EVALUATION OF RENAL HEMODYNAMICS IN AWAKE AND ISOFLURANE-ANESTHETIZED CATS WITH PULSED-WAVE DOPPLER AND QUANTITATIVE RENAL SCINTIGRAPHY

The feasibility and reproducibility of obtaining the pulsed-wave Doppler measurements of resistive index (RI) and pulsatility index (PI) were investigated in intrarenal arteries of normal, nonsedated cats, and cats anesthetized with isoflurane. In addition, relative renal function and relative renal blood flow were evaluated using quantitative renal scintigraphy. The percentage of injected dose uptake, time to peak activity, and two indices of renal blood flow (K/A ratio and flow index) obtained during the first pass of ^99mTc-MAG₃, were determined for both awake and anesthetized cats. Results indicate that measuring RI and PI in nonsedated cats is readily accomplished and that the results are reproducible within an animal. Mean RI and PI values in the awake cats were 0.55 and 0.8, respectively. Significant differences between the awake and anesthetized cats were found for all pulsed-wave Doppler and quantitative renal scintigraphic measurements evaluated.     

DIURETIC RENAL SCINTIGRAPHY IN NORMAL CATS

The purpose of this study was to develop a protocol for diuretic renal scintigraphy (renography) in cats and describe normal findings. ^99mTc‐DTPA renal scintigraphy was performed twice in 10 healthy cats. Furosemide or saline were injected 4.5 min after radiopharmaceutical administration for the diuretic or control scan, respectively. A dynamic acquisition was performed for 8 min. The following parameters were evaluated: (1) global and individual glomerular filtration rate (GFR); (2) shape of the time–activity curve (TAC); (3) time of peak (TOP); (4) individual kidney excretion half‐time (T_1/2) of the radiopharmaceutical; (5) percentage of maximum activity measured at the end of the study. Global GFR in the control studies (2.79±0.83 ml/min/kg, mean±SD) did not differ significantly from the diuretic scans (2.34±0.51 ml/min/kg). The shape of most (16/20) TAC of diuretic renograms was similar to those of control renograms. The TOP of the diuretic renogram curves was 3.06±0.58 min, and did not differ from that of the control scans (3.01±0.61 min). T_1/2 of the diuretic renograms was significantly shorter (5.15±0.83 min) than that of the control renograms (6.31±1.50 min). A significantly lower percentage of maximum activity was present at the end of the study in diuretic renograms (median: 47.25%; range: 33.60–59.60%) compared with control renograms (63.40%; 30.00–69.40%). Diuretic renal scintigraphy is a noninvasive and fast procedure to perform in cats. The applicability of this technique needs to be investigated in patients with significantly impaired renal function and obstructive uropathies.     

QUANTITATIVE HEPATOBILIARY SCINTIGRAPHY WITH DECONVOLUTIONAL ANALYSIS FOR THE MEASUREMETN OF HEPATIC FUNCTION IN DOGS

A nuclear medicine procedure that has been used for quantification of hepatocyte function in man is applied and validated in the dog. This procedure employs deconvolutional analysis of liver and heart time activity curves obtained following peripheral intravenous injection of hepatobiliary radiopharmaceutical. The deconvolutional analysis simulates a bolus injection of the radiopharmaceutical into the afferent blood supple of the liver which permits the calculation of the hepatic extraction fraction. Hepatic extraction fraction is a measure of hepatocyte function. In this report, the deconvolutional analysis via fast Fourier transformations and subsequent calculation of hepatic extraction fraction is validated by direct afferent intravascular ijection of ^99mTc-mebrofenin. The hepatic extraction fraction determined via deconvolutional analysis was found to be the same as the first pass hepatic extraction fraction determined via deconvolutional analysis was found to be the same as the first pass hepatic extraction fraction determined by direct mesenteric (portal) vein injection. The same results can be obtained in a sedated animal, making the technique clinically applicable. Thus hepatic extraction fraction, obtained from a perlpheral intravenous injection of ^99mTc-mebrofenin, can provide a quatitative measure of hepatocyte function from a non-invasive procedure. The quantitative ability to measure hepatocyte function has potential in many clinical and research situations.     

