XERORADIOGRAPHIC ANATOMY OF THE EQUINE DIGIT AND METACARPOPHALANGEAL REGION

The purpose of the project was to use xeroradiography to provide a reference for radiographic anatomy of the equine digit and metacarpophalangeal region. The left foredigits and metacarpophalangeal joints of a mature horse and a 30-day-old foal were radiographed, using xeroradiographic techniques. Fifteen xeroradiographs, illustrating standard projections of each area, were selected and appropriately labeled to demonstrate normal radiographic anatomy of these regions. These xeroradiographs have been used successfully for several years to teach radiographic anatomy of these areas to first-year veterinary students at North Carolina State University.     

EVALUATION OF MAGNETIC RESONANCE IMAGING TECHNIQUES IN THE EQUINE DIGIT

An anatomic study of the equine digit using magnetic resonance imaging (MRI) was performed. Seventeen isolated forelimbs and one hindleg of nine warmblood horses were imaged in transverse, sagittal, and dorsal planes with a 1.5 Tesla magnet using T1-, T2- proton density-weighted spin echo sequences as well as T2 gradient echo sequences. One scan plane in each horse was compared with corresponding anatomic and histologic sections. The best imaging planes to visualize various anatomic structures were determined. Fibrocartilage was visualized in the insertion of the deep digital flexor tendon and the suspensory ligament as well as in the distal sesamoidean ligaments. The correlation of MRI images with anatomic and histologic sections confirmed that all of the anatomic structures in the equine digit could be evaluated in PD and T2 studies.     

THE SCINTIGRAPHIC ANATOMY OF THE EQUINE SACROILIAC JOINT

The aim of this study was to describe the scintigraphic appearance and location of the sacroiliac joint (SI-joint) in dorsal and dorso 30 degree lateral views of the equine pelvis in a scintigram. The pelvis from 10 different horses was prepared by attaching plastic tubes along relevant margins of the bone and around the SI-joint. A radioactive solution was injected into the tubes, and scintigraphic images were acquired with a gamma camera. Five specific landmarks were identified on the left and right sides of the pelvis. There was no significant difference in the distance measurements between the left and right sides in the dorsal view. The SI-joint was roughly ovoid in shape, with its long axis angled to the midline. The most craniolateral point of the SI-joint (Y) was located at the middle (SD = 0.04) of a line drawn from the caudal margin of the tuber sacrale (TS) to the craniolateral margin of the tuber coxa (TC), which was called TS-TC. In 85% of the specimens, the long axis of the SI-joint (SILA) was located caudal to or intersecting TS-TC, and the mean angle between SILA and TS-TC was 16.4 degrees (SD = 5.6 degrees). The distance from the caudomedial point of the SI-joint (Z) to Y was 0.38 times (SD = 0.04) the length of TS-TC. The distance from the tuber sacrale to the medial border of the SI-joint (TS-X) was 0.15 times (SD = 0.02) the length of TS-TC. In the oblique view, the SI-joint appeared wider and was positioned more laterally compared to the dorsal view. The distance TS-Y increased to 0.61 times (SD = 0.046) TS-TC, but SILA/TS-TC was essentially unchanged. The mean angle between TS-TC and SILA increased to 20.9 degrees (SD = 5.6 degrees). TS-X increased to 0.31 times (SD = 0.037) TS-TC. The location of the SI-joint was very similar in all horses, which makes it possible to estimate the location of the SI-joint in a scintigram in which the tuber sacrale and the craniolateral margin of the tuber coxa are identified.     

ULTRASONOGRAPHY OF THE EQUINE CRUS

Ultrasonography was used to delineate the sonographic anatomy of the equine crus, emphasizing the peroneus tertius muscle and the Achilles tendon. The cross-sectional gross anatomy was studied in 6 cadaveric limbs. Using a 5.5 MHz mechanical sector scanner the examined Achilles tendon and per- oneus tertius muscle were easily identified as hyperechoic structures in 10 limbs of normal live horses. In 4 lame horses diagnostic ultrasound aided the diagnosis of peroneus tertius rupture, haematoma of the lateral digital extensor muscle and the presence or absence of Achilles tendon injury associated with intertendinous calcaneal bursitis.     

