Silke Hecht

MRI of Brain Disease in Veterinary Patients Part 2: Acquired Brain Disorders

Magnetic resonance imaging (MRI) has revolutionized brain imaging in veterinary medicine, making possible improved characterization of intracranial pathologic processes. This article focuses on MRI features of acquired brain disorders, including infectious inflammatory, noninfectious inflammatory, cerebrovascular, metabolic, nutritional, toxic, degenerative, traumatic, and neoplastic causes. Congenital intracranial disorders are covered in a companion article.

Magnetic Resonance Imaging Susceptibility Artifacts Due to Metallic Foreign Bodies

Susceptibility artifacts due to metallic foreign bodies may interfere with interpretation of magnetic resonance (MR) imaging studies. Additionally, migration of metallic objects may pose a risk to patients undergoing MR imaging. Our purpose was to investigate prevalence, underlying cause, and diagnostic implications of susceptibility artifacts in small animal MR imaging and report associated adverse effects. MR imaging studies performed in dogs and cats between April 2008 and March 2010 were evaluated retrospectively for the presence of susceptibility artifacts associated with metallic foreign bodies. Studies were performed using a 1.0 T scanner. Severity of artifacts was graded as 0 (no interference with area of interest), 1 (extension of artifact to area of interest without impairment of diagnostic quality), 2 (impairment of diagnostic quality but diagnosis still possible), or 3 (severe involvement of area of interest resulting in nondiagnostic study). Medical records were evaluated retrospectively to identify adverse effects. Susceptibility artifacts were present in 99/754 (13.1%) of MR imaging studies and were most common in examinations of the brachial plexus, thorax, and cervical spine. Artifacts were caused by identification microchips, ballistic fragments, skin staples/suture material, hemoclips, an ameroid constrictor, and surgical hardware. Three studies were nondiagnostic due to the susceptibility artifact. Adverse effects were not documented.

Early detection, aggressive therapy: Optimizing the management of feline mammary masses

Aims This article reviews the incidence, etiology, diagnosis, treatment and prognosis of mammary tumors in cats. Practical relevance Approximately 80% of feline mammary masses are malignant, with adenocarcinoma being the most common tumor type. Early diagnosis is, therefore, essential to improve the prognosis and quality of life of affected cats. Treatment approaches Surgery is the most widely used treatment for malignant tumors. However, as mammary tumors are often advanced and metastasis has already occurred by the time of diagnosis, surgery routinely does not provide a cure. Ovariohysterectomy or hormonal therapy are the treatments of choice for fibroadenomatous hyperplasia (the most common benign mass) and usually lead to a successful outcome.

Topographic and age-dependent distribution of subchondral bone density in the elbow joints of clinically normal dogs.

OBJECTIVE To investigate topographic and age-dependent adaptation of subchondral bone density in the elbow joints of healthy dogs by means of computed tomographic osteoabsorptiometry (CTOAM). Animals-42 elbow joints of 29 clinically normal dogs of various breeds and ages. PROCEDURES Subchondral bone densities of the humeral, radial, and ulnar joint surfaces of the elbow relative to a water-hydroxyapatite phantom were assessed by means of CTOAM. Distribution patterns in juvenile, adult, and geriatric dogs (age, < 1 year, 1 to 8 years, and > 8 years, respectively) were determined and compared within and among groups. RESULTS An area of increased subchondral bone density was detected in the humerus distomedially and cranially on the trochlea and in the olecranon fossa. The ulna had maximum bone densities on the anconeal and medial coronoid processes. Increased bone density was detected in the craniomedial region of the joint surface of the radius. A significant age-dependent increase in subchondral bone density was revealed in elbow joint surfaces of the radius, ulna, and humerus. Mean subchondral bone density of the radius was significantly less than that of the ulna in paired comparisons for all dogs combined and in adult and geriatric, but not juvenile, dog groups. CONCLUSIONS AND CLINICAL RELEVANCE An age-dependent increase in subchondral bone density at the elbow joint was revealed. Maximal relative subchondral bone densities were detected consistently at the medial coronoid process and central aspect of the humeral trochlea, regions that are commonly affected in dogs with elbow dysplasia.

