Radiographic, scintigraphic and magnetic resonance imaging findings in the palmar processes of the distal phalanx

REASON FOR PERFORMING STUDY: Increased radiopharmaceutical uptake (IRU) in the palmar processes of the distal phalanx is recognised but its clinical significance has not been established. OBJECTIVES: To investigate the relationship between radiographic, scintigraphic and MRI findings in the palmar processes of the distal phalanx. HYPOTHESES: Increased radiopharmaceutical uptake in the palmar processes of the distal phalanx is associated with MRI abnormalities; IRU and MRI abnormalities are over-represented in lame limbs. METHODS: Clinical data, radiographic, scintigraphic and MRI findings of 258 horses with unilateral or bilateral foot pain were recorded. Scintigraphic images were assessed subjectively and using region of interest and profile analysis, and intensity of IRU graded. Alteration in signal intensity in T1 and T2 weighted and short tau inversion recovery (STIR) MR images was documented, and MRI abnormalities graded. Relationships between scintigraphic, MRI, radiographic and clinical findings were assessed. RESULTS: Focal IRU was over-represented in palmar processes with most MRI abnormalities. There was a significant correlation between IRU and MRI grades and IRU was over-represented in palmar processes with MRI Grades 2 and 3. Both IRU and MRI abnormalities occurred most frequently in the medial palmar process. MRI abnormalities were generally over-represented in lame limbs. The most common MRI abnormality was mild diffuse decreased signal intensity in T1 and T2 weighted images, which was associated with mild generalised IRU. CONCLUSIONS: There was considerable variation in the radiographic, scintigraphic and MRI appearance of palmar processes of the distal phalanx. Focal IRU in a palmar process was seen in association with MRI abnormalities and lameness or as an incidental finding. Magnetic resonance imaging abnormalities occurred more frequently in lame limbs, either contributing to lameness or as a consequence of lameness. POTENTIAL RELEVANCE: Further investigation is needed to establish the clinical significance of MRI abnormalities in the palmar processes of the distal phalanx and their relationship with lesions in adjacent structures.     

The Clinical Significance of Cerebrospinal Fluid Lipid Peroxides in Central Nervous System Disease

Forty-four dogs were referred to our hospital presenting with neurological symptoms such as seizure or paraparesis. Magnetic resonance imaging (MRI) revealed abnormal results in 21 (abnormal MRI group) and normal results in 23 dogs (normal MRI group). Cerebrospinal fluid (CSF) (normal MRI group, n = 22; abnormal MRI group, n = 21) and serum lipid peroxide (LP) concentrations (normal MRI group, n = 11; abnormal MRI group, n = 15) were measured in a number of these dogs, and revealed a significant difference in the CSF/serum LP values (normal MRI group, n = 10; abnormal MRI group, n = 14) between the abnormal and the normal MRI groups (t-test and Mann–Whitney U-test p < 0.05). No other significant differences were observed. CSF/serum LP values exceeding 1.0 were exhibited in 10 of 14 dogs (71%) in the abnormal MRI group, and in 1 of 10 dogs (10%) in the normal MRI group. In the remaining animals, 4 dogs of the abnormal MRI group showed CSF/serum values lower than 1.0, 3 dogs had morphological abnormalities but no abnormal MRI signals in the central nervous system, and 1 dog had an abnormal MRI signal but no pathological abnormality. In the CSF analysis, 3 of 16 dogs (19%) of the abnormal MRI groupshowed abnormal cell counts and/or protein content. We conclude that the CSF/serum LP value can be used for the detection of neurological lesions such as oedema, inflammation and tumour.     

