Comparison of thoracic radiographs and single breath-hold helical CT for detection of pulmonary nodules in dogs with metastatic neoplasia

Imaging studies in people indicate that x-ray computed tomography (CT) is a more sensitive technique than thoracic radiography for the detection of pulmonary metastasic neoplasia. Systematic studies comparing CT and thoracic radiographic techniques in veterinary patients have not been performed. The present retrospective study was designed to directly compare the efficacy of these 2 techniques in detecting pulmonary nodules in dogs. Eighteen dogs with histologically confirmed pulmonary metastatic neoplasia had contemporaneous thoracic radiographs and pulmonary CT scans compared. Quantitative analyses included estimation of pulmonary nodule size, number, and lobar distribution on thoracic radiographs and CT images. Only 9% of CT-detected pulmonary nodules were identified on thoracic radiographs (P < .003). The lower size threshold was approximately 1 mm to detect pulmonary nodules on CT images and 7-9 mm to reliably detect nodules on radiographs (P < .0001). Additionally, pulmonary nodules were detected in a significantly greater number of lung lobes using CT as compared with thoracic radiographs (P < .0001). These data indicate that CT is significantly more sensitive than thoracic radiography for detecting soft-tissue nodules in dogs. As such, thoracic CT should be considered in any patient with neoplasia that has potential for pulmonary metastasis to more reliably stage the disease, particularly when accurate characterization of the extent and distribution of pulmonary metastatic disease affects therapeutic planning.     

BONE SCINTIGRAPHY FOR METASTASIS DETECTION IN CANINE OSTEOSARCOMA

The purpose of this study was to assess the usefulness of serial bone scintigraphy in the detection of skeletal and extraskeletal metastases in dogs with appendicular osteosarcoma. Twenty-six dogs with primary, appendicular osteosarcoma were entered into a limb-sparing protocol. Bone scintigraphy was performed upon presentation, after neoadjuvant therapy but prior to surgery and at selective intervals after limb-sparing surgery to evaluate for the presence of metastasis. Thoracic radiographs, and radiographs of other sites, were also made at the time of each bone scan. All dogs had a complete necropsy. No dog had bone or lung metastases detected prior to treatment. The bone scans, medical records, and radiographs of each dog were reviewed retrospectively. All but one dog developed metastatic disease. Bone metastatic sites were confirmed at necropsy in 12 of the 26 dogs. Seven of these 12 dogs had bone metastatic sites which were not producing clinical signs, i.e. an occult metastasis. In five of the seven dogs, the occult site was the first metastatic site detected. Extraskeletal metastases were identified scintigraphically in six of the 26 dogs, but these were clinically apparent prior to bone scintigraphy in each dog. Suspected malignant scintigraphic lesions were proven benign in six dogs. In five dogs with malignant bone lesions at necropsy the last bone scan prior to euthanasia was normal. The time interval between scintigraphy and necropsy was variable in these five dogs. All dogs without bone metastases at necropsy had normal bone scans. This study validates the usefulness of bone scintigraphy for detection of occult bone metastasis and improved ability for tumor staging in dogs with appendicular osteosarcoma.     

