CT-guided stereotactic brain biopsy using the Kopf stereotactic system

This report describes computed tomography (CT)-guided stereotactic brain biopsy using the Kopf stereotactic system, a commercially available patient restraint system which does not require additional modification for use in small animals. The accuracy of biopsy needle placement was determined by injecting dilute iohexol into cadaver brains and comparing the three-dimensional coordinates of the desired target location to the actual needle tract observed on postcontrast CT images. Overall mean error in needle placement in a dorsoventral trajectory was 0.9 +/- 0.9 mm (n = 80 injections) for dogs and 1.0 +/- 1.1 mm (n = 30 injections) for cats. The overall mean error in needle placement via an oblique trajectory in five dogs was 1.7 +/- 1.6 mm (n = 12 injections). These results suggest that this system can be used to successfully place a biopsy needle into the brain to obtain biopsies from small lesions.     

Accuracy testing of a new stereotactic CT -guided brain biopsy device in the dog

The accuracy testing of a new CT -guided stereotactic device was undertaken via an experimental study. Ten dog cadaver heads were submitted to a CT examination and a brain target was determined (coordinates: x1, y1, z1). 0.3 ml of a radiopaque paste was injected in this chosen point. The head was analysed twice by CT and the centre of the injection (x2, y2, z2) was measured on slices. Tridimensional statistical analysis of the variance of the two points was carried out. The procedure always led to the injection of the radiopaque paste and created an intracerebral mass which gave a measurable image on CT examination. The distance between the original target and the centre of the injection was 2.9 +/- 1.08 mm. It is concluded that this new device allows the opportunity to perform stereotactic CT -guided brain biopsy for all unknown brain lesions exceeding 6 mm in diameter in the dog.     

Imaging diagnosis--magnetic resonance imaging findings in a dog with sequential brain infarction

An adult greyhound was evaluated on three occasions for acute, intracranial neurologic signs. Based on magnetic resonance (MR) imaging, there were T2‐hyperintense and T1‐hypointense, noncontrast enhancing lesions in the cerebellum, and brain stem. Using diffusion‐weighted imaging (DWI), the lesions were characterized initially by restricted water diffusion. The presumptive diagnosis on each occasion was acute ischemic cerebrovascular accident leading to infarction. This allowed us to characterize the changes in appearance of infarcted neural tissue on the standard MR sequences over time, and to confirm that the DWI could be successfully used in low‐field imaging. © 2012 Veterinary Radiology & Ultrasound.     

Single fraction stereotactic radiation therapy (stereotactic radiosurgery) is a feasible method for treating intracranial meningiomas in dogs

The aim of this retrospective, pilot study was to evaluate stereotactic radiosurgery as a method for treating intracranial meningiomas in dogs. Included dogs had an imaging diagnosis of presumed intracranial meningioma, were treated using a standardized stereotactic radiosurgery protocol, and had a follow‐up time of >6 months after stereotactic radiosurgery. A single fraction of 16 Gy stereotactic radiosurgery was delivered to the tumor, with an internal simultaneously integrated boost to a total dose of 20–24 Gy to the central portion of the tumor. Thirty‐two dogs were sampled. One dog was euthanized in the periprocedural period, and 10 of the remaining 31 dogs (31%) experienced an acute adverse event (defined as declining neurologic function due to tumor progression or treatment‐associated complication within the first 6 months after stereotactic radiosurgery), three of which were fatal. Too few subjects (n = 6) had cross‐sectional imaging after stereotactic radiosurgery to determine an objective response rate; however, 17/30 (57%) dogs assessed for response had a perceived clinical benefit from treatment. The overall median survival time was 519 days (95% confidence interval: 330–708 days); 64% and 24% of dogs were alive at 1 and 2 years after stereotactic radiosurgery, respectively. Dogs with infratentorial tumor location and high gradient indices had shorter survival. There were no factors identified which were predictive of acute adverse event. Survival times reported herein are similar to what has previously been reported for other stereotactic and traditional fractionated radiotherapy protocols. Findings therefore supported the use of stereotactic radiosurgery as an alternative method for treating dogs with presumed intracranial meningiomas.     

