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.     

Effect of acquisition time and chemical fat suppression on meningeal enhancement on MR imaging in dogs

Our purpose was to characterize meningeal gadolinium enhancement on magnetic resonance (MR) imaging in dogs with inflammatory and neoplastic diseases, and to assess interobserver variability and the impact of delayed acquisition and chemical fat saturation on its conspicuity. Transverse T1-weighted FLAIR images were acquired prior to, and immediately following gadolinium injection (T0), and at 5 (T5) and 15-20 min delay (TD), with and without fat suppression, in 155 consecutive dogs imaged for suspected brain disease. The agreement on meningeal enhancement was globally substantial (kappa = 0.61) and the likelihood of obtaining a definite diagnosis was significantly increased with the use of fat suppression (P < or = 0.004). Meningeal enhancement was judged definitively present by consensus in 46 of 155 (30%) dogs. Of these, meningeal enhancement was characterized qualitatively and quantitatively in 30 dogs with a clinical diagnosis (18 inflammatory, 11 neoplastic, 1 infarct), and image sequences were compared. Meningeal enhancement was more often diffuse and leptomeningeal in animals with inflammation versus neoplasia (50% vs. 42%, and 69% vs. 48%, respectively), but significant associations were not found. Meningeal thickness and contrast ratio were higher with neoplasia (P < or = 0.02), but results did not vary significantly between series for either group. Yet, images with fat suppression were most useful 50% of the time for definite diagnosis and/or characterization of meningeal enhancement. While delayed image acquisition following gadolinium injection does not improve characterization of meningeal enhancement in dogs, fat suppression is beneficial qualitatively.     

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.     

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.     

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.     

IMAGING DIAGNOSIS: TRAUMATIC DURAL TEAR DIAGNOSED USING INTRATHECAL GADOPENTATE DIMEGLUMINE

A dog with traumatic monoplegia had a spinal cord lesion, identified using conventional magnetic resonance imaging. In addition, the intrathecal use of gadopentate dimeglumine allowed identification of two sites of cerebrospinal fluid leakage from the vertebral canal, supporting a diagnosis of brachial plexus avulsion.     

MULTIPHASE TIME-RESOLVED CONTRAST-ENHANCED PORTAL MRA IN NORMAL DOGS

Portal vein anomalies are common in dogs and cats. Diagnostic imaging is central in their diagnosis and fundamental with regard to choosing the best therapeutic option. Various imaging techniques are used in veterinary medicine to assess the portal vein. Each has individual advantages and disadvantages. Contrast-enhanced magnetic resonance angiography (CE-MRA) is used routinely in humans to image the portal system and has excellent spatial and temporal resolution and three-dimensional (3D) acquisition. Herein, we report the development of a CE-MRA protocol that resulted in fast 3D imaging of the arterial splanchnic and portal venous system in normal dogs. Multiphase acquisition strategy allowed acquiring the same volume several times during one single breath-hold, thereby capturing the portal venous phase with excellent signal. Excellent depiction of the vascular anatomy, especially the portal afferent vessels and branches, was observed. Elliptical centric view ordering of k-space was used to acquire the contrast-sensitive data faster. Parallel imaging was used to increase coverage in the dorsal to ventral direction while keeping imaging time short. It is anticipated that 3D CE-MRA is a fast and noninvasive imaging method that could be used to diagnose various portal vascular anomalies in small animals.     

MAGNETIC RESONANCE IMAGING FINDINGS IN HORSES WITH SEPTIC ARTHRITIS

Fourteen horses with septic arthritis underwent high‐field (1.5 T) magnetic resonance imaging (MRI). Septic arthritis was diagnosed based on results from historical and clinical findings, synovial fluid analyses and culture, and radiographic, ultrasonographic, arthroscopic, and histopathologic findings. MR findings included diffuse hyperintensity within bone and extracapsular tissue on fat‐suppressed images in 14/14 horses (100%), joint effusion, synovial proliferation, and capsular thickening in 13/14 horses (93%), bone sclerosis in 11/14 horses (79%), and evidence of cartilage and subchondral bone damage in 8/14 horses (57%). Intravenous gadolinium was administered to five of the 14 horses and fibrin deposition was noted in all horses. Other findings after gadolinium administration included synovial enhancement in 4/5 (80%) horses, and bone enhancement in 1/5 (20%) horses. The MR findings of septic arthritis in horses were consistent with those reported in people. MRI may allow earlier and more accurate diagnosis of septic arthritis in horses as compared with other imaging modalities, especially when the clinical diagnosis is challenging. It also provides additional information not afforded by other methods that may influence and enhance treatment.