COMPARISON OF FLUID-ATTENUATED INVERSION RECOVERY AND T2-WEIGHTED MAGNETIC RESONANCE IMAGES IN DOGS AND CATS WITH SUSPECTED BRAIN DISEASE

To compare fluid-attenuated inversion recovery (FLAIR) and T2-weighted magnetic resonance (MR) imaging in small animal patients with suspected brain disease, paired sets of FLAIR and T2-weighted MR images of 116 dogs and cats were reviewed separately without any patient information. Images were rated as normal or abnormal using a five-point scale, and the distribution, signal intensity, and anatomic location of abnormalities were recorded. In 60 animals, both FLAIR and T2-weighted images were normal. In 50 animals, the same abnormalities were identified in both FLAIR and T2-weighted images. Overall, very good agreement was found between FLAIR and T2-weighted MR images (kappa = 0.88). FLAIR images had abnormalities that were not recognized in the corresponding T2-weighted images in six of 116 examinations (5%). In four of these, the abnormalities in FLAIR images were thought to represent pathology, including granulomatous meningoencephalitis in one dog, postictal edema in one dog, and undiagnosed lesions in two dogs. In the remaining two examinations, the abnormalities in FLAIR images were probably artifacts. No examples were found of intracranial abnormalities in T2-weighted images that were not visible in FLAIR images. In this study, acquiring FLAIR images in addition to T2-weighted images resulted in detection of otherwise occult abnormalities in relatively few patients.     

Brain and spinal cord haemorrhages associated with Angiostrongylus vasorum infection in four dogs

Multifocal haemorrhages associated with Angiostrongylus vasorum infection were observed in the central nervous system of four dogs with neurological signs including depression, seizures, spinal pain and paresis. In magnetic resonance images the majority of the lesions were isointense or slightly hyperintense in T1-weighted images, hyperintense in T2-weighted images and hypointense in T2*-weighted (gradient echo) images, compatible with haemorrhages more than seven days old. Lesions were found in the brain of three of the dogs and in the spinal cord of two. The cerebrospinal fluid contained high concentrations of protein and evidence of erythrophagia. All the dogs had coagulopathy and pulmonary haemorrhage of varying severity. A vasorum larvae were detected in the faeces of each of the dogs. Neural A vasorum was confirmed at postmortem examination in two dogs.     

Magnetic resonance imaging of the femoral head of normal dogs and dogs with avascular necrosis.

The purpose of this study was to describe the appearance of the femoral head of normal, young, small breed dogs, and dogs with avascular necrosis using low-field (0.3 T) magnetic resonance (MR) imaging. Images of the femoral heads were obtained in the dorsal plane, and included T1-weighted spin-echo, T2-weighted fast spin-echo, fast spin echo-inversion recovery, and fluid attenuated inversion recovery pulse sequences. MR imaging features of the asymptomatic femoral heads and necks included uniform high signal intensity compared with muscle on T1- and T2-weighted images. There was either uniform enhancement or no enhancement on postcontrast T1-weighted images. The MR imaging findings of dogs affected with avascular necrosis differed from those of asymptomatic dogs. Typically, the affected dogs had inhomogeneous intermediate to low-signal intensity within the femoral head and neck compared with muscle on T1-weighted images, inhomogeneous enhancement of the femoral head and/or neck on postcontrast T1-weighted images, and inhomogeneous low- to high- signal intensity within the femoral head and neck on T2-weighted images.     

MRI features of CNS lymphoma in dogs and cats

The magnetic resonance (MR) imaging features of central nervous system lymphoma in eight dogs and four cats are described. Intracranial lesions affected the rostrotentorial structures in six dogs and caudotentorial structures in two cats. Lesions affected the spinal cord in two dogs and in two cats. One dog and one cat with intracranial lymphoma had signs of local extracranial extension and lymphadenopathy. Lesions were considered extraparenchymal in four dogs and three cats, intraparenchymal in two dogs and one cat, and appeared to have both intra- and extraparenchymal components in two dogs. All lesions were hyperintense in T2-weighted images when compared to white matter, most were hypointense in T1-weighted images (7/12), and most were hyperintense in fluid-attenuated inversion recovery (FLAIR) images (5/9). When compared to grey matter, these lesions appear either isointense (5/12) or hyperintense (7/12) on T2-weighted images, half of them were hypointense in T1-weighted images (6/12), and most were isointense in FLAIR images (7/9). Lesion margins were usually indistinct in T2-weighted images (10/12) and had perilesional hyperintensity in FLAIR images (7/9). The majority of lesions (10/12) had abnormal meninges around the lesion and half (6/12) had generalized contrast enhancement. Mass effect was evident in all lesions. Although not specific, when combined with the history and neurologic signs, MR features aid presumptive diagnosis that should be confirmed by cytology or histopathology.     

