POSITIVE CONTRAST SHOULDER ARTHROGRAPHY WITH IOPROMIDE* AND DIATRIZOATE† IN DOGS WITH OSTEOCHONDROSIS

Forty-one dogs (60 joints) with clinical and radiographic signs of shoulder osteochondrosis were randomized in a study to compare the diagnostic quality of iopromide (Ultravist, Schering AG) (n = 29) and meglumine-sodium diatrizoate (Urografin, Schering AG) (n = 31) in arthrography. The studies were performed using 1.5 to 4 ml of a solution of each contrast media at a concentration of 140 mg I/ml. Exposures were made within 5 minutes after intra-articular injection. Iopromide gave a significantly better arthrographic quality (P < 10^?6).     

A COMPARISON OF DIATRIZOATE* AND IOXAGLATE† FOR POSITIVE CONTRAST SHOULDER ARTHROGRAPHY IN DOGS

In six experimental dogs, arthrographic quality and synovial inflammatory response with shoulder arthrography comparing meglumine-sodium diatrizoate (Urovison) and the monoacidic dimer, meglumine-sodium ioxaglate (Hexabrix) was evaluated. In our study initial films were of equally high diagnostic quality for both contrast media, but delayed films significantly favored ioxaglate for diagnostic quality. The rise in white blood cells in synovial fluid samples collected 24 hours after the arthrographic procedure was significantly lower after the use of ioxaglate. Histologic examination performed 14 days after the intra-articular injection revealed no drug related lesions.     

OSTEOCHONDROSIS LESIONS OF THE CANINE SHOULDER: CORRELATION OF POSITIVE CONTRAST ARTHROGRAPHY AND ARTHROSCOPY

In this study the correlation between positive contrast arthrography and arthroscopy was evaluated in a series of 20 shoulder joints (12 dogs) with radiographic and clinical evidence of osteochondrosis. The joints were consecutively examined by arthrography and arthroscopy. In 12 joints arthrography revealed the presence of a cartilage flap, and this finding was confirmed by arthroscopy. In 3 out of 8 joints where arthrography failed to demonstrate rupture of the cartilage, arthroscopy revealed the presence of a distinct fissure line. In 2 joints arthroscopy demonstrated a lesion comparable with chondromalacia and in 3 only a dimple in the articular cartilage was found. In 2 joints arthroscopy revealed the presence of small joint mice not detected by arthrography. Kissing lesions on the surface of the glenoid cavity opposite to cartilage flaps could be demonstrated as well. Evaluation of synovial inflammation, judged by the aspect and pattern of the synovial villi, correlated well with histologic findings. These results indicate that arthroscopy is a complementary examination in painful joints where arthrography fails to demonstrate rupture of the articular cartilage. It could be the procedure of choice if diagnostic and surgical arthroscopy can be combined. However, arthrography remains the technique of choice to demonstrate joint mice within the bicipital tendon sheath.     

COMPUTED TOMOGRAPHY AND POSITIVE CONTRAST COMPUTED TOMOGRAPHIC ARTHROGRAPHY OF THE CANINE SHOULDER: NORMAL ANATOMY AND EFFECTS OF LIMB POSITION ON VISIBILITY OF SOFT TISSUE STRUCTURES

Soft tissue injuries of the shoulder are an important cause of forelimb lameness in dogs. The objectives of this canine cadaver study were to describe normal anatomy of shoulder soft tissue structures using computed tomography (CT) and computed tomographic arthrography (CTA) and to determine the effects of positioning on visualization of shoulder soft tissue structures. Thirteen forelimbs were removed from eight canine cadavers. Two forelimbs were used for contrast dose optimization. For the remaining 11 forelimbs, shoulder CT and CTA were performed using three defined joint angles (140°, 90°, and 70°). For three forelimbs, CT and CTA images were compared with frozen anatomic sections to describe normal anatomy. Ten forelimbs were used for analysis of positioning effects. Soft tissue structures evaluated were the joint capsule, cartilage, ligaments, tendons, and muscles. A visual assessment score was assigned to each structure using a consensus of two observers. The range and mode of scores were calculated and compared for each modality and limb position. The shoulder joint capsule and medial and lateral glenohumeral ligaments were completely visible with CTA. All tendons and muscles were visualized in all the examinations except for the teres minor muscle tendon and the coracobrachialis muscle, which were not visible on all scans. Positioning the limb in an extended position significantly improved visualization of most soft tissue shoulder structures. Shoulder cartilage was best seen with CTA and with neutral or flexed positioning of the shoulder. Findings indicated that both CT and CTA are feasible imaging techniques for visualization of soft tissue structures of the canine shoulder.     

