ULTRASONOGRAPHY AND RADIOGRAPHY OF THE CANINE POSTPARTUM UTERUS

A vulvovaginal discharge following parturition in a bitch is often a cause of concern to owners and clinicians, especially if whelping was complicated in any way. Ultrasonography could potentially distinguish between normal and abnormal postpartum uterine states because the uterine wall and luminal contents can be imaged in detail. Five normal bitches were examined to determine the normal ultrasonographic appearance of the postpartum uterus and the sensitivity of ultrasonography in detecting the involuting uterus, comparing this sensitivity with that of radiography. Ultrasonography was done at 1, 4, 8, 12, 18 and 24 days postpartum, radiography at 1, 4, 8, 12 and 18 days postpartum. By 12 days postpartum, the uterus could not be seen on radiographs, while at 24 days postpartum the uterus was still sonographically identifiable. The ultrasonographic characteristics of the involuting uterus are described.     

ULTRASOUND-GUIDED BIOPSY OF THE CANINE LIVER, KIDNEY, AND PROSTATE

Sixty-nine hepatic, 25 renal, and 16 prostatic biopsies were performed under ultrasound guidance using a biopsy guide. The majority (98 of 110) were tissue-core biopsies. Multiple attempts at obtaining a sample were required; however, in the kidney, the number of attempts was restricted to two. Adequate samples were obtained in 94% (65/69) hepatic, 88% (22/25) renal, and 94% (5/6) prostatic biopsies. Postbiopsy scanning did not demonstrate parenchymal hemorrhage. In three renal and one prostatic biopsy, gross hematuria, noted immediately following biopsy, resolved in 2–3 days. Animals with prostatic disease frequently had hematuria, making evaluation for this complication difficult. One animal died acutely 2 days following prostatic biopsy due to an unrelated problem, a ruptured aortic àneurysm. Complications were not encountered with the liver biopsy procedure. Animals biopsied under sedation tolerated the procedure well. The authors preferred to anesthetize uncooperative animals and those needing kidney biopsy to minimize the likelihood of complications. Problems encountered during the procedure, overlying bowel gas obscuring the target organ or poor visualization of the biopsy needle, were corrected by changing patient or transducer position or the procedure was postponed. The usefulness of the biopsy procedure is illustrated in four case reports.     

COMPARISON OF ULTRASONOGRAPHIC AND RADIOGRAPHIC MEASUREMENTS OF CANINE PROSTATE DIMENSIONS

The purposes of this study were to: 1) compare prostatic dimensions measured on radiographic and ultrasonographic images and 2) compare a subjective radiographic assessment of prostate size with a previously-described objective method. Thirty-four male dogs undergoing investigation of prostatic disorders were used. Prostate length and depth were measured from ultrasonographic and radiographic images. A subjective assessment of prostate size ('small', 'normal', or 'enlarged') was made in 29 animals by one of the authors who was unaware of radiographic or ultrasonographic measurements. In addition, the distance from sacral promontory to the pubic brim was also measured. A prostate length or depth of >70% of this distance was defined as 'enlarged' and <70% as 'normal'. After the effects of magnification on radiographic measurements were eliminated, there were no significant differences between prostatic length measured by the two methods. However, a significant difference was obtained between prostatic depth measurements. The subjective assessment agreed with a previously described objective assessment of prostatic size in 21/29 dogs for prostate length but in only 12/29 for depth. Prostatic length varied from 46.6 to 116.4% (mean 75.7%) of the distance from the pubic brim to the sacral promontory. Prostatic depth varied from 33.0% to 94.6% (mean 59.7%) of the same distance. It is recommended that prostate length, rather than depth, be used when evaluating prostate size from lateral abdominal radiographs.     

DETERMINATION OF CANINE PROSTATIC VOLUME USING TRANSABDOMINAL ULTRASONOGRAPHY

The prostate gland from cadavers of 12 intact adult male dogs euthanized less than 3 hour were used to compare prostatic volume measured by ultrasonography to volume measured by water displacement, and to determine specific gravity of the canine prostate. Prostate glands were scanned by transabdominal ultrasonography with a 4-7 MHz curved linear array transducer. The greatest craniocaudal (L), transverse (W), and dorsoventral (D) diameters of the prostate were recorded. Prostatic volume was calculated using formulas for an ellipsoid and for a box. Prostate glands were removed, and the prostate weight was measured and prostatic volume was measured by water displacement. The mean +/- SD specific gravity of the prostate was 1 +/- 0.05 (range = 0.90 to 1.09) g/cm. There were positive correlations (R2 = 0.94) between prostatic volume calculated from ultrasound measurement and measured volume. Measured prostatic volume (VM) can be predicted using the formula: VM = [1/2.6 (L x W x D)] + 1.8 (cm3).     