A comparison of clinical,magnetic resonance imaging and pathological findings in dogs with gliomatosis cerebri,focusing on cases with minimal magnetic resonance imaging changes‡

The primary study objective was to determine whether clinical examination and magnetic resonance imaging (MRI) can underestimate canine gliomatosis cerebri (GC); we also investigated immunohistochemical features. Seven dogs with GC were studied; four recruited specifically because of minimal MRI changes. Neuroanatomic localization and the distribution of MRI, gross and sub‐gross lesions were compared with the actual histological distribution of neoplastic cells. In six cases, clinical examination predicted focal disease and MRI demonstrated a single lesion or appeared normal. Neoplastic cells infiltrated many regions deemed normal by clinical examination and MRI, and were Olig2‐positive and glial fibrillary acid protein‐negative. Four dogs had concurrent gliomas. GC is a differential diagnosis for dogs with focal neurological deficits and a normal MRI or a focal MRI lesion. Canine GC is probably mainly oligodendrocytic. Type II GC, a solid glioma accompanying diffuse central nervous system neoplastic infiltration, occurs in dogs as in people.     

Conventional and functional magnetic resonance imaging features of late subacute cortical laminar necrosis in a dog

Cerebral cortical laminar necrosis (CLN) is a consequence of severe hypoxic, ischemic, or hypoglycemic events. In humans, these cortical lesions show characteristic linear T1‐weighted (T1W) hyperintensity in the late subacute stage. Limited information reporting magnetic resonance imaging (MRI) findings in dogs affected by CLN is available. A 3‐year‐old Belgian Shepherd dog was referred 8 days after sudden onset of blindness after general anesthesia. Neurological examination showed central blindness and mild ataxia. Three‐Tesla MRI examination of the brain revealed bilateral asymmetrical areas of T2‐weighted hyperintensity within the occipital, parietal, temporal, and frontal cortex, involving gray and white matter. Furthermore, linear T1W‐hyperintense lesions were found in the cerebral cortex of the same areas and showed heterogeneous contrast enhancement. Perfusion‐weighted images revealed hyperperfusion in the affected regions. Lesions were compatible with subacute CLN with corresponding edema suspected to be secondary to anesthesia‐related brain hypoxia. Three‐Tesla MRI enabled identification of the laminar pattern of the cortical lesions.     

Sequential magnetic resonance imaging changes after suspected global brain ischaemia in a dog

Sequential magnetic resonance imaging studies over a period of 18 months were performed in a two-year-old pug dog after suspected global brain ischaemia following an anaesthetic accident. The dog was presented with seizures and neurological deficits consistent with a left brainstem and multifocal/diffuse forebrain lesion after an asymptomatic interval of 72 hours following the ischaemic event. Magnetic resonance imaging scans were performed three hours, six weeks, seven and 18 months after the incident. In the acute stage, signal hyperintensity was evident in the occipital and parietal regions of the cerebral cortex and in both rostral caudate nuclei. Slight involvement of the white matter was also noticed. In the chronic phase, the signal hyperintensity in the affected areas of the cortex was diminished and smaller in size, whereas the white matter did not appear to be compromised anymore.     

Stereotactic CT-guided brain biopsy in the dog

This study evaluated the accuracy of a new stereotactic CT-guided brain biopsy (SCTGBB) device on 23 client-owned dogs which presented with a brain lesion. Biopsy of the lesion was achieved in 95 per cent of cases. The target tissue was not sampled in one dog. Complications were observed in six dogs. Two dogs with highly vascularised brainstem tumours died after SCTGBB. Minor complications (slight variation in the neurological status) were observed in a further four cases. A diagnosis was reached in 16 dogs after cytological examination and in 21 dogs after histological evaluation. SCTGBB is an accurate diagnostic method for the diagnosis of brain lesions.     

