for the parenchyma (pMTT) and whole kidney (wMTT) were determined by evaluation of renal time-activity curves before and after deconvolution analysis. Percentage uptake for each kidney between 1 and 3 minutes after injection of Tc 99m-DTPA was determined and used to indicate glomerular filtration rate. The effect of diuresis was determined by measuring the slope of decrease in activity after i.v. administration of furosemide. Obstruction was documented by direct inspection of the ureter. RESULTS: There was a concomitant increase in pTOP, wTOP, pMTT, and wMTT of the kidney with the partially obstructed ureter in all dogs at various times between 2 and 9 days after surgery. Concurrently, renal time-activity curves changed shape. Percentage renal uptake of the affected kidney was decreased in 2 dogs. Response to furosemide injection was inconsistent for kidneys before surgery and for kidneys with obstructed and nonobstructed ureters after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Scintigraphy may be a useful procedure for the evaluation of renal function in dogs with ureteral obstruction. Induction of diuresis appears to be of little value for differentiating renal function in dogs with obstructed and nonobstructed ureters.     

IMAGING DIAGNOSIS—URINARY BLADDER DUPLICATION IN A CAT

A female kitten presented for chronic, intermittent, antibiotic‐responsive urinary incontinence and chronic kidney disease. Abdominal ultrasound identified bilateral pelvic/ureteral dilation and three closely apposed thin‐walled fluid‐filled structures in the caudal abdomen, extending toward the pelvic inlet. Excretory urography and negative contrast cystography identified contrast medium accumulation from the dilated ureters into two tubular soft tissue masses of the caudal abdomen, with subsequent gradual filling of a more cranially located urinary bladder. A retrograde vaginocystourethrogram identified a normal uterus, normal vagina, and a single urethra continuous with the cranially located urinary bladder. Antemortem diagnosis was suspicious for bilateral ectopic ureteroceles. Postmortem diagnosis, 35 months following initial presentation, determined the fluid‐filled masses to have abundant smooth muscle in the wall, including a muscularis mucosa connected by a common ostium, consistent with urinary bladder duplication. Urinary bladder duplication should be included as a differential diagnosis in cats with these clinical and imaging characteristics. In this case, differentiation of ectopic ureterocele from urinary bladder duplication required histological confirmation.     

MAGNETIC RESONANCE IMAGING CONTRAST ENHANCEMENT OF EXTRA‐OCULAR MUSCLES IN DOGS WITH NO CLINICAL EVIDENCE OF ORBITAL DISEASE

Enhancement of extra‐ocular muscles has been reported in cases of orbital pathology in both veterinary and medical magnetic resonance imaging. We have also observed this finding in the absence of orbital disease. The purpose of this retrospective study was to describe extra‐ocular muscle contrast enhancement characteristics in a group of dogs with no known orbital disease. Magnetic resonance images (MRI) from dogs with no clinical evidence of orbital disease and a reportedly normal MRI study were retrieved and reviewed. Contrast enhancement percentages of the medial, lateral, ventral, and dorsal rectus muscles were calculated based on signal‐to‐noise ratios that were in turn determined from hand‐traced regions of interest in precontrast, immediate postcontrast and 10‐min postcontrast scans. Comparison measurements were made in the pterygoid muscle. Contrast enhancement of the extra‐ocular muscles was observed in all patients (median contrast enhancement percentage 45.0%) and was greater than that of pterygoid muscle (median contrast enhancement percentage 22.7%). Enhancement of the extra‐ocular muscles persisted 10 min after contrast administration (median contrast enhancement percentage 43.4%). Findings indicated that MRI contrast enhancement of extra‐ocular muscles is likely normal in dogs.     

Contrast‐enhanced computed tomography may be helpful for characterizing and staging canine gastric tumors

In humans, computed tomography (CT) is a widely performed technique for the diagnosis and staging of gastric tumors. The purpose of this retrospective case series study was to describe CT findings in a group of dogs with confirmed gastric tumors. For each included dog, the following CT parameters were recorded: gastric tumor location, tumor shape, gastric involvement pattern, tumor enhancement pattern in early and late phases, presence and location of lymphadenopathy, gastric tumor attenuation values, attenuation values of enlarged lymph nodes, maximum short‐axis diameter (mm) of enlarged lymph node, maximum long‐axis diameter (mm) of enlarged lymph node, and short‐axis diameter to long‐axis diameter ratio (short axis/long axis). A total of 16 dogs met inclusion criteria and had the following final diagnoses: five lymphoma, six adenocarcinoma, three inflammatory polyps, and two leiomyoma. In the early‐ and delayed‐phase postcontrast images, the mean CT attenuation value for lymphoma was lower than that of other gastric tumors. Lymphadenopathy was widespread in lymphomas and regional in adenocarcinomas. Lymphadenopathy was not detected in leiomyomas. Lymph node measurements in lymphoma were larger than lymph node measurements in adenocarcinoma. Although there were overlapping findings for the different types of gastric tumors, contrast‐enhanced CT provided helpful information for characterizing gastric tumors based on the following criteria: early and late enhancement patterns, the site of origin of the mass lesion, and extent of local invasion and distant metastases. Lymphoma should be considered for canine gastric tumors with low mean attenuation values during early‐ and delayed‐phase postcontrast images, and widespread, bulky, and rounded lymphadenopathy.     