Magnetic Resonance Imaging Characteristics of Necrotizing Meningoencephalitis in Pug Dogs

Background: The magnetic resonance imaging (MRI) characteristics of necrotizing meningoencephalitis (NME) are not well documented.
Objectives: To describe common MRI features of NME, to compare the MRI features to histopathologic findings, and to determine whether or not MRI lesions are predictive of survival time.
Animals: Eighteen Pugs with NME.
Methods: Retrospective MRI case study of Pugs identified by a search of medical records at 6 veterinary institutions. Eighteen dogs met inclusion criteria of histopathologically confirmed NME and antemortem MRI exam. MRI lesions were characterized and compared with histopathology with the kappa statistic. Survival times were compared with MRI findings by use of Mann-Whitney U -tests and Spearman's ρ.
Results: Twelve of 18 lesions were indistinctly marginated with mild parenchymal contrast enhancement. Prosencephalic (17/18) lesion distribution included the parietal (16/18), temporal (16/18), and occipital (16/18) lobes. There were cerebellar (4/18) and brainstem (3/18) lesions. Asymmetric lesions were present in both gray and white matter in all dogs. Falx cerebri shift was common (11/18), and 6 dogs had brain herniation. Leptomeningeal enhancement was present in 9/18 dogs. A moderate positive association was found between parenchymal contrast enhancement and both necrosis (κ= 0.45; P = .045) and monocytic inflammation (κ= 0.48; P = .025). Higher MRI lesion burden was correlated with longer time from disease onset to MRI ( P = .045). MRI lesion burden did not correlate to survival time.
Conclusions and Clinical Importance: Asymmetric prosencephalic grey and white matter lesions with variable contrast enhancement were consistent MRI changes in Pugs with confirmed NME. While not pathognomonic for NME, these MRI characteristics should increase confidence in a presumptive diagnosis of NME in young Pugs with acute signs of neurologic disease.     

Basic magnetic resonance imaging principles used for evaluating animal patients with neurologic disease.

The use of MRI in veterinary medicine is growing, because it provides excellent anatomic and pathologic detail. Acquiring a useful MRI study depends upon understanding basic MRI principles and choosing the correct pulse sequences. This article introduces the reader to principles of MRI, image contrast, and appropriate pulse sequence selection for imaging. Lastly, the article briefly describes diffusion imaging, magnetic resonance angiography, and chemical shift artifact. The fundamental topics addressed in this article are items that exotic animal practitioners using MRI should know and be able to put to immediate use.     

CT angiography and MRI imaging features do not predict the tumor type and grade of feline injection site sarcoma

Computed tomographic angiography (CTA) and magnetic resonance imaging (MRI) have been described as methods for preoperative surgical planning in cats with feline injection site sarcomas (FISS), however, few published studies have compared these modalities. The objective of this retrospective, secondary analysis study was to determine if imaging features of FISS on CTA and MRI are predictive of neoplastic peritumoral projections. Archived data from a previous prospective study were retrieved for 10 cats with FISS. All cats had been evaluated in a single anesthetic episode with MRI and dual phase CT (CTA) imaging followed by surgical removal. Histopathological grading and targeted histopathology of imaging‐identified peritumoral projections were performed. Two observers evaluated the CTA and MRI studies for FISS shape, margination, size, enhancement pattern, postcontrast uniformity, pre‐ and postcontrast margination, the number of muscles involved, mass mineralization, and bone lysis. Metal was present in the imaging field of three of 10 cats, resulting in one nondiagnostic MRI. Peritumoral projections were detected in all cats with both imaging modalities, and most were benign. At least one neoplastic peritumoral projection was detected in six cats using MRI, five cats using CTA, and three cats with both modalities. Higher grade FISS were larger than low grade using MRI, and FISS were larger using MRI. Other FISS imaging features using MRI and CTA were similar. Findings supported use of either MRI or CTA for detecting neoplastic peritumoral projections in cats with FISS. Authors recommend CTA for cats with known metallic objects in the scan field.     

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.     

Magnetic resonance imaging application to live horse for diagnosis of tendinitis

Six live horses with various stages of acute to chronic superficial digital flexor (SDF) tendinitis were examined using magnetic resonance imaging (MRI). In each case, MRI findings were compared to the corresponding ultrasonographic (USD) and histologic findings, to establish the usefulness of MRI. In the acute cases, lesions characterized by hemorrhage were well defined as high signal intensity on MRI and hypoechoic regions on USD. Chronic tendon fibrosis was slightly hyperechoic and difficult to distinguish from the normal tendon tissue around the original injury by using USD. In contrast, MRI visualized the chronic lesion as a low intensity signal, which could be distinguished from the black background of the normal SDF tendon tissue. This study clearly demonstrated MRI was the better imaging modality for the objective detection of chronic scar tissue in live horses. These findings, from living horses, suggest an advantage of MRI in the clinical application to diagnose tendinitis in cases where there is chronic scar tissue that is difficult to discern on USD.     

