IMAGING DIAGNOSIS—MAGNETIC RESONANCE IMAGING PULSATILITY ARTIFACT IN THE CANINE CERVICAL SPINE

Pulsatile venous flow in the internal vertebral venous plexus of the cervical spine can lead to vertical, linear T2‐hyperintensities in the spinal cord at the cranial aspect of C3 and C4 in transverse T2‐weighted images in large breed dogs that are not accompanied by ghosting. The artifact is more conspicuous in pre‐ and postcontrast transverse T1‐weighted images and is accompanied by ghosting in that sequence, typical of a pulsatility artifact. A flow‐related artifact was confirmed as the cause for this appearance by noting its absence after either exchange of phase and frequency encoding direction or by flow compensation. Care should be exercised to avoid misdiagnosing this pulsatility artifact seen in transverse T2‐weighted images of the midcervical spine in large dogs as an intramedullary lesion when T1‐images or phase‐swap images are not available to confirm its artifactual origin.     

DISCOGRAPHY AND EPIDUROGRAPHY FOR EVALUATION OF THE LUMBOSACRAL JUNCTION IN DOGS WITH CAUDA EQUINA SYNDROME

Cauda equina syndrome in the dog is a common neurologic disorder caused by compression of the spinal cord, nerve roots and spinal nerves caudal to the fifth lumbar vertebra. This paper describes the clinical signs, radiographic findings of discography and/or epidurography, and comparison with surgery or necropsy of 21 dogs with cauda equina syndrome. Discograms were performed by using a 20- or 22-gauge spinal needle introduced in a sagittal plane into the lumbosacral (LS) disc space under fluoroscopic guidance. Epidurograms were performed following discography by injecting contrast medium after repositioning the tip of the needle into the ventral epidural space at the level of the LS junction. Direct examination of the LS junction was performed in all dogs by surgical exploration and/or necropsy. On survey radiographs, the most common findings were spondylosis, malalignment of the sacrum to the last lumbar vertebra, collapse of the LS disc space, stenosis of the vertebral canal at the LS junction, and transitional vertebral segments. Discography was considered of diagnostic quality in 19/21 (90%) of the dogs, showing disc protrusion in 14/21 (67%). Epidurography was of diagnostic quality in 18/18 (100%) dogs, showing abnormal findings in 14/18 (78%). No adverse reaction was noted to the radiographic procedure when dogs were allowed to recover from anesthesia before surgery. Based on macroscopic findings, combination of survey radiographs and disco-epidurography was correctly positive in 16/18 dogs (89%). It is concluded that discography associated with epidurography is a valuable procedure for evaluation of the LS junction in the dog. A combination of both procedures reduces the possibility of technical artifacts by outlining both sides of the compressive lesion, i.e., the disc and the epidural space.     

CANINE CHEMONUCLEOLYSIS

Lumbar and cervical chemonucleolysis was evaluated on 16 clinically normal adult Beagle dogs in two age groups, using chymopapain at dose rates of 200 and 500 units (U). Lumbar discs injections in four discs were made transcutaneously under fluoroscopic guidance, and cervical disc injections in four discs were made after surgical exposure. Postinjection radiographs revealed a progressive narrowing of the disc spaces, first noted 24 hours after injection. Gross examination of the discs at 1-, 2-, 4-, and 8-day intervals showed a time-dependent change, with no detectable difference between the two doses and age groups. The overall rate of successful chemonucleolysis was 82.4% in the cervical discs and 78% in the lumbar discs. Clinically, the dogs showed minimal evidence of pain and no detectable postural abnormality following chemonucleolysis.     

A REVIEW OF IMAGING TECHNIQUES FOR CANINE CAUDA EQUINA SYNDROME

There are many imaging modalities available for evaluating the canine lumbosacral region. These include conventional radiography, stress radiography, myelography, epidurography, transosseous and intravenous venography, discography, linear tomography, computed tomography, and magnetic resonance imaging. Myelography, epidurography and discography are commonly used, but often lack sensitivity. Myelography is of little value when evaluating the cauda equina because the dural sac is elevated from the vertebral canal floor and frequently ends before the lumbosacral junction. Epidurography will identify a ventrally located compressive lesion and discography can delineate the dorsal extent of the diseased disc; however, both are sometimes difficult to interpret. Therefore, more than one of these imaging techniques must be used in order to make a diagnosis. Computed tomography and magnetic resonance imaging have become valuable in evaluating the lumbosacral region in dogs. These modalities have proven to be both sensitive and specific for determining cauda equina compression in both humans and in dogs.     

