IMAGING: RADIOGRAPHY-11*

In this paper an overview of principles involved in radiographic imaging by tomography, magnification radiography, xeroradiography, and computed tomography is presented. Tomography is a method to selectively blur distracting superimposed shadows while maintaining relative image sharpness in a plane of concern. Magnification radiography is a method to directly enlarge the radiographic image by increasing object-film distance and utilizing a small focal spot. Xeroradiography is an electrostatic imaging process that provides wide latitude and good resolution through enhanced contrast in tissues with poor inherent contrast. Computed tomography involves imaging by computer analysis of x-ray absorption utilizing rotational x-ray projections.     

COMPARISON OF GROSS AND HISTOPATHOLOGIC FINDINGS WITH QUANTITATIVE COMPUTED TOMOGRAPHIC BONE DENSITY IN THE DISTAL THIRD METACARPAL BONE OF RACEHORSES

Comparison of subchondral bone density determined by quantitative computed tomography (CT) with gross and histopathologic changes have not been made in horses. The goal of this study was to determine if mean quantitative CT density and mean voxel standard deviation are associated with the presence and severity of osteochondral lesions in the palmar aspect of the distal third metacarpal bone in racing horses. Metacarpophalangeal joints from nine racehorses were imaged using CT and scored for gross damage. Four-millimeter-thick sagittal and 30 degrees palmar dorsal plane sections were cut, decalcified and stained with hematoxylin and eosin from the distal third metacarpal bone. Microscopic osteochondral lesions and subchondral remodeling were scored on a scale of 0-3. Percent subchondral bone, expressed as the ratio of bone volume to tissue volume, was also measured. Mean quantitative CT density and mean voxel standard deviation were measured from three-dimensional models of CT images comparable with histologic sections. Mean quantitative CT density was not associated with lesion severity or number of lesions. A weak correlation between mean quantitative CT density and gross score was found, but mean quantitative CT density was not predictive for gross score. Mean voxel standard deviation was not correlated with gross or histopathologic measures, but was predictive of mild osteochondral lesions. Results support the association of subchondral remodeling with the development of palmar metacarpal lesions. However, there was not a strong correlation between mean quantitative CT density or mean voxel standard deviation and histopathologic lesions of the distal third metacarpal bone.     

DIAGNOSIS OF ARTERIOPORTAL FISTULAE IN FOUR DOGS USING COMPUTED TOMOGRAPHIC ANGIOGRAPHY

Arterioportal fistulae are rare congenital anomalies of the hepatic vasculature. Diagnosis is conventionally made by selective angiography or ultrasonography. This report describes use of a dual-phase computed tomographic (CT) angiographic technique to diagnose arterioportal fistulae in four dogs. Advantages of this method include a noninvasive peripheral injection of contrast medium, ability to diagnose multiple acquired extrahepatic shunts, and observation of hemodynamic changes such as hepatofugal blood flow and reduced circulation to the caudal abdomen. The hepatic vasculature including arteries, veins, and portal veins can be completely evaluated. Dual-phase CT angiography is a safe and minimally invasive method of diagnosing arterioportal fistulae in dogs.     

Differences between µCT‐imaging and conventional CT for the diagnosis of possible diseases of the middle and inner cat ear

The aim of this study was to check the relevance of using in‐vivo micro computed tomography (µCT) for the diagnosis of possible diseases of the middle and inner ear of the cat. Therefore, on the one hand, differences of the detail detectability between the two imaging methods conventional computed tomography (cCT) and in‐vivo µCT were analyzed. Six healthy cat ears were dissected and scanned several times and the obtained images were compared with each other. On the other hand, histological slices of all ears were prepared and pictures of defined anatomical structures were taken and compared with the identical sectional plane of the µCT‐images. This way it was possible to evaluate the quality and clinical limitations of the in‐vivo µCT. The results show that an in‐vivo µCT is suitable to analyze even the smallest osseous structures, such as the semicircular ducts, the spiral osseous lamina or the ossicles whereas with the help of cCT it is not possible to identify such small osseous structures because of their blurred and less detailed representation. Delicate soft tissue structures as the membranous labyrinth including hearing and vestibular organ cannot be differentiated with as well in‐vivo µCT‐ as with cCT‐images. In‐vivo µCT represent a good possibility for more detailed diagnosis of extremely fine structures which cannot be detected with cCT. Histological slices can nonetheless not be replaced by in‐vivo µCT due to a too low spatial resolution and the limitations of the in‐vivo µCT with regard to the evaluation of soft tissue dense structures.     

