Structure-related echoes in ultrasonographic images of equine superficial digital flexor tendons

OBJECTIVE: To develop a method to discriminate between structure-related echoes and echoes resulting from interference, as observed in transverse ultrasonographic images of equine superficial digital flexor (SDF) tendons. SAMPLE POPULATION: 2 normal (injury-free) SDF tendons obtained from a 3-year-old Thoroughbred and a 9-year-old Dutch Warmblood horse. PROCEDURE: Tendons were mounted in a custom-made device that permitted exact transverse and perpendicular sequential scanning with precise steps of 0.5 mm along the long axis of the tendon. Photographs of transverse tendon sections at the exact scanning locations were obtained. Propagation, reflection, and refraction artifacts were quantified, and an image rectification procedure was developed, allowing exact matching of each photograph with the corresponding ultrasonographic image. A correlation routine was developed that departed from this transverse ultrasonographic image (position 0); this routine added information from images collected at precise distances of 0.5 and 1 mm on both sides of the actual scan location (positions -2, -1, +1, +2). RESULTS: By use of the correlation routine, echoes that remained steady over all 5 images were enhanced and resolved, and constantly changing echoes were multiplicatively reduced and faded. This correlated image could be projected over the rectified photograph, and the resolved echoes matched perfectly with the endotendon septa surrounding fibers and fasciculi. CONCLUSIONS AND CLINICAL RELEVANCE: The correlation routine permits exclusive resolution of structure-related echoes, as echoes resulting from interference are faded. The technique described can produce images that depict only the essential structure-related information. In this way, the clinical assessment of tendon integrity is greatly facilitated.     

RELEVANCE OF SONOGRAPHIC ARTIFACTS OBSERVED DURING IN VITRO CHARACTERIZATION OF UROCYSTOLITH MINERAL COMPOSITION

Nine pure mineral type canine uroliths (bladder or urethral origin only) were imaged ultrasonographically using 3.5 MHz, 5.0 MHz, and 7.5 MHz fixed focus, mechanical sector transducers in a urinary bladder phantom. The uroliths studied were those composed of 100% magnesium ammonium phosphate, calcium oxalate monohydrate, calcium oxalate dihydrate, calcium phosphate appatite, and calcium hydrogen phosphate dihydrate (brushite), ammonium acid urate, sodium acid urate, cystine, and silica. The occurrence of both reverberation/streak and acoustic shadowing artifacts were compared to urocystolith mineral type (classified by effective atomic number), urocystolith width, urocystolith height (thickness), and ultrasonographic imaging frequency. No predictable relationship was found between either of the artifacts seen beyond the urocystolith (reverberation/streak or the acoustic shadowing) and urocystolith mineral type. There was no statistical relationship between the occurrence of reverberation/streak artifact and the size (width or height) of the urocystolith or the ultrasonographic frequency. There was, however, a statistically relevant relationship between ultrasonographic imaging frequency and the occurrence of acoustic shadowing and between urocystolith height (thickness) and the occurrence of acoustic shadowing. However, regardless of ultrasound frequency, acoustic shadowing was observed less than 35% of the time in any of the urocystolith mineral types examined. Based on the imaging of the bladder phantom supporting apparatus (7.0 mm bolts covered by plastic), the accurate characterization of a curved object surface directly facing the transducer was found to be directly related to the frequency of sound used for imaging and at best predictably limited to curved vs flat. Accurate measurement of the maximum transverse dimension of an echogenic curved object or accurate characterization of the lateral borders of such an object was considered unlikely with general ultrasonographic equipment of the frequencies studied. Therefore, detailed architectural characterization of urocystoliths suitable for mineral composition prediction is considered highly unlikely with general pulse-echo ultrasonographic techniques.     

Lung ring-down artifact as a sign of pulmonary alveolar-interstitial disease

Three dogs with presumptive cardiogenic pulmonary edema underwent a thoracic ultrasonographic examination. Multiple ring-down artifacts involving both sides of the thorax emanating from the pleural-lung interface were detected. When clinical and radiographic signs of pulmonary edema were resolved, ring-down artifacts were not observed. The ring-down artifact may be a useful diagnostic sign for screening the lung of animals with acute respiratory distress where radiographs are not feasible.     

DIGITAL RADIOGRAPHY ARTIFACTS

Radiographic artifacts may mimic a clinical feature, impair image quality, or obscure abnormalities. With the development of digital radiography (DR), a new set of artifacts is introduced. Regardless of the technology, the classic technical errors that occur with film screen radiography still occur using DR. Artifacts created using computed radiography, DR, and incorrect image processing are discussed. Methods for correction of the artifacts are presented.     