THORACIC COMPUTED TOMOGRAPHY FINDINGS IN DOGS EXPERIMENTALLY INFECTED WITH ANGIOSTRONGYLUS VASORUM

To characterize the computed tomography (CT) features of thoracic lesions caused by infection with Angiostrongylus vasorum, pre‐ and postcontrast CT was performed in six experimentally infected Beagles 13 weeks postinoculation and in four of these 9 weeks postchemotherapy. Findings were compared with survey radiographs and necropsy findings. A multicentric bronchoalveolar pattern more pronounced at the lung periphery was present radiographically. On CT, the predominant abnormality underlying this alveolar pattern was multiple large nodules merging to areas of consolidation, and containing air bronchograms of varying extent. These nodular changes corresponded to histopathologic granulomata, consisting mainly of macrophages, multinucleated giant cells, and lymphocytes that had accumulated around larvae and eggs. Morphologically, no bronchial changes were observed on CT or histologically. Quantitatively, however, on CT there was evidence of bronchial thickening at 13 weeks postinoculation and mild very peripheral bronchiectasia 9 weeks postchemotherapy. Regional lymph nodes were enlarged after infection, and smaller after treatment. On postcontrast CT, several suspicious intraluminal filling defects suggestive of thrombosis were found; however, the tortuosity of some pulmonary arteries seen radiographically was not present in CT images. After treatment, the consolidations and large nodules had almost completely disappeared. A remaining radiographic interstitial pattern was characterized on CT as ground‐glass opacifications, subpleural interstitial thickening, subpleural lines, and interface signs. These interstitial changes reflected fibrosis as documented histopathologically. CT allowed very detailed and accurate characterization of pulmonary parenchymal lesions, bronchi, and lymphnodes and closely reflected histopathological changes.     

Comparison of examination of thoracic radiographs and thoracic computed tomography in dogs with appendicular osteosarcoma

Appendicular osteosarcoma (OSA) is a highly metastatic tumour in dogs. The aim of the study was to compare thoracic radiographs with thoracic computed tomography (CT) in the staging of canine appendicular OSA. In all, 39 canine patients histologically diagnosed with OSA were reviewed in the retrospective study. All dogs underwent radiographic examination as well as CT examination of the thoracic cavity. Pulmonary nodules were detected radiographically in two cases (5%), whereas the CT imaging showed that pulmonary nodules were evident in 11 cases (28%, P = 0.024). There was an improved detection of small pulmonary nodules in the lung parenchyma with CT (P = 0.021). The number of nodules in CT examination had a significant negative influence on survival time (P = 0.005). However, whether nodules were present in CT or not did not influence overall survival (P = 0.368). CT examination was superior to thoracic radiography in the screening and detection of pulmonary nodules in dogs with OSA.     

Computed tomographic characteristics of cavitary pulmonary adenocarcinoma in 3 dogs and 2 cats

Cavitary pulmonary lesions can result from the localized breakdown of pulmonary parenchyma or be caused by the expulsion of a necrotic part of a mass. The objectives of this study were to describe the clinical and computed tomographic characteristics for cases of cavitary pulmonary adenocarcinoma and find associations between the features and those identified in human pulmonary cavitary soft tissue lesions. Five cases were identified that had a cavitary pulmonary mass on thoracic computed tomography (CT) and histopathology of the lesions. Three dogs and 2 cats had cavitary pulmonary adenocarcinoma. Common features of CT in these cases included lesions in the caudal lung lobes, lobular and spiculated lesion margins, air bronchograms within the mass, pleural tags, heterogeneous contrast enhancement, and ground glass opacity in the surrounding parenchyma. The findings of this case series suggest there are similarities in the CT characteristics of malignancy in human and animal cavitary pulmonary masses.     

Bone scintigraphy in the initial evaluation of dogs with primary bone tumors

Bone scintigraphy was performed as part of an initial diagnostic evaluation of 70 dogs admitted with primary bone tumors during a 2-year period. Tumors involved major long bones of the appendicular skeleton and included 62 osteosarcomas, 6 fibrosarcomas, and 2 chondrosarcomas. All dogs were free of radiographically detectable pulmonary metastases. Bone scintigraphy was not of value in distinguishing among various types of primary tumors. One dog with an ulnar chondrosarcoma had a scintigraphically detectable occult osseous metastasis or synchronous primary tumor, and 1 dog with osteosarcoma had a scintigraphically detectable lymph node metastasis. Pulmonary metastases were not detected scintigraphically. Of the 70 dogs, 44.3% had areas of increased isotope uptake associated with nonneoplastic disease processes.     

