AN INNOVATIVE TECHNIQUE FOR DISPLAYING THREE DIMENSIONAL RADIOGRAPHIC ANATOMY OF SYNOVIAL STRUCTURES IN THE EQUINE DISTAL LIMB

Radiography is the most commonly applied imaging modality in equine practice and forms an essential part of the diagnostic work-up of lame horses. Radiographic signs of musculoskeletal pathology are frequently localized at sites of soft tissue attachment, which are often not clearly visible on radiographs. Different lesions carry different prognoses and require a variety of treatments, and a good knowledge of the position of the synovial structures in the distal limb of the horse is essential for practitioners in the interpretation of radiographs. This study describes a new technique for creating three-dimensional (3D) models of the synovial structures and superimposing them onto radiographs for the purpose of teaching radiographic anatomy. A set of standard radiographs was acquired of the metacarpophalangeal and the distal interphalangeal joints of a fresh cadaver leg while the leg was positioned in a material-testing machine to mimic the weight-bearing horse. Computed tomography of the same regions was performed after injection of negative contrast medium into the joints. 3D reconstructions of the joints were created using grayscale thresholding and polynomial surface meshing in Mimics. The resulting 3D reconstructions were superimposed on top of the radiographs using Adobe^© Photoshop^© CS3 Extended, thus allowing the visualization of the joint anatomy in relation to the bone on all projections. The main advantage of this technique is that it allows synovial structures to be visualized on radiographs where they are normally indistinct, which will serve as a teaching aid for anatomy.     

RADIOGRAPHIC AND ULTRASONOGRAPHIC EVALUATION OF THE PATELLAR LIGAMENT FOLLOWING TIBIAL TUBEROSITY ADVANCEMENT

Effect of tibial tuberosity advancement (TTA) on the patellar ligament has not been described. Our purpose was to evaluate the patellar ligament radiographically and ultrasonographically before and after a TTA. Twenty‐one stifles (20 dogs) were evaluated preoperatively (T0), and at six (n=18) (T1) and 16 weeks (n=17) (T2) postTTA. Radiographically, proximal and distal thickness of the patellar ligament was assessed and a ratio to the total length of the ligament was calculated to compensate for the magnification. Ultrasound evaluation included measurements of the transverse thickness and cross‐sectional area at three different levels, as well as a subjective score of ligament changes. In comparison with T0, all radiographic and ultrasonographic measurements increased significantly, 6 weeks postoperatively (P≤0.04), and did not change 16 weeks postoperatively compared with T1. The subjective score worsened significantly from T0 to T1 and T0 to T2 (P<0.0001), and improved significantly from T1 to T2 (P=0.02). Larger cage size was associated with a more severe increase in radiographic proximal thickness to total length ratio and ultrasonographic middle transverse area at both follow‐up examinations (P0.02). Dogs in which arthrotomy was not performed appeared to have ultrasonographically less changes. In conclusion, patellar desmopathy was a common postoperative sequel to TTA. Surgical trauma, arthrotomy, perfusion injury, complete vs. partial cranial cruciate ligament rupture, larger tibial advancement, postoperative activity or altered insertion angle of the patellar ligament at the tibial tuberosity are suggested causes, that should be elucidated in a larger study cohort.     

COMPARISON OF RADIOGRAPHIC SUBCHONDRAL BONE CHANGES WITH ARTHROSCOPIC FINDINGS IN THE EQUINE FEMOROPATELLAR AND FEMOROTIBIAL JOINTS: A RETROSPECTIVE STUDY OF 72 JOINTS (50 HORSES)

Radiographs of 72 femoropatellar and femorotibial joints from 50 horses were evaluated. Ninety four arthroscopically evaluated areas were graded according to a predetermined system. The radiographic grade was then compared to arthroscopic findings in the same location. Statistical analysis was performed to determine the association between the radiographic subchondral bone changes and arthroscopic findings. Radiographically normal areas in the femoropatellar joint were arthroscopically positive for cartilaginous changes in 40% of the femoropatellar joints. Areas of mild subchondral bone flattening (grade I) in the lateral trochlear ridge were arthroscopically positive for cartilage changes 78% of the time. Ninety six percent of moderate to severe subchondral bone changes (grades II-V) were arthroscopically positive for cartilage damage. This research demonstrates that (1) a significant number of radiographically normal joints will have cartilage changes, (2) areas of mild subchondral bone flattening have cartilage changes present in the majority of cases and (3) areas of moderate to severe subchondral bone changes have arthroscopically detectable cartilage changes present.     

