TIME-RESOLVED RENAL CONTRAST-ENHANCED MRA IN NORMAL DOGS

In humans, contrast-enhanced magnetic resonance angiography (CE-MRA) is a documented method to quantitatively and qualitatively evaluate renal vessels. It offers a safer alternative to computed tomography angiography. The aim of this study was to establish a renal MRA protocol in dogs using a 3D multiphase Fast Spoiled Gradient Recalled echo CE-MRA sequence (3D FSPGR CE-MRA). We used an elliptical centric ordering of k -space to acquire the contrast-sensitive data faster. Four to five consecutive 3D dorsal slabs, encompassing both kidneys, could be acquired in 40–65 s. The renal arterial and venous phases were obtained separately during phases 1 or 2, and 2 or 3, respectively without the need for any contrast medium bolus timing. The renal arteries and veins were clearly visualized. In conclusion, multiphase FSPGR 3D CE-MRA with an elliptical centric k -space ordering allows distinguishing renal arterial and venous phases in dogs, and can be used as a noninvasive diagnostic imaging alternative to map renal vessels in this species. Potential applications include the screening of renal donors in renal transplantation programs, and the pretreatment evaluation of animals with invasive renal neoplasia or renal vascular anomalies when surgery or embolization are contemplated.     

CARDIAC MAGNETIC RESONANCE IMAGING IN NORMAL DOGS AND TWO DOGS WITH HEART BASE TUMOR

We describe the technique for in vivo cardiac‐gated magnetic resonance imaging (MRI) in normal dogs and its application in two dogs with a large right atrial tumor. The dogs with a cardiac tumor were also imaged using contrast‐enhanced magnetic resonance angiography (CE‐MRA). Cardiac‐gated MRI and CE‐MRA are both feasible in animals with short acquisition times compatible with breath‐hold imaging under anesthesia, and provide detailed two‐ and three‐dimensional (3D) depiction of the cardiac anatomy and great vessels with or without contrast medium. Although cardiac MRI will not replace echocardiography, it is a powerful alternative technique to use when knowledge of the 3D anatomy of the vasculature is required, when precise volume measurements are needed or when myocardial characterization is indicated. As opposed to contrast‐enhanced computed tomography angiography, cardiac MRI does not use ionizing radiation or iodinated contrast medium.     

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.     

USE OF MAGNETIC RESONANCE ANGIOGRAPHY FOR DIAGNOSIS OF PORTOSYSTEMIC SHUNTS IN DOGS

A prospective study was conducted to determine the sensitivity and specificity of diagnosis of portosystemic shunts (PSS) and the accuracy of anatomically locating single congenital PSS in dogs using magnetic resonance angiography (MRA). MRA was performed on 10 normal dogs and 23 dogs with PSS. Sensitivity and specificity of MRA to diagnose any shunt among all dogs were 80% and 100%, respectively. Among dogs identified with PSS, sensitivity and specificity of MRA for diagnosis of multiple extrahepatic shunts were 63% and 97%, respectively, and for diagnosis of single congenital shunts were 79% and 100%, respectively. Using MRA, radiologists correctly identified shunts as extrahepatic or intrahepatic in 83% of patients and correctly identified the origin and insertion of the shunts in 57% and 97% of patients, respectively. Use of MRA is specific for diagnosis of PSS and is a sensitive indicator of anatomic location of single congenital portosystemic shunts.     

