Evaluation of serum feline pancreatic lipase immunoreactivity and helical computed tomography versus conventional testing for the diagnosis of feline pancreatitis

Serum feline trypsinogen-like immunoreactivity (fTLI) concentrations and abdominal ultrasound have facilitated the noninvasive diagnosis of pancreatitis in cats, but low sensitivities (33% and 20–35%, respectively) have been reported. A radioimmunoassay has been validated to measure feline pancreatic lipase immunoreactivity (fPLI), but the assay's sensitivity and specificity have not been established. In human beings, the sensitivity of computed tomography (CT) is high (75–90%), but in a study of 10 cats, only 2 had CT changes suggestive of pancreatitis. We prospectively evaluated these diagnostic tests in cats with and without pancreatitis. In all cats, serum was obtained for fTLI and fPLI concentrations, and pancreatic ultrasound images and biopsies were acquired. Serum fPLI concentrations ( P <.0001) and ultrasound findings ( P = .0073) were significantly different between healthy cats and cats with pancreatitis. Serum fTLI concentrations ( P = .15) and CT measurements ( P = .18) were not significantly different between the groups. The sensitivity of fTLI in cats with moderate to severe pancreatitis was 80%, and the specificity in healthy cats was 75%. Feline PLI concentrations were both sensitive in cats with moderate to severe pancreatitis (100%) and specific in the healthy cats (100%). Abdominal ultrasound was both sensitive in cats with moderate to severe pancreatitis (80%) and specific in healthy cats (88%). The high sensitivities of fPLI and abdominal ultrasound suggest that these tests should play an important role in the noninvasive diagnosis of feline pancreatitis. As suggested by a previous study, pancreatic CT is not a useful diagnostic test for feline pancreatitis.     

Computed tomographic anatomy of the head of the loggerhead sea turtle (Caretta caretta)

The heads of three loggerhead sea turtles were disarticulated and imaged immediately to minimize postmortem changes and then frozen and sectioned. For computed tomography (CT) imaging, the heads were positioned in ventral recumbency. Transverse CT images with soft-tissue window were obtained from the olfactory sac region to the temporomandibular joint region. After CT imaging, the heads were sectioned and the gross sections were compared to CT images, to assist in the accurate identification of the anatomic structures. Different clinically relevant anatomic structures were identified and labelled in two series of photographs (CT images and anatomic cross-sections). CT images provided good differentiation between the bones and the soft tissues of the head. The information presented in this paper should serve as an initial reference to evaluate CT images of the head of the loggerhead sea turtle and to assist in the interpretation of lesions of this region.     

Differences in the morphology of distal border synovial invaginations of the distal sesamoid bone in the horse as evaluated by computed tomography compared with radiography

Reasons for performing study: Distal border synovial invaginations of the distal sesamoid bone are radiographically assessed during the selection process of horses admitted as breeding stallions or in purchase examinations. Nowadays, many moderately or some deeply penetrating proximally enlarged synovial invaginations are considered as moderate or severe radiographic findings. Objective: To measure the difference between and agreement of the morphology of distal border synovial invaginations on radiography vs. computed tomography (CT). It was hypothesised that the morphology of distal border synovial invaginations would be better evaluable on CT compared with radiography. Methods: Computed tomography scans and 3 dorsoproximal–palmarodistal oblique (DPr‐PaDiO) radiographs were obtained on 50 cadaver forefeet from 25 Warmblood horses. Computed tomography was assumed to be the gold standard. The number, shape and depth of penetration of distal border synovial invaginations into the distal sesamoid bone were evaluated with both methods, and the comparison of their measurements was statistically described. Results: A statistically significant mean difference for number of distal synovial invaginations between CT and all 3 DPr‐PaDiO projections was found and was approximately equal to 2, meaning that CT permits visualisation of an average of 2 more invaginations than radiography. In none of the cases did radiography have a higher number observed than CT. A large variation in the difference of measurements for depth of penetration against their mean difference between CT and the 3 radiographic projections was seen. Radiography underestimated the depth of invaginations, and more so when these were deeper. There was no statistically significant mean difference found between the techniques for depth. A moderate to good agreement between measurements on CT and the three DPr‐PaDiO projections for shape was seen, in which the D55°Pr‐PaDiO projection showed the best agreement. A high specificity (90–99%) and low sensitivity (65%) for all projections for shape were found. Conclusions and potential relevance: Radiography differs considerably from CT concerning the morphology of distal navicular border synovial invaginations. For the evaluation of the number, depth and shape of distal synovial invaginations in the distal sesamoid bone, radiography shows only partially the morphology seen on CT.     