PROSTATIC REFLUX DURING POSITIVE CONTRAST RETROGRADE URETHROGRAPHY IN THE DOG

Forty-five positive contrast retrograde urethrograms in which contrast medium reflux into the prostate was identified were evaluated to determine whether a correlation existed between the time and pattern of reflux and the nature of the prostatic disease. Prostatic diseases identified included prostatitis (25 dogs), prostatic tumor (13 dogs), and prostatic hyperplasia (1 dog). Six dogs with contrast medium reflux had no evidence of prostatic disease. No correlation was found between presence of prostatic reflux and specific prostatic diseases; however, prostatic tumor or infection was observed more frequently than hyperplasia, metaplasia, or cyst in the dogs with contrast medium reflux. A linear pattern and irregular, indistinct margination of the contrast medium reflux were associated with prostatitis; however, these patterns were also observed in dogs without prostatic disease     

ULTRASONOGRAPHY OF THE EQUINE BICIPITAL TENDON REGION: A CASE HISTORY REPORT AND REVIEW OF ANATOMY

The equine shoulder region is difficult to investigate by conventional imaging modalities. Diagnostic ultrasound has proven valuable for investigation of soft tissue injuries of the human shoulder. In a horse with shoulder lameness, the authors employed diagnostic ultrasound to augment the use of conventional radiography. A defect in the subchondral bone layer of the medial humeral tuberosity, with adjacent bony fragments were clearly identified with ultrasound. Ultrasound was used for initial evaluation of the bicipital tendon and bursa. The technique was subsequently used to follow and evaluate the post-operative condition of the proximal cranial humerus, bicipital tendon and bursa in this patient. The bicipital regions of 2 immature and 3 adult normal horses were also examined with to illustrate the normal ultrasonographic anatomy of the cranial shoulder region.     

ULTRASONOGRAPHIC FINDINGS IN 38 HORSES WITH SEPTIC ARTHRITIS/TENOSYNOVITIS

Septic arthritis/tenosynovitis in the horse can have life‐threatening consequences. The purpose of this cross‐sectional retrospective study was to describe ultrasound characteristics of septic arthritis/tenosynovitis in a group of horses. Diagnosis of septic arthritis/tenosynovitis was based on historical and clinical findings as well as the results of the synovial fluid analysis and/or positive synovial culture. Ultrasonographic findings recorded were degree of joint/sheath effusion, degree of synovial membrane thickening, echogenicity of the synovial fluid, and presence of hyperechogenic spots and fibrinous loculations. Ultrasonographic findings were tested for dependence on the cause of sepsis, time between admission and beginning of clinical signs, and the white blood cell counts in the synovial fluid. Thirty‐eight horses with confirmed septic arthritis/tenosynovitis of 43 joints/sheaths were included. Degree of effusion was marked in 81.4% of cases, mild in 16.3%, and absent in 2.3%. Synovial thickening was mild in 30.9% of cases and moderate/severe in 69.1%. Synovial fluid was anechogenic in 45.2% of cases and echogenic in 54.8%. Hyperechogenic spots were identified in 32.5% of structures and fibrinous loculations in 64.3%. Relationships between the degree of synovial effusion, degree of the synovial thickening, presence of fibrinous loculations, and the time between admission and beginning of clinical signs were identified, as well as between the presence of fibrinous loculations and the cause of sepsis (P ≤ 0.05). Findings indicated that ultrasonographic findings of septic arthritis/tenosynovitis may vary in horses, and may be influenced by time between admission and beginning of clinical signs.     