Postoperative susceptibility artifact during magnetic resonance imaging of the vertebral column in two dogs and a cat.

In humans that have undergone cervical diskectomy, magnetic susceptibility artifacts are often found on postoperative magnetic resonance (MR) images of the affected region. In some patients, these artifacts complicate image interpretation, while in others the artifacts lead to a false diagnosis of spinal cord compression. We describe two dogs and one cat that had susceptibility artifacts visible in postoperative MR images. In each patient, multiple, small-to-large, distinct, magnetic susceptibility artifacts were visible along the surgery site. In both dogs, interpretation was impossible and subsequently computed tomography (CT) was performed. During CT, no cause for the MR artifact was identified. The most likely source of the artifact is microscopic metal fragments from the burr, suction tip or other surgical instruments, but other possible causes include hemorrhage or paramagnetic suture material. These artifacts may cause difficulty in interpretation or suggest a clinical problem. MR imaging therefore might not be the most appropriate examination for patients following certain types of surgery due to the possibility of susceptibility artifacts. Although this artifact probably is common in the postoperative patient, the frequency that this finding will prevent accurate diagnosis is unknown.     

Artifacts in digital radiography

Digital radiography is becoming more prevalent in veterinary medicine, and with its increased use has come the recognition of a number of artifacts. Artifacts in digital radiography can decrease image quality and mask or mimic pathologic changes. They can be categorized according to the step during which they are created and include preexposure, exposure, postexposure, reading, and workstation artifacts. The recognition and understanding of artifacts in digital radiography facilitates their reduction and decreases misinterpretation. The purpose of this review is to name, describe the appearance, identify the cause, and provide methods of resolution of artifacts in digital radiography.     

Repeatability of diagnostic ultrasonography in the assessment of the equine superficial digital flexor tendon

A quantitative investigation of the variation that can occur during the course of ultrasonography of the equine superficial digital flexor tendons (SDFT) was undertaken. The aim of this investigation was to use an objective measure, namely the measurement of CSA, to quantify the variability occurring during the course of the ultrasonographic assessment of the equine SDFT. The effects of 3 variables on the CSA measurements were determined. 1) Image acquisition operator (IAc): two different operators undertaking the ultrasonographic examination; 2) image analysis operator (IAn): two different operators undertaking the calculation of CSA values from previously stored images; and 3) analytical equipment (used during CSA measurement) (IEq): the use of 2 different sets of equipment during calculation of CSA values. Tendon cross-sectional area (CSA) measurements were used as the comparative variable of 3 potential sources: interoperator, during image acquisition; interoperator, during CSA measurement; and intraoperator, when using different analytical equipment. Two operators obtained transverse ultrasonographic images from the forelimb SDFTs of 16 National Hunt (NH) Thoroughbred (TB) racehorses, each undertaking analysis of their own and the other operator's images. One operator undertook analysis of their images using 2 sets of equipment. There was no statistically significant difference in the results obtained when different operators undertook image acquisition (P>0.05). At all but the most distal level, there was no significant difference when different equipment was used during analysis (P>0.05). A significant difference (P<0.01) was reported when different operators undertook image analysis, one operator consistently returning larger measurements. Different operators undertaking different stages of an examination can result in significant variability. To reduce confounding during ultrasonographic investigations involving multiple persons, one operator should undertake image analysis, although different operators may undertake image acquisition.     

Ultrasonographic-anatomic correlation and imaging protocol for the spleen in anesthetized dogs

Sonographic and/or anatomic observations were made of the spleen in 27 dogs. Anatomic studies were used to establish precise correlations between the gross anatomic features of the organ and its ultrasonographic image. In 8 anesthetized dogs, ultrasonographic images of the spleen were made in dorsal, transverse, and sagittal planes. When it was incident to the ultrasonic beam, the splenic capsule was represented by a fine echogenic line that defined the boundaries of the organ. The splenic substance had a uniformly mottled echogenicity apart from the anechoic lumen of the splenic venous rami, which were detected at and near the hilus of the spleen. Less regularly, splenic arterial rami were detected at the hilus, but not within the splenic substance. Dorsal and transverse images were made with the ultrasonic transducer perpendicular to the left thoracic and abdominal wall at the 11th intercostal space and caudoventrad to it. Sagittal images were produced with the transducer's face directed craniad, placed parallel to the left lateral abdominal wall, and pushed under the costal arch. The adoption of such an ultrasonographic imaging protocol ensures that all of the spleen is inspected. A definitive opinion can then be given as to whether the spleen is normal or abnormal. Pathologic changes in the spleen must also be differentiated from changes in adjacent organs or structures.     