Estimation of glomerular filtration rate in healthy cats using single-slice dynamic CT and Patlak plot analysis

Commonly used clinical indicators of renal disease are either insensitive to early dysfunction or have delayed results. Decreased glomerular filtration rate (GFR) indicates renal dysfunction before there is a loss of 50% of functional nephrons. Most tests evaluate global rather than individual kidney function. Dynamic computed tomography (CT) and Patlak plot analysis allows for individual GFR to be tested. Our objectives were to establish a procedure and provide reference values for determination of global GFR in 10 healthy cats using dynamic CT (CTGFR). This method of GFR determination was compared against serum iohexol clearance (SIC). A single CT slice centered on both kidneys and the aorta was acquired every fifth second during and after a bolus injection of iohexol (240 mgI/ml; 300 mgI/kg) for 115 s. Using data from this dynamic acquisition, Patlak plots were obtained, GFR was calculated, and results were compared to global GFR determined by iohexol clearance. The average global CTGFR estimate was 1.84 ml/min x kg (SD = 0.43; range = [1.22, 2.45]). The average global GFR measured using SIC was 2.45 ml/min x kg (SD = 0.58; range = [1.72, 3.69]). GFR measurements estimated by both dynamic CT and SIC were positively associated (estimated Spearman rank correlation coefficient = 0.72; P = 0.0234). The CTGFR method consistently underestimated GFR with a bias of -0.62 (SE = 0.1307) when compared to SIC (P = 0.0011). In healthy cats, CTGFR was capable of determining individual kidney function and appears clinically promising.     

APPLICATION AND MACHINE ACCURACY OF A NEW FRAMELESS COMPUTED TOMOGRAPHY‐GUIDED STEREOTACTIC BRAIN BIOPSY SYSTEM IN DOGS

The purpose of this study was to describe application and machine accuracy for a new computed tomography (CT) guided, frameless, stereotactic brain biopsy system in dogs. Heads from ten canine cadavers were secured to a bite‐plate with six attached fiducial markers and imaged using CT. Fiducialized CT images were imported into stereotactic software and spherical phantom lesions between 3.9 and 5.5 mm in diameter were created in six locations. Infrared cameras and reflective markers were used to register fiducials to the reconstructed image set. Coordinates in the X, Y, and Z planes were identified for each lesion center. Iohexol (1.5 μl of 240 mgI/ml) was injected into the center of each lesion and CT scans were repeated. Pre‐ and postinjection CT images for each cadaver were fused using the system software. Application accuracy was calculated using the center of each phantom lesion and the center of each injected contrast material location. Machine accuracy was calculated using a phantom with known distances between four fixed points in the X, Y, and Z planes. Mean application accuracy in the first 5 cadavers was 4.3 mm (95% confidence interval [CI] 2.9–4.3 mm) and in the second 5 cadavers was 2.9 mm (95% CI 2–3.9 mm). The more superficial lesions were targeted significantly less accurately than the deeper lesions (P = 0.0183). Median machine accuracy was 0.1 mm and the range was 0.1–0.2 mm. Findings supported use of the new biopsy system for canine brain lesions >3.9 mm in diameter.     

COMPUTED TOMOGRAPHIC FEATURES OF BASIHYOID ECTOPIC THYROID CARCINOMA IN DOGS

Eight dogs with a firm, nonpainful swelling in the ventral laryngeal region and with a final diagnosis of ectopic thyroid carcinoma were investigated by Computed Tomography (CT) at six different institutions. Computed Tomography findings were reviewed, focusing on lesion volume, shape, margins, relationship with surrounding structures and adjacent vessels, attenuation characteristics, and presence of metastases. Ectopic thyroid carcinomas were seen as oval‐to‐bilobed masses centered on the basihyoid bone with associated bone lysis, highly vascularized capsules with central poorly contrast enhancing areas. In all cases there was laryngeal wall infiltration, in two dogs invasion of the laryngeal lumen and in one case invasion of the ventral muscular and subcutaneous plane. Metastases were found in retropharyngeal lymph nodes (three cases) and in the lung (two cases). Ectopic thyroid carcinoma should be considered in the differential diagnosis when a mass in the basihyoid region is present. Described CT features may be typical for ectopic thyroid neoplasia and could be used to help decide the therapeutic plan.     