POSITIVE CONTRAST RETROGRADE URETHROGRAPHY: A USEFUL PROCEDURE FOR EVALUATING URETHRAL DISORDERS IN THE DOG

Positive contrast retrograde urethrography proved to be a useful and relatively simple technic for the evaluation of lower urinary tract disorders in the dog. The case histories of 12 dogs with such disorders were used to illustrate the role of positive contrast retrograde urethrography in the evaluation of urethral and urinary bladder integrity after caudal abdominal and pelvic trauma, and in the investigation of incontinence, stranguria, dysuria, and hematuria.     

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

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

QUANTITATIVE EVALUATION OF IMAGENT® AS AN ABDOMINAL ULTRASOUND CONTRAST MEDIUM IN DOGS

Diagnostic ultrasound currently provides a noninvasive, economical means to evaluate internal organ structure. Methods to increase the amount of diagnostic information obtained from the sonographic examination are being explored. A new area of research has recently focused on the ability of microbubble contrast agents to help provide additional information. A prospective study was undertaken to quantitatively evaluate the amount of gray scale enhancement of ultrasound images of six canine livers, spleens, and left kidneys that occurs after intravenous injection of Imagent. Computerized analysis was used to assess the percent change in brightness of these images. A transient decrease in the percent change in brightness was seen to occur after injection of higher doses of Imagent. This effect was more pronounced in the deeper portions of the organs of interest. Imagent provides a measurable change in the brightness of the organs of interest and would be potentially useful in a clinical setting.     

COMPUTED TOMOGRAPHIC ARTHROGRAPHY OF THE NORMAL CANINE STIFLE

Computed tomographic (CT) imaging of eight normal cadaveric canine stifles was performed before and after intra-articular administration of iodinated contrast medium. Transverse CT images were reconstructed in dorsal, parasagittal, and oblique planes. The following ligamentous structures were identified on transverse CT images in all stifles: cranial cruciate ligament, caudal cruciate ligament, medial meniscus, lateral meniscus, and the medial and lateral collateral ligaments. The following ligamentous structures were identified on transverse computed tomographic arthrography (CTA) images in all stifles: cranial cruciate ligament, caudal cruciate ligament, medial meniscus, lateral meniscus, meniscofemoral ligament, cranial meniscotibial ligaments, caudal meniscotibial ligaments, intermeniscal (transverse) ligament, and the medial and lateral collateral ligaments. The patellar tendon was identified on transverse and reconstructed dorsal and sagittal CT and CTA images in all stifles. Multiplanar reconstructions enabled further evaluation of the continuity of the cranial and caudal cruciate ligaments and menisci. The medial and lateral collateral ligaments were not clearly identified on CT or CTA multiplanar reconstructed images.     

COMPARISON OF THE ULTRASONOGRAPHIC APPEARANCE OF OSTEOCHONDROSIS LESIONS IN THE CANINE SHOULDER WITH RADIOGRAPHY, ARTHROGRAPHY, AND ARTHROSCOPY

Osteochondrosis lesions in 29 shoulder joints (from 20 dogs) were evaluated with ultrasound (US) and the results were compared with survey radiography, arthrography, and arthroscopy. US was performed with a 7-12 MHz linear matrix transducer which was placed in cranio-caudal direction just distally to the acromion while the joint was adducted and maximally endorotated to visualize the caudal aspect of the humeral head. With US, the subchondral defect was completely visible in 21 joints and partially visible in 8 joints. The length of the subchondral defect measured on US was comparable with the length measured on survey radiographs. In two joints, the cartilage flap was mineralized and thus already visible on survey radiographs. The mineralized flap was visible on US as a straight hyperechoic line above the subchondral defect. In the other joints, survey radiographs could not assess the status of the articular cartilage. In 17 joints, the presence of a cartilage flap or cartilage fissuring was suspected based on the presence of a second hyperechoic line at the base of the subchondral defect, and this suspicion was confirmed by arthroscopic examination in 16 joints and also by arthrographic examination in 15 joints. One joint that was suspected of having a cartilage flap on US was normal on arthroscopy and arthrography. When US revealed only focal thickening of the anechoic cartilage layer (5 joints), the joints appeared normal on arthroscopic and arthrographic examination. Of the four joints where the subchondral defect was irregular and covered by heteroechogeneous material on US, arthroseopy revealed the presence of a lesion resembling chondromalacia in two joints, the presence of a small cartilage flap in one joint and the presence of scar tissue underneath the flap at the level of the subchondral defect in one joint. In conclusion, US is a helpful imaging modality in the identification of osteochondritic lesions in the canine shoulder joint. US also appears to be a satisfactory imaging tool for identifying lesions such as joint mice, joint effusion, and distinct new bone formation.     

