COMPUTED TOMOGRAPHY OF THE NORMAL FELINE NASAL CAVITY AND PARANASAL SINUSES

Computed tomography (CT) images of the feline nasal cavity and paranasal were acquiredfrom noraml adult cats. Good resolutin and amatomic detail were obtained from the CT images using soft tissue formatting. A desciption of normal feline nasal cavity and paranasal sinus anatomy using CT is presented.     

COMPUTED TOMOGRAPHY IN HORSES

Computed tomography (CT) is a valuable imaging procedure but one that requires significant technical support. Although scanners are available for veterinary use, their successful installation requires in-depth facility planning. Maintenance costs for these highly complex systems are high and may greatly exceed acquisition costs. Equipment to move anesthetized horses and support them during scanning is also expensive. Transport and scan table equipment suitable for equine CT studies are described. Clinical scan protocols used for CT of the equine skull and extremities are detailed. Precise positioning is essential for interpretable scans. Significant training in anatomy and CT physics is required for the veterinary computed tomographer.     

DIAGNOSTIC VALUE OF COMPUTED TOMOGRAPHY IN DOGS WITH CHRONIC NASAL DISEASE

Computed tomographic (CT) studies of 80 dogs with chronic nasal disease (nasal neoplasia (n = 19), nasal aspergillosis (n = 46), nonspecific rhinitis (n = 11), and foreign body rhinitis (n = 4)) were reviewed retrospectively by two independent observers. Each observer filled out a custom-designed list to record his or her interpretation of the CT signs and selected a diagnosis. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the diagnosis of each disease. The agreement between observers was evaluated. The CT signs corresponded to those previously described in the literature. CT had an accuracy greater than 90% for each observer in all disease processes. The sensitivity, specificity, PPV, and NPV were greater than 80% in all dogs with the exception of the PPV of foreign body rhinitis (80% for observer A and 44% for observer B). There was a substantial, to almost perfect, agreement between the two observers regarding the CT signs and diagnosis. This study indicates a high accuracy of CT for diagnosis of dogs with chronic nasal disease. The differentiation between nasal aspergillosis restricted to the nasal passages and foreign body rhinitis may be difficult when the foreign body is not visible.     

COMPUTED TOMOGRAPHIC EVALUATION OF ANATOMIC AND PATHOLOGIC VARIATIONS IN THE FELINE NASAL SEPTUM AND PARANASAL SINUSES

The purpose of this study was to compare the prevalence of nasal septal deviation and variations of the paranasal sinuses in normal and diseased cats. Prevalence of nasal septal deviation was 86.7%, 68.4%, and 71.4% in cats with rhinitis, neoplasia, and normal cats, respectively, with no statistically significant difference (P = 0.244). There was a statistically significant difference (P = 0.01) in the magnitude of nasal septal deviation between cats with and cats without nasal disease, using a cutoff value of 1 mm for maximum distance of deviation from midline. There was a statistically significant difference (P = 0.019) between cats with rhinitis and neoplasia when comparing the presence of a mass (7.7% and 53.8%, respectively), but not when comparing for lysis of the septum. Deviation of the frontal sinus septum occurred in 27.7% of all cats, while the sphenoid septum was oblique and eccentric in 96.6% of all cats. The mean length of the frontal sinus was longer in male cats than female cats. The presence of nasal septal deviation alone cannot be used as a criterion to diagnose nasal disease, but cats with rhinitis or neoplasia have more marked deviation than normal cats. The presence of a mass and lysis of the septum were only seen in cats with nasal disease and a mass is more likely to be seen with neoplasia than rhinitis. Male cats have a longer frontal sinus than female cats. Almost all cats have an oblique, eccentric sphenoid septum.     

USING SEMI‐AUTOMATED SEGMENTATION OF COMPUTED TOMOGRAPHY DATASETS FOR THREE‐DIMENSIONAL VISUALIZATION AND VOLUME MEASUREMENTS OF EQUINE PARANASAL SINUSES

