Results of using multiplanar reconstructed CT images for assessing elbow joint osteoarthritis in dogs are consistent with results of radiographic assessment.

OBJECTIVE: To compare osteoarthritis scores assigned through radiographic evaluation of 18 anatomic regions in the elbow joint with scores assigned through evaluation of 3-D maximum intensity projection (MIP), 3-D surface rendering (TSR), and multiplanar reconstructed (MPR) CT images, and to evaluate intraobserver and interobserver agreement of radiographic and CT scoring. SAMPLE: Radiographic and CT images of 39 elbow joints in 20 dogs. PROCEDURES: Images were anonymized and graded independently by 5 observers. One observer graded 12 elbow joints 3 times. Intraobserver consistency and repeatability, interobserver agreement, consistency among methods, and bias between methods were calculated. RESULTS: The most severe changes were observed at the proximal aspect of the anconeal process, and the medial and cranial aspects of the medial coronoid process. Intraobserver consistency was moderate or better for 11/16 regions with MIP images, 11/16 regions with TSR images, 17/18 regions with MPR images, and 14/18 regions with radiographic images. Interobserver agreement was moderate or better for 5/16 regions with MIP images, 9/16 regions with TSR images, 12/18 regions with MPR images, and 6/18 regions with radiographic images. Mean scores from CT-based methods were higher than mean radiographic scores. CLINICAL RELEVANCE: Assessments of osteoarthritis severity in the elbow joints of dogs obtained by examining radiographic images were generally consistent with assessments obtained by examining CT scans. MPR scores were more consistent and more comparable to radiographic scores than were MIP or TSR scores.

Computed tomographic assessment of the completeness of arthroscopic subtotal coronoidectomy in dogs with medial coronoid disease.

BACKGROUND: Until recent years, arthroscopic subtotal coronoidectomy has been the universally accepted treatment for medial coronoid disease but has variable clinical outcomes. The aim of this study was to evaluate the completeness of arthroscopic medial coronoid debridement and to detect the most vulnerable location of failure. METHODS: Eighty-three dogs with a diagnosis of medial coronoid disease were included in the study. Arthroscopic debridement was performed in 92 elbow joints, and the completeness of removal was assessed by postoperative computed tomography scans. RESULTS: Pathological changes were confined to the coronoid apex in 92/92 (100%) of cases and combined with radial incisure lesions in 39/92 (42%). Apical lesions were completely removed in 66/92 (72%) of cases and radial incisure lesions in 2/39 (5%). Bony remnants were detected at the apex (46%) and base (24%) of the medial coronoid process, free within the elbow joint (9%), and/or within the instrument port (84%). Fissures were positively associated with the occurrence of bony remnants (p = 0.038) and a 37% higher probability of incomplete removal of radial incisure lesions (p = 0.001). CONCLUSION: In this study, incomplete removal was more likely to occur in the presence of radial incisure lesions. Thorough assessment of this region during arthroscopy is strongly recommended.

Anatomic, computed tomographic, and ultrasonographic assessment of the lymph nodes in presumed healthy adult cats: The head, neck, thorax, and forelimb.

Assessment of the lymph nodes is key in staging cancer patients. Descriptions of normal features of the feline lymph nodes using computed tomography (CT) and ultrasound (US) are limited. A prospective anatomic and comparative imaging study was performed. The frequency of identification and the size of the lymph nodes during gross pathology from 6 feline cadavers were compared to the images of lymph nodes from 30 presumed healthy adult cats obtained by CT and US. Measurements (length, width, and height) were compared among techniques. The CT and US features of the identified lymph nodes were also recorded. The frequency of identification of the lymph centers varied among techniques and individually. The mandibular lymph nodes were identified in 100% of the cadavers and in 100% of the healthy cats using CT and US. The medial retropharyngeal lymph nodes were identified in 100% of the cats using CT and US. The deep cervical lymph nodes were not visualized in the cadavers. The cranial mediastinal and tracheobronchial lymph nodes were not visualized using US. Lymph nodes showed a higher length on CT and higher width on US. The height was the most statistically significant variable measurement among techniques. On CT, lymph nodes were most frequently isoattenuating or slightly hypoattenuating to surrounding musculature, with homogeneous contrast enhancement. On US, most lymph nodes were isoechoic or hypoechoic to surrounding fat tissue. The lymph nodes were most frequently elongated or rounded.

Radiographic assessment of carpal conformation in the horse, part 2: Finding acceptable limits to postural and rotational variations during radiography.