DIAGNOSIS AND TREATMENT OF A PHARYNGEAL SQUAMOUS CELL CARCINOMA IN A MADAGASCAR GROUND BOA (BOA MADAGASCARIENSIS)

Abstract:  A 15-yr-old female Madagascar ground boa (Boa madagascariensis) presented with a history of anorexia, wheezing, and occasional open-mouth breathing. On oral examination, a firm, caseous mass was noted in the right caudoventral pharyngeal region, which was confirmed as a carcinoma on incisional biopsy. Advanced imaging (computed tomography and magnetic resonance imaging) was performed to evaluate local tumor invasion and to plan for palliative radiation therapy. However, following the second treatment (10 Gy), the mass had increased in size, and the snake was euthanatized. Radiation-associated vasculitis was noted within the soft tissues surrounding the mass and within muscles and the lung, which was verified on histopathology. The squamous cell carcinoma of the snake in this report was resistant to palliative radiation therapy.

Diagnosis and Surgical Treatment of a Chiari I–like Malformation in an African Lion (Panthera leo)

Abstract A 13-mo-old intact male African lion (Panthera leo) presented with a 3-mo history of lethargy, ventral flexion of the neck, abnormal vocalization, and ataxia. Hemogram and serum biochemistries were within normal limits except for the presence of hypokalemia (2.7 mEq/L) and hypochloridemia (108 mEq/L). When no improvement was noted with oral potassium gluconate supplementation, a computed tomography scan of the brain and skull was performed, and no abnormalities were noted. However, magnetic resonance imaging detected occipital bone thickening, crowding of the caudal cranial fossa with cerebellar compression and herniation, and cervical syringohydromyelia, which was consistent with a Chiari I–like malformation. Foramen magnum decompression was performed to relieve the compression of the cerebellum. The animal recovered well with subsequent resolution of clinical signs. Hypovitaminosis A has been proposed previously as the underlying etiology for this malformation in lions with similar clinical presentations. This lions serum and liver vitamin A concentrations were low (100 ng/ml and 25.31 μg/g, respectively) compared to concentrations reported for domestic carnivores and support hypovitaminosis A as the underlying cause of this animals Chiari I–like malformation.

Malignant Mediastinal Extra-Adrenal Paraganglioma with Spinal Cord Invasion in a Dog

A 1.5-year-old castrated, male, mixed-breed dog was evaluated because of a 2-week history of lethargy, stiffness, and progressive paraparesis. Spinal radiographs, myelography, and computed tomography of the region showed a locally invasive mass involving the thoracic wall. Upon necropsy, an encapsulated, fluctuant mass was noted attached to the right dorsal body wall in the region of the fifth to seventh thoracic vertebra. Churukian-Schenk staining revealed positive granules within the neoplastic cell cytoplasm and immunohistochemistry was positive for expression for cytoplasmic neuron-specific enolase and synaptophysin. Chromogranin A and S100 expression were found to be negative. Immunohistochemistry and silver staining did not allow further differentiation of the tumor, and the diagnosis remains consistent with either a chromaffin paraganglioma or a nonchromaffin paraganglioma (chemodectoma) with some production of catecholamines. Extra-adrenal paragangliomas are rare neoplasms in dogs but should be considered as a possible differential diagnosis for a primary paraspinal thoracic mass.