COMPARISON OF COMPUTED TOMOGRAPHY, TANGENTIAL VIEW RADIOGRAPHY, AND CONVENTIONAL RADIOGRAPHY IN EVALUATION OF CANINE PELVIC TRAUMA

Thirteen dogs with fractures requiring surgical repair were evaluated by standard two-view (i.e., lateral and ventrodorsal) radiography, tangential view (ventro 20 degrees cranial-dorsocaudal [inlet] and ventro 20 degrees caudal-dorsocranial [outlet]) radiography, and computed tomography (CT). Radiographic and CT examinations were reviewed independently by the three authors, and specific anatomic sites were graded for the presence or possibility of lesions. The results of radiographic interpretations were compared to CT scan interpretations. Eighty-one percent of skeletal lesions detected by CT scans were diagnosed definitively radiographically. Differences between the interpretation of CT and radiographic examinations included abnormalities associated with soft-tissue structures (P < 0.0001), the sacroiliac joints (P = 0.02), and the acetabula (P = 0.04). Interpretation of the lateral/ventrodorsal and inlet/outlet radiographic series were not statistically different, although inlet views may be complimentary to the standard radiographic examination. Its use deserves further study. Reader variation was less on evaluation of CT examinations than radiographic examinations. CT multiplaner reformations and three-dimensional reconstructions were useful for surgical planning in seven dogs. CT scanning is superior to survey radiography in assessing skeletal and soft-tissue injuries in dogs with pelvic trauma, although all clinically significant surgical lesions were described accurately radiographically. Based on this small series, the routine CT examination of dogs with pelvic trauma may not be justifiable for diagnosis but may be advantageous for surgical planning, especially if acetabular fractures are suspected on radiographs.     

COMPUTED TOMOGRAPHIC AND RADIOGRAPHIC CHARACTERISTICS OF AORTIC LESIONS IN 42 DOGS WITH SPIROCERCOSIS

Spirocerca lupi is a common cause of vomiting, regurgitation, and sudden death in dogs that live in tropical or subtropical regions. Sudden death due to aortic rupture may occur with no preceding clinical signs. The purpose of this prospective study was to compare radiographic and computed tomographic (CT) characteristics of aortic lesions in a cohort of 42 dogs with endoscopically confirmed spirocercosis. Dorsoventral and right lateral recumbent thoracic radiographic findings were compared with pre‐ and postcontrast thoracic CT findings. Aortic mineralization was detected using CT in 18/42 dogs (43%). Three dogs had faint diffuse aortic wall mineralization. Using CT as the reference standard, radiographs had a sensitivity and specificity of 6% and 96%, respectively, for detecting aortic mineralization. A total of 20 aortic aneurysms were detected using CT in 15/42 dogs (36%). Using CT as the reference standard, radiographs had a sensitivity and specificity of 86% and 56%, respectively, for detecting aortic aneurysms. Respiratory motion, aortic displacement by esophageal masses and Spirocerca nodules adjacent to the aorta mimicked aneurysm formation on radiographs. Aortic thrombi were seen in two dogs in postcontrast CT images. Findings from this study indicated that aortic mineralization and aneurysm formation are common in dogs with spirocercosis. Findings also supported the use of pre‐ and postcontrast CT as effective methods for detecting and characterizing these lesions.     

COMPARISON OF RADIOGRAPHIC AND COMPUTED TOMOGRAPHY LYMPHANGIOGRAPHY FOR IDENTIFICATION OF THE CANINE THORACIC DUCT

Standard radiographic lymphangiograms and computed tomography (CT) lymphangiograms were performed on 10 female dogs without intrathoracic disease. Positive contrast lymphagiography was performed by injection into a catheterized mesenteric lymphatic vessel, and lateral thoracic radiographs, ventrodorsal thoracic radiographs, and thoracic CTs were obtained. The number of visible ducts was recorded for each image at the midbody of the ninth thoracic vertebra (T9) through the first lumbar vertebra (L1). Data were combined for all dogs at each data acquisition point. Data were analyzed by comparing data from all three images independently, and then by combining data for the radiographs and comparing the study with the highest number of visible duct branches to the CT. Significant differences in numbers of branches were found at T11 and L1. This study suggests that CT may be able to quantify branches of the thoracic duct more accurately than standard radiographic lymphangiography.     