The system of the paranasal sinuses morphologically represents one of the most complex parts of the equine body. A clear understanding of spatial relationships is needed for correct diagnosis and treatment. The purpose of this study was to describe the anatomy and volume of equine paranasal sinuses using three‐dimensional (3D) reformatted renderings of computed tomography (CT) slices. Heads of 18 cadaver horses, aged 2–25 years, were analyzed by the use of separate semi‐automated segmentation of the following bilateral paranasal sinus compartments: rostral maxillary sinus (Sinus maxillaris rostralis), ventral conchal sinus (Sinus conchae ventralis), caudal maxillary sinus (Sinus maxillaris caudalis), dorsal conchal sinus (Sinus conchae dorsalis), frontal sinus (Sinus frontalis), sphenopalatine sinus (Sinus sphenopalatinus), and middle conchal sinus (Sinus conchae mediae). Reconstructed structures were displayed separately, grouped, or altogether as transparent or solid elements to visualize individual paranasal sinus morphology. The paranasal sinuses appeared to be divided into two systems by the maxillary septum (Septum sinuum maxillarium). The first or rostral system included the rostral maxillary and ventral conchal sinus. The second or caudal system included the caudal maxillary, dorsal conchal, frontal, sphenopalatine, and middle conchal sinuses. These two systems overlapped and were interlocked due to the oblique orientation of the maxillary septum. Total volumes of the paranasal sinuses ranged from 911.50 to 1502.00 ml (mean ± SD, 1151.00 ± 186.30 ml). 3D renderings of equine paranasal sinuses by use of semi‐automated segmentation of CT‐datasets improved understanding of this anatomically challenging region.     

COMPARISON OF RADIOGRAPHY AND COMPUTED TOMOGRAPHY FOR THE DIAGNOSIS OF CANINE NASAL ASPERGILLOSIS

To compare the radiographic and computed tomographic (CT) findings and to evaluate the sensitivity of radiography and CT for diagnosis of nasal aspergillosis in dogs, the radiographic and CT studies of 48 dogs with chronic nasal disease were reviewed separately. The radiographic and CT findings were recorded, and a diagnosis was made. The results obtained in the dogs with nasal aspergillosis (n = 25) were used. Based on definite aspergillosis as diagnosis, CT had a sensitivity of 88% and radiography of 72%. Considering definite and probable aspergillosis as equivalent, CT had a sensitivity of 92% and radiography of 84%. The sensitivity was higher in dogs with lesions affecting the entire nasal cavity and frontal sinus on at least one side (n = 20) with a sensitivity of 100% for CT and 90-95% for radiography than in dogs with lesions restricted to the nasal cavities (n = 5) where CT had a sensitivity of 60-80% and radiography of 0-40%. CT was superior to radiography for evaluation of the nasal cavities (mucosal thickening along the nasal bones, surrounding bone hyperostosis/lysis), frontal sinuses (mucosal thickening along the frontal bone, fluid/soft tissue, frontal bone hyperostosis/lysis), and differentiation between a cavitated-like or a mass-like process. This study suggests that CT is more sensitive than radiography for diagnosis of nasal aspergillosis in the dog because of a better demonstration of some changes suggestive of nasal aspergillosis. A diagnosis of a nasal aspergillosis restricted to the nasal cavities or associated with an FB is challenging, even with the use of CT.     

COMPUTED TOMOGRAPHIC ANATOMY OF THE CANINE NASAL PASSAGES

A normal German shepherd dog underwent CT imaging with contiguous 10 mm thick images made of the nasal cavity from the caudal limit of the frontal sinuses to the rostral aspect of the nose. Normal structures were identified. This normal anatomic information will be of use in assessing CT images of dogs suspected of having nasal cavity disease.     

MAGNETIC RESONANCE IMAGING AND CROSS SECTIONAL ANATOMY OF THE NORMAL EQUINE SINUSES AND NASAL PASSAGES

The purpose of this investigation was to define the magnetic resonance imaging anatomy of the rostral part of the equine head. 10 mm-thick, T1-weighted images of two isolated equine cadaver heads were obtained using a 1.5 Tesla magnet and a body coil. MR images were compared to corresponding frozen cross-sections of the cadaver head. Relevant anatomic structures were identified and labeled at each level. The resulting images provided excellent anatomic detail of the oral and nasal cavities, paranasal sinuses and associated structures. Annotated MR images from this study are intended as a reference for clinical MR imaging studies of the equine head.     

COMPUTED TOMOGRAPHY OF CHOLESTERINIC GRANLOMAS IN THE CHOROID PLEXUS OF HORSES

Cholesterinic granulomas are tumor-like masses in the choroid plexuses of horses. This report describes the computed tomographic findings in four horses with cholesterinic granulomas, including the clinical and the pathologic features. All four horses had bilateral cholesterinic granulomas in the lateral ventricles. Computed tomographic images clearly delineated the masses, the opacity of the granulomas, and the enhancement pattern after intravenous bolus injection of contrast medium; these factors varied considerably. Additional CT findings were symmetric or asymmetric widening of the lateral ventricles.     