Relative skeletal distribution of proliferating marrow in the adult dog determined using 3′‐deoxy‐3′‐[18F]fluorothymidine

3′‐deoxy‐3′‐[¹⁸F]fluorothymidine (¹⁸FLT) is a radiopharmaceutical tracer used with positron emission tomography (PET), often in combination with computed tomography (CT), to image DNA synthesis, and thus, cellular proliferation. Characteristic accumulation of the tracer within haematopoietic bone marrow provides a noninvasive means to assess marrow activity and distribution throughout the living animal. The present study utilizes three‐dimensional analysis of ¹⁸FLT‐PET/CT scans to quantify the relative skeletal distribution of active marrow by anatomic site in the dog. Scans were performed on six healthy, adult (3–6 years of age), mixed‐breed dogs using a commercially available PET/CT scanner consisting of a 64‐slice helical CT scanner combined with an integrated four ring, high‐resolution LSO PET scanner. Regions of interest encompassing 11 separate skeletal regions (skull, cervical vertebral column, thoracic vertebral column, lumbar vertebral column, sacrum, ribs, sternum, scapulae, proximal humeri, ossa coxarum, and proximal femora) were manually drawn based on CT images and thresholded by standardized uptake value to delineate bone marrow activity. Activity within each skeletal region was then divided by the total skeletal activity to derive the per cent of overall marrow activity within an individual site. The majority of proliferative marrow was located within the vertebral column. Of the sites traditionally accessed clinically for marrow sampling, the proximal humerus contained the largest percentage, followed by the ossa coxarum, proximal femur, and sternum, respectively. This information may be used to guide selection of traditional marrow sampling sites as well as inform efforts to spare important sites of haematopoiesis in radiation therapy planning.     

CISTERNOGRAPHY COMBINED WITH LINEAR TOMOGRAPHY FOR VISUALIZATION OF THE PITUITARY GLAND IN HEALTHY DOGS A Comparison with Computed Tomography

Cisternography combined with linear tomography was performed in ten clinically healthy dogs (weighing 14-33 kg) to visualize the pituitary gland, and results were compared with the results from sagittal midline computed tomography (CT) in these dogs. With cisternography, the length of the pituitary gland of nine dogs ranged from 5.7 to 9.9 mm (mean ± SD, 7.9 ± 1.3), and the width from 5.4 to 8.7 mm (6.4 ± 1.0). With sagittal linear tomography following cisternography, the height of the pituitary gland of these nine dogs ranged from 4 to 6 mm (5.1 ± 0.7); and, with sagittal CT, it ranged from 4.3 to 6 mm (5.0 ± 0.6). In an 11-year-old female Greyhound, two small nodules were found at the periphery of the pituitary gland using cisternography but were not recognized on CT images. It is concluded that cisternography combined with linear tomography is a safe and accurate alternative for the visualization of the pituitary gland when CT is not available.     

CT measures of osseous cervicothoracic intervertebral foramina are repeatable and associated with CT measures of adjacent articular processes in horses

Narrowing of the equine cervicothoracic intervertebral foramina (IF) has the potential to cause forelimb lameness and/or neck pain although limited information is available on CT of the IF. The aims of this retrospective, analytical study were to describe a protocol for quantifying CT cervicothoracic IF size; evaluate the repeatability of IF size measures; test associations between IF size and adjacent articular process (AP) size, ventral extent, and anatomic location; and determine the proportion of IF with narrowing. Computed tomographic images were acquired in 20 Warmblood horses that presented with forelimb lameness and/or neck pain. All IF between C5 and T2 (n = 160) were evaluated. IF cross-sectional area (CSA), APCSA, and AP ventral extent were measured. The repeatability of IFCSA measurement was calculated. Possible associations between IFCSA and: APCSA, ventral extent, side, or location were assessed. IF narrowing was defined as more than 50% of reduction in IF height when compared with its widest part(s). The repeatability of IFCSA measurement was excellent. There was a significant association between IFCSA and: APCSA (P < 0.001; R² = 0.859; slope = −0.106), ventral extent (P = 0.022; R² = 0.161; slope = −0.0617), and location (P < 0.001; higher values between C7 and T2). The association between IFCSA and ventral extent was small. Narrowing was identified in 61 (38.1%) IF. Maximum degree of narrowing was most common at the cranial (26.3%) and middle (68.8%) third of the IF. Narrowing was not identified at T1-T2. In conclusion, CT cervicothoracic IF size can be measured with excellent repeatability, and associations were found between IF size and: AP size, ventral extent, and location.     

IMAGING DIAGNOSIS—CONGENITAL LOBAR EMPHYSEMA IN A DOG

A 14‐week‐old female West Highland White Terrier developed acute dyspnea. Radiographically there was an enlarged, hyperlucent caudal portion of the left cranial lung lobe and a diffuse, severe interstitial‐to‐alveolar pattern in the remaining lung lobes that was accentuated caudodorsally. Computed tomography confirmed the presence of the emphysematous lobe and further showed it to have focal lobar bronchial collapse. Lung lobe resection was performed, and the diagnosis was congenital lobar emphysema secondary to bronchial cartilage hypoplasia.     

COMPUTED TOMOGRAPHIC CHARACTERISTICS OF INTRAPELVIC MASSES IN DOGS

In people, the computed tomography (CT) characteristics of intrapelvic masses can be used to distinguish a malignant from a benign mass. As prognosis varies greatly between malignant and benign intrapelvic masses, knowledge of their biological behavior can aid treatment planning before surgery. The purpose of this study was to determine if CT characteristics exist to help differentiate benign from malignant intrapelvic masses in dogs. The CT images of 14 dogs with a histopathologically confirmed intrapelvic mass were evaluated. Postcontrast internal heterogeneity of the mass was the only characteristic significantly associated with malignancy (P=0.005). Preoperative CT examination of intrapelvic masses in dogs can provide prognostic information before invasive surgical treatment.     