Myxosarcoma in the eye and brain in a dog

A male mixed breed dog of unknown age was presented with sudden onset of blindness and a slightly exophthalmic right eye. Ophthalmoscopically, a spherical, pinkish mass protruding from the region of the optic disc into the vitreous was seen in the right eye. Ultrasound and computer tomography demonstrated an extension of the mass into the right retrobulbar space, continuing intracranially to the optic chiasm. Cytologic findings, obtained by ultrasound-guided fine needle aspiration from the retrobulbar space, were consistent with myxosarcoma. On the basis of these findings of a well-delineated mass in the brain stem area, irradiation was planned as the therapy of choice. The dog was treated under general anesthesia using a proton beam at the Paul Scherrer Institute (PSI, Villigen, Switzerland). A curative protocol (56 Gy in 16 fractions over 4 weeks, 3.5 Gy/fraction) was used. Twenty-seven days post radiation therapy the dog was euthanized, as clinical symptoms progressed. Enlargement of the intracranial tumor was seen on a CT study repeated on the day of euthanasia. A gross pathologic and histologic examination were performed and confirmed the diagnosis of a myxosarcoma involving the eye, retrobulbar space of the right side, and the optic chiasm. Post-mortem examination failed to identify any abnormalities or metastases elsewhere in the body.     

MRI features of gliomatosis cerebri in a dog

The features of gliomatosis cerebri involving the brainstem and cerebellum in a 3-year-old dog are described. In magnetic resonance (MR) images, there was diffuse loss of the cerebellar folia and cerebellar gray and white matter contrast. Multiple illdefined T2-hyperintensities were present in the cerebellar parenchyma. A poorly defined, T2-hyperintense mass effect was present ventral to the pons and rostral medulla. No contrast enhancement was noted. Cerebrospinal fluid (CSF) was normal. Postmortem examination was consistent with gliomatosis cerebri, based on compatible histopathology and immunohistochemical findings. Although rare, gliomatosis cerebri should be included as a differential for diffuse infiltrative central nervous system (CNS) lesions.     

Brain proton magnetic resonance spectroscopy findings in a Beagle dog with genetically confirmed Lafora disease

Cortical atrophy has been identified using magnetic resonance imaging (MRI) in humans and dogs with Lafora disease (LD). In humans, proton magnetic resonance spectroscopy (1HMRS) of the brain indicates decreased N-acetyl-aspartate (NAA) relative to other brain metabolites. Brain 1HMRS findings in dogs with LD are lacking. A 6-year-old female Beagle was presented with a history of a single generalized tonic-clonic seizure and episodic reflex myoclonus. Clinical, hematological, and neurological examination findings and 3-Tesla MRI of the brain were unremarkable. Brain 1HMRS with voxel positioning in the thalamus was performed in the affected Beagle. It identified decreased amounts of NAA, glutamate-glutamine complex, and increased total choline and phosphoethanolamine relative to water and total creatine compared with the reference range in healthy control Beagles. A subsequent genetic test confirmed LD. Abnormalities in 1HMRS despite lack of changes with conventional MRI were identified in a dog with LD.     

Safety and feasibility of stereotactic radiotherapy using computed portal radiography for canine intracranial tumors

Stereotactic radiotherapy is a highly conformal treatment option for intracranial and extracranial malignancies. Stereotactic radiotherapy utilizes specialized equipment specifically designed to avoid normal tissue while delivering ablative treatments with submillimeter precision and accuracy. Linear accelerator based stereotactic radiotherapy incorporates on‐board image guidance utilizing cone beam computed tomography (CT). Many institutions lack the ability to provide image guidance with cone beam CT but delivery of highly conformal treatments with submillimeter precision and accuracy is still feasible. The purpose of this retrospective, pilot study was to describe clinical outcomes for a group of dogs with neurological disease that were treated with an stereotactic radiotherapy technique utilizing intensity modulated radiation therapy, megavoltage computed portal radiography, a bite plate, thermoplastic mold, and mask based positioning system. Twelve dogs with neurological clinical signs were included. The diagnosis of intracranial tumor was made based on advanced imaging (12/12) and confirmed via histopathology (3/12). Twelve courses of stereotactic radiotherapy, utilizing three fractions of 8.0 Gy, were delivered on alternating days. Self‐resolving neurological deterioration was observed in two patients during stereotactic radiotherapy. Neurological progression free interval and median survival time were 273 days (range: 16–692 days) and 361 days (range: 25–862 days). Stereotactic radiotherapy using computed portal radiography may be a safe treatment option for dogs with intracranial tumors.     