RADIOGRAPHY OF THE EQUINE THORAX: ANATOMY AND TECHNIC

Radiographic evaluation of the entire adult equine thorax in the standing position requires a minimum of four overlapping lateral radiographs. Small horses could often be studied with fewer radiographs. This basic examination provided the optimal radiographic opportunity for detecting lung diseases in the horse. An understanding of normal gross and radiographic anatomy is an absolute necessity if one is to avoid the potential diagnostic pitfalls inherent in radiographic interpretation of the equine thorax. Of equal importance is an appreciation for the technic required to produce thoracic radiographs. The advent of rare-earth intensifying screen and highspeed film systems has enhanced the opportunity for obtaining diagnostic standing lateral equine thoracic radiographs.     

ULTRASONOGRAPHY OF THE EQUINE TARSUS

Ultrasonography was used to delineate the sonographic anatomy of the equine tarsus with emphasis on the flexor tendons and plantar ligament at the plantar surface of the tarsus, the medial collateral ligaments and the dorsomedial joint capsule of the tibiotarsal joint. The cross-sectional gross anatomy of these tendons and ligaments was evaluated in 6 cadaver limbs. Using a 5.5 MHz mechanical sector scanner, the examined tendons and ligaments were easily identified as hyperechoic structures in 10 limbs of normal live horses. The normal ultrasonographic appearance of the dorsomedial tibiotarsal joint capsule was studied in 8 cadaver limbs. The inner surface of the tibiotarsal joint capsule was covered with villi; short and pointed in the mid region, resembling a small nodular mass proximally and a straggly beard distally. In 4 lame horses diagnostic ultrasound aided the diagnosis of plantar swellings, medial collateral joint ligamentous injury and hypertrophic synovitis.     

MAGNETIC RESONANCE IMAGING ANATOMY OF THE NORMAL EQUINE LARYNX AND PHARYNX

The purpose of the present study was to describe normal magnetic resonance (MR) imaging anatomy of the equine larynx and pharynx and to present the optimal protocol, sequences, and possible limitations of this examination technique. Using a 0.3 T unit, the laryngeal and pharyngeal regions was imaged in two horses. The protocol consisted of sagittal and transverse T2-weighted (T2w) fast spin echo, transverse T1-weighted (T1w) spin echo, and dorsal high-resolution T1w gradient echo (both pre- and postcontrast enhancement) sequences. Euthanasia was performed at the end of the imaging procedure. Macroscopic anatomy of the cadaver sections were compared with the MR images in transverse, midsagittal, and parasagittal planes. There was good differentiation of anatomic structures, including soft tissues. The laryngeal cartilages, hyoid apparatus, and upper airway muscle groups with their attachments could be clearly identified. However, it was not always possible to delineate individual muscles in each plane. Most useful were both T2w and T1w transverse sequences. Intravenous application of contrast medium was helpful to identify blood vessels. The MR images corresponded with the macroscopic anatomy of cadaver sections.     

ULTRASONIC ANATOMY OF THE TENDONS AND LIGAMENTS IN THE DISTAL METACARPAL-METATARSAL REGION OF THE EQUINE LIMB

In a two-phase study, ultrasound was used to delineate the normal sonographic anatomy of soft tissues of the equine distal limb. The study was limited to the soft tissues of the palmar surface of the limb just proximal to the fetlock joint. In the first phase, cadavers were evaluated with a B-mode ultrasound machine, † Then the limbs were radiographed and dissected to compare their gross, radiographic, and ultrasonographic appearances. In the second phase, nine normal adult horses were ultrasonographically scanned. The sonographic appearance of the normal animals was compared with that of the cadavers. Front and rear limbs of all horses had similar ultrasonographic appearances. Flexor tendons and the suspensory ligament were easily identified as having linear, uniformly intense ecogenicity. The borders of the digital sheath and of the proximal palmar pouch of the fetlock joint had a less organized and less intense ecogenic appearance than the flexor tendons and suspensory ligament, and they were poorly delineated unless distended with fluid. Ultrasonography was used in three lame horses and aided the diagnoses of synovial proliferation in the fetlock joint, tendosynovitis, and bowed tendon. Diagnostic ultrasonography was effective in identifying and characterizing soft-tissue structures of the distal equine limb. It is a valuable, noninvasive diagnostic aid.     