A COMPLEMENTARY RADIOGRAPHIC PROJECTION OF THE EQUINE TEMPOROMANDIBULAR JOINT

The complexity of the equine skull makes the temporomandibular joint a difficult area to evaluate radiographically. The goal of this study was to determine the optimal angle for a complementary radiographic projection of the equine temporomandibular joint based on a computed tomography (CT) cadaver study. CT was performed on six equine cadaver heads of horses that were euthanized for other reasons than temporomandibular joint disease. After the CT examination, 3D reconstruction of the equine skull was performed to subjectively determine the angle for a complementary radiographic projection of the temporomandibular joint. The angle was measured on the left and right temporomandibular joint of each head. Based on the measurements obtained from the CT images, a radiographic projection of the temporomandibular joint in a rostral45°ventral-caudodorsal oblique (R45°V-CdDO) direction was developed by placing the X-ray unit 30° laterally, maintaining at the same time the R45°V-CdDO angle (R45°V30°L-CdDLO). This radiographic projection was applied to all cadaver heads and on six live horses. In three of the live horses abnormal findings associated with the temporomandibular joint were detected. We conclude that this new radiographic projection of the temporomandibular joint provides superior visualization of the temporomandibular joint space and the articular surface of the mandibular condyle.     

RADIOGRAPHIC AND ULTRASONOGRAPHIC EVALUATION OF THE PATELLAR LIGAMENT FOLLOWING TIBIAL PLATEAU LEVELING OSTEOTOMY

Objective evaluation of patellar ligament changes following tibial plateau leveling osteotomy (TPLO) for cranial cruciate ligament injury has not been published to date. In this study, the patellar ligament was evaluated using radiographs and high-resolution ultrasound in 31 stifles (29 dogs) preoperatively and at 1 month (n=31), 2 months (n=18), and 6 months (n=13) postTPLO. A ratio of the thickness of the proximal to distal patellar ligament was determined for all radiographs evaluated. Ultrasound evaluation included proximal, middle, and distal mid-sagittal thickness and transverse thickness, and transverse area measurements. Subjective grading (0 being normal through a scale of 3) of the ultrasound changes was also performed at each evaluation. Significant thickening of the distal patellar ligament was noted postoperatively as evidenced by thickness and area measurements and a decreased radiographic ratio (P < 0.01). Preoperative patellar ligament thickness and area were similar at the proximal, middle and distal sites. Ultrasound-derived thickness and area measurements of the distal patellar ligament were increased at 1 and 2 months (P < 0.01). The radiographic ratio was significantly decreased at 1, 2 and 6 months (P < 0.01). Subjectively, all patellar ligaments scored a 0 preoperatively and 16/31 received a score of 2 or 3 during follow-up evaluation. Additionally, these dogs had ultrasonographic and radiographic changes consistent with distal patellar ligament thickening. Body weight (kg) and postoperative TPLO angle had a significant influence on 1-month postoperative distal patellar ligament area using a stepwise logistic model (P < 0.05). Patellar ligament desmitis is a common postoperative sequela to the TPLO procedure, however its clinical significance (i.e., correlation with a residual lameness) was not evaluated in this study.     

TRANSCUTANEOUS ULTRASONOGRAPHIC EVALUATION OF THE AIR-FILLED EQUINE STOMACH AND DUODENUM FOLLOWING GASTROSCOPY

Gastroscopy with air insufflation was performed in 10 ponies, after which a transcutaneous ultrasound examination of the stomach and duodenum was performed immediately and at 1, 2, and 4 h postgastroscopy, and 24 h after feeding. Stomach measurements included the dorsoventral and craniocaudal dimensions, as well as the stomach depth from the skin surface and stomach wall thickness at the different time periods. Gastric wall folding was observed in one pony, becoming most distinct 2–4 h postgastroscopy. An undulating stomach wall was noted in eight other ponies postgastroscopy. These observations appeared to be a response to the deflation of the stomach as the insufflated air was released gradually. Gas was detected in the duodenum after the gastroscopy. The parameters measured were noted to be useful to evaluate the extent of stomach distension due to air or feed. The ultrasonographic appearance of the stomach can, therefore, be altered by gastroscopy and this should be borne in mind when examining horses with suspected gastric disease.     