MAGNETIC RESONANCE ARTHROGRAPHY OF THE CANINE STIFLE JOINT TECHNIQUE AND APPLICATIONS IN ELEVEN MILITARY DOGS

The stifle joints of eleven military working dogs were evaluated using conventional magnetic resonance (MR) imaging and MR arthrography. A protocol optimizing MR imaging of the canine stifle joint is discussed, as well as potential uses for administration of intra-articular gadolinium. The technique for performing MR arthrography is described, and post-contrast image findings are reviewed. MR arthrography was performed by using an intra-articular injection of diluted gadolinium. Consistently good quality images were obtained, and no complications were clinically detected following MR arthrography. Cranial cruciate ligament abnormalities were seen in six dogs, meniscal abnormalities were visualized in nine menisci, and synovitis and medial ligament strain were seen in eight dogs. Surgical and post-mortem confirmation of these findings is discussed in seven dogs. Although MR arthrography adds an invasive procedure to conventional MR imaging, it can provide useful information on pathologic changes in the canine stifle joint.     

COMPUTED TOMOGRAPHIC ARTHROGRAPHY OF THE INTERCARPAL LIGAMENTS OF THE EQUINE CARPUS

Injuries of the intercarpal ligaments are an important cause of lameness in performance horses. The purpose of this prospective cadaver study was to determine whether computed tomography (CT) arthrography would be a feasible method for visualizing and characterizing intercarpal ligaments in the horse. One cadaver limb from each of eight nonlame horses was collected immediately after euthanasia. For each limb, overlapping 2.0 mm CT images were acquired before and after injection of iodinated contrast medium into the antebrachiocarpal joint, middle carpal joint, and carpal sheath. Spin echo magnetic resonance imaging (MRI) sequences were acquired in three planes using a 1.5 Tesla MRI scanner in three limbs. Following MRI, colored resin was injected into the synovial structures of these three limbs, limbs were frozen, and anatomic sections were obtained in three planes. Findings from CT arthrograms were compared to findings from precontrast CT, MRI, anatomic slices, and arthroscopy. Medial and lateral palmar intercarpal ligaments, radiocarpal and transverse intercarpal ligaments, and palmar carpal ligament were visible in CT arthrograms of all limbs. The proximal and distal entheses of all ligaments were readily identifiable. Findings indicated that CT arthrography is feasible for visualizing intercarpal ligaments and may be a useful adjunct imaging technique for diagnosing lameness due to suspected carpal ligament injury in horses.     

IMAGING DIAGNOSIS—POSITIVE CONTRAST PERITONEOGRAPHIC FEATURES OF TRUE DIAPHRAGMATIC HERNIA

A true diaphragmatic hernia is a congenital diaphragmatic malformation that can appear identical to a peritoneopericardial diaphragmatic hernia (PPDH). True diaphragmatic hernias are rare in dogs. Herein we describe the use of positive contrast peritoneography for diagnosis of a true diaphragmatic hernia in two dogs.     

