Sarah M. Puchalski

Hemodynamic and serum biochemical alterations associated with intravenous administration of three types of contrast media in anesthetized dogs

OBJECTIVE To determine the incidence and type of alterations in heart rate (HR), peak systolic blood pressure (PSBP), and serum biochemical variables (total bilirubin, BUN, and creatinine concentrations) associated with IV administration of ionic-iodinated contrast (IIC), nonionic-iodinated contrast (NIC), and gadolinium dimeglumine (GD) contrast media in anesthetized dogs. ANIMALS 280 anesthetized dogs undergoing cross-sectional imaging. PROCEDURES HR and PSBP were recorded at 5-minute intervals for 20 minutes for untreated control dogs and dogs that received IIC, NIC, or GD contrast medium. The development of an HR of < 60 beats/min or > 130 beats/min that included a > or = 20% change from baseline was considered a response. The development of PSBP of < 90 mm Hg or > 160 mm Hg that included a > or = 20% change from baseline was considered a response. Pre- and postcontrast serum biochemical values were recorded. Results-Of dogs receiving IIC medium, 3% (3/91) had a response in HR and 4% (4/91) had a response in PSBP at > or = 1 time points. None of the dogs receiving NIC medium had a response in HR; 1 of 16 had a response in PSBP. Of dogs receiving GD contrast medium, 1% (1/92) had a response in HR and 4% (4/92) had a response in PSBP. Of control dogs, 2% (2/81) had a response in HR and 4% (3/81) had a response in PSBP. No serum biochemical alterations were observed. CONCLUSIONS AND CLINICAL RELEVANCE IV administration of contrast media in anesthetized dogs caused moderate bradycardia, tachycardia, hypotension, or hypertension.

Brainstem Auditory-Evoked Responses in Horses with Temporohyoid Osteoarthropathy

BACKGROUND Facial and vestibulocochlear nerve dysfunction occurs commonly in horses with temporohyoid osteoarthropathy (THO); however, auditory dysfunction has not been thoroughly assessed. OBJECTIVE To determine if auditory abnormalities occur in horses with THO. ANIMALS Eleven diseased and 8 control horses. METHODS This is a prospective study in which brainstem auditory-evoked responses (BAER) were recorded in 11 horses diagnosed with THO through neurologic, endoscopic, radiographic, or computed tomographic examinations. BAER findings were compared with those recorded from 8 adult control horses. RESULTS All horses with THO were found to have BAER abnormalities that included complete unilateral BAER loss (82%, n=9/11), partial unilateral BAER loss (18%, n=2/11) on the most affected side, and contralateral partial BAER loss (46%, n=5/11). Nine horses had bilateral THO based on diagnostic imaging findings; of these, 5 (56%) horses also had bilateral BAER abnormalities. The complete absence of BAER in affected horses was most consistent with peripheral sensorineural hearing loss. There was a significant association between complete BAER loss and neurologic and diagnostic abnormalities. CONCLUSIONS AND CLINICAL IMPORTANCE Auditory abnormalities such as complete or partial BAER loss are common in horses with THO. The BAER test is an objective diagnostic tool that can aid along with other diagnostic modalities in the assessment, management, and follow-up of horses with THO. Furthermore, BAER studies may help to elucidate the pathophysiology of THO in horses.

Comparisons of computed tomography, contrast-enhanced computed tomography and standing low-field magnetic resonance imaging in horses with lameness localised to the foot. Part 2: Lesion identification

REASONS FOR PERFORMING STUDY No previous study compares computed tomography (CT), contrast-enhanced computed tomography (CECT) and standing low-field magnetic resonance imaging (LFMRI) to detect lesions in horses with lameness localised to the foot. This study will help clinicians understand the limitations of these techniques. OBJECTIVES To determine if CT, CECT and LFMRI would identify lesions within the distal limb and document discrepancies with lesion distribution and lesion classification. METHODS Lesions in specific structures identified on CT and MR images of feet (31 limbs) from the same horse were reviewed and compared. Distributions of lesions were compared using a Chi-squared test and techniques analysed using the paired marginal homogeneity test for concordance. RESULTS Lesions of the deep digital flexor tendon (DDFT) were most common and CT/CECT identified more lesions than LFMRI. Deep digital flexor tendon lesions seen on LFMRI only were frequently distal to the proximal extent of the distal sesamoid and DDFT lesions seen on CT/CECT only were frequently proximal to the distal sesamoid. Lesions identified on LFMRI only were core (23.3%) or splits (43.3%), whereas lesions identified only on CT were abrasions (29.8%), core (15.8%), enlargement (15.8%) or mineralisation (12.3%). Contrast-enhanced CT improved lesion identification at the DDFT insertion compared to CT and resulted in distal sesamoidean impar ligament and collateral sesamoidean ligament vascular enhancement in 75% of cases. Low-field MRI and CT/CECT failed to identify soft tissue mineralisation and bone oedema, respectively. CONCLUSIONS AND POTENTIAL RELEVANCE Multiple lesions are detected with CT, CECT and LFMRI but there is variability in lesion detection and classification. LFMRI centred only on the podotrochlear apparatus may fail to identify lesions of the pastern or soft tissue mineralisation. Computed tomography may fail to identify DDFT lesions distal to the proximal border of the distal sesamoid.