High field magnetic resonance imaging anatomy of feline carpal ligaments is comparable to plastinated specimen anatomy

Feline carpal ligament injuries are often diagnosed indirectly using palpation and stress radiography to detect whether there is instability and widening of joint spaces. There are currently no reports describing normal feline carpal ligament anatomy and the magnetic resonance imaging (MRI) appearance of the carpal ligaments. The objective of this prospective, anatomic study was to describe normal feline carpal ligament anatomy using gross plastinated specimens and MRI. We hypothesized that MRI could be used to identify the carpal ligaments as previously described in the dog, and to identify species specific variations in the cat. The study was conducted using feline cadaver antebrachii that were radiographed prior to study inclusion. Three limbs were selected for MRI to confirm repeatability of anatomy between cats. The proton density weighted pulse sequence was used and images were acquired in transverse, dorsal, and sagittal planes. Following MRI, the limbs were plastinated and a collagen stain was used to aid in identification of carpal ligament anatomy. These limbs were sliced in sagittal section, and a further six paired limbs were included in the study and sliced in transverse and dorsal planes. Anatomic structures were initially described using MRI and then subjectively compared with gross plastinated specimens. Readers considered the transverse MRI plane to be most useful for visualizing the majority of the carpal ligaments. Findings indicated that MRI anatomy of the carpal ligaments was comparable to plastinated anatomy; therefore MRI appears to be a beneficial imaging modality for exploration of feline carpal pathology.     

DCE‐MRI: a review and applications in veterinary oncology

Dynamic contrast enhanced magnetic resonance imaging (DCE‐MRI) is a functional imaging technique that assesses the physiology of tumour tissue by exploiting abnormal tumour microvasculature. Advances made through DCE‐MRI include improvement in the diagnosis of cancer, optimization of treatment choices, assessment of treatment efficacy and non‐invasive identification of prognostic information. DCE‐MRI enables quantitative assessment of tissue vessel density, integrity, and permeability, and this information can be applied to study of angiogenesis, hypoxia and the evaluation of various biomarkers. Reproducibility of DCE‐MRI results is important in determining the significance of observed changes in the parameters. As improvements are made towards the utility of DCE‐MRI and interpreting biologic associations, the technique will be applied more frequently in the study of cancer in animals. Given the importance of tumour perfusion with respect to tumour oxygenation and drug delivery, the use of DCE‐MRI is a convenient and powerful way to gain basic information about a tumour.     

The use of magnetic resonance imaging in the diagnosis of neurological disease

Magnetic resonance imaging (MRI) data were correlated with clinical and cerebrospinal fluid (CSF) findings in one cat and two dogs with brain lesions. In all three cases, localization of the lesions, as determined clinically, was confirmed using MRI. Magnetic resonance imaging also helped us to define the full extent of the lesion(s) in each case. In one case, the lesion would have been diagnosed as purely inflammatory based on the abnormalities in the CSF. The MRI study, however, showed a homogeneous mass with circumferential changes characteristic of peritumoral edema or inflammation. In two cases, the MRI findings were confirmed at necropsy. An MRI study was also done on a normal dog, demonstrating the variable contrast and anatomical detail possible using this technique. We also discuss difficulties in identifying tumor type using MRI.     