OSTEOSARCOMA OF THE PATELLA WITH PULMONARY METASTASES IN A DOG

A 6-year-old neutered male Rottweiler was examined for a progressive right pelvic limb lameness. In radiographs of the right stifle, there was an osteolytic lesion with irregular new bone formation along the cranial aspect of the patella consistent with an aggressive bone lesion. In thoracic radiographs, there were multiple soft tissue nodular opacities throughout the lung fields, consistent with pulmonary metastases. Microscopically, fine needle aspirate samples from the right patella contained pleomorphic spindle cells with cytologic features of osteosarcoma. The presence of pulmonary metastases at the time of initial diagnosis in the dog described herein suggests that osteosarcoma of the patella has the potential for similar aggressive biologic behavior as that seen in dogs with appendicular osteosarcoma.     

MAGNETIC RESONANCE IMAGING SCORING OF AN EXPERIMENTAL MODEL OF POST‐TRAUMATIC OSTEOARTHRITIS IN THE EQUINE CARPUS

Magnetic resonance imaging (MRI) is the most sensitive imaging modality to detect the early changes of osteoarthritis. Currently, there is no quantifiable method to tract these pathological changes over time in the horse. The objective of this experimental study was to characterize the progression of MRI changes in an equine model of post‐traumatic osteoarthritis using a semiquantitative scoring system for whole‐organ evaluation of the middle carpal joint. On day 0, an osteochondral fragment was created in one middle carpal joint (OCI) and the contralateral joint (CON) was sham‐operated in 10 horses. On day 14, study horses resumed exercise on a high‐speed treadmill until the completion of the study (day 98). High‐field MRI examinations were performed on days 0 (preosteochondral fragmentation), 14, and 98 and scored by three blinded observers using consensus agreement. Images were scored based on 15 independent articular features, and scores were compared between and within‐groups. On days 14 and 98, OCI joints had significantly (P ≤ 0.05) higher whole‐organ median scores (29.0 and 31.5, respectively), compared to CON joints (21.5 and 20.0, respectively). On day 14, OCI joints showed significant increases in high‐signal bone lesion scores, and osteochondral fragment number and size. On day 98, high‐signal bone lesion, low‐signal bone lesion, osteophyte formation, cartilage signal abnormality, subchondral bone irregularity, joint effusion, and synovial thickening scores were significantly increased in OCI joints. Study results suggest that the MRI whole‐organ scoring system reported here may be used to identify onset and progression of pathological changes following osteochondral injury.     

RADIOGRAPHIC CHANGES IN RHESUS MACAQUES AFFECTED BY SCURVY

Spontaneous vitamin C deficiency, or scurvy, was recognized in juvenile rhesus monkeys maintained in a research center as a result of being fed a commercial diet for 2 to 3 months with low levels of vitamin C. Most severely affected animals (13) were radiographed repeatedly up to day 300 following detection of the disease. Early radiographic changes consisted of widened, lucent metaphyses with lateral flaring and radiopaque metaphyseal lines at the junction of the metaphyses and physes. Physeal slippage was noted commonly. Following institution of vitamin C therapy, calcification of subperiosteal hemorrhage occurred in the metaphyseal regions. Metaphyses and physes returned to normal radiographic appearance within 15 to 30 days. Initially, the ubperiosteal hemorrhage progressed and a longer time was required for resolution of the calcified hematomas. The macaques improved clinically and were released from the hospital when fractures were stable at 4–5 weeks after admission. Of the 13 macaques studied, all but one returned as normal members of the colony.     