CONTRAST‐ENHANCED MAGNETIC RESONANCE ANGIOGRAPHY FOR DIAGNOSIS OF PORTOSYSTEMIC SHUNTS IN 10 DOGS

Computed tomography angiography, sonography, scintigraphy, and portography can be used to evaluate the portal vasculature to evaluate for a portosystemic shunt (PSS). Time‐of‐flight magnetic resonance angiography (TOF‐MRA) and contrast‐enhanced MRA (CE‐MRA) are other potentially useful techniques. The aim of this study was to evaluate CE‐MRA in 10 dogs suspected of having a PSS. Noncontrast MR images of the abdomen were obtained using a Siemens Symphony MR‐scanner (1.5 T) and a T1‐weighted FLASH‐3D sequence with a very short scan time (about 20 s). After injection of contrast medium, the initial sequence was repeated five times. The sequence with the best contrast medium filling of the portal vasculature was selected subjectively, subtracted from the initial survey image series, and a maximum intensity projection (MIP) of the subtraction data, in multiple views, was created. The cross‐sectional and MIP images were evaluated for abnormal portosystemic vasculature. A single PSS was identified and confirmed at surgery in all dogs. A portocaval shunt was found in five dogs, a portophrenic shunt in three dogs, a portoazygos shunt in one, and a central divisional intrahepatic shunt in one other dog. Based on our results, CE‐MRA is a useful tool for imaging abdominal and portal vasculature and for the diagnosis of a PSS.     

IMAGING DIAGNOSIS—PORTAL VEIN APLASIA AND INTERRUPTION OF THE CAUDAL VENA CAVA IN THREE DOGS

Severe portal vascular anomalies have been reported previously accompanying azygos continuation of the caudal vena cava, polysplenia, and situs anomalies in dogs and people. Three dogs with portal vascular anomalies were identified by means of CT angiography as having portal vein aplasia with portal insertion into the caudal vena cava, azygos continuation of the caudal vena cava, and interruption of the pre‐hepatic caudal vena cava. This information confirms that complex embryological defects may occur in patients presenting for congenital portosystemic shunt, and that CT angiography is a non‐invasive method of completely evaluating these potentially non‐surgical portal vascular anomalies.     

MAGNETIC RESONANCE IMAGING FEATURES OF THE TEMPOROMANDIBULAR JOINT IN NORMAL DOGS

Evaluation of the canine temporomandibular joint (TMJ) is important in the clinical diagnosis of animals presenting with dysphagia, malocclusion and jaw pain. In humans, magnetic resonance imaging (MRI) is the modality of choice for evaluation of the TMJ. The objectives of this study were to establish a technical protocol for performing MRI of the canine TMJ and describe the MRI anatomy and appearance of the normal canine TMJ. Ten dogs (one fresh cadaver and nine healthy live dogs) were imaged. MRIs were compared with cadaveric tissue sections. T1‐weighted (T1‐W) transverse closed‐mouth, T1‐W sagittal closed‐mouth, T1‐W sagittal open‐mouth, and T2‐W sagittal open‐mouth sequences were obtained. The condylar process of the mandible and the mandibular fossa of the temporal bone were hyperintense to muscle and isointense to hypointense to fat on T1‐W images, mildly hyperintense to muscle on T2‐W images, and were frequently heterogeneous. The articular disc was visible in 14/20 (70%) TMJs on T1‐W images and 13/20 (65%) TMJs on T2‐W images. The articular disc was isointense to hyperintense to muscle on T1‐W images and varied from hypointense to hyperintense to muscle on T2‐W images. The lateral collateral ligament was not identified in any joint. MRI allows evaluation of the osseous and certain soft tissue structures of the TMJ in dogs.     

COMPARISON OF THREE METHODS FOR CALCULATING PORTAL BLOOD FLOW VELOCITY IN DOGS USING DUPLEX-DOPPLER ULTRASONOGRAPHY

Measurement of portal blood flow in dogs using duplex-Doppler ultrasonography has potential clinical utility for diagnosis of cirrhosis and portosystemic shunts. Three methods for calculating portal blood flow were compared to identify a consistent method with minimal potential for intraoperator variation. Sixteen unsedated, normal beagles had their mean portal blood flow velocity determined using three methods: method 1 used a small Doppler sample volume positioned over the center of the portal vein and manual selection of data points on the resulting velocity spectra, followed by arithmetic correction of the calculated maximum velocity to mean velocity using the factor 0.57; method 2 used a small centrally-located Doppler sample volume and computed maximum flow determination, again corrected using the factor 0.57; method 3 used a large Doppler sample volume that overlapped the walls of the portal vein followed by computed mean blood flow velocity determination. The calculated mean (SD) portal blood flow velocity was 15.8 (1.8), 15.1 (1.4), and 14.7 (2.5) cm/s using methods 1–3, respectively. There was no significant difference between the results of the three methods; however, method 3 (uniform insonation) was easier to use and produced a higher amplitude Doppler signal and therefore represents a useful alternative to the peak flow methods.     