Magnetic resonance imaging findings in 40 dogs with histologically confirmed intracranial tumours

Magnetic resonance (MR) images of 40 dogs with histologically confirmed primary and secondary intracranial tumours were reviewed. Forty-one tumours were diagnosed by means of MR imaging (MRI). MRI findings allowed diagnosis of a neoplastic lesion in 37/41 cases. Based on MRI features, differentiation between neoplastic and non-neoplastic lesions was possible in 24/27 (89%) primary brain tumours and in 13/14 (92%) secondary brain tumours. Diagnosis of tumour type based on MRI features was correct in 19/27 (70%) primary tumours and in 13/14 secondary tumours. The results of this study show that MRI is a good diagnostic imaging modality to detect neoplastic lesions and to diagnose tumour type in dogs. However, as some neoplasms show equivocal MRI features the technique has limitations in the detection of some intracranial tumours and in predicting tumour type.     

Sectional anatomic and magnetic resonance imaging features of the head of juvenile loggerhead sea turtles (Caretta caretta)

Objective-To compare anatomic features of cross-sectional specimens with those of MRI images of the heads of loggerhead sea turtles (Caretta caretta). Animals-5 cadavers of juvenile female loggerhead sea turtles. Procedures-Spin-echo T1-weighted and T2-weighted MRI scans were obtained in sagittal, transverse, and dorsal planes with a 0.2-T magnet and head coil. Head specimens were grossly dissected and photographed. Anatomic features of the MRI images were compared with those of gross anatomic sections of the heads from 4 of these turtles. Results-In the MRI images, anatomic details of the turtles' heads were identified by the characteristics of signal intensity of various tissues. Relevant anatomic structures were identified and labeled on the MRI images and corresponding anatomic sections. Conclusions and Clinical Relevance-The MRI images obtained through this study provided valid information on anatomic characteristics of the head in juvenile loggerhead sea turtles and should be useful for guiding clinical evaluation of this anatomic region in this species.     

Magnetic resonance imaging findings and clinical associations in 52 dogs with suspected ischemic myelopathy

BACKGROUND: The magnetic resonance imaging (MRI) features of ischemic myelopathy have been described in the human literature and in a small number of cases in the veterinary literature. HYPOTHESIS: The aims of this study were to identify associations among MRI findings, timing of imaging, and presenting neurologic deficits in a large series of dogs with a presumptive diagnosis of ischemic myelopathy. ANIMALS AND METHODS: The medical records and MR images of dogs with a presumptive diagnosis of ischemic myelopathy (2000-2006) were reviewed retrospectively. Inclusion criteria were acute onset of nonprogressive and nonpainful myelopathy, 1.5-tesla MRI of the spine performed within 7 days of onset, and complete medical records and follow-up information. Presumptive diagnosis was based on history, as well as clinical, MRI, and cerebrospinal fluid (CSF) findings. The extent of the lesion on MRI was assessed as the following: (1) the ratio between the length of the hyperintense area on sagittal T2-weighted images and the length of C6 or L2 vertebral body, and (2) the maximal cross-sectional area of the hyperintense area on transverse T2-weighted images as a percentage of cross-sectional area of the spinal cord. RESULTS: Fifty-two dogs met the inclusion criteria. MRI findings were abnormal in 41 dogs and normal in 11 dogs. The presence of MRI abnormalities was not significantly associated with the timing of imaging (P = .3) but was associated with ambulatory status on presentation (P = .04). Severity of signs on presentation was associated with extent of the lesion on MRI (P = .02). CONCLUSION AND CLINICAL IMPORTANCE: The severity of signs on presentation is associated with the presence and the extent of the lesion on MRI.     

Feline hip joint anatomy in magnetic resonance images

The aim of this study was to develop an anatomical model of the feline hip joint for low‐field magnetic resonance imaging (LF‐MRI) based on high‐field magnetic resonance imaging (HF‐MRI). The study was performed on six adult clinically healthy European shorthair cats, aged 1–3 years, with body weight of 2.8–4.4 kg. The animals were examined with the use of the Vet‐MRI Grande Esaote LF (0.25 T) scanner and high‐field Siemens Magnetom TRIO (3 T) MRI scanner. In the LF‐MRI, most satisfactory results in T1‐weighted images were obtained when TE was 26 ms in all three planes and when TR was 350–950 ms in the transverse plane, 950–1150 ms in the sagittal plane and 520–750 ms in the dorsal plane. In T2‐weighted images, TE was 90 ms in the transverse and dorsal plane and 120 ms in the sagittal plane. The results were presented as images acquired with LF‐MRI scanners in three planes. The slice thickness was 3 mm for each plane. In LF‐MRI, muscles in the hip joint region and round ligament were well visualized. Unlike in LF‐MRI, the cross section of the femoral nerve was identified in HF‐MRI scans. In examinations of the feline hip joint, the main limitations of LF‐MRI were a lack of reliable contrast between articular cartilage and synovial fluid as well as longer scan time. Despite the above, LF‐MRI images were characterized by good contrast between bones and the surrounding soft tissues.     