CT FEATURES OF ALVEOLITIS AND SINUSITIS IN HORSES

Sinusitis is a common disorder in horses and may result from trauma, dental diseases, or space-occupying lesions. Radiography can only provide a limited amount of information. Computed tomography (CT) has been documented as an alternative imaging method. Eighteen horses (mostly Warmblood) with signs of chronic sinusitis were examined preoperatively with CT to assist in diagnosis of the underlying cause. There was a group of common CT features in horses with dental disease and sinusitis. The first molar was the most frequently affected maxillary cheek tooth. Hypoattenuation of the cementum, destruction of the enamel, and filling of the infundibular cavity with gas were the most frequent CT findings associated with caries. Gas bubbles within the bulging root area or fragmentation of the root in combination with swelling of the adjacent sinus lining were the most important CT features of dental decay. CT findings associated with sinusitis included excessive thickening of the respiratory epithelium in the rostral maxillary sinus; the caudal maxillary sinus was less often involved. The infraorbital canal, the nasomaxillary duct, and the frontomaxillary aperture were usually involved. The maxillary bone, however, especially the facial crest, was involved in nearly every horse, being characterized by endosteal sclerosis, thickening, periosteal reaction, and deformation leading to facial swelling in chronic infections. CT images allowed identification of involvement of individual teeth more clearly to reveal the diseased one for treatment. Three-dimensional imaging allowed improved understanding of the extent and severity of the pathologic change.     

A COMPARISON OF RADIOGRAPHIC AND COMPUTED TOMOGRAPHIC FINDINGS IN 31 DOGS WITH MALIGNANT NASAL CAVITY TUMORS

Nasal cavity radiographs and CT images from 31 dogs with nasal cavity cancer were compared. All dogs had abnormal clinical signs relating to -nasal cancer and histologic confirmation of malignant nasal cavity neoplasia. No dog had cyto reductive surgery prior to imaging. All radiographic and CT examinations were abnormal. CT was more accurate than radiographs in identifying unilateral versus bilateral nasal cavity disease and tumor extension into adjacent structures such as the cranial cavity, hard palate, and pterygopala-tine fossa. The improved accuracy of CT in these respects was not of benefit in the confirmation of nasal cavity disease because radiographs were abnormal in every instance. However, CT may be useful for more accurate tumor staging, predicting possible treatment-related complications, and planning of surgery and radiation therapy. It was also determined that one dorsally located radiation therapy portal bounded laterally by the medial ocular canthi, as described in previous reports, would not have been adequate for encompassing all abnormal tissue in 28 of the 31 dogs evaluated.     

COMPUTED TOMOGRAPHY OF THE LLAMA HEAD: TECHNIQUE AND NORMAL ANATOMY

Computed tomography was performed on the head of 6 normal adult llamas. The animals were under general anesthesia and positioned in dorsal recumbency on the scanning table. The area scanned was from the external occipital protuberance to the rostral portion of the nasal passage, and the images are presented in both a bone window and a soft tissue window to allow evaluation and identification of the anatomy of the head. Computed tomography of the llama head can be accomplished by most computed tomography scanners utilizing a technique similar to that used in small animals with minor modification of the scanning table.     

USE OF RADIOGRAPHY, COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING FOR EVALUATION OF NAVICULAR SYNDROME IN THE HORSE

Radiographic evaluation of navicular syndrome is problematic because of its inconsistent correlation with clinical signs. Scintigraphy often yields false positive and false negative results and diagnostic ultrasound is of limited value. Therefore, we assessed the use of computed tomography and magnetic resonance imaging in a horse with clinical and radiographic signs of navicular syndrome. Cadaver specimens were examined with spiral computed tomographic and high-field magnetic resonance scanners and images were correlated with pathologic findings. Radiographic changes consisted of bony remodeling, which included altered synovial fossae, increased medullary opacity, cyst formation and shape change. These osseous changes were more striking and more numerous on computed tomographic and magnetic resonance images. They were most clearly defined with computed tomography. Many osseous changes seen with computed tomography and magnetic resonance imaging were not radiographically evident. Histologically confirmed soft tissue alterations of the deep digital flexor tendon, impar ligament and marrow were identified with magnetic resonance imaging, but not with conventional radiography. Because of their multiplanar capability and tomographic nature, computed tomography and magnetic resonance imaging surpass conventional radiography for navicular imaging, facilitating earlier, more accurate diagnosis. Current advances in imaging technology should make these imaging modalities available to equine practitioners in the future.     