COMPUTED TOMOGRAPHIC CHANGES ASSOCIATED WITH THE PREPATENT AND EARLY PATENT PHASE OF DIROFILARIASIS IN AN EXPERIMENTALLY INFECTED DOG

Evolution of pulmonary arterial and parenchymal changes as assessed with computed tomography (CT) is described in a dog experimentally infected with Dirofilaria immitis. The dog was imaged 125, 168, 216, and 402 days after infection. Initial changes during the prepatent phase of infection included enlargement of the peripheral caudal lobar pulmonary arteries and intermittent periarterial interstitial infiltrates. The changes were progressive, involving additional arteries over time, but remained mild. With the presence of adult filariae a filling defect was observed in the caudal lobar pulmonary artery using CT angiography. Recognizing thoracic CT findings associated with the prepatent phase of canine heartworm infection may be important in endemic areas.     

COMPUTED TOMOGRAPHY IN HORSES

Computed tomography (CT) is a valuable imaging procedure but one that requires significant technical support. Although scanners are available for veterinary use, their successful installation requires in-depth facility planning. Maintenance costs for these highly complex systems are high and may greatly exceed acquisition costs. Equipment to move anesthetized horses and support them during scanning is also expensive. Transport and scan table equipment suitable for equine CT studies are described. Clinical scan protocols used for CT of the equine skull and extremities are detailed. Precise positioning is essential for interpretable scans. Significant training in anatomy and CT physics is required for the veterinary computed tomographer.     

COMPUTED TOMOGRAPHY AND BLOOD GAS ANALYSIS OF ANESTHETIZED BLOODHOUNDS WITH INDUCED PNEUMOTHORAX

Increasingly severe degrees of pneumothorax were produced in 6 adult anesthetized bloodhounds. Computed tomography (CT) of the thorax was performed on each dog to evaluate the effects of pneumo thorax on thoracic and on pulmonary cross-sectional area (TA and PA). Arterial PO₂ (PaO₂) and PCO₂ (PaCO₂), heart rate (HR), and mean arterial blood pressure (MAP) were determined and related to the severity of pneumothorax. Volumes of air equal to 1, 1.5 and 2 times functional residual capacity of the lung produced approximately 33%, 40%, and 50% reductions in pulmonary area respectively. These amounts of atelectasis correspond to a radiographically "moderate" degree of pneumothorax. As severity of pneumothorax increased, thoracic area consistently increased, PaO₂ consistently decreased, and PaCO₂ consistently increased, with all being statistically significant relationships (p<0.0001); but HR and MAP were variable and showed no statistical correlation to the degree of pneumothorax (p>0.2).     

IMAGING DIAGNOSIS—HYPEROSTOSIS ASSOCIATED WITH MENINGIOMA IN A DOG

A 5-year-old neutered male Beagle mix dog had a 5-day history of generalized tonic-clonic seizures. Before the seizures, the dog had a 1-2-month history of progressive right hemiparesis. In computed tomography images, a presumed extraaxial mass with hyperostosis and destruction of the skull covering the mass were identified. Surgical excision was performed and the histopathologic diagnosis was meningioma. Hyperostosis is frequently associated with feline meningioma, but this report documents that hyperostosis may also occur secondary to meningioma in the dog.     

Radiographic differentiation of mediastinal versus pulmonary masses in dogs and cats can be challenging

The ability to differentiate thoracic masses of mediastinal and pulmonary origins is often confounded by their complex spatial relationship. The objectives of this retrospective, observational cross‐sectional study were to assess radiographic differentiation of mediastinal versus pulmonary masses, and to determine if there are any correlations with specific radiographic findings. Thoracic radiographs of 75 dogs and cats with mediastinal and/or pulmonary masses identified on CT were reviewed. Radiographic studies were anonymized, randomized, and reviewed twice by three reviewers. Reviewers categorized the origin of each mass(es) as mediastinal, pulmonary, or both. On the second review, the presence or absence of 21 different radiographic findings was recorded for each mass. Agreement between the radiographic and CT categorization of mass origin, as well as inter‐ and intraobserver agreement, was calculated. Overall agreement between radiographs and CT was moderate for both mediastinal (68.6%) and pulmonary masses (63%). Overall, interobserver agreement was moderate (κ = 0.50‐0.74), with moderate to strong intraobserver agreement (κ = 0.58‐0.93). Masses within the mediastinum were significantly more likely to displace other mediastinal structures. Alternatively, masses lateral to midline and in the caudal thorax were found to be significantly positively correlated with a pulmonary origin. The results of this study highlight the limitations of radiography for differentiation of mediastinal and pulmonary masses, with mass location and displacement of other mediastinal structures potentially useful for radiographic findings that may help improve accuracy.