DEEP DIGITAL FLEXOR TENDONITIS IN THE EQUINE FOOT DIAGNOSED BY LOW-FIELD MAGNETIC RESONANCE IMAGING IN THE STANDING PATIENT: 18 CASES

Injury to the distal aspects of the deep digital flexor tendon (DDFT) is an important cause of lameness in horses. The purpose of this study was to review the magnetic resonance imaging (MRI) findings of 18 horses affected by DDFT injuries in the foot. The MRI was performed with the horses standing using an open low-field (0.21 T) MRI scanner. The results were compared with those previously reported for horses using high-field MRI. Eighteen of 84 horses (21%) with undiagnosed forefoot pain were found to have lesions affecting the DDFT. The history, clinical findings and results of radiography, diagnostic ultrasonography and nuclear scintigraphy of these horses were reviewed. The duration of lameness ranged from 1 to 12 months, and the severity varied from 1/10 to 6/10. Fifteen horses had unilateral lameness (right fore in nine, left fore in six), whereas three horses were bilaterally foreleg lame. Radiological changes, considered of equivocal significance, were found in six of 18 horses. Ultrasonographic changes involving the DDFT were identified in only one of nine horses. DDFT lesions were detected in both T1- and T2-weighted MRI sequences. Four different types of lesions were identified: core lesions, sagittal splits, dorsal border lesions, and insertional lesions. Combinations of different lesion types within the same horse were common. The types and locations of the DDFT lesions were similar to those previously reported using high-field MRI. The use of low-field standing MRI avoids the necessity for general anesthesia and access to conventional high-field MRI scanners. However, studies comparing the results of standing low-field MRI with high-field MRI (and other imaging procedures) are required before the sensitivity and specificity of the technique can be assessed.     

Clinical application of multidetector computed tomography and magnetic resonance imaging for evaluation of cranial nerves in horses in comparison with high resolution imaging standards

Although horses are affected by cranial nerve disease, our understanding of these structures' imaging anatomy is limited, and the optimal modality for imaging of each of these nerves is unclear. The aim of this study was to describe the imaging appearance of the equine cranial nerves on high‐resolution 1.5T magnetic resonance imaging (MRI) and computed tomography (CT) scans of a cadaver head, and with these as standards, examine the utility of MRI and CT performed in clinical cases. High‐resolution MRI and CT images were prospectively acquired of the head of a normal Thoroughbred gelding following euthanasia. Ten clinical cases undergoing high‐field MRI under general anaesthesia and 10 clinical cases undergoing CT in the standing horse under sedation were retrospectively evaluated by three reviewers to assess cranial nerve visibility. On high‐resolution, thin‐slice, MRI scans of the normal cadaver head, each of the 12 cranial nerves and their topographic location could be appreciated. On high‐resolution cadaver CT, cranial nerves II, V and VII were clearly visible, but others were less easily identified; osseous structures were clearly visualised. Clinical MRI and CT allowed for variable visualisation of the cranial nerves, dependent on the sequence and the orientation of scan planes. High‐field MRI allowed excellent visualisation of equine cranial nerves, whereas CT allowed for more detailed visualisation of the osseous canals and foramina. In live horses, the ability to identify all 12 nerves is challenging with either MRI or CT; however, high‐field MRI enables better visualisation of the nerve bundles than CT.     

