Low-field standing magnetic resonance imaging findings of the metacarpo/metatarsophalangeal joint of racing Thoroughbreds with lameness localised to the region: a retrospective study of 131 horses

Reasons for performing study: The metacarpo/metatarsophalangeal (MCP/MTP) joint is a common site of lameness in the Thoroughbred racehorse. Radiographs may fail to show pathology consistent with the degree of lameness. With a high incidence of stress fractures occurring in the distal third metacarpal/metatarsal (MC3/MT3) condyles and proximal phalanx, a definitive diagnosis as to the nature of the pathology is essential. Objective: To describe the low‐field magnetic resonance imaging (MRI) findings in Thoroughbred racehorses with MCP/MTP joint pain scanned under standing sedation. Methods: The MR images and clinical records of all Thoroughbred racehorses undergoing MRI of the MCP/MTP joint between October 2006 and August 2010 were reviewed. A total of 168 joints from 131 horses were selected for inclusion. The MRI finding considered most significant in the lame (or lamest) limb was noted. Results: Diagnostic quality images were obtainable in 97.8% of horses. The most common finding was palmar/plantar osteochondral disease in MC3/MT3 (54.9% of horses). Incomplete condylar fracture was diagnosed in 19.8% of horses, with the lateral condyle predominating. An incomplete sagittal fracure of P1 was diagnosed in 14.5% of horses and 11.4% were diagnosed with ‘dorsal joint disease’. Other findings included transverse MC3 stress fractures (1.5%), soft tissue injuries (12.2%) and proximal phalangeal ‘contusions’ (3.8%). No significant bone/soft tissue injury was detected in 5.4% of cases. Conclusions: Standing MRI can detect a spectrum of disease within the MCP/MTP joints of racehorses. The procedure is well tolerated and may lead to a definitive diagnosis where radiographic imaging is inconclusive. Potential relevance: A total of 35.8% of cases had MRI findings consistent with fracture pathology, which could not be confirmed radiographically at the time of the MRI examination. This has important therapeutic and prognostic implications and may help to prevent catastrophic injury.     

Normal anatomic reference of pastern and coffin joints in Egyptian buffalo (Bubalus bubalis): A compared atlas of cross-sectional anatomy,magnetic resonance imaging and computed tomography

The purpose of this study was to describe normal magnetic resonance imaging and computed tomographic anatomy of pastern and coffin joints in Egyptian buffalo using cadaveric distal limbs. This study was achieved using twelve fresh cadaveric distal limbs from adult healthy buffaloes of both sexes. These cadaveric limbs were scanned using a 1 Tesla MRI scanner and CT scanner, injected with red latex, frozen at −20°C for 1 week, and then sectioned into sagittal, dorsal and transverse slices. The obtained MR and CT images were selected to be matched with their corresponding anatomical cross-sections for identification and evaluation of the clinically correlated anatomical structures of the pastern and coffin joints. The difference in signal intensities on CT and MRI scans amongst the tissues allowed clear differentiation of major bone and soft tissue structures of the pastern and coffin joints. CT provided a high spatial resolution of bone and soft tissue structures, however, MRI allowed a better and higher resolution and definition between soft tissues. The current study provided a normal CT and MRI anatomic reference which could help veterinary clinicians for interpretation and diagnosis of the clinically affected pastern and coffin joints in buffalo.     

Ultrasonographic, computed tomographic and magnetic resonance imaging anatomy of the normal canine stifle joint

Ultrasonographic (US), magnetic resonance (MR) and computed tomographic (CT) images of normal canine stifle joints were obtained and compared with plastinated cross-sectional slices of cadaver specimens from the same dogs. The bony and articular structures were identified and correlated with the three diagnostic imaging modalities. These results provide an atlas of normal cross-sectional US, MR and CT anatomy of the canine stifle, which can be used for the interpretation of stifle images from any of these imaging modalities.     

Application and indications of magnetic resonance imaging and computed tomography of the equine head

The equine head is an anatomically highly complex area affected by a range of disorders, making the diagnosis of head conditions challenging. Imaging techniques play a crucial role in the diagnostic work-up of head disorders. Tomographic imaging methods, such as computed tomography (CT) and magnetic resonance imaging (MRI) are particularly useful in avoiding problems associated with superimposition of multiple structures in this highly complex region. Both techniques are becoming more widely available in equine medicine. However, the choice between CT and MRI for imaging the equine head is not always straightforward. Each modality has advantages and disadvantages in terms of practicality, costs and diagnostic value for particular problems. The aim of this review is to describe the application of CT and MRI for imaging the equine head and to provide a practical guide for their use in different anatomical structures and clinical indications. This should allow the equine practitioner to make an informed decision on which modality to choose.     