COMPUTED TOMOGRAPHIC IMAGING PROTOCOL FOR THE CANINE CERVICAL AND LUMBAR SPINE

Computed tomography (CT) has been applied previously for assessment of canine spinal disease using a multitude of different technical imaging parameters. The purpose of this study was to establish an optimized imaging protocol for the cervical and lumbar canine spine using a single-detector-row helical CT unit. Thin slice thickness (1–2 mm), low pitch (axial scan mode, helical pitch <2), and medium-frequency image reconstruction algorithm significantly improved the visibility of the intervertebral disk and spinal cord. Tube current, helical reconstruction interval, and the use of an additional edge enhancement filter had no significant effect on the visibility of the intervertebral disk and spinal cord. There was also no interaction between the use of an additional edge enhancement filter and image reconstruction algorithm. Use of an additional edge enhancement filter introduced a double ring artifact in the periphery of the spinal canal lumen that did not correspond to the spinal cord or pachymeningeal margin.     

METRIZAMIDE MYELOGRAPHY OF THE EQUINE CERVICAL SPINE

Case histories of 14 horses with pelvic limb ataxia requiring myelography were reviewed. Because differential diagnosis requires radiography, comparisons of lesion location, radiographic techniques, and lesion patterns were studied. Survey radiography and myelography were performed under general anesthesia, with recumbent-lateral and flexed-lateral views of the carnial and caudal cervical spine. Metrizamide was the myelographic contrast medium. Assessment of radiography as a diagnostic aid for cervical vertebral instability and cervical stenotic myelopathy was made through the comparison of survey radiographs and myleograms, in nonflexed and flexed positions, using these criteria: width of dorsal and ventral columns of contrast medium, compression of intervertebral disc spaces, presence or absence of bone proliferation at articular facets, remodeling secondary to vertebral instability. Radiography was an adequate diagnostic aid for cervical vertebral instability and cervical stenotic myelopathy. Distribution of lesions showed C_3–4 most common, with C_2–3 and C_4–5 following.     

PAROSTEAL OSTEOSARCOMA OF THE CERVICAL VERTEBRA IN A DOG

A 12-year-old Maltese terrier was evaluated for progressive tetraparesis and neck pain. On radiographs, there was a periosteal reaction involving the fourth cervical vertebra. Myelographically, there was extradural compression of the spinal cord associated with the lesion. The dog was euthanized and necropsied. Histopathologic diagnosis was parosteal osteosarcoma of the vertebra.     

NORMAL ULTRASONOGRAPHIC ANATOMY OF THE CANINE NECK

High-resolution, real-time ultrasonographic examinations of the neck were performed on eight normal dogs maintained under general anesthesia. Water-soluble dye was injected into imaged structures under sonographic guidance in two dogs. The anatomy of the neck was verified at postmortem by visualization of dye deposited in the injected structures. Anatomical mapping was then completed by performing complete cervical ultrasound examinations in the remaining six dogs. Normal ultrasonographic anatomy of the canine neck and major anatomic landmarks useful in clinical imaging are described.     

MAGNETIC RESONANCE IMAGING OF THE CERVICAL SPINE IN 27 DOGS

The cervical spine of 27 dogs with cervical pain or cervical myelopathy was evaluated using magnetic resonance imaging (MRI). Spin echo T1, T2, and post-contrast T1 weighted imaging sequences were obtained with a 0.5 Tesla magnet in 5 dogs and a 1.5 Tesla magnet in the remaining 22 dogs. MRI provided for visualization of the entire cervical spine including the vertebral bodies, intervertebral discs, vertebral canal, and spinal cord. Disorders noted included intervertebral disc degeneration and/or protrusion (12 dogs), intradural extramedullary mass lesions (3 dogs), intradural and extradural nerve root tumors (3 dogs), hydromyelia/syringomyelia (1 dog), intramedullary ring enhancing lesions (1 dog), extradural synovial cysts (1 dog), and extradural compressive lesions (3 dogs). The MRI findings were consistent with surgical findings in 18 dogs that underwent surgery. Magnetic resonance imaging provided a safe, useful non-invasive method of evaluating the cervical spinal cord.     