Comparative sonographic appearance of nephroliths and associated acoustic shadowing artifacts in conventional vs. spatial compound imagingm

Spatial compound sonography improves visualization of tissue details and allows clearer delineation of structural margins. Improved image clarity is due to reduced speckling artifact; however, other types of acoustic shadowing artifacts may be unchanged or variably altered when conventional and spatial compound sonographic images are compared. Because intrarenal distal shadowing artifacts in conventional sonographic images are oftentimes the first or only evidence that a nephroliths is present, we compared the appearance and associated artifacts of nephroliths examined with both imaging modes. Consensus evaluation by two evaluators confirmed differences in appearance of nephroliths based on imaging mode. Nephroliths with conventional imaging mode were less hyperechoic and had better margin delineation while nephroliths were more hyperechoic and had less distinct margins with spatial compound imaging mode. Distal acoustic shadowing artifacts were present in 43% of spatial compound imaging mode vs. 86% of conventional imaging mode. When present in both imaging modes, intensity of these artifacts was weaker and the distance traveled was shorter in spatial compound imaging mode. Multiple diverging acoustic shadowing artifacts originating from a single source, the nephroliths were occasionally noted in spatial compound but not conventional imaging mode. These results demonstrate that the absence of distal acoustic shadowing cannot be used to exclude the presence of a nephrolith in dogs and cats. Optimal diagnosis of nephroliths, margin delineation, and visualization of the distal renal parenchyma requires paired radiography and sonography, and alternating between sonographic imaging modes is therefore suggested.     

ULTRASONOGRAPHIC EVALUATION OF EQUINE TENDONS: A QUANTITATIVE IN VITRO STUDY OF THE EFFECTS OF AMPLIFIER GAIN LEVEL, TRANSDUCER-TILT, AND TRANSDUCER-DISPLACEMENT

The objective of the in vitro experiments described in this paper was to quantify the effects of some instrumental variables on the quantitative evaluation, by means of first-order gray-level statistics, of ultrasonographic images of equine tendons. The experiments were done on three isolated equine superficial digital flexor tendons that were mounted in a frame and submerged in a waterbath. Sections with either normal tendon tissue, an acute lesion, or a chronic scar, were selected. In these sections, the following experiments were done: 1) a gradual increase of total amplifier gain output subdivided in 12 equal steps; 2) a transducer tilt plus or minus 3 degrees from perpendicular, with steps of 1 degree; and 3) a transducer displacement along, and perpendicular to, the tendon long axis, with 16 steps of 0.25 mm each. Transverse ultrasonographic images were collected, and in the regions of interest (ROI) first-order gray-level statistics were calculated to quantify the effects of each experiment. Some important observations were: 1) the total amplifier gain output has a substantial influence on the ultrasonographic image; for example, in the case of an acute lesion, a low gain setting results in an almost completely black image; whereas, with higher gain settings, a marked "filling in" effect on the lesion can be observed; 2) the relative effects of the tilting of the transducer are substantial in normal tendon tissue (18%) and chronic scar (12%); whereas, in the event of an acute lesion, the effects on the mean gray level are dramatic (40%); and 3) the relative effects of displacement of the transducer are small in normal tendon tissue, but on the other hand, the mean gray-level changes 7% in chronic scar, and even 20% in an acute lesion. In general, slight variations in scanner settings and transducer handling can have considerable effects on the gray levels of the ultrasonographic image. Furthermore, there is a strong indication that this quantitative method, as far as based exclusively on the first-order gray-level statistics, may be not discriminative enough to accurately assess the integrity of the tendon. Therefore, the value of a quantitative evaluation of the first-order gray-level statistics for the assessment of the integrity of the equine tendon is questionable.     