COMPARISON OF THREE RADIOGRAPHIC CONTRAST PROCEDURES IN THE EVALUATION OF THE CANINE LUMBOSACRAL SPINAL CANAL

Lumbar myelography, intraosseous caudal vertebral venography, and epidurography were performed in 12 normal, mature mixed-breed dogs. The radiographic appearance of the lumbosacral region was evaluated in both the lateral and ventrodorsal projections. These three radiographic contrast procedures were repeated in the same dogs after the introduction of a silicone mass into the spinal canal at the lumbosacral junction. The radiographic findings were compared with postmortem findings to determine which contrast procedure was most useful in detecting the mass in the lumbosacral spine. None of the procedures evaluated consistently produced good-quality studies in the normal dogs. After introduction of the silicone mass, lumbosacral epidurography yielded the largest number of positive correlations. However, the sensitivity of lumbosacral epidurography was less than 50% in the lateral projection and less than 20% in the ventrodorsal projection. Though none of the procedures were consistently helpful in the diagnosis of the lumbosacral masses, lumbosacral epidurography has the most potential to give consistently good-quality studies and thereby a greater probability of detecting an abnormality.     

DOUBLE CONTRAST GASTROGRAPHY IN THE NORMAL DOG

Double contrast gastrography affords more accurate detection of gastric lesions because it allows direct evaluation of mucosal pattern contours. The technic involves the induction of gastric hypomotility with intravenous glucagon, gastric intubation for the introduction of air and high-density barium directly into the stomach, and positional manipulation for maximal air-barium interface demonstration. Some dogs require sedation. Although fluoroscopic observation is an asset in isolating gastric anatomic abnormalities, this study may be performed using conventional radiographic equipment without fluoroscopic guidance. Double contrast gastrography is used to demonstrate the stomach mucosal surface by coating it with high-density barium and having the mucosa contrast with the air-filled gastric lumen. There are three elements to each double contrast image: the dependent surface, the nondependent surface, and the barium pool. The barium pool is manipulated to coat the mucosal surface and fill depressions of the dependent surface. Protrusions of the dependent surface appear as radiolucencies in the barium pool. Depressions and protrusions of the nondependent surface are outlined by barium. Double contrast gastrography is indicated in dogs where clinical signs suggest anatomic changes in the gastric mucosal surface, e.g., neoplasms, ulcers, or polyps. Concurrent gastrointestinal motility evaluation is precluded by sedation and the glucagon-induced gastric hypomotility.     

PREVALENCE OF COMPUTED TOMOGRAPHIC SUBCHONDRAL BONE LESIONS IN THE SCAPULOHUMERAL JOINT OF 32 IMMATURE DOGS WITH THORACIC LIMB LAMENESS

Osteochondrosis is a common developmental abnormality affecting the subchondral bone of immature, large breed dogs. The purpose of this retrospective study was to describe CT lesions detected in scapulohumeral joints of 32 immature dogs undergoing CT for thoracic limb lameness. Eight dogs (14 scapulohumeral joints) had arthroscopy following imaging. Thirteen dogs (19 scapulohumeral joints) were found to have CT lesions, including 10 dogs (16 scapulohumeral joints) with subchondral bone lesions and 3 dogs with enthesopathy of the supraspinatus tendon. In one dog, subchondral bone lesions appeared as large oval defects within the mid‐aspect of the glenoid cavities, bilaterally. These lesions resembled osseous cyst‐like lesions commonly identified in the horse. This is the first report of such a presentation of a subchondral bone lesion in the glenoid cavity of a dog. In all dogs, small, focal, round or linear lucent defects were visible within the cortical bone at the junction of the greater tubercle and intertubercular groove. These structures were thought to represent vascular channels. Findings from this study support the use of CT as an adjunct modality for the identification and characterization of scapulohumeral subchondral bone lesions in immature dogs with thoracic limb lameness.     

DOUBLE VERSUS SINGLE CONTRAST GASTROGRAPHY IN THE DOG AND CAT

It was hypothesized that double contrast gastrography (DCG) in the dog and cat would be more sensitive and specific than single contrast gastrography (SCG). In 13 dogs and three cats single and double contrast studies were performed and final diagnoses confirmed. DCG was found to be more sensitive and specific than SCG in detection of gastric disease. The loss of specificity of DCG was due entirely to technical difficulties that when recognized, were avoidable. The increased sensitivity of DCG included the ability to characterize the appearance as well as the location of the lesion. A discussion of the DCG appearance of some gastric lesions is included.