IMAGING FINDINGS IN 14 DOMESTIC FERRETS (MUSTELA PUTORIUS FURO) WITH LYMPHOMA

Lymphoma is the most common malignant neoplasia in domestic ferrets, Mustela putorius furo. However, imaging findings in ferrets with lymphoma have primarily been described in single case reports. The purpose of this retrospective study was to describe imaging findings in a group of ferrets with confirmed lymphoma. Medical records were searched between 2002 and 2012. A total of 14 ferrets were included. Radiographs (n = 12), ultrasound (n = 14), computed tomography (CT; n = 1), and magnetic resonance imaging (MRI; n = 1) images were available for review. Median age at the time of diagnosis was 5.2 years (range 3.25–7.6 years). Clinical signs were predominantly nonspecific (8/14). The time between the first imaging study and lymphoma diagnosis was 1 day or less in most ferrets (12). Imaging lesions were predominantly detected in the abdomen, and most frequently included intra‐abdominal lymphadenopathy (12/14), splenomegaly (8/14), and peritoneal effusion (11/14). Lymphadenopathy and mass lesions were typically hypoechoic on ultrasound. Mild peritoneal effusion was the only detected abnormality in two ferrets. Mild pleural effusion was the most common thoracic abnormality (3/12). Expansile lytic lesions were present in the vertebrae of two ferrets with T3‐L3 myelopathy and the femur in a ferret with lameness. Hyperattenuating, enhancing masses with secondary spinal cord compression were associated with vertebral lysis in CT images of one ferret. The MRI study in one ferret with myelopathy was inconclusive. Findings indicated that imaging characteristics of lymphoma in ferrets are similar to those previously reported in dogs, cats, and humans.     

IMAGING DIAGNOSIS: FIBRODYSPLASIA OSSIFICANS PROGRESSIVA IN A CAT

A 1‐year‐old female cat was presented for progressive alopecia, gait abnormalities, and stiffness. Radiography demonstrated multiple calcified lesions within the soft tissues of the cervical and thoracic spine, shoulder, and limbs. Postmortem computed tomography provided more detailed information on the distribution, pattern, and extension of lesions. In addition, computed tomography helped guide sample selection for histopathology. The final diagnosis was fibrodysplasia ossificans progressiva. This is a rare disorder of unknown etiology, characterized by fibrosis and heterotopic bone formation in connective tissues. To the authors’ knowledge, this is the first report describing this disease in a European cat.     

IMAGING DIAGNOSIS—PULMONARY ALVEOLAR PROTEINOSIS IN A DOG

A young dog was presented for cyanosis and right heart failure. Radiographic and CT characteristics included right heart/pulmonary artery enlargement, hepatomegaly, abdominal effusion, and severe, generalized air‐space filling. Focal increased opacities were present in the peripheral lung, as were multiple pulmonary blebs and bullae. Echocardiographic findings were consistent with cor pulmonale and pulmonary hypertension. Bronchoscopic findings were consistent with chronic inflammation. Pulmonary alveolar proteinosis (PAP) was confirmed at necropsy. Pulmonary alveolar proteinosis is an interstitial lung disease that results in accumulation of phospholipoproteinaceous material and should be included as a differential diagnosis for dogs with these clinical and imaging characteristics.     

Computed tomographic assessment of vascular invasion and resectability of mediastinal masses in dogs and a cat

AIMS: To assess the sensitivity of non-angiographic contrast-enhanced computed tomography (CT) to determine the presence of vascular invasion of cranial mediastinal masses in dogs and a cat, and to evaluate the association between vascular invasion and peri-operative mortality.

METHODS: A retrospective study was conducted on 25 dogs and one cat. CT scans were completed with slices ranging from 2 to 10 mm. CT images were evaluated by a board-certifi ed radiologist blinded to previous diagnoses and surgical fi ndings. Each CT study was evaluated for vascular invasion, defi ned as disruption of the vessel wall and extension of the mass into the vessel lumen. Data retrieved from the surgery reports included surgical approach, whether vascular invasion was present, the surgeon's decision on operability, and post-operative complications.

RESULTS: Computed tomographic evaluation revealed 25/26 masses had no evidence of vascular invasion. During surgical exploration, 10/26 masses were found to invade major regional vasculature; the cranial vena cava (CVC) was the vessel most commonly invaded (7/10 animals), and 4/7 (57%) patients with invasion of the CVC were euthanised or died in the perioperative period, from surgical or disease-related problems, which was signifi cantly higher than patients without vascular invasion (p=0.045).

CONCLUSIONS: Non-angiographic contrast-enhanced CT was signifi cantly less sensitive for detecting vascular invasion of cranial mediastinal masses when compared with surgical evaluation. If the CVC was invaded by a tumour there was a signifi cant risk of death peri-operatively when compared with non-invasive cases.

CLINICAL RELEVANCE: Due to the signifi cantly higher mortality risk associated with invasion of the CVC, a more sensitive method than CT should be investigated to determine vascular invasion of mediastinal masses pre-operatively.