ULTRASONOGRAPHY OF THE CANINE, FELINE AND EQUINE TONGUE: NORMAL FINDINGS AND CASE HISTORY REPORTS

A submental approach using a 5, 7.5 and 10 MHz mechanical sectorial transducers was used to evaluate the ultrasonographic appearance of the normal and abnormal canine, feline and equine tongue. Seven normal animals were used to characterize the in vivo normal ultrasonographic appearance of the oropharynx. Consistently seen anatomical landmarks included the lingual parenchyma, lingual artery, soft and hard palate interfaces, mandible, basihyoid bone and sublingual musculature. Seven fresh canine, feline and equine cadavers were dissected to confirm the ultrasonographic findings. Seven animals with signs of ptyalism, dysphagia, halitosis and visible lingual lesions were also studied. A foreign body and abscesses secondary to a penetrating wound were detected in a horse. Ultrasound guidance aided surgical dissection, removal of the foreign body and intraoperative drainage of the abscesses. Ultrasound provided valuable non-invasive documentation of the architecture, size and margins of six lingual neoplasms. Ultrasonographic monitoring of the response to the treatment of lingual lesions may be beneficial in the management of patients.     

CONTRAST‐ENHANCED ULTRASOUND OF THE NORMAL CANINE PROSTATE GLAND

Canine prostate gland abnormalities affect a large number of adult male dogs. In veterinary medicine, the commonly used methods to diagnose canine prostate gland disease are digital rectal examination and abdominal ultrasound. We evaluated the ability of ultrasound contrast agent to provide additional information about the vascularity of the canine prostate gland; such information could be useful in detecting early prostate gland disease and in staging disease known to be present. We characterized the ultrasonographic appearance of prostate gland vascularity in 10 healthy dogs before and after the injection of an ultrasound contrast agent (Levovist^?). Before injecting Levovist^?, the prostate gland blood flow was classified as poor in all dogs, whereas after contrast agent injection blood flow was classified as moderate or good, in 3 and 7 dogs respectively. Knowledge of the status of prostate gland vascularity could be useful for the characterization, diagnosis and therapeutic monitoring of canine prostate gland lesions.     

TRANSESOPHAGEAL ULTRASONOGRAPHY OF THE NORMAL CANINE MEDIASTINUM

The mediastinum of eight normal research dogs was examined by transesophageal ultrasonography with a 5MHz frequency transducer to establish a baseline for future use of this new imaging modality as a diagnostic tool. Each examination consisted of 360 degree scans in both transverse and sagittal planes from the thoracic inlet to the esophageal hiatus. Dissections of four of these research dogs were then performed to confirm transesophageal ultrasonography findings. Transesophageal ultrasonography of the mediastinum was a good imaging modality for the evaluation of the heartbase, the major cranial mediastinal vessels, the descending aorta, and occasionally part of the azygos vein. Anatomic orientation was best obtained by beginning the examination at the heart base. Lymph nodes and smaller caliber vessels could not be distinguished from surrounding tissues; however, Doppler ultrasound was useful for identifying the smaller vessels. Although a 5 MHz frequency transducer is preferred for transesophageal echocardiography, a higher frequency transducer would improve the resolution of the images of small near-field structures and may be more appropriate for mediastinal imaging.     

TRANSABDOMINAL SONOGRAPHIC EVALUATION OF THE CANINE PROSTATE

The present study sought to determine the accuracy of ultrasonographic measurement of the prostate; to observe the ultrasonographic appearance of the normal prostate; and to compare these observations with those in prostates affected by cystic hyperplasia, benign hyperplasia, land neoplasia. Trassabdominal ultrasonography of the canine prostate was performed in eight normal dogs to establish criteria for evaluating enlarged prostates. Marginal boundries, size, and ultrasonographic architecture were compared with dissection findings to assess the accuracy of ultrasonography. Four enlarged prostates were evaluated ultrasonographically, and the findings were correlated with results of needle aspiration and urethral wash and with surgical and histopathologic findings. Differentiation between cystic and solid prostatic enlargement by ultrasonography proved efective. Transducer frequency and gain manipulation were important factors in describing the nature of the fluid within a cyst. Assenssment of the nature of solid prostatic enlargement and accurate size determination proved to be areas in which ultrasonography should by used in conjunction with other diagnostic techniques.     