Gas arthroscopy for removal of osteochondral fragments of the palmar/plantar aspect of the metacarpo/metatarsophalangeal joint in horses

Objective— To evaluate the use of carbon dioxide (CO₂) gas for joint distention during arthroscopy for removal of osteochondral (OC) fragments of the palmar/plantar aspect of the metacarpo (MCP)/metatarsophalangeal (MTP) joints in horses.
Study Design— Clinical study.
Animals— Horses (26) with OC fragment(s) of palmar/plantar aspect of 1 or 2 MCP/MTP joint(s).
Methods— OC fragments were removed using arthroscopic technique. Joint distention was maintained by isotonic Ringer's acetate at the beginning and at the end of the procedure but during fragment removal, CO₂ was used for joint distention. After surgery, fragment removal was confirmed by radiography. Horses were discharged the day after surgery, and outcome was determined by telephone contact 3–24 months later.
Results— CO₂ joint distention resulted in a sharp image without villi obscuring the operative field. Fragments were identified and completely removed in all horses except one where a 1 mm × 3 mm radiodense body was seen on postoperative radiographs. In 5 horses, bleeding from the arthroscopic or instrument portal precluded optimal visualization when the joint was distended by gas; however, repeatedly rinsing the tip of the arthroscope with Ringer's acetate solution delivered from the fluid ingress line easily restored joint visualization. No specific complications were observed postoperatively.
Conclusions— Joint distention by CO₂ permitted optimal visualization of the palmar/plantar aspect of the MCP/MTP joints, which facilitated fragment removal.
Clinical Relevance— Gas arthroscopy is a useful technique for removal of OC fragments of the palmar/plantar aspect of the MCP/MTP joints in horses.     

Deep erosions of the palmar aspect of the navicular bone diagnosed by standing magnetic resonance imaging

Reasons for performing study: Erosion of the palmar (flexor) aspect of the navicular bone is difficult to diagnose with conventional imaging techniques. Objectives: To review the clinical, magnetic resonance (MR) and pathological features of deep erosions of the palmar aspect of the navicular bone. Methods: Cases of deep erosions of the palmar aspect of the navicular bone, diagnosed by standing low field MR imaging, were selected. Clinical details, results of diagnostic procedures, MR features and pathological findings were reviewed. Results: Deep erosions of the palmar aspect of the navicular bone were diagnosed in 16 mature horses, 6 of which were bilaterally lame. Sudden onset of lameness was recorded in 63%. Radiography prior to MR imaging showed equivocal changes in 7 horses. The MR features consisted of focal areas of intermediate or high signal intensity on T1‐, T2*‐ and T2‐weighted images and STIR images affecting the dorsal aspect of the deep digital flexor tendon, the fibrocartilage of the palmar aspect, subchondral compact bone and medulla of the navicular bone. On follow‐up, 7/16 horses (44%) had been subjected to euthanasia and only one was being worked at its previous level. Erosions of the palmar aspect of the navicular bone were confirmed post mortem in 2 horses. Histologically, the lesions were characterised by localised degeneration of fibrocartilage with underlying focal osteonecrosis and fibroplasia. The adjacent deep digital flexor tendon showed fibril formation and fibrocartilaginous metaplasia. Conclusions: Deep erosions of the palmar aspect of the navicular bone are more easily diagnosed by standing low field MR imaging than by conventional radiography. The lesions involve degeneration of the palmar fibrocartilage with underlying osteonecrosis and fibroplasia affecting the subchondral compact bone and medulla, and carry a poor prognosis for return to performance. Potential relevance: Diagnosis of shallow erosive lesions of the palmar fibrocartilage may allow therapeutic intervention earlier in the disease process, thereby preventing progression to deep erosive lesions.     

Clinical and low field magnetic resonance imaging features of osseous cyst‐like lesions of the proximal sesamoid bones in seven horses

Osseous cyst‐like lesions of the proximal sesamoid bones (PSBs) were diagnosed in 7 horses. The diagnosis was achieved radiographically prior to magnetic resonance imaging (MRI) in only one horse, and in the other 6 horses the diagnosis was made using low field MRI (retrospective evaluation of the radiographs after the MRI revealed ill‐defined radiolucencies of the PSBs in 4 of these horses). The horses ranged in age from 3 to 12 years, and the affected limbs included 3 forelimbs and 4 hindlimbs. The onset of lameness was reported to be sudden in 6 horses and insidious in one, and the duration of lameness at the time of MRI ranged from 0.3 to 11 months. The degree of lameness in the 6 horses with sudden‐onset lameness was moderate to severe. Pain on flexion of the affected metacarpo(tarso)phalangeal (fetlock) joint or exacerbation of the degree of lameness following fetlock flexion was recorded in 4 of the 7 horses. The MRI findings in all cases included a focal high signal intensity lesion (all magnetic resonance sequences) at various locations in one PSB. Both septic and nonseptic aetiologies were identified. Four of the 7 horses were subjected to euthanasia due to persistent lameness, one remained chronically lame and only 2 were able to return to their previous level of exercise.     