QUANTITATIVE HEPATIC SCINTIGRAPHY IN THE DOG

Quantitative hepatic scintigraphy is a noninvasive test for measurement of relative arterial and portal blood flow to the liver. This technique has been used to evaluate human patients with known or suspected liver tumors or diffuse hepatocellular disease. A computer program to assess the hepatic perfusion index (HPI) in the normal dog is described. Factors affecting study quality and accuracy include injection technique, cardiac function, patient position, respiration, gross patient motion, and user intervention during data processing. HPI for a group of 12 normal dogs was 0.9±0.4 (X±SD). Quantitative scintigraphy could be used to evaluate dogs with primary or secondary liver tumors, portacaval shunts, or chronic liver disease     

THYROID SCINTIGRAPHY FINDINGS IN 2096 CATS WITH HYPERTHYROIDISM

Thyroid scintigraphy is currently the reference standard for diagnosing and staging cats with hyperthyroidism, but few studies describing the scintigraphic characteristics in a large number of cats have been reported. The objective of this study was to better characterize thyroid scintigraphy findings by evaluating 2096 consecutive cats with hyperthyroidism that were referred over a 3.5‐year period. Of these cats, 2068 (98.7%) had a high thyroid‐to‐salivary ratio (>1.5), whereas 2014 (96.1%) were found to have a high thyroid‐to‐background ratio (>6.1). When the patterns of the cats’ thyroid disease were recorded, 665 (31.7%) had unilateral disease, 1060 (50.6%) had bilateral‐asymmetric disease (two thyroid lobes unequal in size), 257 (12.3%) had bilateral‐symmetric disease (both lobes similar in size), and 81 (3.9%) had multifocal disease (≥3 areas of increased radionuclide uptake). The number of areas of ^99mTcO^?₄ uptake in the 2096 cats ranged from 1 to 6 (median, 2), located in the cervical area in 2057 (98.1%), thoracic inlet in 282 (13.5%), and in the thoracic cavity in 115 (5.5%). Ectopic thyroid tissue (e.g. lingual or mediastinal) was diagnosed in 81 (3.9%) cats, whereas thyroid carcinoma was suspected in 35 (1.7%) of the cats. The results of this study support conclusions that most hyperthyroid cats have unilateral or bilateral thyroid nodules, but that multifocal disease will develop in a few cats that have ectopic thyroid disease or thyroid carcinoma. Both ectopic thyroid disease and thyroid carcinoma are relatively uncommon in hyperthyroid cats, with a respective prevalence of ～4% and ～2% in this study.     

QUANTITATIVE HEPATOBILIARY SCINTIGRAPHY USING 99mTC-DISIDA IN THE DOG

Quantitative hepatobiliary scintigraphy using ^99mTc-2,6 diisopropylphenylcarbamoylmethyl iminodiacetic acid (DISIDA) was performed in normal dogs. ^99mTc-DISIDA is excreted by the hepatocyte into the biliary tract. Hepatic blood flow from arterial and portal venous sources was measured as the hepatic perfusion index. The hepatic clearance of the radiopharmaceutical was used to assess hepatocyte function and parenchymal biliary transport. Biliary ejection was evaluated using synthetic cholecystokinin infusion. The procedure should be useful in evaluating dogs with hepatic and biliary disease.     

DETECTION OF PORTAL BLOOD FLOW USING PER-RECTAL 99mTc-PERTECHNETATE SCINTIGRAPHY IN NORMAL CATS

This study reports data obtained from per-rectal ^99mTc-pertechnetate portal scintigraphy in normal cats. It examines the effects of chemical restraint and the methods employed in defining regions of interest (ROIs) on the shunt index derived from this data. Six normal cats were used for the study; all six were chemically restrained for imaging using propofol and later four of them were manually restrained for comparison. Portal blood flow was studied and the mean shunt index was found to be 5.9%± 3.9 when ROIs were operator defined and 9.2%± 4.4 when ROIs were defined using an isocontour program. In cats that were restrained using propofol and operator defined ROIs, the mean value for the time between detection of radioactivity in the liver and in the heart was 14 ± 1 seconds.     