Results of computed tomography in horses with ethmoid hematoma: 16 cases (1993–2005)

OBJECTIVE To determine whether CT provides unique information about the treatment or prognosis for horses with ethmoid hematoma (EH). DESIGN Retrospective case series. ANIMALS 16 horses with EH. PROCEDURES Horses with a diagnosis of EH that had undergone a diagnostic CT study were included. Clinical features, treatment, outcome, radiographic and CT images, and histologic specimens were reviewed. RESULTS CT provided new diagnostic information that affected treatment in 10 of 16 horses. Bilateral disease occurred in 8 of 16 horses and was undetected in 5 horses prior to CT. Paranasal sinus involvement occurred in all horses, but was incompletely defined prior to CT in 7 of 16 horses. The sphenopalatine sinus was affected in 6 of 16 horses as detected on CT; 4 of 6 of these were bilaterally affected. Medical and surgical treatments were performed. Six of 10 horses had a successful outcome, with recurrence in 4 of 10. Five of 6 patients in which treatment addressed all lesion sites identified by CT had a successful outcome. Bilateral disease did not confer a poor prognosis when all affected sites were treated. Sphenopalatine sinus involvement may have been associated with recurrence. CONCLUSIONS AND CLINICAL RELEVANCE CT provided anatomic information that may facilitate effective treatment of horses with EH, particularly in patients with bilateral disease and paranasal sinus involvement. Computed tomography is recommended for patients in which the lesion cannot be viewed endoscopically, when sinus involvement or multifocal disease are suspected, or when the lesion has been unresponsive to treatment.

Advances in Equine Computed Tomography and Use of Contrast Media

Advances in equine computed tomography have been made as a result of improvements in software and hardware and an increasing body of knowledge. Contrast media can be administered intravascularly or intrathecally. Contrast media is useful to differentiate between tissues of similar density. Equine computed tomography can be used for many different clinical conditions, including lameness diagnosis, fracture identification and characterization, preoperative planning, and characterization of skull diseases.

Comparisons of computed tomography, contrast enhanced computed tomography and standing low-field magnetic resonance imaging in horses with lameness localised to the foot. Part 1: anatomic visualisation scores.

REASONS FOR PERFORMING STUDY To date, few reports exist comparing magnetic resonance imaging (MRI) and computed tomography (CT) for imaging of the equine distal limb, yet clinicians are required to decide which modality to use regularly. OBJECTIVES To report and compare anatomic visualisation scores obtained for CT, contrast enhanced CT (CECT) and standing low-field MRI (LFMRI) in the equine foot. HYPOTHESIS Anatomic visualisation score discrepancies would exist between CT, CECT and LFMRI. METHODS Images of 22 lame horses (31 limbs) undergoing both CT and LFMRI of the foot were reviewed. When available, CECT images were reviewed. The deep digital flexor tendon (DDFT) was categorised into proximal to distal levels (A-D), structures were assigned visualisation scores (Grades 0-3) and technique comparisons were made using the paired marginal homogeneity test. RESULTS Computed tomography and LFMRI had similar visibility scores for the navicular bone, middle phalanx, DDFT-B, collateral ligaments of the distal interphalangeal joint and collateral sesamoidean ligament of the navicular bone. The proximal and distal phalanx had lower visibility scores with LFMRI. The distal DDFT (C-D), distal sesamoidean impar ligament and synovial structures had higher scores with LFMRI. Contrast enhanced CT lowered DDFT and collateral sesamoidean ligament scores and raised distal interphalangeal synovium CT visualisation scores. CONCLUSIONS AND POTENTIAL RELEVANCE Visualisation scores differ depending on imaging technique and anatomic structure of interest. This information increases our understanding of the limitations of CT, CECT and LFMRI to visualise anatomy in clinical cases.

Clinical and scintigraphic findings in horses with a bone fragility disorder: 16 cases (1980–2006)