MAGNETIC RESONANCE IMAGING FINDINGS IN 25 DOGS WITH INFLAMMATORY CEREBROSPINAL FLUID

To describe the signs that may be associated with intracranial inflammatory conditions, magnetic resonance (MR) images of 25 dogs that had inflammatory cerebrospinal fluid (CSF) were mixed with those of a control group of 40 dogs that had CSF negative for inflammatory disease and reviewed without knowledge of the clinical signs or diagnosis. CSF was considered inflammatory if the protein level was > 0.25 g/l and the white cell count was > 5 mm(-3). Abnormalities were found by MR imaging in 19 (76%) dogs with inflammatory CSF. Two dogs had focal lesions, 10 had multifocal lesions, and seven had diffuse lesions. Lesions affected all divisions of the brain. Mass effect was identified in seven (28%) dogs, including one that had a choroid plexus carcinoma. Lesions were hyperintense in T2-weighted images in 18 dogs and hypointense in T1-weighted images in six dogs. Multifocal or diffuse intraaxial lesions that were hyperintense in T2-weighted images were observed in 17 (68%) dogs with inflammatory CSF. Administration of gadolinium resulted in enhancement of intraaxial lesions in nine (36%) dogs and enhancement of meninges in seven (28%) dogs. Six (24%) dogs with inflammatory CSF had images interpreted as normal.     

CANINE MENINGEAL DISEASE: ASSOCIATIONS BETWEEN MAGNETIC RESONANCE IMAGING SIGNS AND HISTOLOGIC FINDINGS

In order to compare the accuracy of MR sequences for diagnosis of meningeal disease, MR images of the brain, and histopathologic specimens including the meninges of 60 dogs were reviewed retrospectively by independent observers in a cross‐sectional study. MR images included T1‐weighted pre‐ and postgadolinium images, subtraction images, T2‐weighted images, and T2‐weighted fluid‐attenuated inversion‐recovery (FLAIR) images. Pathologic changes affected the pachymeninges in 16 dogs, leptomeninges in 35 dogs, and brain in 38 dogs. The meninges were normal in 12 dogs. Meninges were classified histopathologically as normal (grade 0), slightly or inconsistently affected (grade 1), or markedly affected (grade 2). When applying relaxed pathologic criteria (grades 0 and 1 considered normal), the results of ROC analysis (area under curve, AUC) were: T1‐weighted postcontrast images 0.74; subtraction images 0.7; T2‐weighted images 0.68; FLAIR images 0.56. The difference in AUC between T1‐weighted postgadolinium images and FLAIR images was significant (P = 0.04). AUC for FLAIR images was not significantly different from 0.5. When applying strict pathologic criteria (only grade 0 considered normal), none of the MR sequences had AUC significantly different from 0.5. On the basis of T1‐weighted postgadolinium images and subtraction images, correct anatomic classification of lesions occurred more often for pachymeningeal than leptomeningeal lesions (P < 0.001). Overall, MR imaging had low sensitivity for diagnosis of meningeal pathology in dogs, particularly for changes affecting the leptomeninges. Subtraction images had similar accuracy to T1‐weighted postgadolinium images for meningeal lesions in dogs. T2‐weighted FLAIR images appear to have limited diagnostic utility for meningeal lesions.     