Contrast-enhanced ultrasonography (CEUS) in canine liver examination

Ultrasonography is a noninvasive diagnostic tool used to image size, shape, parenchyma and vascularization of various body organs. Unfortunately, the ultrasonographic image is characterized by a low contrast due to similar acoustic properties of the soft tissue. The Doppler mode provides information about blood flow, but is incapable of imaging small vessels and capillaries because of their low blood flow velocity (1 mm/s). However, a possibility to increase the effectiveness of ultrasonographic diagnostics exists, thanks to intravenous ultrasound contrast agents (UCAs) consisted of gas microbubbles. The purpose of this review paper is to characterize specific imaging techniques necessary to conduct a contrast-enhanced liver examination and indications for CEUS as an alternative diagnostic method.     

Relationships between ultrasonographic image attributes, histomorphology and proliferating cell nuclear antigen expression of bovine antral follicles and corpora lutea ex situ.

The aim of this study was to examine the relationships between quantitative ultrasonographic image characteristics, histological attributes and cell proliferating ability of bovine antral follicles and corpora lutea (CL) ex situ. Bovine ovaries (n = 30) from animals at various reproductive states (metoestrus-early dioestrus, n = 8; mid-dioestrus, n = 12; oestrous phase of peripubertal heifers, n = 6; and pregnancy, n = 4) were collected at the slaughterhouse. High-resolution ultrasonographic images of the ovaries were obtained in the water bath, digitized and subjected to computerized image analyses. The analyses utilized line and spot techniques designed to determine pixel values of the follicular wall (the largest follicles >2 mm in diameter in each ovary) and CL, respectively. Individual ovarian structures were dissected and processed for histology and immunohistochemical detection of proliferating cell nuclear antigen (PCNA). The mean follicular diameter was negatively correlated with total cell density (r = -0.45, p < 0.05), granulosa layer thickness (r = -0.67, p < 0.001) and the percentage of PCNA-positive cells (r = -0.57, p < 0.001). Numerical pixel values and heterogeneity of the follicular wall were positively correlated with total cell density (r = 0.42, p < 0.05 and r = 0.62, p < 0.05; respectively), granulosa layer thickness (both r = 0.39, p < 0.05), and the percentage of PCNA-positive cells (r = 0.54, p < 0.01 and r = 0.69, p < 0.001, respectively). Estimates of cell density and proliferating cell index were not correlated with the ultrasonographic image attributes of CL. We conclude that follicular size and echotextural variables, as determined by computer-assisted image analysis of ovaries ex situ, are reliable markers of the histophysiological properties of bovine antral follicles, but the ultrasonographic characteristics are not indicative of cell density and proliferation in the bovine CL.     

Advances in diagnostic ultrasonography

A wide variety of ultrasonographic equipment currently is available for use in equine practice, but no one machine is optimal for every type of imaging. Image quality is the most important factor in equipment selection once the needs of the practitioner are ascertained. The transducer frequencies available, transducer footprints, depth of field displayed, frame rate, gray scale, simultaneous electrocardiography, Doppler, and functions to modify the image are all important considerations. The ability to make measurements off of videocassette recorder playback and future upgradability should be evaluated. Linear array and sector technology are the backbone of equine ultrasonography today. Linear array technology is most useful for a high-volume broodmare practice, whereas sector technology is ideal for a more general equine practice. The curved or convex linear scanner has more applications than the standard linear array and is equipped with the linear array rectal probe, which provides the equine practitioner with a more versatile unit for equine ultrasonographic evaluations. The annular array and phased array systems have improved image quality, but each has its own limitations. The new sector scanners still provide the most versatile affordable equipment for equine general practice.     

LHRH Fusion Protein Immunization Alters Testicular Development, Ultrasonographic and Histological Appearance of Ram Testis

This study was designed to evaluate the effectiveness of a luteinizing hormone releasing hormone (LHRH) fusion protein immunization on reproductive traits in ram lambs including the changes in histology and ultrasonographic appearance of testis. Thirty native ram lambs at 19 weeks of age were divided into control (C, n = 10), immunization (I, n = 10) and castration (E, n = 10) groups. Animals in immunization group were immunized against LHRH using ovalbumin‐LHRH‐7 (OL) protein generated by recombinant DNA technology as a primary and a booster injection at 19 and 23 weeks of age respectively. Animals were bled via jugular venepuncture at 2‐week intervals to determine LHRH antibody and testosterone concentrations. Bi‐weekly ultrasonographic examination of the testes was performed to determine the changes in ultrasonographic appearance as the age increased. Biopsied testicular tissues taken at 19, 29 and 41 weeks age were also evaluated. At 41 weeks of age, animals were slaughtered. Semen and epididymis were evaluated for the presence of sperm cells. Testicular development and sperm production were suppressed in the immunized animals. Semineferous tubule diameters decreased, basal membrane of the tubule was thickened and hyalinized in immunized ram lambs. While testes of control animals gained their normal ultrasonographic appearance as the age increased, immunized animals had uniform hypoechogenic testicular structure as observed at 19 weeks of age until slaughter. Simultaneous histological and ultrasonographic evaluations indicated that the changes in testicular histology could partly be monitored via ultrasonographic imaging. Nevertheless, it is difficult to claim that ultrasonographic image reflects the exact changes in such instances. In conclusion, these results indicate that recombinant OL fusion protein is effective in immunocastration in ram lambs and has a potential to be used as an alternative to physical castration. Further research studies should be conducted to help assess reproductive status of testes from ultrasound images.     