ANATOMY OF THE PORTAL AND HEPATIC VEINS OF THE DOG: A BASIS FOR SYSTEMATIC EVALUATION OF THE LIVER BY ULTRASONOGRAPHY

The objective of this study was to define, in detail, the anatomy of the portal and hepatic veins in the dog in order to establish a procedure for the systematic evaluation of the liver by ultrasonography. Anatomical details were obtained from the formalin fixed livers of ten dogs. The hepatic and portal veins were removed intact from these livers so that a detailed pattern of distribution could be established and the numbers of branches could be counted. Silastic casts were also made of the hepatic and portal veins of two livers, one in situ and one in which it had been removed. The former was to enable the relationship of the portal to the hepatic veins to be established as closely as possible within the animal and the other to provide a model of the distribution of each venous system within the liver. Contrast medium was infused into two other livers and radiographs taken to establish the relationship of each branch to each lobe. It was found that there was a consistent pattern of venous branching to each lobe of the liver in the dog with little variation between individual specimens. All liver lobes contained definite venous branches so that the left lateral and medial, quadrate, right medial and lateral, caudate and papillary veins could be distinguished in each venous system. We believe that an appreciation of this venous distribution will aid in the systematic evaluation of the liver during ultrasonography by enabling identification of each liver lobe. It should be of value for differentiating portal from hepatic veins and veins from dilated bile ducts.     

ULTRASONOGRAPHIC EXAMINATION OF THE CANINE LIVER BASED ON RECOGNITION OF HEPATIC AND PORTAL VEINS

A method for systematic examination of the livers was developed, based on identification of the hepatic and portal veins in sixteen dogs. The right medial, quadrate, left medial and lateral hepatic veins and the hepatic branches of the portal veins were easily located with the dog in dorsal recumbency. The right lateral and caudate hepatic veins were identified more easily from the right side with the transducer positioned between the ninth to the eleventh intercostal spaces. Visibility was affected by the fullness of the stomach but this effect could be minimized by changing the position of the transducer to select a more suitable anatomical approach. Identification of the two systems depended on their echogenicity, the anatomical position of the main branches and their pattern of distribution. As in humans, the portal veins were in general, more echogenic than the hepatic veins and the hepatic veins could be traced from their junctions with the caudal vena cava. Identification of the branches of the hepatic and portal veins was complicated by the anatomical shape, the nutritional status and respiratory stage of the animal. A systemic approach based on a knowledge of the distribution patterns produced by the hepatic and portal veins ensures that all liver lobes are identified and all important structures are assessed.     

CONTRAST‐ENHANCED ULTRASONOGRAPHY OF THE NORMAL CANINE ADRENAL GLAND

Contrast‐enhanced ultrasonography is useful in differentiating adrenal gland adenomas from nonadenomatous lesions in human patients. The purposes of this study were to evaluate the feasibility and to describe contrast‐enhanced ultrasonography of the normal canine adrenal gland. Six healthy female Beagles were injected with an intravenous bolus of a lipid‐shelled contrast agent (SonoVue^®). The aorta enhanced immediately followed by the renal artery and then the adrenal gland. Adrenal gland enhancement was uniform, centrifugal, and rapid from the medulla to the cortex. When maximum enhancement was reached, a gradual homogeneous decrease in echogenicity of the adrenal gland began and simultaneously enhancement of the phrenicoabdominal vessels was observed. While enhancement kept decreasing in the adrenal parenchyma, the renal vein, caudal vena cava, and phrenicoabdominal vein were characterized by persistent enhancement until the end of the study. A second contrast enhancement was observed, corresponding to the refilling time. Objective measurements were performed storing the images for off‐line image analysis using Image J (ImageJ^©). The shape of the time–intensity curve reflecting adrenal perfusion was similar in all dogs. Ratios of the values of the cortex and the medulla to the values of the renal artery were characterized by significant differences from initial upslope to the peak allowing differentiation between the cortex and the medulla for both adrenal glands only in this time period. Contrast‐enhanced ultrasonography of the adrenal glands is feasible in dogs and the optimal time for adrenal imaging is between 5 and 90 s after injection.     