Alterations to the synovial invaginations of the navicular bone are associated with pathology of both the navicular apparatus and distal interphalangeal joint when evaluated using high field MRI

Limited information exists regarding associations between distal interphalangeal joint (DIPJ) abnormalities and synovial invagination changes in the distal sesamoid (navicular) bone. This retrospective, analytical study aimed to measure specific characteristics of the synovial invaginations of the navicular bone to determine whether any single characteristic was associated with abnormalities in the DIPJ or navicular apparatus (NA) using high field MRI and a sample of 200 horses’ feet. The DIPJ and NA were graded independently by three scorers. The grades were averaged, creating a global pathology score for the DIPJ, NA, and synovial invaginations. Higher global scores represented more severe pathology. The number of invaginations, depth of penetration, invagination shape, and cross-sectional area (CSA) of the largest invagination were recorded. Interobserver agreement was measured using Cohen's Kappa. Associations of global scores of the DIPJ and NA with individual invagination characteristics were assessed using linear mixed modeling. A significant relationship was found between the number of invaginations and global DIPJ score, with higher invagination numbers associated with higher DIPJ scores. For invagination depth and CSA, a significant relationship was noted with global scores of both the DIPJ and NA. Reliable relationships between the shape of synovial invaginations and global scores of DIPJ and NA were not found, likely due to poor interobserver scoring (0.305). These findings suggest that primary DIPJ disease and NA pathology should be considered when noticing alterations to navicular synovial invaginations on MRI. This contrasts traditional views that synovial invagination abnormalities are indicative solely of NA pathology.     

Recent advances in articular cartilage evaluation using computed tomography and magnetic resonance imaging

Articular cartilage is a critical joint tissue and its evaluation remains a diagnostic challenge in horses. Coupled with a poor capacity for healing, early degenerative changes in articular cartilage are difficult to characterise using routine diagnostic imaging evaluations. Both computed tomography (CT) and magnetic resonance imaging (MRI) provide volumetric joint assessment and highlight morphological and quantitative properties of articular cartilage, improving assessment of this essential tissue. While the use of CT and MRI for joint evaluation is not new, there still remains a shortage of literature and scientific studies on the ability of these methods to evaluate articular cartilage in the horse. This review article summarises current CT and MRI techniques capable of characterising equine articular cartilage, highlights recent advances in these techniques and discusses the numerous methods studied in human subjects that have been minimally investigated in horses. Imaging techniques are presented in terms of their capabilities of offering morphological and quantitative evaluation along with a discussion of their benefits and limitations. Finally, it summarises the current state‐of‐the‐art approaches and identifies unmet clinical imaging needs to propel the advancement of articular cartilage and joint imaging in the horse.     

Post mortem evaluation of palmar osteochondral disease (traumatic osteochondrosis) of the metacarpo/metatarsophalangeal joint in Thoroughbred racehorses

Reasons for performing study: Thoroughbred racehorses are commonly affected by subchondral bone injury, but the exact prevalence and the distribution of palmar/plantar osteochondral disease (POD) lesions are unknown. The relationship between pathologies has not been elucidated, although it is widely accepted that POD is a manifestation of traumatic overload arthrosis. Hypothesis: There is an association between grade of POD and other pathologies affecting the third metacarpal and metatarsal (MC/MTIII) condyles (wear lines, cartilage loss, marginal remodelling, dorsal impact injuries and linear fissures). Objectives: To evaluate the pathology found affecting the distal MC/MTIII condyles of Thoroughbred racehorses at post mortem examination, to describe the prevalence and distribution of POD lesions within a population of racing Thoroughbreds and to determine relationships between pathologies of the distal condyles of the third metacarpal and metatarsal bones. Methods: The metacarpo/metatarsophalangeal joints of 64 Thoroughbred racehorses were examined at routine post mortem examination and graded for third metacarpal and metatarsal condylar pathology. Associations between pathologies were determined. Results: POD had a within horse prevalence of 67%. There was a significant linear relationship between grade of POD and grades of wear lines, cartilage ulceration and dorsal impact injuries. There was a significant relationship, but this was not linear, between grade of POD and grade of linear fissures. Using ordinal logistic regression, compared to condyles with grade 0 or grade 2 linear fissures, condyles with grade 1 linear fissures were found to be more likely to have a lower POD grade. Potential relevance: POD can be considered to be a manifestation of traumatic overload arthrosis, but the role of subchondral bone adaptation is complex and warrants further investigation.     

