Steven De Decker

Agreement and repeatability of linear vertebral body and canal measurements using computed tomography (CT) and low field magnetic resonance imaging (MRI).

OBJECTIVEnTo evaluate agreement and repeatability of vertebral column measurements using computed tomography (CT) and magnetic resonance imaging (MRI).nnnSTUDY DESIGNnRetrospective observational study. ANIMALS; Dogs (n=18) with disc associated wobbler syndrome; Dog cadavers (n=3).nnnMETHODSnFive measurements of the 5th cervical vertebra were performed: vertebral body length (VBL), vertebral canal height (VCH), vertebral body height (VBH), vertebral canal width (VCW), and vertebral body width (VBW). Measurements were performed independently twice by 2 observers. Bland-Altman plots were created to evaluate agreement. Cadaveric vertebrae with soft tissue removed had the same variables and actual dimensions measured.nnnRESULTSnThe largest discrepancy between CT and MRI measurement was for VBL (mean difference+/-SD=1.262 mm+/-1.245; P<.001), with the difference for all the other variables being acceptable. The 1st measurement was significantly higher than the 2nd only for VBL using CT (mean difference=0.476 mm+/-1.120; P=.009), with all other variables having acceptable differences. Mean difference for all measurements between 2 observers was small, except for VBL using CT (mean difference=0.762 mm+/-1.042; P<.001). Only the difference for VBL between CT and cadaver specimens was statistically significant.nnnCONCLUSIONSnOur results suggest high repeatability and good agreement for most vertebral measurements of interest. VBL measurement using CT was considered problematic.nnnCLINICAL RELEVANCEnProvided limitations are understood, linear measurements of vertebral dimensions from CT and MRI images can be used clinically.

Morphometric dimensions of the caudal cervical vertebral column in clinically normal Doberman Pinschers, English Foxhounds and Doberman Pinschers with clinical signs of disk-associated cervical spondylomyelopathy

Client-owned, clinically normal Doberman Pinschers (n=20), English Foxhounds (n=17), and Doberman Pinschers with clinical signs of disk-associated cervical spondylomyelopathy (DA-CSM) (n=17) were prospectively studied. All dogs underwent magnetic resonance imaging (MRI) of the cervical vertebral column. To evaluate vertebral canal stenosis, the canal occupying ratios of the spinal cord and cerebrospinal fluid (CSF)-column were calculated from C5 to C7. To evaluate the degree of spinal cord compression and the amount of canal compromise, the compression ratio, remaining spinal cord and CSF-column area, and vertebral canal and dorsoventral vertebral canal compromise ratios were calculated at the site of most severe compression. For each canal occupying ratio, there was a significant higher value (implicating less space available for the spinal cord in the vertebral canal) at the level of C7 for clinically affected Doberman Pinschers compared with clinically normal English Foxhounds. The remaining spinal cord area was significantly smaller in dogs with clinically relevant spinal cord compression compared to dogs with clinically irrelevant spinal cord compression. Relative stenosis of the caudal cervical vertebral canal occurred more often in Doberman Pinschers with DA-CSM compared to English Foxhounds and a critical degree of spinal cord compression should be reached to result in clinical signs.

Intraobserver and interobserver agreement for results of low-field magnetic resonance imaging in dogs with and without clinical signs of disk-associated wobbler syndrome.

OBJECTIVEnTo determine interobserver and intraobserver agreement for results of low-field magnetic resonance imaging (MRI) in dogs with and without disk-associated wobbler syndrome (DAWS).nnnDESIGNnValidation study.nnnANIMALSn21 dogs with and 23 dogs without clinical signs of DAWS.nnnPROCEDURESnFor each dog, MRI of the cervical vertebral column was performed. The MRI studies were presented in a randomized sequence to 4 board-certified radiologists blinded to clinical status. Observers assessed degree of disk degeneration, disk-associated and dorsal compression, alterations in intraspinal signal intensity (ISI), vertebral body abnormalities, and new bone formation and categorized each study as originating from a clinically affected or clinically normal dog. Interobserver agreement was calculated for 44 initial measurements for each observer. Intraobserver agreement was calculated for 11 replicate measurements for each observer.nnnRESULTSnThere was good interobserver agreement for ratings of disk degeneration and vertebral body abnormalities and moderate interobserver agreement for ratings of disk-associated compression, dorsal compression, alterations in ISI, new bone formation, and suspected clinical status. There was very good intraobserver agreement for ratings of disk degeneration, disk-associated compression, alterations in ISI, vertebral body abnormalities, and suspected clinical status. There was good intraobserver agreement for ratings of dorsal compression and new bone formation. Two of 21 clinically affected dogs were erroneously categorized as clinically normal, and 4 of 23 clinically normal dogs were erroneously categorized as clinically affected.nnnCONCLUSIONS AND CLINICAL RELEVANCEnResults suggested that variability exists among observers with regard to results of MRI in dogs with DAWS and that MRI could lead to false-positive and false-negative assessments.