TECHNIQUE FOR ULTRASOUND‐GUIDED INTRAARTICULAR CERVICAL ARTICULAR PROCESS INJECTION IN THE DOG

Ultrasound‐guided intraarticular injection of cervical articular process joints is a well‐established procedure in both humans and horses for neck pain resulting from osteoarthritis, but the technique has not been described in dogs. Aims of this study were to describe the ultrasonographic anatomy and landmarks for cervical articular process joint injections in the dog, develop a technique for articular process joint injections using these landmarks, and determine the accuracy of injections and factors that may influence it. Eleven canine cadavers were used and bilateral joint spaces from C2–3 to C7‐T1 were injected under ultrasound guidance with a blue radiopaque solution. A computed tomographic scan was acquired following each injection, and an injection score was assigned and compared with other patient‐specific factors. Of the 132 injections performed, 110 (83.3%) were intraarticular, 20 (15.1%) were periarticular within 5 mm, and 2 (1.5%) were periarticular beyond 5 mm from the joint. There was no significant difference in mean scores between dogs. Only C2–3 had a significantly lower mean score than any other joint. There was no significant correlation between injection score and any other factors measured. The transverse processes of the cervical vertebrae served as excellent ultrasonographic landmarks for identifying the cervical articular process joints in dogs regardless of the size of the dog or location along the vertebrae. Accuracy of ultrasound‐guided intraarticular process joint injection was 83% in dogs and similar to published techniques in horses. Further studies are needed to examine the safety and efficacy of this procedure in live animals.     

MAGNETIC RESONANCE IMAGING FEATURES OF CERVICAL STENOTIC MYELOPATHY IN 21 DOGS

The cervical spine of 21 dogs with clinical signs of cervical stenotic myelopathy was evaluated using magnetic resonance (MR) imaging. Spin echo T1, T2 and gradient echo T2 weighted images were obtained with a 1.5 Tesla magnet in 12 dogs and a 1.0 Tesla magnet in 9 dogs. Sagittal or parasagittal T1W and T2W images were helpful in determining the presence of spinal cord compression or degenerative disease of the articular processes. Transverse T1W and T2W images were the most useful for the identification of dorsolateral spinal cord compression secondary to soft tissue and ligament hypertrophy, as well as synovial cysts, associated with the articular processes. The MR imaging findings were consistent with the surgical findings in all 14 dogs that underwent surgery. Magnetic resonance imaging provided a safe, non-invasive method of evaluating the cervical spine in dogs suspected of having cervical stenotic myelopathy. Veterinary     

ULTRASONOGRAPHIC EXAMINATION OF CERVICAL MASSES IN THE DOG AND CAT

The ultrasonographic appearance of clinically undifferentiated neck masses for which a definitive diagnosis was eventually obtained in nineteen dogs and one cat is presented in this report. Multiple lesions were seen ultrasonographically in 4 dogs and no cervical abnormalities were seen in 2 dogs resulting in 22 lesions in 20 annuals. Of 7 benign lesions, there were 2 patients with reactive lymph nodes from a regional inflammatory process, and 1 patient each with primary pyogranulomatous lymphadenitis, arteriovenous malformation, foreign body granuloma, cellulitis, and hematoma. Of 15 malignant lesions, 7 were thyroid carcinomas, 3 were lymphomas with submandibular and cervical lymph node enlargement, 3 were lymph node enlargements associated with regional metastasis of malignant tumors, one was a leiomyosarcoma and one was a carotid body tumor. One dog with a diffuse soft tissue swelling of the ventral cervical region had only slight asymmetry of the thyroid lobes on ultrasound examination and no abnormalities of the neck at post mortem. A second dog examined with ultrasound 4 months after surgical removal of a carotid body tumor had no evidence of tumor recurrence. Ultrasonographic examination provided information regarding the character of the lesions, the tissue or organ of origin, and invasion into other anatomic structures. Ultrasound examination in conjunction with fine needle or tissue biopsy provided a definitive diagnosis in those animals in which biopsies were performed.     