ASSESSMENT OF SENTINEL LYMPH NODE METASTASIS IN CANINE MAMMARY GLAND TUMORS USING COMPUTED TOMOGRAPHIC INDIRECT LYMPHOGRAPHY

In the staging process of the breast cancer, demonstrating metastasis of the sentinel lymph node (SLN) has an important prognostic value, in both humans and animals. The aim of this prospective case‐control study was to determine the diagnostic value of computed tomographic indirect lymphography (CT‐LG) for detecting SLN metastasis in dogs with mammary cancer. Thirty‐three female dogs with tumors in the abdominal and inguinal mammary glands were prospectively selected and subjected to CT‐LG, 1 and 5 min after injection of 1 ml of contrast agent (iopamidol) in the subareolar tissue of the neoplastic and the contralateral normal mammary glands. The pattern of postcontrast opacification, degree of postcontrast enhancement, and size and shape were assessed in 65 SLNs in total and were correlated with histopathological findings. The absence of opacification or heterogeneous opacification 1 min after contrast medium injection showed the highest sensitivity, specificity, and accuracy (93%, 100%, and 98.4%, respectively). In images taken 1 min after injection, an absolute density value lower than 444 Hounsfield units (HU) in the center of the SLN also provided significant sensitivity and specificity (93.8% and 75%, respectively). The size and shape of the SLN (maximum and minimum diameter, maximum/minimum diameter ratio, maximum diameter/height of fifth thoracic vertebral body ratio) showed the lowest sensitivity and specificity. Results of this study support the hypothesis that CT‐LG could help in the assessment of SLN metastasis in cases of mammary gland tumors in dogs.     

Evaluation of transurethral cystoscopy and excretory urography for diagnosis of ectopic ureters in female dogs: 25 cases (1992-2000)

OBJECTIVE: To evaluate transurethral cystoscopy and excretory urography for diagnosis of ectopic ureter in female dogs and identify concurrent urogenital abnormalities. DESIGN: Retrospective study. ANIMALS: 25 female dogs. PROCEDURE: Medical records of female dogs that underwent transurethral cystoscopy, excretory urography, and ventral cystotomy were reviewed for signalment, history, physical examination findings, results of bacteriologic culture of urine, and surgical findings. Videotapes of transurethral cystoscopy and radiographic studies were reviewed systematically without knowledge of surgical findings. RESULTS: Ectopic ureters were diagnosed in 24 of 25 (96%) of the dogs, bilaterally in 22 of 24 (91.6%) dogs. Cystoscopic evaluation yielded a correct diagnosis in all dogs when results of ventral cystotomy were used as the diagnostic standard. Cystoscopic evaluation identified a terminal ureteral opening for all ureters. Urethral fenestrations, troughs, striping, and tenting were identified. Abnormalities of the vestibule were identified in all examinations available for review (24/25). The paramesonephric septal remnant and its association with ectopic ureters were identified and characterized by cystoscopy. Radiographic findings were discordant with surgical findings and correctly identified 36 of 46 (78.2%) ectopic ureters and 2 of 4 normal ureters. Hydroureter and renal abnormalities were associated with distal urethral ectopic ureters on radiographic evaluations. CONCLUSIONS AND CLINICAL RELEVANCE: Transurethral cystoscopy was accurate and minimally invasive for identification and classification of ectopic ureters in dogs. Contrast radiography had limitations in diagnosis of ectopic ureters. Cystoscopic findings and associated vaginal and vestibular abnormalities support abnormal embryologic development in the pathogenesis of ectopic ureters.     

