Anaïs Combes

Ultrasonography of the feline kidney: Technique, anatomy and changes associated with disease.

Practical relevance: Ultrasonography is an important tool for the detection of kidney disorders, which are among the most common health problems suffered by cats. It is more accurate than radiography for this purpose and is considered to be the reference modality for imaging the feline kidney, providing excellent visualisation of renal size, shape and internal architecture. Compared with more advanced imaging modalities, such as computed tomography or magnetic resonance imaging, ultrasonography is more accessible, less expensive, does not require general anaesthesia and allows real-time procedures to be performed. Clinical challenges: On ultrasound examination, focal or multifocal disorders may be readily identified, but diffuse changes are more challenging. B-mode ultrasonography is of limited use for differentiating between benign and malignant focal lesions. However, based on the presence and pattern of vascularity as an indicator of malignancy, contrast-enhanced ultrasonography allows distinction between benign and malignant focal renal lesions. Audience: This review provides a framework for the ultrasonographic approach to feline renal and perirenal disorders for the general practitioner. Evidence base: Drawing on current literature relating to ultrasonographic examination of feline kidneys, the aim is to summarise ultrasonographic technique, anatomy and changes associated with renal and perirenal diseases.

Prospective evaluation of healthy Ragdoll cats for chronic kidney disease by routine laboratory parameters and ultrasonography

Ragdoll breeder organisations often forewarn Ragdoll cat owners that renal problems may develop as a result of polycystic kidney disease (PKD), chronic interstitial nephritis, familial renal dysplasia or nephrocalcinosis. Healthy Ragdoll and non-Ragdoll cats were prospectively evaluated by measuring serum creatinine and urea concentrations, routine urinalysis and abdominal ultrasonography. All Ragdoll cats also underwent genetic PKD testing. One hundred and thirty-three Ragdoll and 62 control cats were included. Ragdoll cats had significantly lower serum urea concentrations and higher urinary specific gravity. However, median creatinine concentration, median urinary protein-to-creatinine ratio, and the proportion of cats with serum creatinine or urea concentration exceeding the reference interval did not differ. One or more renal ultrasonographical changes were detected in 66/133 (49.6%) Ragdoll and in 25/62 (40%) control cats. Ragdoll cats showed significantly more frequent segmental cortical lesions (7.5% versus 0%), abnormal renal capsule (19.5% versus 8%) and echogenic urine (51.9% versus 25.8%). Chronic kidney disease (CKD) was ultrasonographically suspected in 7/133 (5.3%) Ragdoll and in none of the control cats, which approached significance. Laboratory parameters confirmed kidney dysfunction only in 1/7 of these Ragdoll cats. All Ragdoll cats were PKD negative. In conclusion, first, breed-specific serum creatinine reference intervals are not likely required for Ragdoll cats. Second, renal ultrasonographical abnormalities are common, both in Ragdoll and non-Ragdoll cats. Third, healthy young Ragdoll cats are uncommonly affected by PKD and CKD, but an increased susceptibility of Ragdoll cats to develop CKD cannot be excluded. Finally, Ragdoll cats are predisposed to segmental cortical lesions, which may indicate renal infarction or cortical scarring.

Ultrasonographic appearance of adrenal glands in healthy and sick cats

The first part of the study aimed to describe prospectively the ultrasonographic features of the adrenal glands in 94 healthy cats and 51 chronically sick cats. It confirmed the feasibility of ultrasonography of adrenal glands in healthy and chronically sick cats, which were not statistically different. The typical hypoechoic appearance of the gland surrounded by hyperechoic fat made it recognisable. A sagittal plane of the gland, not in line with the aorta, may be necessary to obtain the largest adrenal measurements. The reference intervals of adrenal measurements were inferred from the values obtained in the healthy and chronically sick cats (mean ± 0.96 SD): adrenal length was 8.9–12.5 mm; cranial height was 3.0–4.8 mm; caudal height was 3.0–4.5 mm. The second part of the study consisted of a retrospective analysis of the ultrasonographic examination of the adrenal glands in cats with adrenal diseases (six had hyperaldosteronism and four had pituitary-dependent hyperadrenocorticism) and a descriptive comparison with the reference features obtained in the control groups from the prospective study. Cats with hyperaldosteronism presented with unilateral severely enlarged adrenal glands. However, a normal contralateral gland did not preclude a contralateral infiltration in benign or malignant adrenal neoplasms. The ultrasonographic appearance of the adrenal glands could not differentiate benign and malignant lesions. The ultrasonographic appearance of pituitary-dependent hyperadrenocorticism was mainly a symmetrical adrenal enlargement; however, a substantial number of cases were within the reference intervals of adrenal size.

Scintigraphic thyroid volume calculation in hyperthyroid cats.