Intraobserver, interobserver, and intermethod agreement for results of myelography, computed tomography-myelography, and low-field magnetic resonance imaging in dogs with disk-associated wobbler syndrome

OBJECTIVEnTo determine intraobserver, interobserver, and intermethod agreement for results of myelography, computed tomography-myelography (CTM), and low-field magnetic resonance imaging (MRI) in dogs with disk-associated wobbler syndrome (DAWS).nnnDESIGNnProspective cross-sectional study.nnnANIMALSn22 dogs with DAWS.nnnPROCEDURESnAll dogs underwent myelography, CTM, and low-field MRI. Each imaging study was interpreted twice by 4 observers who were blinded to signalment and clinical information of the patients. The following variables were assessed by all 3 techniques: number, site, and direction of spinal cord compressions; narrowed intervertebral disk spaces; vertebral body abnormalities; spondylosis deformans; and abnormal articular facets. Intervertebral foraminal stenosis was assessed on CTM and MRI images. Intraobserver, interobserver, and intermethod agreement were calculated by κ and weighted κ statistics.nnnRESULTSnThere was very good to good intraobserver agreement for most variables assessed by myelography and only moderate intraobserver agreement for most variables assessed by CTM and low-field MRI. There was moderate to fair interobserver and intermethod agreement for most variables assessed by the 3 diagnostic techniques. There was very good or good intraobserver, interobserver, or intermethod agreement for the site and direction of the worst spinal cord compression as assessed by all the imaging modalities; abnormal articular facets and intervertebral foraminal stenosis were the least reliably assessed variables, with poor interobserver agreement regardless of imaging modality used.nnnCONCLUSIONS AND CLINICAL RELEVANCEnThere was considerable variation in image interpretation among observers and between use of various imaging modalities; these imaging techniques should be considered complementary in assessment of dogs with DAWS.

Evolution of clinical signs and predictors of outcome after conservative medical treatment for disk-associated cervical spondylomyelopathy in dogs.

OBJECTIVEnTo evaluate the evolution of clinical signs and their correlation with results of magnetic resonance imaging (MRI) and transcranial magnetic stimulation (TMS) and to assess potential prognostic variables after conservative medical treatment for disk-associated cervical spondylomyelopathy (DA-CSM) in dogs.nnnDESIGNnProspective cohort study.nnnANIMALSn21 client-owned dogs with DA-CSM.nnnPROCEDURESnAfter neurologic grading, dogs underwent low-field MRI and TMS with measurement of onset latencies and peak-to-peak amplitudes from the extensor carpi radialis and cranial tibial muscles. Dimensions calculated from MRI images were remaining spinal cord area, spinal cord compression ratio, vertebral occupying ratio, vertebral canal height-to-body height ratio, vertebral canal height-to-body length ratio, and vertebral canal compromise ratio. Intraparenchymal signal intensity changes were graded. Dogs were reevaluated 1, 3, 6, 12, and 24 months after initial diagnosis.nnnRESULTSnOutcome was successful in 8 of 21 dogs. Negative outcomes were characterized by rapid progression of clinical signs. All dogs with more severe clinical signs of DA-CSM 1 month after diagnosis had unsuccessful outcomes. Outcome was associated with the remaining spinal cord area and vertebral canal compromise ratio. Prognosis was not associated with severity of clinical signs or results of TMS. There were no significant correlations among clinical signs, MRI findings, and TMS results.nnnCONCLUSIONS AND CLINICAL RELEVANCEnConservative medical treatment of DA-CSM was associated with a guarded prognosis. Selected MRI variables and clinical evolution 1 month after diagnosis can be considered prognostic indicators. The lack of correlation among clinical signs, results of diagnostic imaging, and results of electrophysiologic evaluation in dogs with DA-CSM warrants further investigation.