HEPATIC AND PANCREATICOBILIARY MRI AND MR CHOLANGIOPANCREATOGRAPHY WITH AND WITHOUT SECRETIN STIMULATION IN NORMAL CATS

Magnetic resonance (MR) cholangiopancreatography is useful in humans to diagnose biliary and pancreatic diseases. Some of these protocols incorporate the use of secretin, which stimulates the exocrine pancreas to release bicarbonate with secondary dilation of the pancreatic duct. We compared the utility and quality of multiple hepatic‐pancreaticobiliary MR imaging sequences before and after secretin stimulation of the pancreatic duct in five healthy cats. Multiple MR sequences were evaluated, including fast Spoiled Gradient Recalled in‐ and out‐of‐phase, Single Shot Fast Spin Echo (SSFSE), T2 Fast Spin Echo, MR cholangiopancreatography (pre‐ and postsecretin administration), and Fast Acquisition with Multiphase Efgre (FAME) (postsecretin and before and after gadolinium administration). The MR cholangiopancreatography protocol with secretin stimulation was feasible and yielded high‐contrast maps of the biliary ductal anatomy but the pancreactic duct was seen inconsistently. The FAME series most consistently provided visualization of biliary and postsecretin pancreatic ductal anatomy, combined with very good depiction of the liver and pancreas. The remaining sequences each had satisfactory utility and diagnostic quality, with the exception of the SSFSE sequences. Secretin improved the conspicuity of the pancreatic duct.     

THE EFFECTS OF IOHEXOL ADMINISTRATION ON TECHNETIUM THYROID SCINTIGRAPHY IN NORMAL CATS

Administration of iodinated contrast medium interferes with iodide uptake in the human thyroid gland and compromises diagnostic thyroid scintigraphy and radioiodine treatment for 4–6 weeks. However, the degree and duration of inhibition of thyroid uptake of pertechnetate (^99mTcO₄^?) by iodinated contrast medium has not been established in any species. The main objective of this study was to better understand the temporal characteristics and magnitude of inhibition of feline thyroid uptake of ^99mTcO₄^? due to iohexol administration. Routine thyroid scintigraphy was performed in eight cats by intravenous (IV) injection of 185 MBq (5 mCi) of ^99mTcO₄^? both 4 days before and 0,1, 3, 7,14, and 28 days after IV administration of 880 mg I/kg iohexol (240 mg I/ml). Thyroid scintigraphy data were used to calculate thyroid:salivary gland ratios (T:S) and the percentage of total injected ^99mTcO₄^? dose uptake within the thyroid (%TU) at 20 min postinjection. After iohexol administration, mean T:S was significantly decreased below baseline only on day 1. At no point during the study did any cat have a T:S that fell below the published normal reference range of 0.71±0.14. There was a significant decrease in %TU on day 1, 3, and 14; however, at no point during the study, did any cat have a %TU that fell below the published normal reference ranges of 0.64±0.57, 0.68±0.9, or 0.75±1.38.     

QUANTITATIVE THYROID SCINTIGRAPHY AS A PREDICTOR OF SERUM THYROXIN CONCENTRATION IN NORMAL AND HYPERTHYROID CATS

Quantitative thyroid scintigraphy using pertechnetate was performed in 43 cats with various T4 concentrations and compared to eight normal control cats. Quantitative parameters included percentage dose uptake of the radioisotope by the thyroid, thyroid:salivary ratio and rate of thyroid uptake. All cats were anesthetized for the scan, and images were obtained using both low-energy all purpose (LEAP) and pinhole collimators. All quantitative parameters were significantly correlated to the serum T4 concentration, but the best correlation was obtained using the 20-minute thyroid:salivary ratio using only the most intense of the two thyroid lobes. The thyroid:salivary ratio was a good predictor of the metabolic status of the thyroid.     

RETROSPECTIVE ANALYSIS OF BRAIN SCINTIGRAPHY IN 116 DOGS AND CATS

We performed a retrospective study of 100 dogs and 16 cats with planar brain scintigraphy and histopathologically established diagnoses from a total of 485 studies performed from 1976 to 1992. Necropsy (112) or surgical biopsies (4) diagnoses were categorized in two ways: first as focal brain disease, diffuse brain disease or normal; second as either neoplastic, non-neoplastic or normal. A radiologist reviewed brain scintigrams and categorized the studies as focal areas of increased accumulation, diffuse or poorly localized areas of increased accumulation, or normal. We calculated for this population of 116 animals that focal brain scintigrams had 75% sensitivity and 90% specificity for any focal brain disease. The sensitivity and specificity of a focal scintigraphic lesion for a brain tumor was 72% and 82% respectively. The sensitivity and specificity of a diffuse or poorly localized scintigraphic lesion as a test for diffuse brain disease was 40% and 88% respectively.     