COMPARISON OF MAGNETIC RESONANCE IMAGING AND MYELOGRAPHY IN 18 DOBERMAN PINSCHER DOGS WITH CERVICAL SPONDYLOMYELOPATHY

Eighteen Doberman pinscher dogs with clinical signs of cervical spondylomyelopathy (wobbler syndrome) underwent cervical myelography and magnetic resonance (MR) imaging. Cervical myelography was performed using iohexol, followed by lateral and ventrodorsal radiographs. Traction myelography was performed using a cervical harness exerting 9 kg of linear traction. MR imaging was performed in sagittal, transverse, and dorsal planes using a 1.5 T magnet with the spine in neutral and traction positions. Three reviewers independently evaluated the myelographic and MR images to determine the most extensive lesion and whether the lesion was static or dynamic. All reviewers agreed with the location of the most extensive lesion on MR images (100%), while the agreement using myelography was 83%. The myelogram and MR imaging findings agreed in the identification of the affected site in 13-16 dogs depending on the reviewer. MR imaging provided additional information on lesion location because it allowed direct examination of the spinal cord diameter and parenchyma. Spinal cord signal changes were seen in 10 dogs. Depending on the reviewer, two to four dogs had their lesions classified as dynamic on myelography but static on MR images. Myelography markedly underscored the severity of the spinal cord compression in two dogs, and failed to identify the cause of the signs in another. The results of this study indicated that, although myelography can identify the location of the lesion in most patients, MR imaging appears to be more accurate in predicting the site, severity, and nature of the spinal cord compression.     

CERVICAL VERTEBRAL FUSION AND CONCURRENT INTERVERTEBRAL DISC EXTRUSION IN FOUR DOGS

Cervical vertebral fusion was noted radiographically in four dogs presented for signs of cervical spinal cord compression. Ventral extradural spinal cord compression was seen on myelography at intervertebral disc spaces adjacent to the fused vertebrae in two dogs and at a site removed in two dogs. At surgery, no intervertebral disc space was found in the area of fusion. No other instances of cervical vertebral fusion were identified in reviewing radiographs of 1225 other dogs with cervical intervertebral disc extrusion evaluated at our hospital. Clinical signs resolved in all dogs after surgical removal of extruded intervertebral disc material. Information from these four dogs suggest vertebral fusion may predispose adjacent discs to herniation.     

IMAGING DIAGNOSIS: CRANIAL CERVICAL INTRASPINAL SCHWANNOMA IN A DOG

A 3‐year‐old, intact female Golden Retriever was presented with acute tetraplegia. Neurologic examination was consistent with a C1–C5 myelopathy. On magnetic resonance (MR) imaging a well‐defined, extradural mass was detected within the spinal canal at the level of C1–C2. The mass was isointense to normal spinal cord gray matter on T1‐weighted (T1W) images, hyperintense on T2‐weighted (T2W), and gradient‐echo (GE) images, and enhanced homogeneously after intravenous contrast administration. MR imaging features were mainly consistent with a meningioma. Surgical treatment was refused by the owners, and the dog was euthanized. Postmortem examination demonstrated that the intraspinal mass was a schwannoma.     

SPATIAL ACCURACY OF FRACTIONATED IMRT DELIVERY STUDIES IN CANINE PARASPINAL IRRADIATION

Intensity modulated radiation therapy (IMRT) theoretically allows detailed tailoring of the dose distribution in tissue. The goal of this study was to determine if a method of dynamic IMRT could be used to deliver a high dose of radiation to a concave shaped target around the cervical spinal cord. Fifteen young adult dogs from our laboratory population were randomly divided into two groups. A radiation dose of 84 Gy in 4 Gy fractions was delivered with a conventional 4 field technique for Group A dogs, and with dynamic IMRT for Group B dogs to a "C-shaped" target close to the cervical spinal cord. Neurologic status, magnetic resonance imaging results and histopathologic changes were compared among dogs in the two groups. Group A dogs developed myelomalacia with a latency period of 65 +/- 9 days. Group B dogs did not have any histologic changes to the cervical spinal cord when euthanasia was performed 12 months after irradiation. The results demonstrate that this IMRT technique can be safely and precisely delivered to a patient in a clinical situation.     