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 AND PATHOLOGIC FEATURES OF OSTEOPETROSIS IN TWO PERUVIAN PASO FOALS

The radiographic and pathologic findings of two Peruvian Paso foals with osteopetrosis are described. Both foals, one male and one female, presented with respiratory difficulty, brachygnathia and failure to rise after birth. Both foals were mildly anemic, hypogammaglobulinemic and had elevations in serum alkaline phosphatase. Increased medullary bone opacity was noted on radiographs of the extremities, spine and skull in both foals. A lack of normal cortical:medullary bone distinction was evident radiographically. The medullary primary spongiosa appeared to run in parallel columns away from the physes of all long bones and the vertebrae. This created a distinctive hour glass appearance to the osteopetrotic bones. One foal developed a bacterial pneumonia. Both foals were euthanized due to failure to thrive. Histopathology and electron microscopy documented these foals to have normal osteoclastic numbers but lack normal ruffled borders, lack of a clear zone and normal lysosomal numbers indicative of cellular dysfunction. These clinical, radiographic and pathologic findings are similar to the juvenile, lethal autosomal recessive form of osteopetrosis described in humans. Osteopetrosis has not been previously described in a female foal.     

COMPUTED TOMOGRAPHIC APPEARANCE OF MELANOMAS IN THE EQUINE HEAD: 13 CASES

Melanomas are one of the most common neoplasms in the horse and are frequently found in the head region. There is a genetic predisposition in horses with a gray hair coat. Computed tomography (CT) is frequently used in referral practice to evaluate the equine head but there are few reports describing the CT appearance of melanomas in this location. The aim of this retrospective, case series study was to describe characteristics in a group of horses with confirmed disease. Case records from two referral hospitals were reviewed, and 13 horses were identified that had undergone CT of the head, with a diagnosis of melanoma based on cytology, histopathology, or visual assessment of black (melanotic) tissue. A median of 11 melanomas was identified per horse (range 3–60), with a total of 216 masses. Melanomas were found most frequently in the parotid salivary gland, guttural pouches, surrounding the larynx and pharynx and adjacent to the hyoid apparatus. In noncontrast CT images, all melanomas were hyperattenuating (median; 113.5 Hounsfield units (HU), IQR; 26 HU) compared to masseter musculature (median; 69 HU, IQR; 5.5 HU). Fifty‐six (25.9%) masses were partially mineralized and 41 (19.4%) included hypoattenuating areas. Histopathological assessment of these melanomas suggested that the hyperattenuation identified was most likely a result of abundant intracytoplasmic melanin pigment. Melanomas of the equine head appeared to have consistent CT features that aided detection of mass lesions and their distribution, although histopathological analysis or visual confirmation should still be obtained for definitive diagnosis .     

RADIOGRAPHIC CHANGES IN TESTES OF BULLS INFECTED WITH BESNOITIOSIS

Ten beef bulls infected with Besnoitiosis were examined radiographically and pathologically. Eight of these were slaughtered soon after diagnosis; two were left for a six-month observation period. The radiographic findings were focal and branching-tree calcification of the testes. Histopathologic examination proved these calcifications to be necrotic sections of the seminiferous tubules. Radiography of the testes as a means of evaluating the fertility status of the infected bull is recommended.     

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.     

RADIOGRAPHY AND COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF NONNEOPLASTIC EQUINE MANDIBULAR DISEASE

We compared the information gained from computed tomography (CT) vs. radiography in horses with nonneoplastic disease of the mandible. We hypothesized that CT would provide additional diagnostic information. Medical records, radiographs, and CT images of horses with nonneoplastic mandibular disease evaluated between 1994 and 2008 were reviewed. Nineteen horses were identified; 11 had a tooth root abscess and related disease, four had a fracture of the teeth and/or mandible, and four had a nonneoplastic mass. Both CT images and radiographs allowed identification of diseased teeth that appeared clinically normal otherwise. CT allowed identification of teeth that were clinically affected but appeared normal radiographically. Parameters such as tooth pulp involvement, lamina dura destruction, presence of bone fragments, lingual and buccal mandibular bone periosteal reaction, and cortical bone destruction were more conspicuous with CT. Performing radiography and CT in horses with nonneoplastic mandibular disease provides a more complete evaluation than either technique alone. CT contributes additional information that could otherwise be overlooked with radiographs alone in horses with a mandibular fracture. CT provides ancillary information to radiographs in horses with dental infection or a nonneoplastic mass of the mandible.     