QUANTITATIVE PERTECHNETATE THYROID SCINTIGRAPHY AND THE ULTRASONOGRAPHIC APPEARANCE OF THE THYROID GLAND IN CLINICALLY NORMAL HORSES

We characterized the scintigraphic and sonographic appearance of the thyroid gland in clinically normal horses to establish the value of these modalities for assessment of the thyroid gland in this species. Horses were divided into two age groups. One group consisted of eight horses between 3 and 10 years of age and the other of seven horses between 11 and 20 years of age. Total T₄ concentrations were within the laboratory reference interval in all horses. Thyroid to salivary (T/S) ratio, percent dose uptake of pertechnetate (Na^99mTcO₄) and thyroid lobe volume were calculated. The echogenicity of thyroid lobes and presence of nodules was documented. The two groups were compared using appropriate parametric and nonparametric statistics. Mean total T₄ concentration was lower in older horses. Sixty minute mean±standard deviation (SD) T/S ratios for old vs. young horses were 5.8±3.0 and 5.3±2.2, respectively. Sixty‐minute median and interquartile ranges for percent dose uptake of pertechnetate for old vs. young horses were 3.64% (1.5–3.98%) and 2.55% (2.33–2.90%), respectively. Mean±SD thyroid lobe volume for old vs. young horses were 18.93±5.16 cm ³ and 13.55±3.56 cm³, respectively. Differences between groups were not significant. Most thyroid lobes were hyper or isoechoic to the sternocephalicus muscle. Prevalence of thyroid nodules did not differ between groups. Further study is needed to determine if thyroidal percent dose uptake is significantly different in horses with thyroid dysfunction and if it is clinically useful.     

USE OF QUANTITATIVE HEPATIC SCINTIGRAPHY TO EVALUATE SPONTANEOUS PORTOSYSTEMIC SHUNTS IN 12 DOGS

Quantitative hepatic scintigraphy is a valid means for estimating total liver blood flow and relative portal hepatic perfusion. The Hepatic perfusion index (HPI) was determined for a group of 12 dogs with portosystemic shunts prior to and two days after corrective surgery. HPI values for the dogs prior to operation were significantly elevated (p<0.001) as compared with those for a group of normal dogs, indicating reduced effective portal hepatic perfusion in dogs with shunts. Dogs showing a favorable clinical response after surgery had a significant decrease (p<0.02) in HPI values after operation. One dog showing a poor clinical response after operation had an increase in HPI score after operation. Quantitative hepatic scintigraphy is a valuable diagnostic test for screening presumptive cases of portosystemic shunts and monitoring the response to surgical intervention.     

TRANS-SPLENIC PORTAL SCINTIGRAPHY IN NORMAL DOGS

The purpose of this study was to (1) establish a technique for ultrasound-guided trans-splenic portal scintigraphy (TSPS) using 99mTcO4(-), (2) evaluate portal vein morphology, (3) compare the radiation exposures for TSPS vs. per-rectal portal scintigraphy (PRPS), and (4) compare the quality of numerical data from the TSPS vs. PRPS. Eight juvenile dogs underwent PRPS and TSPS (minimum of 48h between studies) after initial screening tests. PRPS was done according to established protocol using 425 +/- 36MBq (mean +/- SD) of 99mTcO4(-). TSPS was done with the dogs in right lateral recumbency over the gamma camera. 99mTcO4(-) (57 +/- 13.9 MBq) was injected into the spleen 1-2s following initiation of the dynamic acquisition. The frame rate was 4 frames/s for 5 min. There was significantly lower radioactivity of 99mTcO4(-) given and significantly higher total counts recorded in the liver and heart during the TSPS compared with PRPS. The total counts for the TSPS and PRPS were 7120 +/- 4386 and 830 +/- 523, respectively. Percent absorption from the spleen was 52.5 +/- 19.1% compared with 9.2 +/- 5.7% for the colon. Calculated transit time for the TSPS studies was 7 +/- 2.3s. In TSPS studies, the splenic and portal veins were clearly identified. Radiation exposure levels of the dogs were significantly lower following TSPS than after PRPS. TSPS appears superior to PRPS as a method to image the portal venous system representing a valid alternative diagnostic test for animals with suspected portosystemic shunts.     