ULTRASONOGRAPHIC APPEARANCE OF THE LOWER URINARY TRACT IN FIFTEEN NORMAL HORSES

The purpose of this study was to describe the normal ultrasonographic appearance of the caudal portion of the equine ureters, pelvic urethra, and urinary bladder and to assess ureteral contractility. Fifteen horses with no evidence of urinary tract disease (five females, five intact males and five geldings) were studied. The lower urinary tract was evaluated ultrasonographically using a transrectal approach. The normal ultrasonographic appearance and anatomic location of structures of the lower urinary tract were evaluated and anatomic relationships described. Both ureters were identified dorsal to the bladder and at their openings into the bladder. Their relationship and different appearance from the male deferent ducts/ampullae and vesicular glands was noted. Ultrasonographic measurements of the diameter of the ureters and urethra were obtained and the ureteral, urethral, and urinary bladder wall thickness recorded. The normal parameters established in this study will be useful during sonographic examination of horses with suspected urinary tract disease. Transrectal ultrasonographic examination is valuable in assessing the presence and frequency of ureteral contractions as well as in detecting structural abnormalities of the lower urinary tract. The use of high-frequency transrectal ultrasound transducers allows for excellent visualization of the structures of the equine lower urinary tract.     

Digital fluoroscopic excretory urography, digital fluoroscopic urethrography, helical computed tomography, and cystoscopy in 24 dogs with suspected ureteral ectopia

The purpose of this study was to determine the diagnostic utility of helical computed tomography (CT) for the diagnosis of ectopic ureters in the dog and to compare these findings with those of digital fluoroscopic excretory urography and digital fluoroscopic urethrography. Ureteral ectopia was confirmed or disproved based on findings from cystoscopy and exploratory surgery or postmortem examination. Of 24 dogs (20 female, 4 male) evaluated, 17 had ureteral ectopia. Digital fluoroscopic excretory urography and CT correctly identified ureteral ectopic status and site of ureteral ectopia (P < .05). Urethrography did not reliably detect ureteral ectopia. No false-positive diagnoses of ureteral ectopia were made in any of the imaging studies. Cystoscopic findings significantly agreed with findings during surgery in determining ureteral ectopic status and ectopic ureter site. One false-positive cystoscopic diagnosis of unilateral ureteral ectopia was made in a male dog. Kappa statistics showed better agreement between CT and both cystoscopy and surgical or postmortem examination findings with regard to presence and site of ureteral ectopia compared with other imaging techniques. CT was more useful than other established diagnostic imaging techniques for diagnosing canine ureteral ectopia.     

ULTRASONOGRAPHIC FINDINGS IN 14 DOGS WITH ECTOPIC URETER

To evaluate ultrasonography as an alternative to contrast radiography for diagnosis of ectopic ureter in dogs, ultrasonography of the urinary tract was performed prospectively in a series of urinary incontinent dogs anesthetized for contrast radiography. Fourteen dogs had ectopic ureter based on surgical, necropsy or unequivocal contrast radiographic findings. There were eight females and six males of a variety of breeds; five were Labrador retrievers. Mean (range) age at the time of diagnosis was 1.2 (0.2–4) years for females and 3.5 (0.3–5) for males (p < 0.05). Ectopic ureters were unilateral in five dogs (2 left; 3 right) and bilateral in nine dogs. Both ultrasound images and contrast radiographs were positive for 21 (91%) ectopic ureters; the same two ectopic ureters were not detected using either modality. The termination of each of the five normal ureters was visible on ultrasound images; two (40%) were visible on radiographs. Other ultrasonographic findings included dilatation of the ectopic ureter and/or ipsilateral renal pelvis in ten (43%) instances, evidence of pyelonephritis in two dogs (with enlargement of the contralateral kidney in one dog), and urethral diverticuli in one dog. Ultrasonography is a practical diagnostic test for ectopic ureter in dogs. In this series there was close correlation between the ultrasonographic and contrast radiographic findings for each ectopic ureter, but ultrasonography enabled more accurate determination of normal ureteral anatomy.     