Ultrasonographic appearance of the bovine uterus during the estrous cycle

The uteri of 22 Holstein heifers were monitored during 58 interovulatory intervals by transrectal ultrasonographic imaging. The ultrasonographic appearance of the uterus was influenced by the stage of the estrous cycle. Profound changes in characteristics visualized by ultrasonography included thickness of the uterine body, ultrasonographic evidence of edema, and accumulation of intravaginal and intrauterine fluids. Scores representing intravaginal fluid, intrauterine fluid, ultrasonographic texture, and number of gray-scale zones (comprising the image of the uterus) increased before ovulation, then decreased until approximately day 3 to day 6 (ovulation = day 0). The scores for uterine shape and number of cross sections of a uterine horn in one 5-MHz field began to increase before ovulation, reached a high plateau during the period associated with maximal progesterone production, and decreased before the time associated with estrus and ovulation.     

Changes in Testicular Development, Ultrasonographic and Histological Appearance of the Testis in Buck Kids Immunized Against LHRH Using Recombinant LHRH Fusion Protein

This study was designed to evaluate the effectiveness of recombinant Ovalbumin-LHRL (OL) immunization on changes in testicular size, histological appearance and testosterone production in buck kids. Thirty native buck kids at 18 weeks of age were divided into three groups, control (n = 10), immunization (n = 10) and castration (n = 10) groups. Immunized animals received OL protein generated by recombinant DNA technology. Ultrasonographic and histological examinations of the testes were performed. Animals were slaughtered at 44 weeks of age. Semen and epididymides were evaluated for the presence of sperm cells. Immunized animals generated anti-LHRH antibodies. Testosterone production, testicular and accessory glands development and sperm production were suppressed in the immunized animals (p < 0.01). Semineferous tubule diameters decreased (p < 0.01), basal membrane of the tubule was thickened and hyalinized in immunized kids. Immunization affected ultrasonographic appearance of the testes drastically. While testes of control animals gained their normal ultrasonographic appearance as the age increased, immunized animals had uniform hypoechogenic testicular structure as observed at 18 weeks of age until slaughter. Simultaneous histological and ultrasonographic evaluations indicated that the changes in testicular histology could partly be monitored via ultrasonographic imaging; nevertheless, it is difficult to claim that ultrasonographic image reflects the exact changes in such instances. In conclusion, these results indicate that recombinant OL fusion protein is effective in immunocastration in buck kids and has a potential to be used as an alternative to physical castration. Further researches should be conducted to help assessing reproductive status of testes from ultrasound images.     

母牛卵巢囊肿的B超诊断与治疗

本研究利用B-型超声波图像显示母牛卵泡囊肿和黄体直径变化以及卵巢轮廓诊断母牛卵巢囊肿。通过激素治疗、穿刺的方法对卵巢囊肿进行对症治疗,治疗效果显著。     

Ultrasonographic examination of the ovine thorax

Ultrasonographic examination of the thorax of 15 adult healthy sheep using a 5.0MHz sector transducerrevealed the lung surface as a hyperechoic (white) linear echo at a distance of 1.2–2cm from the transducer head with equidistant reverberation artifacts below this line. Ultrasonographic examination of 10 sheep with pulmonary disorders included five sheep with pleural abscesses which appeared as hypeechoic areas extending up to 8cm deep containing multiple hyperechoic spots (gas echoes). The distribution of gross lung pathology caused by sheep pulmonary adenomatosis (five ewes), with secondary abscess formation in three sheep, could be outlined by ultrasonographic examination. Modern portable ultrasound machines provide the veterinary practitioner with an inexpensive, non-invasive tool with which to examine the pleural surfaces and superficial lung parenchyma of sheep on the farm.