B-MODE AND DOPPLER ULTRASOUND IMAGING OF THE SPLEEN WITH CANINE SPLENIC TORSION: A RETROSPECTIVE EVALUATION

The ultrasonographic appearance of splenic torsion has been described; the splenic parenchyma can be normal, hypoechoic or anechoic with interspersed linear echoes (coarse/"lacy" appearance). The ultrasonographic parenchymal appearance of 15 dogs in this report with splenic torsion varied: mottled hypoechoic regions (n=2), diffusely hypoechoic (n=11) and normal (n=2). Because splenic torsion causes vascular congestion due to splenic vein compression and eventual thrombosis, visible splenic vein intraluminal echogenicities compatible with thrombi were seen in 13 dogs using B-mode. Using spectral Doppler and color Doppler imaging of the splenic veins, no measurable flow velocities were detected in any of the 15 dogs. The varied B-mode ultrasonographic appearance of the splenic veins for intraluminal echoes and spectral or color Doppler evaluation for absent velocity flow.     

QUANTITATIVE ULTRASONOGRAPHY FOR ASSESSMENT OF BONE MINERAL DENSITY IN THE CANINE RADIUS AND TIBIA

Quantitative ultrasound allows noninvasive assessment of cortical bone density. Potential applications include monitoring of fracture healing, rehabilitation, and skeletal diseases. The objectives of this study were to determine the three most accessible portals to obtain speed of sound measurements of the radius and tibia with an Omnisense multisite quantitative ultrasound device and to determine probe-dependent intra- and interoperator variability for speed of sound measurements of the radius and tibia in six healthy hounds. The radius was most accessible at the cranial proximal metaphysis, the cranial middiaphysis, and medial distal metaphysis. Speed of sound measurements were possible at these sites on the radius with acceptable intra- and interoperator variation (1.6–4.6%). Measurements differed significantly when performed with different probes at the cranial proximal radial metaphysis. The tibia was most accessible at the cranial proximal metaphysis, the medial middiaphysis, and medial distal metaphysis. The medial middiaphyseal and mediodistal tibial sites allowed measurements with lowest intra- and interoperator variation (<3.5%). A smaller probe allowed tibial measurements with lowest interoperator variation. Measurements did not differ significantly at each tibial site when different probes were used. Measurements did not differ significantly between observers when measuring with the same probe at each specific site on radius and tibia. A medium-size probe allowed for most time-efficient measurements and the least number of failed measurements on the radius and tibia. Speed of sound can be consistently measured by different observers on the radius and tibia in healthy hounds.     

USE OF INTRAOPERATIVE ULTRASONOGRAPHY IN CANINE SPINAL CORD LESIONS

The purpose of this retrospective study was to describe the intraoperative appearance of various spinal cord conditions, and to investigate how intraoperative ultrasonography assisted in modification of surgical and postoperative treatment plans. Intraoperative ultrasonography (B-mode, and power Doppler mode) was used in 25 dogs undergoing spinal surgery. The neurologic conditions included cervical spondylomyelopathy, intervertebral disc (IVD) protrusion, IVD extrusion, spinal tumors, nerve sheath mass, granulomatous myelitis, and discospondylitis. All of these diagnoses were supported by histopathologic and/or cytologic evaluation. It was possible to visualize the spinal cord and the abnormal spinal tissue in all of the patients. Power Doppler imaging allowed assessment of the spinal cord microcirculation, and assisted in judgment of the degree of decompression. Ultrasound imaging directly impacted the surgical and the medical treatment plans in four patients. Owing to the intraoperative imaging, two hemilaminectomies were extended cranially and caudally, and additional disc spaces were fenestrated, one hemilaminectomy site was extended dorsally to retrieve the disc material from the opposite side, and one intramedullary cervical spinal cord lesion was discovered, aspirated, and consequently diagnosed as granulomatous inflammation, which altered the long-term medication protocol in that dog. This study suggests that intraoperative sonographic spinal cord imaging is a useful and viable technique.     

TWO-DIMENSIONAL REAL-TIME OCULAR ULTRASONOGRAPHY IN THE DOG

Two-dimensional real-time ultrasonography was performed with three different methods to determine the optimal technique for scanning canine orbital soft tissues. The three techniques included positioning the transducer on the clipped closed eyelid (eyelid contact method), directly on the cornea (corneal contact method), or on a small waterfilled balloon in direct contact with the cornea (water bath offset method). Horizontal and vertical images from the three techniques were compared and graded for diagnostic quality. The corneal contact method provided superior anatomic definition of the posterior globe and extraorbital tissues, whereas the water bath method gave higher-quality images of the anterior chamber and lens. Use of the eyelid contact method to image the eye and periorbital structures was not recommended because of multiple artifacts that severely degrade the image.     