CONTRAST-ENHANCED ULTRASONOGRAPHY IN NORMAL CANINE LIVER. EVALUATION OF IMAGING AND SAFETY PARAMETERS

Contrast-enhanced ultrasonography, a new imaging modality in veterinary medicine, can provide data on tissue perfusion. The objective of this study was to use the ultrasonographic contrast agent SonoVue to evaluate various transit time indices in the normal canine liver, to examine the effect of anesthesia on these parameters, and to evaluate the safety of this agent in dogs. The liver of 11 healthy dogs was studied by ultrasound during an intravenous bolus injection of SonoVue. Each dog underwent the examination twice, first with and later without the use of anesthesia. A time-intensity curve was generated from a selected region of interest within the liver from each scanning session. Ratios derived from peak enhancement, time to peak enhancement, up-slope and full-width half-maximum (FWHM) of the curve were calculated from the time-intensity curves, and are reported. There were no statistically significant differences (P > 0.05) in peak enhancement, up-slope and FWHM between dogs that were anesthetized and dogs that were not. Time to peak enhancement, however, was significantly shorter when the dogs were anesthetized than when they were nonanesthetized (P < 0.05). There were no biologically significant changes in clinical laboratory findings. This study indicates that contrast-enhanced ultrasound using SonoVue gives reproducible liver perfusion data, and appears to be a safe and well-tolerated agent for use in dogs. When considering normal values, the use of anesthetic drugs has to be considered.     

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.     

MENSURATION OF THE NORMAL PITUITARY GLAND FROM MAGNETIC RESONANCE IMAGES IN 96 DOGS

The pituitary gland was measured from transverse magnetic resonance T1-weighted images after Gadolinium administration in 96 dogs weighing from 13 to 45 kg. The measurements were done by hand with calipers. The mean (+/- standard deviation) pituitary gland height was 5.1 mm (+/-0.9 mm). The mean width was 6.4 mm (+/- 1.1 mm). The correlation coefficient between pituitary and brain measurements, between pituitary measurement and body weight, and brain measurements and body weight was 0.0 to 0.3. A hyperintense region was present on T1-weighted images in the center of the pituitary gland in 64% of the dogs. At necropsy the pituitary glands were grossly and histologically normal. No pituitary gland measurements were performed at necropsy.     

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.     

HELICAL COMPUTED TOMOGRAPHIC PORTOGRAPHY IN TEN NORMAL DOGS AND TEN DOGS WITH A PORTOSYSTEMIC SHUNT

Contrast enhanced helical computed tomography (CT) of the liver and portal system is routinely performed in human patients. The purpose of this project is to develop a practical protocol for helical CT portography in the dog. Ten clinically normal dogs were initially evaluated to develop a protocol. Using this protocol, ten dogs with confirmed portosystemic shunts (PSS) were then evaluated. Each patient was anesthetized, and a test dose of sodium iothalamate (400 mg I/ml) at 0.55 ml/kg was injected. Serial images were acquired at the level of T12-13 or T13-L1. The time to maximum enhancement of the portal vein was determined. This time period was used as the period between the second injection (2.2 ml/kg) and the start of the helical examination of the cranial abdomen. Delay times for normal dogs ranged from 34.5 s-66.0 s (median: 43.5 s) or 1.41 s/kg-4.12 s/kg (median: 2.09 s/kg). For patients with a PSS, the delay times were 16.5-70.5 s (median: 34.5 s) or 1.47-19.17 s/kg (median: 3.39 s/kg). The aorta, caudal vena cava, portal vein, shunt vessels, and their respective branches were well visualized on the CT images. Clinical case results were surgically confirmed. The surgeons reported that the information gained from the CT portography resulted in a subjective decrease in surgical time and degree of dissection necessary compared with similar surgeries performed without angiographic information. We believe that helical CT portography in the dog will be a useful adjunct in the diagnosis of PSS. The use of helical CT portography may allow clinicians to give clients a more accurate prognosis prior to surgery and will allow patients with lesions that are not surgically correctable to avoid a costly and invasive procedure.     