Clinical and magnetic resonance imaging findings in 92 cats with clinical signs of spinal cord disease

Medical records of 92 cats presented with clinical signs of spinal cord disease, which had undergone magnetic resonance imaging (MRI), were reviewed. The cats were grouped into seven categories based upon the diagnosis suggested by results of MRI, cerebrospinal fluid analysis and other diagnostic procedures: neoplastic (n=25), inflammatory or infectious (n=13), traumatic (n=8), vascular (n=6), degenerative (n=5), anomalous (n=3) and those with an unremarkable MRI (n=32). There were two independent predictors of abnormal MRI findings: severity of clinical signs and presence of spinal pain. Abnormal MRI findings and speed of onset of disease were significantly associated with survival. For the 32 cats with unremarkable MRI findings, only nine died due to spinal disease and, therefore, the median survival time (MST) was not reached (lower 95% confidence interval (CI)=970 days). For the 60 cats with abnormal MRI findings, 37 died due to their disease and the MST was 138 days (95% CI: 7-807).     

Standing low‐field MRI of the equine proximal metacarpal/metatarsal region is considered useful for diagnosing primary bone pathology and makes a positive contribution to case management: A prospective survey study

High‐field MRI of the proximal metacarpal/metatarsal region has been associated with great diagnostic potential and clinical reports of standing low‐field MRI of the forelimb suggest the same. To better understand diagnostic outcomes with standing low‐field MRI of the proximal suspensory region, a prospective survey study was conducted and users of a widely available system questioned on their experience, operating procedures, and interpretation of standing low‐field MRI findings. Response data included scores on a modified Likert scale from which weighted ratings were calculated for statistical analyses. Depending on the question, responses were obtained from 17 to 29 of the 38 invited facilities. Users indicated that standing low‐field MRI was most frequently performed in the face of equivocal diagnostic findings; compared to Sports horses, general purpose riding horses were thought less likely to have detectable abnormalities and standing low‐field MRI was rated most useful for the detection of primary bone pathology in the proximal metacarpal region. Standing low‐field MRI signal change involving both the suspensory ligament and adjacent bone concurrently was rated most relevant and abnormalities solely affecting the muscle/adipose tissue bundles least relevant for diagnosing suspensory ligament injury. Transverse scans and in decreasing order T1‐weighted gradient echo, short‐tau inversion recovery FSE, T2*‐weighted gradient echo, and T2‐weighted FSE sequences were most frequently acquired and judged most useful by the majority of users experienced in imaging of the target area. This survey supports the relevant impact of standing low‐field MRI on clinical case management, particularly in the context of imaging the proximal metacarpal region.     

Equine cervical intervertebral disc degeneration is associated with location and MRI features

Morphology of the equine cervical intervertebral disc is different from that in humans and small companion animals and published imaging data are scarcely available. The objectives of this exploratory, methods comparison study were (a) to describe MRI features of macroscopically nondegenerated and degenerated intervertebral discs (b) to test associations between spinal location and macroscopic degeneration or MRI‐detected annular protrusion and between MRI‐detected annular protrusion and macroscopic degeneration, and (c) to define MRI sequences for characterizing equine cervical intervertebral disc degeneration. Ex vivo MRI of intervertebral discs was performed in 11 horses with clinical signs related to the cervical region prior to macroscopic assessment. Mixed‐effect logistic regression modeling included spinal location, MRI‐detected annular protrusion, and presence of macroscopic degeneration with “horse” as random effect. Odds ratio and 95% confidence interval were determined. Reduced signal intensity in proton density turbo SE represented intervertebral disc degeneration. Signal voids due to presence of gas and/or hemorrhage were seen in gradient echo sequences. Presence of macroscopic intervertebral disc degeneration was significantly associated with spinal location with odds being higher in the caudal (C5 to T1) versus cranial (C2 to C5) part of the cervical vertebral column. Intervertebral discs with MRI‐detected annular protrusion grades 2‐4 did have higher odds than with grade 1 to have macroscopic degeneration. It was concluded that MRI findings corresponded well with gross macroscopic data. Magnetic resonance imaging of the equine cervical intervertebral disc seems to be a promising technique, but its potential clinical value for live horses needs to be explored further in a larger and more diverse population of horses.