ANCILLARY EQUIPMENT TO INCREASE QUALITY AND REDUCE RADIATION EXPOSURE IN THE EQUINE NUCLEAR MEDICINE LABORATORY

The construction of ancillary equipment used to improve image quality and reduce personnel radiation exposure in the equine nuclear medicine laboratory is illustrated. The devices include a self supporting lead sheet for shielding the distal limb or limb pair, a hanging lead sheet for shielding the proximal limb, a lead square for shielding the urinary bladder or jugular catheter, a restraining board for acquiring a palmar view of the foot, a head support to stabilize the head for imaging and a head support for stabilizing the neck for imaging. The restraining board and head supports decrease patient motion, improve image quality, and decrease the number of repeat acquisitions so that the time to perform the complete study is shortened. The self supporting shielding device allows the handlers to increase their distance from the horse which enhances radiation safety.     

COMPARISON OF RADIOGRAPHIC AND SCINTIGRAPHIC FINDINGS OF THE SPINOUS PROCESSES IN THE EQUINE THORACOLUMBAR REGION

Back pain is common in horses, but there has been no large‐scale in‐depth study describing radiographic changes of the spinous processes, the relationship between radiographic and scintigraphic findings, and the effect of size, age, breed, or discipline. The objectives were to investigate the frequency of occurrence in horses with perceived back pain of: (1) radiographic alteration of the spinous process structure; (2) increased radiopharmaceutical uptake (IRU) in the spinous processes; and (3) to compare radiographic and scintigraphic findings; and to determine if there was breed, gender, age, bodyweight, height, or work discipline predisposition for close, impinging, or overriding spinous processes. Radiographic and scintigraphic images of the thoracolumbar spine of 604 horses were graded. A radiographic grade for each spinous process (T8–L6) was assigned (0–7). The maximum radiographic grade for each horse was defined as the highest grade assigned to any spinous process; the total radiographic grade was the sum of all grades for each horse. A scintigraphic grade for each spinous process was determined (0–3). The maximum scintigraphic grade for each horse was defined as the highest grade assigned to any spinous process; the total scintigraphic grade was the sum of all grades for each horse. Associations between radiology and scintigraphy and age, gender, breed, height, weight, and discipline were analyzed statistically. The severity of radiographic lesions of the spinous processes was associated with the severity of scintigraphic abnormalities. The caudal thoracic spine (T14–T17) was most frequently affected. There was a significant breed and age effect, with Thoroughbreds and older horses having higher total and maximum radiographic grades. The severity of the lesions of the spinous processes was significantly associated with the presence of osteoarthritis of the articular process joints. It was concluded that there is a wide range of radiographic abnormalities of the spinous processes seen in horses with or without back pain. There is an association between radiographic and scintigraphic grades of the spinous processes.     

RADIOGRAPHIC AND MYELOGRAPHIC EXAMINATION OF THE CERVICAL VERTEBRAL COLUMN IN 306 ATAXIC HORSES

This study consists of a review of 306 ataxic horses subjected to survey radiography and myelography of the cervical vertebral column. Fifty-eight percent of horses had evidence of compressive spinal cord lesion on myelography. Sixty-six percent of horses were less than 3 years old. Age had no effect on the distribution of spinal cord compressive lesions. No conclusion could be drawn from sex and breed distribution. The most common sites of cord compression on myelography in order of decreasing frequency were C_3–4, C_6–7, C_5–6, and C_4–5. Twenty-nine percent of horses with myelographic evidence of cord compression had multiple compressive sites. Survey radiographs were not reliable to diagnose compressive spinal cord lesions. Myelography was a safe and more accurate procedure. Several factors may result in misinterpretation of the myelographic examination.     

SCINTIGRAPHIC DETECTION OF EQUINE ORTHOPEDIC INFECTION USING Tc-HMPAO LABELED LEUKOCYTES IN 14 HORSES

The aim of this study was to evaluate the diagnostic value of 99mTc-HMPAO leukocyte scintigraphy (LS) by means of a retrospective review of its use in 14 horses that were evaluated for orthopedic infection as a cause of lameness. A total of 17 LS exams were performed in 14 horses. LS studies were positive in 10 of 14 horses. A bacterial infection was confirmed with cytology or culture in 9 of 10 positive horses. Negative LS studies occurred in 4 of 14 horses. Necropsy confirmed the lack of infection in 2 of the 4 horses. Other clinical data and a favorable clinical outcome supported a negative study in the other 2 horses. No false negative or false positive studies were identified. It may be concluded that HMPAO-LS is an effective tool for the diagnosis of orthopedic infection in horses.