Frequency of pulmonary mineralization and hypoxemia in 21 dogs with pituitary-dependent hyperadrenocorticism

The purpose of this study was to determine the frequency of hypoxemia and pulmonary mineralization using ^99mTc-methylene diphosphonate (^99mTc-MDP) in dogs with pituitary-dependent hyperadrenocorticism (PDH). Twenty-one dogs with PDH were pro-spectively evaluated using thoracic radiography, arterial blood gas analysis, and bone phase and pulmonary perfusion scintigraphy (using ^99mTc-macro-aggregated albumin [^99mTc-MAA]). The radiographs and bone and perfusion studies were evaluated subjectively. An averaged quantitative count density ratio was calculated between the thorax and cranial thoraco-lumbar vertebrae from lateral thoracic ^99mTc-MDP images. Thoracic: vertebral ratios were calculated using ^99mTc-MDP studies from 21 control dogs. The thoracic: vertebral ratios were compared between the 2 groups (PDH and control). The mean age (±SD) of the 21 PDH dogs was 10.2 (±3) years, whereas the mean age of the control group was 9.8 (±3) years. Seven of the 21 dogs with PDH were hypoxemic (denned as an arterial partial pressure of oxygen [PaO₂] <80 mm Hg) with an average PaO₂ (±SD) of 62 (±15) mm Hg. Of the 7 hypoxemic dogs, 2 were found to have pulmonary mineralization based on bone scintigraphic images. Pulmonary perfusion abnormalities were not identified using ^99mTc-MAA in any of the 21 PDH dogs. Six PDH dogs had an abnormal interstitial pulmonary pattern and 5 of these dogs were hypoxemic. The average quantitative thoracic: vertebral ratio was not significantly different between the PDH and control dogs (0.5 ± 0.4 versus 0.4 ± 0.1, P = .16). Causes of hypoxemia other than pulmonary thromboembolism should be considered in dogs with PDH. Pulmonary mineralization may contribute to hypoxemia in dogs with PDH.     

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.     

SKELETAL LESIONS OF HISTIOCYTIC SARCOMA IN NINETEEN DOGS

The purpose of this study was to describe the clinical and radiographic findings in dogs with bone lesions secondary to histiocytic sarcoma. Nineteen dogs with radiographically identified bone lesions that were histologically diagnosed as histiocytic sarcoma were assessed. The medical records, all available radiographs and histologic sections were reviewed retrospectively. Dogs were subcategorized into localized or disseminated histiocytic sarcoma groups. Golden Retrievers or Rottweilers greater than 5 years of age, with a history of lameness or neurologic deficits localized to the spinal cord was the most common presentation. Fifteen of 19 dogs had a radiographically detectable soft tissue mass associated with bone destruction. The bone lesions had aggressive characteristics and the sites of involvement included periarticular bones (n = 11), vertebrae (n = 6), proximal humerus (n = 5), and rib (n = 2). Fifteen of 19 dogs had disseminated histiocytic sarcoma, and four had localized histiocytic sarcoma. All Rottweilers had disseminated histiocytic sarcoma. Histiocytic sarcoma should be considered as a differential diagnosis for aggressive periarticular, vertebral, or proximal humeral bone lesions identified on radiographs. The index of suspicion should be increased in greater than 5-year-old Golden Retrievers and Rottweilers when a soft tissue mass is associated with the bone lesion on radiographs or myelography. Bone involvement with histiocytic sarcoma, and the Rottweiler breed, was associated with the disseminated form of the disease.     

A lung nematode in Canadian Arctic muskoxen. Standard radiographic and computed tomographic imaging.

Medical imaging was used before death to follow the development of U. pallikuukensis infection in muskoxen and postmortem to investigate the distribution and characteristics of parasite-associated pulmonary cysts. In two experimentally infected animals, lesions were not visible radiographically until days 178 and 191 PI, 3 months after the parasites became patent. Serial radiographs taken throughout the period of patency of one animal showed an initial increase in lesion size by day 415 PI, but by day 789 PI, lesions had stabilized or decreased in size. Although all lesions detected postmortem were not visible radiographically during life, the radiographs did provide an indication of the relative severity of infection. In contrast to other parasitic pneumonias, there was no evidence of pulmonary disease outside of the discrete parasitic cysts. Radiographs of lungs postmortem proved to be an effective tool for locating parasitic cysts in a lightly infected muskox and demonstrated a bronchovascular cyst distribution. Postmortem CT provided a more rapid and detailed assessment of the number, size, and distribution of cysts in the lungs of one muskox.     