Correlation between fluorodeoxyglucose positron emission tomography and magnetic resonance imaging findings of non-suppurative meningoencephalitis in 5 dogs

This study characterized the [(18)F]2-deoxy-2-fluoro-D-glucose positron emission tomography (FDG-PET) findings of encephalitis in dogs and assessed the role of FDG-PET in the diagnosis of meningoencephalitis. The medical records, magnetic resonance (MR), and FDG-PET images of 3 dogs with necrotizing meningoencephalitis (NME), 1 dog with granulomatous meningoencephalitis (GME), and 1 dog with meningoencephalitis of unknown etiology (MUE) were reviewed. On the FDG-PET, glucose hypometabolism was identified in the dog with NME, whereas hypermetabolism was noted in the dog with GME. The T2-weighted images (WI) and fluid attenuated inversion recovery (FLAIR) images were characterized by hyperintensity, whereas the signal intensity of the lesions on the T1-WI images was variable. The metabolic changes on the brain FDG-PET corresponded well to the hyper- and hypointense lesions seen on the MR imaging. This type of tomography (FDG-PET) aided in the differentiation of different types of inflammatory meningoencephalitis when the metabolic data was combined with clinical and MR findings.     

Contrast-enhanced fluid-attenuated inversion recovery vs. contrast-enhanced spin echo T1-weighted brain imaging

In humans, contrast-enhanced fluid-attenuated inversion recovery (FLAIR) imaging plays an important role in detecting brain disease. The aim of this study was to define the clinical utility of contrast-enhanced FLAIR imaging by comparing the results with those with contrast-enhanced spin echo T1-weighted images (SE T1WI) in animals with different brain disorders. Forty-one dogs and five cats with a clinical suspicion of brain disease and 30 normal animals (25 dogs and five cats) were evaluated using a 0.2 T permanent magnet. Before contrast medium injection, spin echo T1-weighted, SE T1WI, and FLAIR sequences were acquired in three planes. SE T1WI and FLAIR images were also acquired after gadolinium injection. Sensitivity in detecting the number, location, margin, and enhancement pattern and rate were evaluated. No lesions were found in a normal animal. In affected animals, 48 lesions in 34 patients were detected in contrast-enhanced SE T1WI whereas 81 lesions in 44 patients were detected in contrast-enhanced FLAIR images. There was no difference in the characteristics of the margins or enhancement pattern of the detected lesions. The objective enhancement rate, the mean value between lesion-to-white matter ratio and lesion-to-gray matter ratio, although representing an overlap of T1 and T2 effects and not pure contrast medium shortening of T1 relaxation, was better in contrast-enhanced FLAIR images. These results suggest a superiority of contrast-enhanced FLAIR images as compared with contrast-enhanced SE T1WI in detecting enhancing brain lesions.     

Characteristics of magnetic resonance images of granulomatous meningoencephalomyelitis in 11 dogs

The characteristics of magnetic resonance imaging (mri) of the brains and spinal cords of 11 dogs with histologically confirmed granulomatous meningoencephalomyelitis (gme) were determined. The lesions were in the brain of eight of the dogs, in the brain and spinal cord of two, and in the spinal cord alone in one dog. A single lesion was present in four of the dogs and multiple lesions were found in six. In one dog with intracranial signs, no visible lesions could be detected on mri. No meningeal enhancement was detected in T1-weighted images post-contrast, or in fluid attenuation inversion recovery (flair) images, but there were histological lesions in the meninges in nine of the dogs. The T2-weighted images and flair sequences were characterised in all cases by hyperintensity, whereas the signal intensity of the lesions on T1-weighted images was variable. After the administration of paramagnetic contrast, some of the lesions showed no enhancement, but others showed marked patterns of enhancement. The lesions in 10 of the dogs were easily identifiable by mri and the images had several unifying characteristics, but they could not be considered disease-specific.     

MAGNETIC RESONANCE IMAGING AND PATHOLOGIC FINDINGS ASSOCIATED WITH NECROTIZING ENCEPHALITIS IN TWO YORKSHIRE TERRIERS

Two young adult Yorkshire terriers had neurologic signs consistent with forebrain and brainstem involvement or forebrain involvement alone. On magnetic resonance imaging studies there were asymmetric bilateral lesions mainly in the cerebral cortex, and in the diencephalon. These areas were hyperintense on T2-weighted and FLAIR images, but hypointense or isointense on T1-weighted images. Lesions had a varying degree of contrast enhancement. Areas which were isointense on T1-weighted images had no contrast enhancement or only foci of contrast enhancement. Lesions with hypointensity in T1-weighted images had no enhancement or more frequently ring-like enhancement around the lesion. Necrotizing encephalitis was confirmed pathohistologically in both dogs. The degree of contrast enhancement appeared to be related to the degree of lymphohistiocytic inflammation on histologic examination.     