LOW-FIELD MAGNETIC RESONANCE IMAGING OF THE EQUINE TARSUS: NORMAL ANATOMY

The objective of this study was to define the normal gross anatomic appearance of the adult equine tarsus on a low-field magnetic resonance (MR) image. Six radiographically normal, adult, equine tarsal cadavers were utilized. Using a scanner with a 0.064 Tesla magnet, images were acquired in the sagittal, transverse and dorsal planes for T1-weighted and the sagittal plane for T2-weighted imaging sequences. Anatomic structures on the MR images were identified and compared with cryosections of the imaged limbs. Optimal image planes were identified for the evaluation of articular cartilage, subchondral bone, flexor and extensor tendons, tarsal ligaments, and synovial structures. MR images provide a thorough evaluation of the anatomic relationships of the structures of the equine tarsus.     

EVALUATION OF THE EQUINE DIGITAL FLEXOR TENDON SHEATH USING DIAGNOSTIC ULTRASOUND AND CONTRAST RADIOGRAPHY

This study was designed to evaluate the normal anatomy of the digital flexor tendon sheath using contrast radiography and diagnostic ultrasound. Iodinated contrast medium was injected into eight cadaver limbs and the limbs immediately frozen. Lateromedial and dorsopalmar/plantar radiographs were made. These limps were then cut transversely and proximal to distal radiographs of each slab were made. This cross sectional contrast methodology allowed the visualization of the relative size and shape of the superficial and deep digital flexor tendons as well as the potential space taken by effusions of the digital flexor tendon sheath.
The second part of the study used twelve live animals with normal digital flexor tendon sheaths. Ultrasonographic measurement of the structures of the digital flexor tendon sheath at each level were compiled. This documented the ability of diagnostic ultrasound to image: 1) the superficial and deep digital flexor tendons, 2) the proximal and distal ring of the manica flexoria , 3) the straight and oblique sesamoidean ligaments, and 4) the mesotendinous attachments to the superficial and deep flexor tendons. Iodinated contrast medium was then injected into the digital flexor tendon sheath and the ultrasonography repeated. These images were compared with those obtained from contrast radiography and prosections of twenty normal limbs. The iodinated contrast medium enhanced sonographic imaging of the structures of the digital tendon sheath, particularly the abaxial borders of the superficial digital flexor tendon branches and the mesotendinous attachments to the superficial and deep digital flexor tendons.     

ULTRASONOGRAPHY OF THE EQUINE BICIPITAL TENDON REGION: A CASE HISTORY REPORT AND REVIEW OF ANATOMY

The equine shoulder region is difficult to investigate by conventional imaging modalities. Diagnostic ultrasound has proven valuable for investigation of soft tissue injuries of the human shoulder. In a horse with shoulder lameness, the authors employed diagnostic ultrasound to augment the use of conventional radiography. A defect in the subchondral bone layer of the medial humeral tuberosity, with adjacent bony fragments were clearly identified with ultrasound. Ultrasound was used for initial evaluation of the bicipital tendon and bursa. The technique was subsequently used to follow and evaluate the post-operative condition of the proximal cranial humerus, bicipital tendon and bursa in this patient. The bicipital regions of 2 immature and 3 adult normal horses were also examined with to illustrate the normal ultrasonographic anatomy of the cranial shoulder region.     

MAGNETIC RESONANCE IMAGING OF THE EQUINE DIGIT WITH CHRONIC LAMINITIS

Chronic laminitis is a severe disease affecting the equine digit. It was hypothesized that magnetic resonance (MR) imaging would improve visualization of structures within the foot and pathology associated with chronic laminitis. This study aimed to describe the MR imaging findings in chronic laminitis, compare different pulse sequences for visualization of pathology, and to compare MR imaging with standard radiography. Twenty (10 forelimb, 10 hindlimb) cadaver limbs from 10 horses clinically diagnosed with chronic laminitis (group L) and 10 limbs without laminitis (group N) were used. Lateromedial radiographs and sagittal and transverse MR images of the foot were obtained. Radiographs and MR images were evaluated for anatomic definition and evidence of pathology. Dorsal hoof wall thickness and angle of rotation and displacement distance of the distal phalanx were measured. Comparisons were made between group L and N, forelimb and hindlimb within each horse, and MR imaging and radiography. Features consistently noted with MR images in group L, but not detected using radiography, included laminar disruption, circumscribed areas of laminar gas, laminar fluid, and bone medullary fluid. Other findings seen only on MR images included increased size and number of vascular channels, alterations in the corium coronae, and distal interphalangeal joint distension. Magnetic resonance imaging allowed better definition of laminar gas lines and P3 surface irregularity observed on radiographs. Based on measurements, group L had a greater angle of rotation, distal displacement, and dorsal hoof wall thickness than group N; forelimb hoof wall thickness was greater than hindlimb; and distal displacement and hoof wall thickness measurements were smaller using MR imaging than radiography, but had a similar pattern. It is concluded that there are features of chronic laminitis consistently observed using MR imaging and that these may be additional to features observed radiographically.     