EVALUATION OF CANINE PROSTATE INTRAFRACTIONAL MOTION USING SERIAL CONE BEAM COMPUTED TOMOGRAPHY IMAGING

This study used kilovoltage (kV) cone beam computed tomography (CBCT) imaging to characterize canine intrafractional prostate motion during hypofractionated stereotactic radiotherapy treatment. Serial CBCT images taken just prior to initiating treatment, and at several times during the treatment session, were acquired throughout the course of treatment for canine patients. All patients were immobilized in dorsal recumbency while using an air‐inflated rectal balloon. For each treatment session, rigid registration of intrafraction CBCT images with the interfraction CBCT used for setup verification was performed. Contours of the prostate and urethra were drawn on each CBCT image set and the center of mass for each structure was evaluated as a function of time. A total of seven canine patients was included in the study, resulting in 41 CBCT images collected during a total of 12 treatment sessions. Over 70% of our data were collected for CBCTs taken between 20 and 51 min after final patient setup was complete. The mean intrafraction movement in a single direction for the prostate and urethra was ≤0.14 mm and ≤0.22 mm, respectively. The maximum intrafraction movement for the prostate and urethra was ≤ 1.60 mm and ≤ 2.00 mm, respectively. The maximum variability in intrafraction movement for the prostate and urethra, as defined by two standard deviations, was ≤1.40 mm and ≤1.50 mm, respectively. Minimal intrafraction variability using appropriate patient positioning and rectal balloon, combined with kV CBCT image‐guided radiation therapy tools to account for interfraction changes, permit accurate and precise targeting of structures of interest.     

A REVIEW OF NONCONVENTIONAL ULTRASOUND TECHNIQUES AND CONTRAST-ENHANCED ULTRASONOGRAPHY OF NONCARDIAC CANINE DISORDERS

Modern ultrasound contrast media are gas-containing stabilized microbubbles that remain intact in the circulating blood for several minutes after intravenous injection and increase the intensity of the backscattered ultrasound. When the microbubbles disappear from the blood, they can be detected in the parenchyma of the liver and the spleen for about 30 more minutes (late liver- and spleen-specific phase). The insonated microbubbles produce second harmonic ultrasound frequencies, whose detection requires nonconventional ultrasound modalities such as pulsed inversion imaging. Nonconventional ultrasound techniques can also be used without microbubbles because second harmonics can be generated by ultrasound in tissues as well. The physical principles and advantages of nonconventional ultrasound techniques are described. The circulating microbubbles can be used not only to enhance weak Doppler signals, but also to perform dynamic contrast studies. Contrast-enhanced dynamic ultrasound studies--similar to contrast-enhanced CT and MRI examinations--have been used in humans to characterize lesions noninvasively (i.e., without biopsies) found during conventional ultrasound examinations. To map the distribution of contrast medium in a nodule or in an organ, specific scanning techniques such as stimulated acoustic emission have been developed. Stimulated acoustic emission occurs when high acoustic pressure ultrasonic waves disrupt the stationary or slowly moving microbubbles. This results in the release of a large amount of harmonic ultrasound frequencies. When the stimulated acoustic emission technique is used for dynamic studies, scanning must be interrupted several times to allow the microvasculature of the lesion to refill with microbubbles (interval delay imaging). The contrast patterns of malignant and benign hepatic nodules in humans have been the most intensively studied. Another type of dynamic study in humans measures the transit time of the contrast medium; that is, how fast the peripherally injected microbubbles reach the hepatic veins. Hepatic cirrhosis can be differentiated from other diffuse parenchymal liver diseases by a shorter transit time. Introducing nonconventional ultrasound techniques and ultrasound contrast media in veterinary diagnostic imaging may have potential value; however, intensive research should be carried out before ultrasound contrast agents can routinely be used in clinical practice.     

DOPPLER ULTRASOUND OF THE PROSTATE IN NORMAL DOGS AND IN DOGS WITH CHRONIC LYMPHOCYTIC-LYMPHOPLASMOCYTIC PROSTATITIS

The prostate gland of 11 normal dogs and five dogs with histological confirmed chronic lymphocytic or lymphoplasmocytic prostatitis were imaged with grey-scale and Doppler ultrasound. Three vessel types (prostatic artery, capsular artery and parenchymal artery) were identified with color Doppler and the resistive index and maximum and minimum velocities were measured with pulsed wave Doppler. No differences between normal dogs and dogs with prostatitis was identified in either grey-scale ultrasound or in any Doppler parameters measured. Regardless of histologic diagnosis, acepromazine (0.05 mg/kg IV) caused a significant decrease in capsular artery maximum and minimum velocities and prostatic artery resistive index. This study establishes normal Doppler ultrasound parameters for the intact male canine prostate gland. Additional studies are necessary to further evaluate the clinical utility of Doppler ultrasound in canine prostatic diseases.