Kristina Miles

A clinical index for disease activity in cats with chronic enteropathy.

BACKGROUND There is a need for a clinically useful, quantitative index for measurement of disease activity in cats with chronic enteropathy (CE). OBJECTIVE To develop a numerical activity index that is of practical value to clinicians treating CE in cats. ANIMALS Eighty-two cats with CE. METHODS Retrospective case review of 59 cats diagnosed with inflammatory bowel disease (IBD). Prospective validation study of 23 cats having either IBD or food-responsive enteropathy (FRE). Multivariate regression analysis was used to identify which combination of clinical and laboratory variables were best associated with intestinal inflammation of IBD. This combination of variables was expressed in a score that was used as an activity index for the prospective assessment of disease activity and of the effect of treatment in cats with IBD or FRE. RESULTS The combination of gastrointestinal signs, endoscopic abnormalities, serum total protein, serum alanine transaminase/alkaline phosphatase activity, and serum phosphorous concentration had the best correlation with histopathologic inflammation and comprise the feline chronic enteropathy activity index (FCEAI). Positive treatment responses in cats with CE were accompanied by significant (P < .05) reductions in FCEAI scores after treatment. CONCLUSIONS AND CLINICAL IMPORTANCE The FCEAI is a simple numerical measure of inflammatory activity in cats with CE. The scoring index can be reliably used in the initial assessment of disease severity for both IBD and FRE and as a measure of clinical response to treatment for these disorders.

IMAGING ABDOMINAL MASSES

Both radiography and ultrasound provide noninvasive imaging of suspected abdominal masses with minimal discomfort or risk for the geriatric patient. Radiography is more readily available and less expensive than ultrasonography, but contrast resolution is poor. Displacement of adjacent structures and addition of special contrast studies will provide clues to the possible organ of origin and extent of suspected abdominal masses. Cystic lesions can be differentiated from solid masses with ultrasound, but the appearance of focal abnormalities is not specific for any one disease process. Abdominal ultrasonography often provides the best diagnostic yield when used in combination with radiography and image-guided biopsy techniques.

IMAGING DIAGNOSIS—HYPOGLYCEMIA ASSOCIATED WITH CHOLANGIOCARCINOMA AND PERITONEAL CARCINOMATOSIS IN A HORSE

An 8-year-old Thoroughbred mare presented for decreased appetite, ataxia, and weakness. Abdominal ultrasound revealed a large volume of anechoic fluid along with multiple masses involving the spleen, liver, and diaphragm. Pleural fluid was identified via ultrasonography and thoracic radiography. Thoracic radiographs also identified pulmonary interstitial nodules, an undulant dorsal diaphragmatic margin and enlargement of tracheobronchial lymph nodes. Clinical signs of weakness and mild seizures were concurrent with hypoglycemic episodes. The final diagnosis was cholangiocarcinoma with extensive metastasis. Clinical signs of weakness, ataxia, and seizures were attributed to a paraneoplastic syndrome of tumor-associated hypoglycemia that has been infrequently reported in horses.

SINGLE-SHOT TURBO SPIN ECHO PULSE SEQUENCE FINDINGS IN DOGS WITH AND WITHOUT PROGRESSIVE MYELOMALACIA

Progressive myelomalacia is an uncommon type of ischemic, hemorrhagic spinal cord infarction. Diagnosis can be difficult, but prompt recognition is important. We hypothesized that cerebrospinal fluid signal attenuation on magnetic resonance (MR) images would be more extensive in dogs that developed progressive myelomalacia vs. control dogs. A retrospective analytic cohort study was designed. Dogs were included if they presented for acute paraplegia and loss of deep pain perception and had undergone MR imaging using both sagittal single-shot turbo spin echo (SSTSE) and standard sagittal T2-weighted fast spin echo (T2W) pulse sequences. Dogs were divided into progressive myelomalacia and control groups for comparisons. All MR examinations were evaluated by three reviewers blinded to patient outcome. Length of cerebrospinal fluid attenuation was recorded as a ratio to the length of the L2 vertebral body in SSTSE and T2W sequences (CSF:L2SSTSE and CSF:L2T2 , respectively). Length of intramedullary spinal cord hyperintensity was recorded as a ratio to the length of the L2 vertebral body in T2W sequences. A total of 21 dogs were included (five in the progressive myelomalacia group and 16 in the control group). The mean CSF:L2SSTSE attenuation value was significantly higher in dogs that developed progressive myelomalacia (CSF:L2SSTSE = 10.7) compared to controls (CSF:L2SSTSE = 5.4; P = 0.015). A cut off ratio of attenuation >7.4 provided optimal differentiation between groups in this study. Findings supported the conclusion that dogs with CSF:L2SSTSE ≤ 7.4 are unlikely to develop progressive myelomalacia while dogs with CSF:L2SSTSE > 7.4 are indeterminate for progressive myelomalacia.