Transcranial magnetic stimulation in Doberman Pinschers with clinically relevant and clinically irrelevant spinal cord compression on magnetic resonance imaging

OBJECTIVEnTo evaluate the use of transcranial magnetic stimulation for differentiating between clinically relevant and clinically irrelevant cervical spinal cord compression on magnetic resonance imaging (MRI).nnnDESIGNnValidation study.nnnANIMALSnClinically normal Doberman Pinschers without (n = 11) and with (6) spinal cord compression on MRI and 16 Doberman Pinschers with disk-associated wobbler syndrome (DAWS).nnnPROCEDURESnAfter dogs were sedated, transcranial magnetic motor evoked potentials were recorded from the extensor carpi radialis muscle (ECRM) and cranial tibial muscle (CTM). Onset latencies and peak-to-peak amplitudes were measured. Magnetic resonance imaging was performed to identify spinal cord compression.nnnRESULTSnThere were significant differences in ECRM and CTM onset latencies between Doberman Pinschers with DAWS and each of the 2 groups of clinically normal dogs, but there were no significant differences in ECRM and CTM onset latencies between the 2 groups of clinically normal dogs. There were significant differences in CTM peak-to-peak amplitudes between Doberman Pinschers with DAWS and each of the 2 groups of clinically normal dogs, but there were no significant differences in ECRM peak-to-peak amplitudes among groups or in CTM peak-to-peak amplitudes between the 2 groups of clinically normal dogs. There was a significant correlation between severity of spinal cord compression and ECRM onset latency, CTM onset latency, and CTM peak-to-peak amplitude.nnnCONCLUSIONS AND CLINICAL RELEVANCEnResults suggested that transcranial magnetic stimulation may be a useful diagnostic tool to differentiate between clinically relevant and clinically irrelevant spinal cord compression identified on MRI alone.

Prevalence of thoracic vertebral malformations in French bulldogs, Pugs and English bulldogs with and without associated neurological deficits

Congenital vertebral malformations are common incidental findings in small breed dogs. This retrospective observational study evaluated the type and prevalence of thoracic vertebral malformations in 171 neurologically normal and 10 neurologically abnormal screw-tailed brachycephalic dogs. Neurologically normal dogs underwent CT for reasons unrelated to spinal disease, while affected dogs underwent MRI. Imaging studies were reviewed and vertebral malformations including hemivertebrae, block vertebrae, transitional vertebrae, and spina bifida were documented. The group of clinically normal dogs consisted of 62 French bulldogs, 68 Pugs and 41 English bulldogs. The group of affected dogs consisted of one French bulldog and nine Pugs. Overall, 80.7% of neurologically normal animals were affected by at least one vertebral malformation. There was a significant influence of breed, with thoracic vertebral malformations occurring more often in neurologically normal French bulldogs (Pu2009<0.0001) and English bulldogs (Pu2009=u20090.002). Compared to other breeds, hemivertebrae occurred more often in neurologically normal French bulldogs (93.5%; Pu2009<u20090.0001 vs. Pugs; Pu2009=u20090.004 vs. English bulldogs) and less often in neurologically normal Pugs (17.6%; Pu2009=u20090.004 vs. English bulldogs). Neurologically normal Pugs were more often diagnosed with transitional vertebrae and spina bifida compared to other breeds (Pu2009<0.0001 for both malformations). Of Pugs included in the study, 4.7% were diagnosed with clinically relevant thoracic vertebral malformations. When compared to the general veterinary hospital population, this was significantly more than the other two breeds (Pu2009=u20090.006). This study indicates that thoracic vertebral malformations occur commonly in neurologically normal screw-tailed brachycephalic dogs. While hemivertebrae are often interpreted as incidental diagnostic findings, they appear to be of greater clinical importance in Pugs compared to other screw-tailed brachycephalic breeds.