A successful, euthyroid outcome after radioiodine therapy in hyperthyroid cats ranges from 83% to 95%. Thyroid volume has been reported as one of the factors influencing radioiodine therapy outcome in man and cats. The goal of this study was to describe the most reliable and practically applicable formula to determine thyroid volume using scintigraphy. The volume of each thyroid lobe of 32 hyperthyroid cats was determined by ultrasound and scintigraphy. The ultrasonographically determined volume (ellipsoid formula) for each thyroid lobe was compared with the scintigraphic volume that was calculated using eight different formulas: F1 [(π/6) × L × H × W], F2 [(π /2) × L × W2], F3 [0.33 × (area cm2)3/2], F4 [1.08 × (π /6) × L × W2], F5 (area × H), F6 (0.27 × area × L), F7 (π × L × W2) and F8 [π × (4/3) × W3]. F1, F3, F4 and F6 did not differ statistically from the volumes measured on ultrasound, while F2, F5, F7 and F8 did. Subjective shape assessment of the thyroid lobes, assigned as cylindrical or spherical, and the use of corresponding formulas, did not appear to be useful.

Ultrasonographic adrenal gland measurements in healthy Yorkshire Terriers and Labrador Retrievers.

An upper threshold of 7.4 mm for maximal adrenal gland diameter is commonly used to detect pituitary‐dependent hyperadrenocorticism ultrasonographically in dogs. There is a substantial overlap between adrenal gland diameter of healthy dogs and of those with pituitary‐dependent hyperadrenocorticism. The aim of this study is to determine the measurements of both adrenal glands, in particular, of the height at the caudal glandular pole in a longitudinal plane, in the Labrador retriever and Yorkshire terrier, two breeds widely represented in the population suspected of hyperadrenocorticism. Seventeen Labrador retrievers and 24 Yorkshire terriers considered healthy were included in the study. Adrenal gland measurements were taken on static images and comprised in measurements of the length in a longitudinal plane (L), of the height at the cranial (CrHLG) and caudal pole (CdHLG) in a longitudinal plane and in a transverse plane (CrHTR and CdHTR, respectively), and of the width at the cranial and caudal poles in a transverse plane (CrWTR and CdWTR, respectively). This study established new upper thresholds for the left and right height at the caudal pole measured in a longitudinal plane: 7.9 mm (left) and 9.5 mm (right) for the Labrador retrievers and 5.4 mm (left) and 6.7 mm (right) for the Yorkshire terriers. All the measurements were significantly different between the two breeds. There was a significant relationship between CdHTR and CdHLG, and the age of the dogs for both breeds.

ULTRASONOGRAPHIC MEASUREMENTS OF ADRENAL GLANDS IN CATS WITH HYPERTHYROIDISM

Feline hyperthyroidism is potentially associated with exaggerated responsiveness of the adrenal gland cortex. The adrenal glands of 23 hyperthyroid cats were examined ultrasonographically and compared to the adrenal glands of 30 control cats. Ten hyperthyroid cats had received antithyroid drugs until 2 weeks before sonography, the other 13 were untreated. There was no difference in adrenal gland shape between healthy and hyperthyroid cats: bean-shaped, well-defined, hypoechoic structures surrounded by a hyperechoic halo in 43/60 (71.6%) healthy cats and 34/46 (73.9%) hyperthyroid cats; more ovoid in 13/60 (21.6%) healthy cats and 9/46 (19.6%) hyperthyroid cats while more elongated in 4/60 (6.7%) healthy cats, 3/46 (6.5%) hyperthyroid cats. Hyperechoic foci were present in 9/23 (39.1%) hyperthyroid cats and 2/30 (6.7%) healthy cats. The adrenal glands were significantly larger in hyperthyroid cats, although there was overlap in size range. The mean difference between hyperthyroid cats and healthy cats was 1.6 and 1.7 mm in left and right adrenal gland length, 0.8 and 0.9 mm in left and right cranial adrenal gland height, and 0.4 and 0.9 mm in left and right caudal adrenal gland height. There was no significant difference between the adrenal gland measurements in treated and untreated hyperthyroid cats. The adrenomegaly was most likely associated with the hypersecretion of the adrenal cortex documented in hyperthyroid cats. Hyperthyroidism should be an alternative to hyperadrenocorticism, hyperaldosteronism, and acromegaly in cats with bilateral moderate adrenomegaly.