COMPUTED TOMOGRAPHIC ANATOMY OF THE EQUINE TARSUS

The purpose of this study was to provide a detailed computed tomographic (CT) anatomic reference for the equine tarsus. CT examinations of the tarsal regions from four clinically and radiographically normal adult horses, which were euthanized for reasons not related to musculoskeletal disease, were included in the study. Limbs were removed at the level of midtibia, and 3-mm contiguous transverse CT images were obtained, starting at a level proximal to the tuber calcanei and continuing distally into the proximal metatarsus. Soft tissue and bone windows were used to image different anatomic features, including bones, joints, and various soft tissue components of the tarsus. Each transverse slice was compared with bone models and dissected specimens to assist in the accurate identification of specific structures. The results of the study consist of nine CT images of the equine tarsus. Each image incorporates labeled soft tissue and bone-window images, a directional compass indicating cranial (Cr) or dorsal (D) and lateral (L), and a reconstructed scout image indicating the level through which the transverse slice was made.     

ULTRASONOGRAPHIC ANATOMY OF THE CANINE ELBOW

To produce detailed ultrasonographic images of the soft tissue structures around the canine elbow joint, a series of greyhound cadaver limbs were scanned both intact and dissected in a water bath. Suitable transducer positions and bone landmarks are described and the ultrasonographic appearance of the lateral collateral ligament, anconeal process, triceps tendon, origin of olecranon ligament, biceps tendon insertion, medial collateral ligament, and medial coronoid process are illustrated. Improved understanding of the anatomy of the canine elbow will support clinical ultrasonography of this region.     

ANGIOGRAPHY OF THE CAPRINE DIGIT*

Digital angiography of the caprine hindlimb was done via catheterization of dorsal metatarsal artery III. Good arteriograms were consistently produced. The vascular anatomy to the digit was similar to that reported in previous bovine studies. The caprine may be of use as a model for selected ruminant foot disease.     

HOW DOES MAGNETIC RESONANCE IMAGING REPRESENT HISTOLOGIC FINDINGS IN THE EQUINE DIGIT?

Magnetic resonance (MR) imaging is increasingly used in the diagnosis of equine foot pain, but improved understanding of how MR images represent tissue-level changes in the equine foot is required. We hypothesized that alterations in signal intensity and tissue contour would represent changes in tissue structure detected using histologic evaluation. The study objectives were to determine the significance of MR signal alterations in feet from horses with and without lameness, by comparison with histopathologic changes. Fifty-one cadaver feet from horses with a history of lameness improved by palmar digital analgesia (n = 32) or age-matched control horses with no history of lameness (n = 19) were stored frozen before undergoing MR imaging and subsequent histopathological examination at standard sites (deep digital flexor tendon, navicular bone, distal sesamoidean impar ligament, collateral sesamoidean ligament, and navicular bursa). Using MR images, signal intensity and homogeneity, size, definition of anatomic margins, and relationships with other structures were described. Alterations were graded as mild, moderate, or severe for each structure. For each anatomic site examined histologically the structures were described and scored as no changes, mild, moderate, or severe abnormalities, also taking into account adhesion formation within the navicular bursa detected on macroscopic examination. Alterations in MR signal intensity were related to changes at the tissue level detected by histologic examination. A sensitivity and specificity comparison of MR imaging with histologic examination was used to evaluate the significance of MR signal alterations for detection of moderate-to-severe lesions of the deep digital flexor tendon (DDFT), navicular bone, distal sesamoidean impar ligament (DSIL), collateral sesamoidean ligament (CSL) and navicular bursa. Agreement between the MR and histologic grading was assessed for each structure using a weighted kappa agreement. Direct comparison between histology and MR imaging for individual limbs revealed that signal alterations on MR imaging did represent tissue-level changes. These included structural damage, fibroplasia, fibrocartilaginous metaplasia, and hemosiderosis in ligaments and tendons; trabecular damage, osteonecrosis, fibroplasia, cortical defects, and increased vascularity in bone; and fibrocartilage defects. MR imaging had a high sensitivity and specificity for most structures. MR imaging had high specificity for lesions of the DDFT, CSL and navicular bursa, quite high specificity for lesions of the medulla of the navicular bone and its proximal aspect, with moderate specificity for the DSIL, and distal, dorsal and palmar aspects of the navicular bone, and was sensitive for detection of abnormalities in all structures except the dorsal aspect of the navicular bone. When MR and histologic grades alone were compared, there was good agreement between MR and histologic grades for the navicular bursa, DDFT, navicular bone medulla and CSL; moderate-to-good agreement in grades of the distal and palmar aspects of the navicular bone; fair to moderate in grades of the DSIL, and poor agreement for the dorsal and proximal aspects of the navicular bone. The results of this study support our hypothesis and indicate the potential use and limitations of MR imaging for visualization of structural changes within osseous and soft tissue structures of the equine foot.     