COMPUTED TOMOGRAPHIC FINDINGS IN 35 DOGS WITH NASAL ASPERGILLOSIS

The purpose of this study was to describe the computed tomographic (CT) features of nasal aspergillosis in dogs. Initial (n = 35) and follow-up (n = 12) CT images were available from 35 dogs. The most commonly encountered CT findings were (1) moderate to severe cavitary destruction of the turbinates with presence of a variable amount of abnormal soft tissue in the nasal passages, (2) non-specific thickening of the mucosa adjacent to the inner surface of bones of the frontal sinus, maxillary recess and nasal cavity and, (3) thickened reactive bone. The findings were consistent with a disease initially affecting one nasal cavity then progressing into the ipsilateral frontal sinus, the contralateral nasal cavity and the contralateral frontal sinus. Two dogs with associated nasal foreign body had a more localized invasion of the nasal cavity. Attenuation values and contrast enhancement were not specific. With follow-up examinations, a reduction in the amount of abnormal soft tissue was observed in all dogs except one, but this reduction could not be quantified.     

DYNAMIC COMPUTED TOMOGRAPHY OF THE PANCREAS IN NORMAL DOGS AND IN A DOG WITH PANCREATIC INSULINOMA

To establish optimal imaging conditions for enhanced computed tomography (CT) for canine pancreatic tumors, 10 healthy beagles were subjected to dynamic CT. This technique was then applied to a dog with suspected insulinoma. The changes in mean peak enhancement and the delay time of the aorta and pancreas were determined. In normal beagles, maximal arterial and pancreatic CT enhancement was observed at 15 +/- 2 s (795 +/- 52 Housfield unit [HU]) and 28 +/- 9 s (118 +/- 16HU) after contrast medium injection, respectively. Multiphase enhanced CT was performed in a pug with suspected insulinoma using the CT protocol defined for the normal beagles with some parameters modified; the images were acquired at the arterial (14 s after contrast medium injection), pancreatic (after 28 s), and equilibrium (after 90 s) phases; scanning was followed by exploratory laparotomy. CT images were characterized by an enhanced mass in the left pancreatic lobe at the arterial phase, during which the difference between the CT values of the mass and normal pancreas was the highest. Histopathologic diagnosis of the pancreatic mass was insulinoma. Thus, it appears that enhanced CT imaging can be used to delineate the pancreas from a pancreatic mass, and it may be helpful in deciding the need for surgery.     

RADIATION THERAPY COMMUNICATION: NASAL PASSAGE AND PARANASAL SINUS LYMPHOMA IN A PONY

An aged pony with extensive paranasal sinus and nasal passage B-cell lymphoma was treated with palliative radiation therapy. Sixteen gray were administered in two fractions, 7 days apart. A lateral field was used for the first fraction and a dorsal field for the second. Because of tumor being present in the left frontal sinus, gross tumor was knowingly excluded from the treated volume in the lateral field. The tumor regressed within 2 months and the pony remained free of clinical disease for 2.5 years. Acute, temporary blindness developed shortly after the second radiation fraction, but a direct causal relationship with the radiation therapy was not confirmed. The only radiation side effect was leukotrichia. Palliative treatment was successful in improving and prolonging the quality of life. These results suggest that localized equine B-cell lymphoma is radiosensitive, and that palliative radiation therapy is a reasonable consideration for large tumors, even when tumor volume prevents all gross tumor from being irradiated.     

NORMAL CROSS-SECTIONAL ANATOMY OF THE FELINE THORAX AND ABDOMEN: COMPARISON OF COMPUTED TOMOGRAPHY AND CADAVER ANATOMY

Computed tomographic images of two adult domestic short-haired cats were obtained with a whole body scanner. Images of the thorax and abdomen were compared with cross-sectional anatomy cadaver specimens from the same two cats. Anatomic structures were first identified on the cadaver specimens with the aid of numerous anatomy texts and references and were then identified and labeled on the computed tomographic images. Results from this project provide an atlas of normal cross-sectional gross and CT anatomy of the feline thorax and abdomen that can be used in the interpretation of any cross-sectional imaging modality.     