COMPUTED TOMOGRAPHIC FEATURES OF CANINE NONPARENCHYMAL HEMANGIOSARCOMA

The purpose of this retrospective study was to describe pre‐ and postcontrast computed tomographic (CT) characteristics of confirmed nonparenchymal hemangiosarcoma in a group of dogs. Medical records were searched during the period of July 2003 and October 2011 and dogs with histologically confirmed nonparenchymal hemangiosarcoma and pre‐ and postcontrast CT images were recruited. Two observers recorded a consensus opinion for the following CT characteristics for each dog: largest transverse tumor diameter, number of masses, general tumor shape, character of the tumor margin, precontrast appearance, presence of dystrophic calcification, presence of postcontrast enhancement, pattern of postcontrast enhancement, presence of regional lymphadenopathy, and presence of associated cavitary fluid. A total of 17 dogs met inclusion criteria. Tumors were located in the nasal cavity, muscle, mandible, mesentery, subcutaneous tissue, and retroperitoneal space. Computed tomographic features of nonparenchymal hemangiosarcoma were similar to those of other soft tissue sarcomas, with most tumors being heterogeneous in precontrast images, invasive into adjacent tissue, and heterogeneously contrast enhancing. One unexpected finding was the presence of intense foci of contrast enhancement in 13 of the 17 tumors (76%). This appearance, which is not typical of other soft tissue sarcomas, was consistent with contrast medium residing in vascular channels. Findings indicated that there were no unique distinguishing CT characteristics for nonparenchymal hemangiosarcoma in dogs; however, the presence of highly attenuating foci of contrast enhancement may warrant further investigation in prospective diagnostic sensitivity and treatment outcome studies.     

Computed tomography of the prostate gland in apparently healthy entire dogs

Objectives : To describe the computed tomography (CT) features of the prostate gland and determine prostate size using CT in entire male dogs. Methods : The prostate gland was evaluated in 35 dogs. Morphological features including homogeneity, delineation, shape and intraprostatic differentiation were assessed. Height, length, width, area, volume and attenuation values of the prostate gland were measured. Ratios of prostatic height (rH), length and width to the sixth lumbar vertebral body length were calculated. Relationships of prostatic dimensions with body weight and age were evaluated. Results : The prostate gland was homogeneous in 29 dogs on non‐contrast images and 18 of 24 dogs on postcontrast images. Transverse images revealed a semi‐oval prostate gland in 29 dogs and irregularly shaped prostate gland in 6 dogs. A prominent median septum was observed in postcontrast images. Significant positive correlations were found between body weight and age and all prostatic dimensions except between age and rH. The mean ±sd values for attenuation were 59·3 ±9·1 and 121·3 ±22·7 HU in non‐contrast and postcontrast image, respectively. Clinical Significance : CT can be useful for evaluating morphological features of the prostate gland. Prostatic length or width is a better measure than height for computed tomographic estimation of prostate size.     

FEASIBILITY FOR DETECTING LIVER METASTASES IN DOGS USING GADOBENATE DIMEGLUMINE‐ENHANCED MAGNETIC RESONANCE IMAGING

Early detection of liver metastases may improve the prognosis for successful treatment in dogs with primary tumors. Hepatobiliary‐specific contrast agents have been shown to allow an increase in magnetic resonance imaging (MRI) detection of liver metastases in humans. The purpose of this prospective study was to test the feasibility for using one of these agents, gadobenate dimeglumine, to detect liver metastases in dogs. Ten consecutive dogs known to have a primary tumor were recruited for inclusion in the study. All dogs were scanned using the same protocol that included a T2‐weighted respiratory‐triggered sequence, T1 VIBE, diffusion‐weighted imaging, and 3D‐FLASH before and after dynamic injection of gadobenate dimeglumine contrast medium. Delayed imaging was performed less than 30 min after injection and up to 60 min in two cases. Histological analysis of liver lesions identified in delayed phases was performed for each case and confirmed metastatic origin. In all cases, lesion number detected in hepatobiliary contrast‐enhanced sequences was statistically higher than in other sequences. Optimal lesion detection occurred with a 3D‐FLASH sequence acquired in the transverse plane and less than 30 min after injection. Findings indicated that gabobenate dimeglumine enhanced MRI is a feasible technique for detecting liver metastases in dogs.     

IMPROVING CONSPICUITY OF THE CANINE GASTROINTESTINAL WALL USING DUAL PHASE CONTRAST‐ENHANCED COMPUTED TOMOGRAPHY: A RETROSPECTIVE CROSS‐SECTIONAL STUDY