The Nasal Septum of the Dog: Is It Visible RadiographicaIly?

Occlusal nasal radiographs of a normal dog taken before and after resection of the cartilaginous nasal septum were compared. No differences were seen in the midline linear radiopacities previously referred to as the nasal septum. It is concluded that the cartilaginous nasal septum is not visible radiographically and that the midline linear radiopacities visible in normal dogs are the vomer bone.     

THE EFFECT OF DORSAL VERSUS VENTRAL RECUMBENCY ON THE RADIOGRAPHIC APPEARANCE OF THE CANINE THORAX

The thorax of nine dogs was radiographed with a vertical beam in both dorsal (VD) and ventral (DV) recumbency. The radiographs were evaluated subjectively and objectively for differences in appearance. To help explain appearance differences, lateral thoracic radiographs were made with the dogs in dorsal and ventral recumbency using a horizontally (laterally) directed x-ray beam. The appearance of thoracic viscera in VD and DV vertical beam radiographs differed. In VD vertical beam radiographs the craniocaudal axis of the heart appeared longer, the heart had a more consistent positional relationship to the thoracic spine, a larger area of the accessory lung lobe was visible, and a greater length of the caudal vena cava was visible. In DV radiographs the caudal lobar pulmonary arteries were more easily identified. The selection of dorsal versus ventral recumbency for thoracic radiography should be based on the clinical status of the patient and the reason(s) for which the radiograph is being made.     

PULMONARY MINERALIZATION IN FOUR DOGS WITH CUSHING'S SYNDROME

The clinical and imaging features of four dogs with Cushing's syndrome and pulmonary mineralization are reviewed. Three dogs presented with a primary complaint of respiratory distress/dyspnea. Three dogs had pituitary dependent Cushing's syndrome, while the remaining one dog had iatrogenic Cushing's syndrome. Each dog had clinical features typical for Cushing's syndrome. Two of the dogs were euthanized due to progressive hypoxemia. In each dog, the serum calcium, phosphorous, blood urea nitrogen and creatinine were normal.
A generalized increase in unstructured interstitial pulmonary opacity with diffuse mineralization was noted on thoracic radiographs of all dogs. In one dog, an ill-defined nodular interstitial pattern of mineralization was present. Delayed bone phase scintigraphy using ^99mTechnetium methylene diphosphonate documented generalized pulmonary uptake in two dogs. ^99mTechnetium labeled microaggregated albumin lung perfusion scans were normal in these two dogs. ^99mTc-MDP scintigraphy can provide useful information in diagnosing pulmonary mineralization in Cushingoid dogs.     

Computed tomographic findings in three dogs naturally infected with Crenosoma vulpis

Crenosoma vulpis is a nematode lungworm found in wild and domestic canids in some parts of North America and Europe. Reported radiographic findings are nonspecific and consist of a combination of bronchial and interstitial changes of variable severity. This retrospective, case series study aimed to describe thoracic computed tomographic (CT) findings for a group of dogs with confirmed crenosomosis. Selection criteria were presentation with a chronic cough during the period of January 2016 to February 2017, evaluation by thoracic CT, and final diagnosis of C. vulpis infection based on bronchoscopic findings, bronchoalveolar lavage fluid analysis, and quantitative polymerase chain reaction. Medical records and CT images were retrieved and reviewed by a board‐certified veterinary internist, a veterinary internal medicine resident, two board‐certified veterinary radiologists, and a veterinary radiology intern, and findings were recorded. Three dogs met inclusion criteria. Thoracic CT findings for all dogs included the following: diffuse bronchial wall thickening, multifocal peribronchial ground glass attenuation, consolidation of the pulmonary parenchyma, and cylindrical bronchiectasis. In two dogs, the bronchial wall thickening was irregular to nodular, which was consistent with the bronchoscopic findings. Two dogs showed pulmonary parenchymal bands. Thoracic computed tomographic changes in dogs with C. vulpis are consistent with those seen on thoracic radiographs and crenosomosis should be considered in dogs with these findings.     