TISSUE HARMONIC ULTRASOUND FOR IMAGING NORMAL ABDOMINAL ORGANS IN DOGS AND CATS

Normal cats (n = 38) and dogs (n = 40) were imaged with fundamental ultrasound and tissue harmonic ultrasound. Images of the liver, gall bladder, spleen, left kidney, urinary bladder, and jejunum were collected in all animals. Images of the left adrenal gland were collected in all dogs. All normal cats and dogs had improved imaging with tissue harmonic ultrasound. The number of organs with improved conspicuity ranged from one to all organs imaged. The most common organ to have improved conspicuity was the jejunum (100% of dogs and 89% of cats). Significant improvement by tissue harmonic ultrasound was seen in images of gall bladder (p = .05) and left adrenal gland (p = .02) in dogs, and spleen, urinary bladder, and intestinal images (p = .01) in cats. Significant improvement was seen in tissue harmonic ultrasound images of the gall bladder in dogs weighing greater than 16 kilograms (p = .03) and in the images of the urinary bladder of dogs weighing less than 16 kilograms (p = .02). These data suggest that image quality improvement of normal organs using tissue harmonic ultrasound is consistent but not predictable. The exception was the jejunum, where improvement was seen in all dogs. Sonographers should be cognizant of the potential benefits of tissue harmonic ultrasound.     

DIURETIC RENAL SCINTIGRAPHY IN NORMAL DOGS

Diuretic renal scintigraphy is commonly used in human medicine to differentiate obstructive from nonobstructive pyelectasia. In order to determine normal parameters, 99mTc-DTPA renal scintigraphy was performed twice in 20 healthy adult Mongrel dogs. Each dog was injected with either 3.0 mg/kg furosemide or an equivalent volume of saline 4.5 min following injection of the radiopharmaceutical. The following parameters were evaluated: (1) global and individual glomerular filtration rate (GFR); (2) time of peak (TOP) of the time-activity curve (TAC); (3) shape of the TAC; (4) individual kidney excretion half-time (T1/2); (5) proportion of maximum activity measured at end of study (8 min); (6) time of onset; and (7) duration of the effect of the diuretic. Most TAC in the diuretic renography group showed a steep drop in the curve following administration of the diuretic compared with a gradual slope in the saline control group. There was a statistically significant difference in T1/2 between the control renograms (median 10.25 min, range 4.41-18.07 min) and the diuretic renograms (median 4.16 min, range 3.62-5.90 min). There was a statistically significant difference in percentage maximum activity between the control renograms (median 65.25%, range 48.27-93.68%) and the diuretic renograms (median 48.54%, range 35.64-58.76%). Median time of onset of the diuretic effect was 1.10 min (0.20-2.40 min), and median duration was 0.83 min (0.30-2.35 min).     

EVALUATION OF HEPATOBILIARY SCINTIGRAPHY AS AN INDICATOR OF HEPATIC FUNCTION IN DOMESTIC PIGEONS (COLUMBA LIVIA) BEFORE AND AFTER EXPOSURE TO ETHYLENE GLYCOL