PULMONARY ANGIOGRAPHY USING 16 SLICE MULTIDETECTOR COMPUTED TOMOGRAPHY IN NORMAL DOGS

We report a canine computed tomography (CT) pulmonary angiography technique using multidetector CT (MDCT). CT pulmonary angiography using a 16 slice MDCT was performed on five healthy, anesthetized beagles. A helical acquisition with pitch of 1.4 was used. The time delay for the angiographic study was determined using a bolus‐tracking program. A dose of 400 mg I/kg of nonionic contrast medium (Iohexol 300 mg I/ml) was administered to each dog via a cephalic catheter using an angiographic power injector at a rate of 5 ml/s. In two dogs a second study, using a contrast medium dose of 200 and 600 mg I/kg was performed. Arterial enhancement of transverse and reformatted images was classified subjectively as excellent, good, or poor, and assessed objectively by measuring Hounsfield units at the right main pulmonary artery. Angiographic studies were evaluated by two radiologists to determine the number of subsegmental arterial branches visualized. The median number of subsegmental arterial branches identified was five (range: 2–7). Based on the time attenuation curve obtained by the bolus‐tracking program, there was consistent enhancement of the right main pulmonary artery beginning at 6 s and peaking at 8 s in 4/5 dogs. The contrast medium dose of 400 mg I/kg produced good to excellent vascular enhancement in the same 4/5 dogs. A dose of 200 mg I/kg resulted in poor enhancement. CT pulmonary angiography using MDCT and an automated bolus‐tracking program allows rapid, consistent evaluation of the pulmonary vasculature using a single dose of 400 mg I/kg of contrast medium.     

COMPUTED TOMOGRAPHY OF BALL PYTHONS (Python regius) IN CURLED RECUMBENCY

Anesthesia and tube restraint methods are often required for computed tomography (CT) of snakes due to their natural tendency to curl up. However, these restraint methods may cause animal stress. The aim of this study was to determine whether the CT appearance of the lungs differs for ball pythons in a curled position vs. tube restraint. Whole body CT was performed on ten clinically healthy ball pythons, first in curled and then in straight positions restrained in a tube. Curved multiplanar reformatted (MPR) lung images from curled position scans were compared with standard MPR lung images from straight position scans. Lung attenuation and thickness were measured at three locations for each scan. Time for positioning and scanning was 12 ± 5 min shorter for curled snakes compared to tube restraint. Lung parenchyma thickness and attenuation declined from cranial to caudal on both straight and curled position images. Mean lung parenchyma thickness was greater in curled images at locations 1 (P = 0.048) and 3 (P = 0.044). Mean lung parenchyma thickness decreased between location 1 and 2 by 86–87% (straight: curled) and between location 1 and 3 by 51‐50% (straight: curled). Mean lung attenuation at location 1 was significantly greater on curled position images than tube restraint images (P = 0.043). Findings indicated that CT evaluation of the lungs is feasible for ball pythons positioned in curled recumbency if curved MPR is available. However, lung parenchyma thickness and attenuation in some locations may vary from those acquired using tube restraint.     

A COMPARISON OF RADIOGRAPHY, COMPUTED TOMOGRAPHY, AND MAGNETIC RESONANCE IMAGING FOR THE DIAGNOSIS OF PALMAR PROCESS FRACTURES IN FOALS

The relative sensitivity of radiography, computed tomography, and magnetic resonance imaging for detecting palmar process fractures of the distal phalanx in foals was determined and the imaging findings were compared with histomorphologic evaluations of the palmar processes. Compared to radiography, computed tomography and magnetic resonance imaging did not improve the sensitivity for detection of palmar process fractures. Statistical agreement for palmar process fracture diagnosis was excellent among the three imaging modalities. Histomorphologic evaluations were more sensitive for diagnosis of palmar process fracture than any of the imaging modalities. Three-dimensional image reconstructions and volume measurements of distal phalanges and palmar process fracture fragments from computed tomography studies provided more complete anatomical information than radiography. Magnetic resonance imaging confirmed that the deep digital flexor tendon insertion on the distal phalanx is immediately axial to the site where palmar process fractures occur, and differentiated cartilage, bone, and soft tissue structures of the hoof.