Magnetic resonance and computed tomography imaging of a carotid body tumor in a dog

A 5-year-old castrated male Labrador Retriever was presented to a referring veterinarian for a swelling in the neck region. Based on the results of histopathology, a carotid body tumor, was diagnosed. The dog was referred to a medical imaging unit for further staging and follow up. This report describes the magnetic resonance (MR) and computed tomographic (CT) appearance of a carotid body tumor.     

The localization of a conjunctivoscleral foreign body via high‐resolution microscopy coil magnetic resonance imaging in a dog

A 3‐year‐old French bulldog was presented to the ophthalmology service of the Vetsuisse Faculty, University of Zurich with a 3‐day history of conjunctival swelling of the left eye (OS). Ophthalmologic examination revealed a moderate conjunctival hyperemia and chemosis. A migrating foreign body having entered the conjunctival fornix behind the nictitating membrane was suspected. Within the first 24 hours of medical management, OS developed a panuveitis and a scleral perforation was highly suspected. Ocular and orbital ultrasound as well as conventional magnetic resonance imaging (MRI) examinations failed to confirm the presence of a perforating foreign body. A High‐Resolution MRI (HR‐MRI) using a microscopy coil was then performed with findings consistent with a perforating and migrating foreign body. A grass awn of 12 mm length was surgically retrieved “ab externo” from its’ point of entry into the sclera. To the best of our knowledge, HR‐MRI has not yet been used to examine canine eyes. This case report supports the idea that orbital imaging can be greatly enhanced with the introduction of HR‐MRI using microscopy coils with clinically relevant implications.     

Evaluation of magnetic resonance imaging for the differentiation of inflammatory,neoplastic, and vascular intradural spinal cord diseases in the dog

Magnetic resonance imaging (MRI) is a common test for dogs with suspected intradural spinal cord lesions, however studies on diagnostic performance for this test are lacking. Objectives of this multi‐institutional, retrospective, case‐control study were to estimate sensitivity and specificity of MRI for (1) distinguishing between histopathologically confirmed intradural spinal cord disease versus degenerative myelopathy in dogs, (2) categorizing intradural spinal cord diseases as neoplastic, inflammatory, or vascular; and (3) determining tumor type within the etiologic category of neoplasia. Additional aims were to (1) determine whether knowledge of clinical data affects sensitivity and specificity of MRI diagnoses; and (2) report interrater agreement for MRI classification of intradural spinal lesions. Cases were recruited from participating hospital databases over a 7‐year period. Three reviewers independently evaluated each MRI study prior to and after provision of clinical information. A total of 87 cases were sampled (17 degenerative myelopathy, 53 neoplasia, nine inflammatory, and eight vascular). Magnetic resonance imaging had excellent (>97.6%) sensitivity for diagnosis of intradural spinal cord lesions but specificity varied before and after provision of clinical data (68.6% vs. 82.4%, P = 0.023). Magnetic resonance imaging had good sensitivity (86.8%) and moderate specificity (64.7–72.5%) for diagnosing neoplasia. Sensitivity was lower for classifying inflammatory lesions but improved with provision of clinical data (48.1% vs. 81.5%, P = 0.015). Magnetic resonance imaging was insensitive for diagnosing vascular lesions (25.0%). Interrater agreement was very good for correctly diagnosing dogs with intradural lesions (? = 0.882–0.833), and good (? = 0.726–0.671) for diagnosing dogs with neoplasia.