Gastrointestinal (GI) disease is a common clinical complaint in small animal patients; computed tomography (CT) examinations enable a global overview of the GI tract and associated structures. Previously, the GI wall has been reportedly identified from serosa to mucosa in 77% of standard postcontrast CT studies and wall layers seen in ultrasound have not been distinguished. Inconsistent strong contrast enhancement of the inner layer of the GI mucosal surface was noted on dual phase CT studies acquired in our institution, which increased the visibility of the GI tract and disease processes. The aim of this retrospective, observational, cross‐sectional study was to determine the optimal portal vein attenuation for maximizing GI wall conspicuity using dual phase contrast‐enhanced CT. Patients with abdominal CT for a non‐GI related disease were included. In a pilot study, 175 GI segments from 35 CT studies were graded for presence of mucosal surface enhancement (MSE). The strongest mucosal surface enhancement grade correlated with portal vein attenuation of 43–150 HU; this value was used as inclusion criterion in the main study. A total of 441 GI segments were evaluated in 42 CT studies postcontrast for GI wall conspicuity. The GI wall was conspicuous in 56.7% precontrast, 84.5% at 30s, and 77.3% late postcontrast; 4.7% of segments were removed due to motion blur. At 30 s distinct mucosal surface enhancement was seen in the small intestine and gastric mucosal surface enhancement was poor. Findings supported the use of dual phase contrast‐enhanced CT for improving conspicuity of the GI wall.     

Ureteral obstruction after ureteroneocystostomy in dogs assessed by technetium TC 99m diethylenetriamine pentaacetic acid (DTPA) scintigraphy

OBJECTIVE: To use technetium Tc 99m diethylenetriamine pentaacetic acid (99mTc-DTPA) renal scintigraphy to monitor ureteral obstruction after ureteroneocystostomy in a canine model of partial ureteral obstruction. STUDY DESIGN: Experimental study. ANIMALS: Eight normal adult dogs. METHODS: Partial ureteral obstruction was created in 8 dogs by incomplete ligation of the terminal right ureter. Two weeks later, ureteroneocystostomy was performed in 7 dogs with unilateral partial ureteral obstruction and in 1 dog that had developed bilateral partial ureteral obstruction. 99mTc-DTPA scintigraphy was performed intermittently for 2 weeks after ureteroneocystostomy. Renal transit time of each kidney, as assessed by the time to maximal uptake (time of peak), and glomerular filtration rate, as assessed by percentage of kidney uptake of the radiopharmaceutical between 1 and 3 minutes, were estimated. Comparison between affected and nonaffected kidneys was performed with the Wilcoxon rank sum test. RESULTS: Unilateral partial ureteral obstruction was induced successfully in 7 dogs. In 1 dog, bilateral partial obstruction was induced inadvertently. After ureteroneocystostomy, percentage of kidney uptake of 99mTc-DTPA was low in 4 affected kidneys. The uptake returned to within normal limits in 2 of the kidneys during the observation period. The time activity curve had a more rounded appearance or was increasing continuously for all affected kidneys. A significant increase in renal transit time was observed 2 and 4 days after ureteroneocystostomy. Transit time progressively returned to normal by 4 to 11 days for all affected kidneys except 1. CONCLUSION: Ureteroneocystostomy resulted in persistent partial ureteral obstruction for 4 to 11 days as determined by 99mTc-DTPA scintigraphy. CLINICAL RELEVANCE: 99mTc-DTPA scintigraphy may be a useful procedure for monitoring renal function and ureteral obstruction after ureteroneocystostomy. Persistent partial ureteral obstruction may be seen 1 to 2 weeks after ureteral reimplantation in dogs with previously existing dilated ureters.     

Comparison Between Malignant and Nonmalignant Splenic Masses in Dogs using Contrast-Enhanced Computed Tomography

The ability of computed tomography (CT) to distinguish malignant from nonmalignant splenic masses was evaluated in 21 dogs with 24 masses. CT scans of the abdomen were performed pre- and postintravenous contrast medium administration before splenectomy or euthanasia. Splenic masses were evaluated objectively based on Hounsfield units (HU) and volume. Subjective criteria included location within the spleen (head, body, or tail), margination, homogeneity, and attenuation compared to the remaining splenic parenchyma. Characteristics of malignant and nonmalignant masses were compared. The nonmalignant masses were divided into splenic hematomas and nodular hyperplasia for further analysis. Fourteen (58.3%) of the masses were nonmalignant; 10 (41.7%) were malignant. Malignant splenic masses had significantly lower attenuation values, measured in HU, than nonmalignant splenic masses, on both pre- and postcontrast images (P<0.05). On postcontrast images, there was a significant difference in attenuation characteristics among all three subsets of splenic masses (malignant, hematoma, hyperplasia), with nodular hyperplasia having the highest HU values (90.3), hematomas having intermediate HU values (62.5), and malignant splenic masses having the lowest HU values (40.1). A receiver operator characteristic curve of postcontrast medium HU values revealed 55 as the best threshold value to distinguish malignant from nonmalignant masses, with those less than the threshold value being malignant. Abdominal CT is a useful diagnostic imaging modality for evaluation of focal canine splenic masses, with a significant difference in imaging characteristics between malignant and nonmalignant masses.