INTER- AND INTRAOBSERVER AGREEMENT FOR DIAGNOSING PRESUMPTIVE ISCHEMIC MYELOPATHY AND ACUTE NONCOMPRESSIVE NUCLEUS PULPOSUS EXTRUSION IN DOGS USING MAGNETIC RESONANCE IMAGING

Ischemic myelopathy (IM) and acute noncompressive nucleus pulposus extrusion (ANNPE) are common spinal emergencies in dogs with similar clinical presentations. Magnetic resonance imaging (MRI) criteria for a presumptive antemortem diagnosis have been reported, however inter- and intraobserver agreement for use of these criteria has not been established. The aim of this retrospective, descriptive, cross-sectional study was to describe inter- and intraobserver agreement for using previously published MRI criteria to diagnose presumptive IM and ANNPE in a sample dogs. Dogs with a presumptive diagnosis of IM or ANNPE and available MRI scan data were retrieved from medical record archives during the period of 2009 and 2013. A total of 127 dogs were identified. From this sample, MRI scans for 60 dogs were randomly selected and duplicated for intraobserver analysis, giving a total of 187 anonymized studies that were presented to two blinded assessors (one board-certified veterinary neurologist, one board-certified veterinary radiologist). Assessors were asked to diagnose lesions as IM or ANNPE based on previously published MRI characteristics. Interobserver agreement in diagnosing IM or ANNPE was moderate (Kappa = 0.56) and intraobserver agreement was moderate to good (Assessor 1 Kappa = 0.79, Assessor 2 Kappa = 0.47). Agreement was strongest for detecting presence of lesions overlying a vertebral body (94% of lesions that were diagnosed as IM) or overlying an intervertebral disk (85% of lesions that were diagnosed as ANNPE). Findings indicated that use of previously published MRI criteria yields moderate inter- and moderate to good intraobserver agreement for a presumptive diagnosis of IM or ANNPE in dogs.

Radiographic vertebral canal and vertebral body ratios in Doberman Pinschers with and without clinical signs of caudal cervical spondylomyelopathy

OBJECTIVEnTo determine radiographic vertebral ratio values representing vertebral canal stenosis in Doberman Pinschers with and without clinical signs of caudal cervical spondylomyelopathy (CCSM).nnnANIMALSnDoberman Pinschers with (n = 81) and without (39) signs of CCSM.nnnPROCEDURESnAll dogs underwent lateral survey radiography of the cervical vertebral column. Five specific measurements were made at C3 through C7, and from those data, 3 ratios were calculated and analyzed for use in diagnosis of CSSM: canal height-to-vertebral body height ratio (CBHR), canal height-to-vertebral body length ratio (CBLR), and caudal vertebral canal height-to-cranial vertebral canal height ratio (CCHR). The CBHR and CBLR were considered indicators of vertebral canal stenosis, and CCHR described vertebral canal shape.nnnRESULTSnCompared with Doberman Pinschers without CCSM, mean CBHR and CBLR values were significantly smaller for Doberman Pinschers with CCSM; for CBHR, this difference was evident at each assessed vertebra. The CCHR value for C7 was significantly larger in dogs with CCSM. Receiver operating characteristic statistics did not identify a threshold point that had combined high sensitivity and specificity sufficient to differentiate between Doberman Pinschers with and without CCSM.nnnCONCLUSIONS AND CLINICAL RELEVANCEnDoberman Pinschers with CCSM had vertebral canal stenosis combined with a funnel-shaped vertebral canal at C7 significantly more often than did Doberman Pinschers without CCSM. Despite these significant differences, no reliable threshold ratio values were identified to differentiate groups of dogs.

Idiopathic head tremor in English bulldogs.

Idiopathic head tremor (IHT) syndrome is a recognized but poorly characterized movement disorder in English bulldogs (EBs). The data analyzed were collected via a detailed online questionnaire and video recordings. Thirty‐eight percent of the population demonstrated IHT. The first presentation was early in life. There was no sex or neutered status predisposition. The condition disappeared with time in 50% of the cases. The direction of the head movement was vertical or horizontal. The number of episodes per day and the duration of the episodes were greatly variable. The majority of episodes occurred at rest. Most of the episodes were unpredictable. And there was no alteration of the mental status for most dogs during the episodes. Stress has been reported as a suspected trigger factor. IHT in EBs can be considered an idiopathic paroxysmal movement disorder.