Renal dimensions at ultrasonography in healthy Ragdoll cats with normal kidney morphology: correlation with age, gender and bodyweight

Fifty-six healthy Ragdoll cats underwent an ultrasonographical examination of the urinary tract to evaluate if gender, age, bodyweight and presence of a medullary rim sign had a significant influence on renal length and corticomedullary ratio (CM). Individual variation percentage was much more pronounced for renal length in comparison with CM ratio. Mean renal length measured 3.83 ± 0.45 cm (range 2.98–5.09 cm), mean cortical thickness 0.73 ± 0.15 cm (range 0.36–1.18 cm), mean medullary thickness 0.87 ± 0.19 cm (range 0.46–1.39 cm) and mean CM ratio 0.88 ± 0.29 (range 0.29–1.78). Renal length showed a significant positive correlation with bodyweight (P <0.0001), age (P = 0.0073) and male gender (P <0.0001). Therefore, these parameters have to be kept in mind when evaluating renal length on ultrasound. The CM ratio was solely influenced by the presence of a medullary rim sign (P <0.0001). Further research, however, is needed to investigate the usefulness of the CM ratio for the detection of kidney disease by ultrasonography.

Ultrasonographical examination of feline adrenal glands: intra- and inter-observer variability

Interpretation of ultrasonographical measurements requires an understanding of the source and the magnitude of variation. A substantial part of the variation can be attributed to the observer, the equipment or the animal. The aim of this study was to evaluate which adrenal gland measurement is the least variable within and between observers. Three experienced ultrasonographers examined six cats at three different times on the same day, more than 1 h apart, according to a strict scanning protocol. Seven ultrasonographical measurements were performed on each adrenal gland (maximal length on sagittal images, maximal height at the cranial and caudal poles on sagittal and transverse images, and maximal width of the cranial and caudal poles on transverse images). Height measurements in both planes showed the lowest variability within and between observers compared with length and width measurements. Descriptive ultrasonographical features, such as echogenicity of the gland, presence of hyperechoic spots or layering assessment, demonstrated satisfactory-to-good intra- and inter-observer agreement, whereas the shape assessment showed very poor inter-observer agreement. The results of this study describe a reliable scanning protocol that can be the basis for future adrenal ultrasonographical examinations for cats suspected of adrenal disease (eg, hyperaldosteronism, hyperadrenocorticism, sex hormone-producing tumours).

Transsplenic portal scintigraphy using 99mTc-pertechnetate for the diagnosis of portosystemic shunts in cats: a retrospective review of 12 patients

Portosystemic shunts (PSS), congenital or acquired, occur uncommonly in the feline population. The diagnostic approach is similar to one in dogs suspected of a PSS based on the clinical signs and haematological and biochemical changes. Diagnostic imaging, however, is key for the confirmation of a PSS. Although abdominal ultrasound is the first-choice diagnostic imaging modality, the results are not always unequivocal. Transsplenic portal scintigraphy (TSPS) using 99mTc-pertechnetate is a well-established technique in canine medicine, providing relatively fast and easy confirmation of the presence or absence of a PSS. As the prevalence of PSS is much lower in the feline population, this technique has not been widely used in cats. This retrospective study of 12 cases gives an overview of the potential of TSPS in the diagnostic work-up of PSS in cats (2005–2012).

Comparison of renal ultrasonographic measurements between healthy cats of three cat breeds: Ragdoll, British Shorthair and Sphynx

Healthy cats of three cat breeds — Sphynx (n = 11), British Shorthair (n = 15) and Ragdoll (n = 15) — were included in this study. All cats underwent an ultrasonographic examination to assess renal length, cortical thickness, medullary thickness and corticomedullary ratio. Of all ultrasonographic measurements, renal length showed the highest variation. For all ultrasonographic dimensions, individual and kidney side (left vs right) variation were much more pronounced than interbreed variation. Sphynx cats tended to have larger kidneys (4.09 ± 0.33 cm) than British Shorthair (3.77 ± 0.43 cm) and Ragdoll cats (3.87 ± 0.41 cm). British Shorthair cats, however, tended to have a thinner cortex (0.67 ± 0.13 cm) and medulla (0.76 ± 0.18 cm) than Sphynx (0.76 ± 0.14 cm and 0.90 ± 0.25 cm, respectively) and Ragdoll cats (0.75 ± 0.13 cm and 0.91 ± 0.22 cm, respectively). However, statistical tests did not reveal significant differences between these cat breeds. The corticomedullary ratio was similar for the three cat breeds (Sphynx: 0.93 ± 0.43; British Shorthair: 0.91 ± 0.26; Ragdoll: 0.88 ± 0.31). The left kidney (3.83 ± 0.42 cm) was significantly smaller than the right kidney (3.99 ± 0.40 cm) and showed a thicker medulla (left: 0.93 ± 0.21 cm, right: 0.79 ± 0.22 cm), and thus a lower corticomedullary ratio (left: 0.80 ± 0.23, right: 1.01 ± 0.32). For the cortical thickness, no significant difference was observed between the left (0.71 ± 0.14 cm) and right kidney (0.74 ± 0.14 cm).