Magnetic resonance imaging features of spinal epidural empyema in five dogs.

Spinal epidural empyema is defined an accumulation of purulent material in the epidural space of the vertebral canal. Spinal epidural empyema should be considered as a differential diagnosis in dogs with pyrexia, spinal pain, and rapidly progressing myelopathy. Magnetic resonance (MR) imaging is the imaging test of choice in humans. Here, we describe the MR imaging features of five dogs with confirmed spinal epidural empyema. The epidural lesions appeared as high or mixed signal masses in T2-weighted (T2W) images. Increased signal within the spinal cord gray matter at the site of the lesion was detected in T2W images in all dogs. Two patterns of enhancement were detected on postcontrast T1-weighted (T1W) images. Mild to moderate peripheral enhancement was seen in three dogs and a diffuse pattern of enhancement was seen in one. Discospondylitis was identified in three dogs on T1W postcontrast images. Decompressive spinal surgery was performed in all dogs. Bacteria isolated from the abnormal epidural tissue were Enterobacter cloacae, coagulase-positive Staphylococci, Pasteurella multocida, and Escherichia coli. In one dog bacteria were not isolated. These MR imaging features, along with appropriate clinical signs, can allow prompt diagnosis and appropriate treatment planning.     

Intramedullary epidermoid cyst in the thoracic spine of a dog

A 5 yr old female spayed mastiff was evaluated for a 3-4 mo history of paraparesis and 3 days of acutely worse paraparesis and incontinence. On magnetic resonance imaging, a spinal cord lesion was present at the ninth thoracic vertebra. The lesion was hyperintense on T2-weighted images (T2-W), and a hyperintense rim was present on T1-weighted postcontrast images. Histologic examination showed a cystic mass lined by squamous epithelial cells. Histopathologic diagnosis was an intramedullary epidermoid spinal cyst. Epidermoid cyst should be a differential diagnosis in young dogs with a myelopathy and an intramedullary spinal cord lesion on magnetic resonance imaging examination.     

Inner ear fluid‐attenuated inversion recovery MRI signal intensity in dogs with vestibular disease

The inner ear contains endolymph and perilymph. The second is comparable and in continuity with the cerebrospinal fluid (CSF) so it is expected to suppress in fluid‐attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) if normal. Even though inner ear FLAIR abnormalities have been extensively described in humans with inner ear disease, its diagnostic value in dogs is yet to be proven. The goal of this retrospective cohort study was to investigate the diagnostic utility of FLAIR MRI in dogs with vestibular disease. A review of medical records identified 101 dogs that had brain MRI performed because of vestibular signs. Based on the final diagnosis, patients were allocated to three groups: otitis media/interna, idiopathic vestibular disease, and central vestibular disease. Additionally, a control group (n = 73) included dogs with normal MRI and without vestibular signs. Inner ears were delineated using a region of interest, and signal intensity was measured in FLAIR and T2‐weighted images. The percentages of suppression in FLAIR were calculated and compared between affected and unaffected sides of each individual and between groups using a general linear mixed model. Correlation between suppression and CSF cell count and protein concentration was assessed. Affected inner ears in dogs with otitis media/interna had decreased suppression in FLAIR compared to the unaffected side (P < .001), and all other groups (P < .01). No significant correlation was detected between CSF results and suppression. These results show the diagnostic value of FLAIR in otitis media/interna due to lack of suppression in the affected inner ear.     