COMPUTED TOMOGRAPHY IN THE EVALUATION OF CAUDAL CERVICAL SPONDYLOMYELOPATHY OF THE DOBERMAN PINSCHER

Caudal cervical spondylomyelopathy is a common neurologic disorder of Doberman pinschers which has a number of striking similarities to cervical spondylotic myelopathy in humans. Diagnosis of this human disease is facilitated considerably by the use of computed tomographic (CT) myelography. Sixteen Doberman pinscher dogs with caudal cervical spondylomyelopathy were studied by conventional myelography followed by CT myelography. A close correlation was noted between the CT myelographic appearance of the cervical spinal cord in these dogs, and that reported for human cervical spondylotic myelopathy. Five dogs had atrophy of the spinal cord, and in another there was an accumulation of contrast medium within the spinal cord. These features are often associated with a poor response to surgical decompression in humans with cervical spondylotic myelopathy. The CT examination provided information that could not be obtained by conventional myelography alone and should be considered as an additional diagnostic procedure in dogs with caudal cervical spondylomyelopathy.     

ULTRASOUND‐GUIDED CERVICAL CENTESIS TO OBTAIN CEREBROSPINAL FLUID IN THE STANDING HORSE

Horses with intracranial lesions and severe ataxia are not good anesthesia candidates; however, only one method to obtain cerebrospinal fluid (CSF) from the cervical region in a standing horse has been reported. This method is not performed routinely due to the difficulty for sample acquisition. Our hypothesis is that standing cervical centesis can be performed in horses without complication. Ultrasound‐guided centesis of the CSF between C1 and C2 in 11 clinically normal horses and two horses with neurologic signs were performed. Horses were sedated and ultrasound was used to identify the subarachnoid space and spinal cord between C1 and C2. With ultrasound guidance, a needle was introduced into the dorsal aspect of the subarachnoid space using a lateral approach. Ten milliliters of CSF was obtained and analyzed. Two normal horses in this study had moderate red blood cell contamination in the CSF (940 and 612 RBC/μl). One horse had 11 RBC/μl and the remaining horses had <4 RBC/μl. The total procedure time was approximately 2 min. No reaction was observed and no complications were detected up to 48 h after the procedure. Ultrasound‐guided centesis between C1 and C2 is a rapid procedure that causes minimal to no reaction in standing, sedated horses used in this study. The use of ultrasound to guide a standing C1–2 centesis of the subarachnoid space provides an additional route to obtain CSF for analysis in the equine patient.     

EX VIVO COMPUTED TOMOGRAPHIC EVALUATION OF MORPHOLOGY VARIATIONS IN EQUINE CERVICAL VERTEBRAE

Diagnostic imaging is one of the pillars in the clinical workup of horses with clinical signs of cervical spinal disease. An improved awareness of morphologic variations in equine cervical vertebrae would be helpful for interpreting findings. The aim of this anatomic study was to describe CT variations in left–right symmetry and morphology of the cervical and cervicothoracic vertebrae in a sample of horses. Postmortem CT examinations of the cervical spine for horses without congenital growth disorders were prospectively and retrospectively recruited. A total of 78 horses (27 foals, 51 mature horses) were evaluated. Twenty‐six horses (33.3%) had homologous changes in which a transposition of the caudal part of the transverse process (caudal ventral tubercle) of C6 toward the ventral aspect of the transverse process of C7 was present (n = 10 bilateral, n = 12 unilateral left‐sided, n = 4 unilateral right‐sided). There was one horse with occipito‐atlantal malformation, two horses with rudimentary first ribs bilaterally, and one horse with bilateral transverse processes at Th1, representing homeotic (transitional) vertebral changes. Chi‐square tests identified no significant differences in the number of conformational variations between the group of mature horses with or without clinical signs (P = 0.81) or between the group of mature horses and the group of foals (P = 0.72). Findings indicated that, in this sample of horses, the most frequently identified variations were homologous variations (transposition of the caudal part of the transverse process of C6–C7) in the caudal equine cervical vertebral column. Homeotic (transitional) variations at the cervicothoracic vertebral column were less common.     

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

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