OBJECTIVE To describe clinical and scintigraphic abnormalities in horses with a bone fragility disorder. DESIGN Retrospective case series. ANIMALS 16 horses with scintigraphic evidence of multiple sites of increased radiopharmaceutical uptake (IRU). Procedures-Medical records were reviewed for information on signalment; history; clinical, clinicopathologic, and diagnostic imaging findings; and treatment. Follow-up information was obtained through telephone interviews with owners. RESULTS Horses ranged from 4 to 22 years old; there were 8 castrated males and 8 females. Foci of IRU most commonly involved the scapulae, ribs, sternebrae, sacral tubers, ilia, and cervical vertebrae. Most horses were examined because of chronic intermittent (n = 10) or acute (6) lameness involving a single (10) or multiple (6) limbs that could not be localized by means of regional anesthesia. Cervical stiffness (n = 3), scapular bowing (3), swayback (3), and ataxia (1) were also seen in more advanced cases. Signs of respiratory tract disease and exercise intolerance were evident in 4 horses. Ultrasonographic or radiographic evidence of bone remodeling or degeneration was seen in 19 of 33 affected bones. Histologic examination of bone biopsy specimens revealed reactive bone. Improvement was initially seen with conservative treatment in some horses, but the condition worsened in all horses, and 11 horses were euthanized within 7 years. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that horses may develop a bone fragility disorder characterized clinically by an unlocalizable lameness and scintigraphically by multiple sites of IRU involving the axial skeleton and proximal portion of the appendicular skeleton.

Injection of the insertion of the deep digital flexor tendon in horses using radiographic guidance

Insertional tendinopathies of the DDFT have been reported both as the sole lesion and as part of a multifocal lesion (Dyson et al. 2003). Computed tomography (CT) and magnetic resonance imaging allow specific diagnosis of deep digital flexor tendon lesions within the hoof capsule; however, direct intralesional treatment of such lesions is difficult because of the hoof’s rigid structure. A technique designed to mimic intralesional injection of insertional tendinopathies of the DDFT in the standing horse using radiographic guidance was assessed. Radiographic and contrast CT imaging and sectioning of the limbs confirmed accurate injection in all cases although inadvertant administration of injectate into adjacent structures was also evident.

Humeral stress remodelling locations differ in Thoroughbred racehorses training and racing on dirt compared to synthetic racetrack surfaces

REASONS FOR PERFORMING STUDY Veterinarians have observed a putative change in the location of humeral stress remodelling in Thoroughbred racehorses with change from dirt to synthetic racetrack surfaces. OBJECTIVES To determine whether the location and severity of humeral stress remodelling differs between Thoroughbred racehorses exercising on dirt and synthetic racetrack surfaces, the potential significance of different locations of stress remodelling, and the potential usefulness of scintigraphy for prevention of complete humeral fracture. METHODS Scintigraphic images of humeri from 841 Thoroughbred racehorses at 3 racetracks during 2 years before and after conversion from dirt to synthetic surfaces were evaluated for location and severity of lesions. The effects of surface on lesion distributions were examined using Chi-square or Fishers exact tests. Archived fractured humeri were examined to determine the location and severity of stress remodelling associated with complete fracture. Databases were queried to determine whether racehorses with scintigraphic lesions suffered humeral fracture and whether racehorses with a complete humeral fracture had had a scintigraphic examination. RESULTS Horses at synthetic racetracks had a greater proportion of distal humeral lesions, whereas horses at dirt racetracks had a greater proportion of caudoproximal lesions (P<0.001). Proximal lesions were more likely to be severe than distal lesions (P<0.001). Most complete fractures were associated with caudoproximal lesions, which were more often severe than distal lesions (P = 0.002). None of the horses with a scintigraphic lesion had a complete humeral fracture. None of the horses with a complete humeral fracture underwent scintigraphic examination. CONCLUSIONS Race surface affected humeral scintigraphic lesion location and hence the location of stress remodelling. Lesion severity was associated with lesion location. Complete humeral fracture was associated with caudoproximal stress remodelling and lack of scintigraphic examination. POTENTIAL RELEVANCE Risk for complete humeral fracture may be lower on synthetic surfaces than on dirt surfaces, and, by inference, for horses examined using scintigraphy.

Computed tomographic arthrography of the intercarpal ligaments of the equine carpus.

Injuries of the intercarpal ligaments are an important cause of lameness in performance horses. The purpose of this prospective cadaver study was to determine whether computed tomography (CT) arthrography would be a feasible method for visualizing and characterizing intercarpal ligaments in the horse. One cadaver limb from each of eight nonlame horses was collected immediately after euthanasia. For each limb, overlapping 2.0 mm CT images were acquired before and after injection of iodinated contrast medium into the antebrachiocarpal joint, middle carpal joint, and carpal sheath. Spin echo magnetic resonance imaging (MRI) sequences were acquired in three planes using a 1.5 Tesla MRI scanner in three limbs. Following MRI, colored resin was injected into the synovial structures of these three limbs, limbs were frozen, and anatomic sections were obtained in three planes. Findings from CT arthrograms were compared to findings from precontrast CT, MRI, anatomic slices, and arthroscopy. Medial and lateral palmar intercarpal ligaments, radiocarpal and transverse intercarpal ligaments, and palmar carpal ligament were visible in CT arthrograms of all limbs. The proximal and distal entheses of all ligaments were readily identifiable. Findings indicated that CT arthrography is feasible for visualizing intercarpal ligaments and may be a useful adjunct imaging technique for diagnosing lameness due to suspected carpal ligament injury in horses.