ULTRASONOGRAPHIC ANATOMY OF THE NORMAL CANINE CALCANEAL TENDON

To provide a series of detailed ultrasonographic images of the canine calcaneal tendon, greyhound cadaver pelvic limbs were scanned with a high-resolution transducer, and images compared with dissected specimens. The three components of the calcaneal tendon are the tendons of insertion of the gastrocnemius, superficial digital flexor, and a conjoined tendon formed by tendons from the biceps femoris, semitendinosus, and gracilis. Each of these three tendons was visible in transverse ultrasound images, each measuring 2.4-3.2-mm thick at mid-calcaneal tendon. Improved understanding of the anatomy of the calcaneal tendon will support clinical ultrasonography of this region.     

TRANSCUTANEOUS ULTRASONOGRAPHIC EVALUATION OF THE AIR-FILLED EQUINE STOMACH AND DUODENUM FOLLOWING GASTROSCOPY

Gastroscopy with air insufflation was performed in 10 ponies, after which a transcutaneous ultrasound examination of the stomach and duodenum was performed immediately and at 1, 2, and 4 h postgastroscopy, and 24 h after feeding. Stomach measurements included the dorsoventral and craniocaudal dimensions, as well as the stomach depth from the skin surface and stomach wall thickness at the different time periods. Gastric wall folding was observed in one pony, becoming most distinct 2–4 h postgastroscopy. An undulating stomach wall was noted in eight other ponies postgastroscopy. These observations appeared to be a response to the deflation of the stomach as the insufflated air was released gradually. Gas was detected in the duodenum after the gastroscopy. The parameters measured were noted to be useful to evaluate the extent of stomach distension due to air or feed. The ultrasonographic appearance of the stomach can, therefore, be altered by gastroscopy and this should be borne in mind when examining horses with suspected gastric disease.     

ULTRASONOGRAPHY OF THE EQUINE LARYNX

Nasopharyngeal and laryngeal evaluation is important when examining horses with upper airway signs for poor performance. Currently endoscopy is the most common method to evaluate the equine upper airway. Ultrasonography of the equine larynx has not previously been described. Using six cadaveric specimens and four standing horses, the ultrasonographic appearance of the equine larynx was established. A scanning technique, including useful acoustic windows and the normal ultrasonographic appearance at each site, is described. Ultrasound allowed visualization of portions of the hyoid apparatus, laryngeal cartilages, associated soft tissues, and intrinsic and extrinsic laryngeal musculature, that are not seen using endoscopy. Additionally, real-time ultrasound allowed observation of the movement of the vocal folds and the arytenoid cartilages during respiration. In three horses with arytenoid chondritis, ultrasonography aided in the diagnosis and localization of arytenoid abcessation and perilaryngeal inflammation. The establishment of this technique will serve as the basis for future investigations in the evaluation of clinical patients with upper airway abnormalities.