USE OF RADIOGRAPHY IN COMBINATION WITH COMPUTED TOMOGRAPHY FOR THE ASSESSMENT OF NONCARDIAC THORACIC DISEASE IN THE DOG AND CAT

Computed tomography (CT) of the thorax was performed in 28 dogs and five cats and findings were compared with previous thoracic radiographs. The sample population included all animals that had thoracic radiographs and a CT study within 5 days of each other, where the complete imaging studies were available for review. Thoracic radiographs were considered indeterminate in 31 patients and CT examinations were done to acquire additional information. The presence of additional information from CT relating to presence of pathology, location of pathology, extent of pathology, and involvement of mediastinal structures was recorded. Whether there was a change in diagnosis based on the CT findings was also recorded. In only 4/33 animals (all dogs) did CT fail to provide any new information for the parameters evaluated when compared with survey thoracic radiographs. Additional information about the pathology that was present was gained by CT in 5/5 cats and 21/ 28 dogs. New information on compartmental location of pathology was seen in 4/5 cats and 19/28 dogs. New information on pathology extent was noted in 5/5 cats and 20/28 dogs. Additional information regarding involvement of mediastinal structures was obtained in 2/5 cats and 10/28 dogs. A change in diagnosis was made in 3/5 cats and 13/28 dogs. In conclusion, CT is a valuable tool for evaluating intrathoracic disease. CT provides additional cross-sectional anatomic information that can aid in anatomic localization and evaluation of the extent of the pathology in question.     

Hypertrophic osteopathy associated with disseminated metastases of renal cell carcinoma in the dog: a case report

A 6-year-old, mixed breed, intact male dog showed signs of left carpal joint swelling and weakness of the forelimbs one month before presentation. The symptoms gradually progressed to bilateral carpal and tarsal joint swelling and tetraparalysis. There were a number of radiographically identified lytic-proliferative bone lesions noted on the axial skeleton. Hypertrophic osteopathy of the metacarpi and all distal long bones was also evident. Because of the deteriorating quality of life and guarded prognosis, the patient was euthanized and a complete necropsy was performed. Renal cell carcinoma, with metastasis to the lung, thoracic vertebrae, ribs, and the right adrenal gland, was diagnosed. To our knowledge, renal cell carcinoma with bone metastases and hypertrophic osteopathy has not been reported in dogs.     

Survey radiography and computerized tomography imaging of the thorax in female dogs with mammary tumors

Background

Accurate early diagnosis of lung metastases is important for establishing therapeutic measures. Therefore, the present study aimed to compare survey thoracic radiographs and computerized tomography (CT) scans to specifically identify lung metastases in female dogs with mammary tumors.

Methods

Twenty-one female dogs, weighing 3 to 34 kg and aged from 5 years to 14 years and 10 months, with mammary tumors were studied. In all dogs before the imaging examinations, fine-needle aspiration cytology of the mammary tumors was performed to confirm the diagnosis. Three-view thoracic radiographs were accomplished: right lateral, left lateral and ventrodorsal views. Sequential transverse images of the thorax were acquired on a spiral Scanner, before and after intravenous bolus injection of nonionic iodine contrast. Soft-tissue and lung windows were applied. All the mammary tumors were surgically removed and examined histologically.

Results

The correlation between the cytological and histological results regarding presence of malignancy was observed in only 17 cases. In radiographic examinations, no dog displayed signs of lung metastases or thorax chest lesions. CT detected lung metastasis in two cases, while small areas of lung atelectasis located peripherally were found in 28.57% of the dogs.

Conclusion

In this study population, spiral CT showed higher sensitivity than chest radiographies to detect lung metastasis; this indicates that CT should be performed on all female dogs with malignant mammary tumors.