Finding an appropriate location for perpendicular positioning of the X-ray machine to produce zero lateromedial (ZLM) and zero dorsopalmar (ZDP) carpal images (views) and finding an acceptable range of rotational variations for measurement of carpal conformational parameters were two major challenges identified during field radiography of equine forelimbs. 16 cadaver forelimbs transacted at antebrachial midshaft from 10 horses (aged 9.13 ± 4.59 years) were axially mounted into a custom-built frame, and the radiographic machine and plate were perpendicularly aligned with the limb. Each limb was then radiographed at 2.5° interval of vertical rotation of the machine until ZLM and ZDP images were acquired, and at 24 other postural and rotational positions from ZLM and ZDP at 5° interval for comparison of measurements with the standardized ZLM and ZDP images. ZLM radiographs were produced at a mean vertical projection angle (VPA) of 9.84 ± 3.47° palmarolateral-dorsomedial oblique (PaL-DMO), while ZDP was acquired at VPA of 6.41 ± 2.73° dorsolateral-palmaromedial oblique (DL-PaMO). Changes in limbs' postural tilts, vertical plate rotations (VPR) and horizontal beam rotations (HBR) had no effect on the quality of the radiographs and on carpal measurements, while vertical beam rotation (VBR) of X-ray beam produced significant changes on the quality of radiographs and on measurements of carpal parameters. It is recommended that field radiographs of equine forelimbs intended for carpal measurement be obtained within a proposed range of VPA of 2.5° to 12.5° PaL-DMO for ZLM and 2.5° to 10° DL-PaMO for ZDP in order to minimize potential errors attributable to vertical rotational movements.

Radiographic assessment of carpal conformation in the horse: Technique development and validation of the consistency of measurements.

Carpal conformation is often considered as a contributory factor to performance and lameness in the horse; however, few attempts have been made to objectively measure radiographic variations of carpal conformation in horses due to insufficient measurable carpal parameters. This pilot study used carpal radiographic images acquired from 10 cadaveric equine forelimbs transected at the antebrachial midshaft from 7 adult horses (7.2 ± 2.6 years), positioned at 'zero lateromedial' (ZLM) and 'zero dorsopalmar' (ZDP) views, to investigate the anatomy of the equine carpus and develop parameters that could be objectively used to assess carpal conformation in horses. Dorsal carpal angle (DCA: 176.61 ± 0.66º), distal radial slope carpal angle (DRSCA: 145.59 ± 2.19º), intermediate carpal bone proximal tuberosity-radial angle (CiPxTRA: 115.69 ± 3.15º) and third carpal bone palmar facet angle (C3PalFCA: 84.43 ± 1.13º) were all developed from the ZLM view while medial carpal angle (MCA: 183.34 ± 1.02º), disto-dorsal slope angle of the third carpal bone (C3DDSA: 8.27 ± 0.92º) and width ratio of distal radius to proximal metacarpus (WDR:WPM = 1.13±0.03) were 3 of the 10 parameters developed from the ZDP view. Easy to identify and measurable parameters will help to provide quantitative assessment of carpal conformation in the horse with potential of eliminating subjective observational variation errors between clinicians. These newly developed parameters will be useful in further studies to measure variations in the conformation of the equine carpus in live horses and comparison between subjective visual assessment and objective radiographic evaluation methods.

Computed tomography and radiographic assessment of congruity between the ulnar trochlear notch and humeral trochlea in large breed dogs.

OBJECTIVE: Assess the fit between the ulnar trochlear notch (UTN) and humeral trochlea (HT) in elbow radiographs and computed tomography (CT) images by measuring the curvature radii in normal joints. METHODS: Mediolateral extended view (MLE) and CT were performed on 16 elbows from cadaveric dogs weighing over 20 kg. Curves were traced at the subchondral level from the UTN central ridge and the HT sagittal groove related to the UTN on ~132° joint extension. Curvature radii were achieved using appropriate computer software. RESULTS: Intraclass correlation coefficient between MLE/CT measurements were statistically significant, with lower limits of a 95% confidence interval (CI) >0.75. The mean differences between MLE/CT measurements were -0.71 mm (95% CI: -0.97 to -0.45) for UTN and -1.04 mm (95% CI: -1.21 to -0.87) for HT. The UTN and HT curvature radii typology were similar, with maximum radius values at the starting point and two intermediate peaks. The UTN curvature radii were bigger than the HT radii, with the largest differences in the most proximal aspect of the joint and in the second intermediate peak. CLINICAL SIGNIFICANCE: To the authors' knowledge, this is the first report on humeroulnar congruity through curvature radii evaluation. The software and methodology proposed enabled an adequate UTN and HT radii curvature assessment in MLE and CT images. Comparative studies in normal and dysplastic dogs of various breeds could better clarify the role of UTN and HT curvature radii in elbow incongruity and dysplasia.

Assessment of medial coronoid disease in 180 canine lame elbow joints: a sensitivity and specificity comparison of radiographic, computed tomographic and arthroscopic findings.

BACKGROUND: Diagnostic imaging is essential to assess the lame patient; lesions of the elbow joint have traditionally been evaluated radiographically, however computed tomography (CT) has been suggested as a useful technique to diagnose various elbow pathologies. The primary objective of this study was to determine the sensitivity and specificity of CT to assess medial coronoid disease (MCD), using arthroscopy as gold standard. The secondary objective was to ascertain the radiographic sensitivity and specificity for MCD compared with CT. METHODS: For this study 180 elbow joints were assessed, of which 141 had been examined with radiography, CT and arthroscopy; and 39 joints, had radiographic and CT assessment. Sensitivity and specificity were calculated for CT and radiographic findings using available statistical software. RESULTS: Sensitivity and specificity of CT using arthroscopy as gold standard resulted in high values for sensitivity (100 %) and specificity (93 %) for the assessment of MCD. For the radiographic evaluation, a sensitivity of 98 % and specificity of 64 - 69 % using CT as the technique of reference, were found. DISCUSSION: These results suggest that in case of doubt during radiographic assessment, CT could be used as a non-invasive technique to assess the presence of MCD. CONCLUSION: Based on the high sensitivity and specificity obtained in this study it has been considered that CT, rather than arthroscopy, is the preferred noninvasive technique to assess MCD lesions of the canine elbow joint.