This study investigated the use of quantitative hepatobiliary scintigraphy to assess liver function in 14 white Carneaux pigeons (Columba livia). Liver scintigraphy using 99mTc-mebrofenin was performed and liver function was quantified using deconvolutional analysis and the area under the normalized heart time-activity curve as previously described in the dog and horse. Liver biopsies were performed in all birds before and after toxin-induced liver damage with ethylene glycol. Before the induction of liver disease, all biopsy specimens showed varying degrees of granulomatous inflammation. After ethylene glycol administration, hepatic lesions were scored and compared with scintigraphic findings. Scintigraphic results showed a significant decrease (P = 0.04) in hepatic function using the area under the normalized time-activity curve. There was good correlation between the overall histologic score posttoxin exposure and scintigraphic measures of liver function (P < 0.03). Based upon these preliminary results, the area under the heart time-activity curve can determine hepatic extraction as a measure of hepatic parenchymal cell function. The results also showed that worsening hepatic cellular function correlated with increased histologic damage to the liver. The use of hepatobiliary scintigraphy using 99mTc-mebrofenin to determine liver function in pigeons has not been previously reported. Additional studies are warranted to evaluate the application of this technique in clinical patients and to establish the sensitivity of this technique.     

QUANTITATIVE THYROID SCINTIGRAPHY IN GREYHOUNDS SUSPECTED OF PRIMARY HYPOTHYROIDISM

The existence of hypothyroidism in greyhounds remains controversial and its investigation is complicated by the low circulating thyroid hormone concentrations typically found in healthy dogs of this breed. Quantitative measurement of thyroidal technetium-99m pertechnetate (^99mTcO₄⁻) uptake is known to be useful in assessing thyroid function in other breeds. The aim of this study was to evaluate thyroid scintigraphy as a method of assessing thyroid function in greyhounds suspected of primary hypothyroidism. Twenty greyhounds (eight females, 12 males) were studied. Thirteen had bald thigh syndrome and seven poor performance and low total T4. Total T4 concentrations were decreased in 18 (90%), and free T4 in two (10%) dogs. All canine thyroid stimulating hormone concentrations were within the reference interval. Thyroidal ^99mTcO₄⁻ uptake values (mean ± SD, 0.76 ± 0.26%) were within the reference limits published for euthyroid dogs (0.39–1.86%) making hypothyroidism highly unlikely. There were no significant differences ( P <0.05) when comparing data between dogs with bald thigh syndrome (13 dogs) and the remaining dogs (seven dogs). Seventeen (85%) dogs had higher uptake in the left thyroid gland than in the right that might reflect an anatomic feature of the greyhound breed. Calculation of percent thyroidal uptake of ^99mTcO₄⁻ is more accurate than thyroid:salivary gland ratios because of high variability in salivary gland uptake. Percent thyroidal uptake of ^99mTcO₄⁻ should be used when assessing thyroid function scintigraphically in the greyhound breed.     

COMPARISON BETWEEN COMPUTED TOMOGRAPHY AND 99m TC‐ PERTECHNETATE SCINTIGRAPHY CHARACTERISTICS OF THE THYROID GLAND IN CATS WITH HYPERTHYROIDISM

Scintigraphy is currently the reference standard for diagnosing feline hyperthyroidism; however, computed tomography (CT) is more widely available in veterinary practice. The purposes of this prospective study were to describe the CT appearance of thyroid glands in cats with hyperthyroidism and compare CT findings with findings from ^99mTc–pertechnetate scintigraphy. Twenty‐five adult hyperthyroid cats were included. Plain CT images were acquired for each cat and the following characteristics recorded for each thyroid lobe: visibility, delineation, position, attenuation, shape, and subjective size. Scintigraphic images were also acquired and the following characteristics recorded: radiopharmaceutical uptake, delineation, ectopic foci, shape, and subjective size. In CT images, thyroid lobes were most commonly found between the second and fourth cervical vertebrae, dorsolateral to the trachea. Affected thyroid lobes (based on scintigraphy reference standard) were most commonly oval and moderately enlarged in CT images. A heterogeneous attenuation pattern (isoattenuating to adjacent soft tissues with hypo‐ and hyperattenuating foci) was most commonly found in affected thyroid lobes. A positive correlation (P < 0.01) was identified between CT and scintigraphy for left‐to‐right thyroid lobe size relationship and subjective size of the larger thyroid lobe. The CT estimated mass was significantly higher (median = 148.8; range = [0;357.6]) for the more active thyroid lobe compared to the less active thyroid lobe (median = 84.6; range = [0;312.3]); (W = 154; P < 0.01). Findings indicated that CT may not reliably differentiate unilateral vs. bilateral hyperthyroidism in cats; however, CT may be a reliable alternative test for correctly identifying the more active thyroid lobe.