Effect of anesthetizing individual compartments of the stifle joint in horses with experimentally induced stifle joint lameness

OBJECTIVE To evaluate the effects of sequential anesthesia of the individual compartments of the equine stifle joint on lameness induced by intra-articular deposition of interleukin (IL)-1β. ANIMALS 6 horses. PROCEDURES For each horse, baseline hind limb lameness was first evaluated. A randomly selected compartment of 1 stifle joint was then injected with IL-1β to induce synovitis and lameness; subsequently, the same compartment was anesthetized with 2% mepivacaine hydrochloride, and lameness was reevaluated. Two weeks later, baseline lameness was evaluated, and lameness was similarly induced; thereafter, the 2 synovial compartments of the stifle joint not injected with IL-1β were anesthetized sequentially in random order (ie, first and second blocks); lameness was evaluated after each block. Finally, the IL-1β-treated compartment was anesthetized (third block); lameness was again evaluated. This second experiment was repeated for the contralateral stifle joint 2 weeks later. Throughout the study, lameness was quantified objectively by assessing vertical pelvic movement asymmetry with a wireless, inertial sensor-based system. RESULTS Intra-articular deposition of IL-1β induced lameness in all injected limbs. In the first experiment, anesthesia of the compartment injected with IL-1β resulted in a significant decrease in lameness, with vertical pelvic movement asymmetry approaching baseline. In the second experiment, lameness improved significantly after the second and third blocks and was almost completely abolished after all 3 synovial compartments were anesthetized. CONCLUSIONS AND CLINICAL RELEVANCE In horses, lameness caused by a lesion in 1 compartment of a stifle joint can be improved more by instillation of local anesthetic solution into that compartment than by anesthesia of the other compartments.

USE OF ULTRASOUND TO LOCATE RETAINED TESTES IN DOGS AND CATS

Ultrasound was used to locate undescended testes in 30 dogs and 4 cats where the final testicular location was determined surgically. Time between ultrasound and surgery ranged between 0 and 17 days. Forty-three testes (63.2%) were retained and 42/43 (97.7%) were detected ultrasonographically. Retained testes were located in the abdomen (n = 28) and inguinal region (n = 14). One retained testis could not be identified with use of ultrasound. Locations of retained testes ranged from the caudal pole of the kidney to the inguinal region. Descriptions of testicular echogenicity and size were not available for all testes. A 100% positive predictive value was found for all testes with use of ultrasound in both abdominal and inguinal regions. The sensitivity of ultrasound was 96.6% for abdominal and 100% for inguinal testes. Ultrasound is a sensitive test for location of retained testes, and supports the opinion that preoperative ultrasound can help facilitate location of retained testes prior to surgical exploration or laparoscopy.

USE OF THE T2*-WEIGHTED GRADIENT RECALLED ECHO SEQUENCE FOR MAGNETIC RESONANCE IMAGING OF THE CANINE AND FELINE BRAIN

T2*-weighted magnetic resonance imaging (MRI) has been reported to help improve detection of intracranial hemorrhage and is widely used in human neuroimaging. To assess the utility of this technique in small animals, interpretations based on this sequence were compared with those based on paired T2-weighted and fluid-attenuated inversion recovery (FLAIR) sequences in 200 dogs and cats that underwent brain MRI for suspected intracranial disease. Two sets of images (T2 + FLAIR and T2*) were reviewed separately in random order unaccompanied by patient information and were interpreted as normal or abnormal based on whether intracranial abnormalities were seen. The number and location of intracranial lesions were recorded. Eighty-five studies were considered normal and 88 were considered abnormal based on both sets of images, with good agreement (κ = 0.731) between the two. Susceptibility artifact was present in 33 cases (16.5%) on T2*-weighted images. In 12 cases (6%) a total of 69 lesions were seen on T2*-weighted images that were not seen on T2/FLAIR, all of which were associated with susceptibility artifact caused by presumed intracranial hemorrhage. Pseudolesions were seen on T2*-weighted images in five cases, none of which were associated with susceptibility artifact. Abnormalities were seen on T2/FLAIR images that were not seen on T2*-weighted images in 35 cases, confirming that T2* does not replace standard spin echo sequences. These results support inclusion of T2*-weighted sequences in small animal brain MRI studies and indicate that that a large number of abnormalities (especially hemorrhagic lesions) can go undetected if it is not performed.