MAGNETIC RESONANCE IMAGING FEATURES OF ORBITAL INFLAMMATION WITH INTRACRANIAL EXTENSION IN FOUR DOGS

This retrospective study describes the clinical and magnetic resonance (MR) imaging features of chronic orbital inflammation with intracranial extension in four dogs (two Dachshunds, one Labrador, one Swiss Mountain). Intracranial extension was observed through the optic canal (n=1), the orbital fissure (n=4), and the alar canal (n=1). On T1-weighted images structures within the affected skull foramina could not be clearly differentiated, but were all collectively isointense to hypointense compared with the contralateral, unaffected side, or compared with gray matter. On T2-, short tau inversion recovery (STIR)-, or fluid-attenuated inversion recovery (FLAIR)-weighted images structures within the affected skull foramina appeared hyperintense compared with gray matter, and extended with increased signal into the rostral cranial fossa (n=1) and middle cranial fossa (n=4). Contrast enhancement at the level of the affected skul foramina as well as at the skull base in continuity with the orbital fissure was observed in all patients. Brain edema or definite meningeal enhancement could not be observed, but a close anatomic relationship of the abnormal tissue to the cavernous sinus was seen in two patients. Diagnosis was confirmed in three dogs (one cytology, two biopsy, one necropsy) and was presumptive in one based on clinical improvement after treatment. This study is limited by its small sample size, but provides evidence for a potential risk of intracranial extension of chronic orbital inflammation. This condition can be identified best by abnormal signal increase at the orbital fissure on transverse T2-weighted images, on dorsal STIR images, or on postcontrast transverse or dorsal images.     

INTRACRANIAL INTRA-ARACHNOID CYST WITH INTRACYSTIC HEMORRHAGE IN TWO DOGS

Clinical signs, magnetic resonance imaging (MRI) features, treatment, and outcome of two adult dogs with neurologic dysfunction resulting from hemorrhage into a quadrigeminal intracranial intra-arachnoid cyst are described. In dog 1, the cyst was hyperintense to cerebrospinal fluid (CSF) on T1-weighted MRI and hypointense to CSF on T2-weighted images. In dog 2, the cyst was isointense to CSF on T1- and T2-weighted images. Both dogs were treated with craniotomy and cyst fenestration. A large blood clot was removed from the lumen of the cyst in each dog. Dog 1 is clinically normal 3.5 years post-surgery and has a persistent cyst. Dog 2 had a good initial response to therapy but was euthanized 2.5 years post-operatively due to generalized seizures. The late onset of clinical signs in these dogs most likely resulted from hemorrhage into the cyst. Surgical fenestration and hematoma removal appear to provide a satisfactory treatment for adult dogs with an intracranial intra-arachnoid cyst and intracystic hemorrhage. Persistence of the cyst may occur in some dogs.     

Pseudolayering artefact on postcontrast magnetic resonance images of the bladder of 18 dogs and three cats

An artefact was observed on postcontrast magnetic resonance imaging (mri) of the urinary bladder of several small animals; it took the form of a dark layer in the dependent (dorsal) part of the bladder, with a thin hyperintense layer on top of it, and a hypointense signal in the rest of the non-dependent (ventral) part. The mri database was searched for animals with T1-weighted images of the urinary bladder after the injection of gadolinium. Eighteen dogs and three cats were included in the study. The artefact was observed in 16 of the animals on the postcontrast images but not on the T1-weighted and T2-weighted precontrast images. A phantom experiment showed that the signal intensity observed on T1-weighted images decreased rapidly as the concentration of gadolinium increased from 6.25 mmol/l to 25 mmol/l. It is hypothesised that the early excretion of concentrated gadolinium into the bladder causes the pseudolayering artefact observed, which has also been reported in human patients.     

MAGNETIC RESONANCE IMAGING OF ACQUIRED TRIGEMINAL NERVE DISORDERS IN SIX DOGS

The medical records and magnetic resonance (MR) images of dogs with an acquired trigeminal nerve disorder were reviewed retrospectively. Trigeminal nerve dysfunction was present in six dogs with histologic confirmation of etiology. A histopathologic diagnosis of neuritis (n=2) or nerve sheath tumor (n=4) was made. Dogs with trigeminal neuritis had diffuse enlargement of the nerve without a mass lesion. These nerves were isointense to brain parenchyma on T1-weighted (T1W) precontrast images and proton-density-weighted (PDW) images and either isointense or hyperintense on T2-weighted (T2W) images. Dogs with a nerve sheath tumor had a solitary or lobulated mass with displacement of adjacent neuropil. Nerve sheath tumors were isointense to the brain parenchyma on T1W, T2W, and PDW images. All trigeminal nerve lesions enhanced following contrast medium administration. Atrophy of the temporalis and masseter muscles, with a characteristic increase in signal intensity on T1W images, were present in all dogs.