REVERSIBLE MAGNETIC RESONANCE IMAGING ABNORMALITIES IN DOGS FOLLOWING SEIZURES

Reversible magnetic resonance (MR) imaging lesions have been described in humans following seizures. This condition has not yet been reported in animals. This paper describes reversible abnormalities identified in 3 dogs using MR imaging that was performed initially within 14 days of the last seizure and follow-up imaging that was performed after 10 to 16 weeks of anticonvulsant therapy. All three dogs had lesions in the piriform/temporal lobes, characterized by varying degrees of hyperintensity on T2-weighted images and hypointensity on T1-weighted images. In one dog, contrast enhancement was evident. On reevaluation, partial resolution occurred in all 3 dogs. In a fourth animal with an olfactory meningioma, similar appearing lesions in the temporal cortex and right and left piriform lobes were identified after seizure activity. A surgical biopsy of the temporal cortex and hippocampus was performed and edema, neovascularization, reactive astrocytosis, and acute neuronal necrosis were evident. These histologic findings are similar to those reported in humans with seizures. Recognizing the potential occurrence of reversible abnormalities in MR images is important in developing a diagnostic and therapeutic plan in canine patients with seizures. Repeat imaging after seizure control may help differentiate between seizure-induced changes and primary multifocal parenchymal abnormalities.     

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).     

MRI FEATURES OF GASTROCNEMIUS MUSCULOTENDINOPATHY IN HERDING DOGS

Pelvic limb lameness that was localized clinically to the lateral gastrocnemius head was observed in dogs without history of trauma. The aim of this retrospective study was to describe magnetic resonance imaging (MRI) findings of this condition. Nine dogs were identified, eight Border Collies and one Australian Shepherd. They all had chronic pelvic limb lameness; no signs of joint effusion or instability were present. In MR images there was high signal intensity in the lateral head of the gastrocnemius muscle around the sesamoid bone in T2‐weighted, T2^*‐weighted, and STIR images and an iso‐ to mildly hyperintense signal in T1‐weighted images with marked contrast enhancement. The abnormal signal intensity most likely represents a myotendinous strain. The breed affiliation to Border Collies is striking, and a relation to biomechanical forces or motion pattern may be possible. Except for the dog with the most extensive lesion all dogs had an excellent outcome.     

THREE-DIMENSIONAL HELICAL COMPUTED TOMOGRAPHIC ANGIOGRAPHY OF THE LIVER IN FIVE DOGS

The objective of this study was to develop a simple, safe, minimally invasive protocol to evaluate the hepatic vasculature. Five purpose-bred Beagle dogs underwent noncontrast-enhanced computed tomographic scan of the entire abdomen. A dynamic, nonincremental computed tomography scan at the level of T11 was then performed using a test bolus of contrast medium to determine time to peak opacification and to aid in the calculation of scan delay. The time to peak arterial enhancement ranged from 2.0 to 7.0 s, with a median of 2.0 s. The time to peak portal venous enhancement ranged from 23.0 to 46.0 s, with a median of 32.0 s. Scan delay for arterial opacification ranged from 0 to 5.0 s, with a median of 0 s. Scan delay for the portal phase of opacification ranged from 6.0 to 21.0 s, with a median of 17.0 s. Using this information, two separate computed tomographic studies were used to image the arterial and portal venous phases of circulatory opacification, respectively. The dogs were hyperventilated to prevent breathing motion during the scan, each of which required approximately 20 s. A power injector was used to inject diatrizoate meglumine (128 mg I/kg) through an 18-gauge cephalic vein catheter at a rate of 5 ml/s. Scanning was initiated after the appropriate scan delay to optimize the specific phase of vascular filling. Maximum intensity projections allowed clear delineation of the hepatic arteries and the portal venous system, while eliminating overlying structures that might interfere with image analysis. Time/density curves were generated, and the time needed for each study was recorded. Hepatic arteries and portal veins were clearly visualized in all dogs. Parenchymal opacification was also observed.