Radiography, myelography, computed tomography, and magnetic resonance imaging of the spine.

Various methods of documenting pathologic change in the spine and spinal cord are available to the veterinary practitioner. Intimidation caused by the imaging modality and the fear that one will not be able to recognize or diagnose a lesion are the factors that limit the use of diagnostic imaging. One needs only to be able to recognize the variations of normal anatomy to be successful. Once an abnormal area has been identified, the diagnosis is soon to follow. Therefore one should concentrate on improving the simple skills associated with image interpretation and normal anatomy. Lesion identification and definitive diagnoses will follow by natural progression.     

Comparisons of computed tomography, contrast-enhanced computed tomography and standing low-field magnetic resonance imaging in horses with lameness localised to the foot. Part 2: Lesion identification

Reasons for performing study: No previous study compares computed tomography (CT), contrast‐enhanced computed tomography (CECT) and standing low‐field magnetic resonance imaging (LFMRI) to detect lesions in horses with lameness localised to the foot. This study will help clinicians understand the limitations of these techniques. Objectives: To determine if CT, CECT and LFMRI would identify lesions within the distal limb and document discrepancies with lesion distribution and lesion classification. Methods: Lesions in specific structures identified on CT and MR images of feet (31 limbs) from the same horse were reviewed and compared. Distributions of lesions were compared using a Chi‐squared test and techniques analysed using the paired marginal homogeneity test for concordance. Results: Lesions of the deep digital flexor tendon (DDFT) were most common and CT/CECT identified more lesions than LFMRI. Deep digital flexor tendon lesions seen on LFMRI only were frequently distal to the proximal extent of the distal sesamoid and DDFT lesions seen on CT/CECT only were frequently proximal to the distal sesamoid. Lesions identified on LFMRI only were core (23.3%) or splits (43.3%), whereas lesions identified only on CT were abrasions (29.8%), core (15.8%), enlargement (15.8%) or mineralisation (12.3%). Contrast‐enhanced CT improved lesion identification at the DDFT insertion compared to CT and resulted in distal sesamoidean impar ligament and collateral sesamoidean ligament vascular enhancement in 75% of cases. Low‐field MRI and CT/CECT failed to identify soft tissue mineralisation and bone oedema, respectively. Conclusions and potential relevance: Multiple lesions are detected with CT, CECT and LFMRI but there is variability in lesion detection and classification. LFMRI centred only on the podotrochlear apparatus may fail to identify lesions of the pastern or soft tissue mineralisation. Computed tomography may fail to identify DDFT lesions distal to the proximal border of the distal sesamoid.     

Reliability of high‐ and low‐field magnetic resonance imaging systems for detection of cartilage and bone lesions in the equine cadaver fetlock

Reasons for performing study: To determine the reliability of 2 magnetic resonance imaging (MRI) systems for detection of cartilage and bone lesions of the equine fetlock. Objectives: To test the hypotheses that lesions in cartilage, subchondral and trabecular bone of the equine fetlock verified using histopathology can be detected on high‐ and low‐field MR images with a low incidence of false positive or negative results; that low‐field images are less reliable than high‐field images for detection of cartilage lesions; and that combining results of interpretation from different pulse sequences increases detection of cartilage lesions. Methods: High‐ and low‐field MRI was performed on 19 limbs from horses identified with fetlock lameness prior to euthanasia. Grading systems were used to score cartilage, subchondral and trabecular bone on MR images and histopathology. Sensitivity and specificity were calculated for images. Results: High‐field T2*‐weighted gradient echo (T2*W‐GRE) and low‐field T2‐weighted fast spin echo (T2W‐FSE) images had high sensitivity but low specificity for detection of cartilage lesions. All pulse sequences had high sensitivity and low–moderate specificity for detection of subchondral bone lesions and moderate sensitivity and moderate–high specificity for detection of trabecular bone lesions (histopathology as gold standard). For detection of lesions of trabecular bone low‐field T2*W‐GRE images had higher sensitivity and specificity than T2W‐FSE images. Conclusions: There is high likelihood of false positive results using high‐ or low‐field MRI for detection of cartilage lesions and moderate–high likelihood of false positive results for detection of subchondral bone lesions compared with histopathology. Combining results of interpretation from different pulse sequences did not increase detection of cartilage lesions. MRI interpretation of trabecular bone was more reliable than cartilage or subchondral bone in both MR systems. Potential relevance: Independent interpretation of a variety of pulse sequences may maximise detection of cartilage and bone lesions in the fetlock. Clinicians should be aware of potential false positive and negative results.