Radiographic and computed tomographic assessment of the development of the antebrachia and elbow joints in Labrador Retrievers with and without medial coronoid disease.

OBJECTIVES: To compare the development, monitored by radiography and computed tomography, of the antebrachia and elbow joints in seven Labrador Retrievers with healthy elbow joints and in seven Labrador Retrievers that developed medial coronoid disease (MCD), in order to determine whether disturbances in the development of the antebrachia and elbow joints, between the age of six and 17 weeks may lead to medial coronoid disease. METHODS: A prospective study of 14 Labrador Retrievers in their active growth stage was performed. The development of the antebrachia and elbow joints was assessed between six and 17 weeks of age using radiography and computed tomography determining the development of secondary ossification centres, radioulnar length ratio, radial angulation, and inter-relationship between the humerus, ulna and radius. RESULTS: For the parameters of ossification of secondary ossification centres, radioulnar length ratio, radial angulation, and joint congruence evaluation, there was no significant difference in the development of the antebrachia and elbow joints of seven Labrador Retrievers positive and seven Labrador Retrievers negative for MCD at the age of six to 17 weeks. CLINICAL SIGNIFICANCE: These findings demonstrate that the development of MCD in the Labrador Retrievers in our study was not related to any disturbance in the development of the antebrachia and elbow joints during the rapid growth phase.

An assessment of intra- and interobserver agreement of reporting orthopaedic findings on presale radiographs of Thoroughbred yearlings.

REASONS FOR PERFORMING STUDY: Radiography is commonly used in clinical practice but agreement of reporting of radiographically detected orthopaedic findings in horses has rarely been studied. OBJECTIVES: To assess agreement within and between observers for reporting of orthopaedic findings on presale radiographs of Thoroughbred yearlings. STUDY DESIGN: Retrospective analysis of archived radiographs. METHODS: Four veterinary radiology specialists each twice examined 167 sets of radiographs for orthopaedic findings in the fore feet, fore and hind fetlocks, carpi, tarsi and stifles. There were 27 findings analysed for agreement. Kappa statistic (κ), percentage of positive agreement (Ppos) and percentage of negative agreement are reported. RESULTS: An excellent percentage of negative agreement was observed for all findings, with the exception of regular vascular channels of the proximal sesamoid bones. Ppos and κ results were variable. The presence of extra carpal bones, osseous cyst-like lesions of the ulnar carpal bone, sagittal ridge defects of the third metacarpus, fracture of the fore and hind proximal sesamoid bones, regular vascular channels in the hind proximal sesamoids, osteochondrosis lesions of the distal intermediate ridge and/or medial malleoli of the tibia, and osseous cyst-like lesions in the medial femoral condyle was consistently observed with an intra- and interagreement κ≥0.5 and Ppos≥50%. Lucency within the proximal sesamoids consistently had an observed intra- and interagreement κ<0.4 and Ppos<40%. CONCLUSIONS: Observation of orthopaedic findings on yearling repository radiographs showed generally excellent agreement on the absence of findings, but variable agreement on the presence of findings. Agreement was good for larger and easy to categorise radiographic findings. More accurate definitions and training need to be developed to improve agreement within and between observers for orthopaedic findings with poor or fair to good agreement.

Assessment of ultrasonographic morphometric measurements of digital flexor tendons and ligaments of the palmar metacarpal region in Icelandic Horses.

OBJECTIVE: To obtain morphometric values for the superficial digital flexor tendon, deep digital flexor tendon, accessory ligament of the deep digital flexor muscle, and suspensory ligament in the palmar metacarpal region of Icelandic Horses. ANIMALS: 50 nonlame Icelandic Horses in training. PROCEDURES: Horses included 2 stallions, 30 geldings, and 18 mares from 4 to 20 years of age with a body mass index from 149.1 to 250.11 kg/m2. Transverse ultrasonographic images were obtained with an 8- to 10-MHz linear transducer and a standoff pad. In both forelimbs, the cross-sectional area, circumference, dorsopalmar width, and lateromedial width were measured 3 times at 5 regions of interest (ROIs). RESULTS: The coefficient of variation for all measurements of each ROI was <5%. Comparisons were performed among and within structures and for each variable at all ROIs. Comparisons among horses revealed homogeneity because no significant influences of age, sex, height at the withers, or body mass index were found. Additionally, a characteristic skin condition interfering with ultrasonographic examination was observed. CONCLUSIONS AND CLINICAL RELEVANCE: The morphometric values of the structures examined were consistent with those reported for other breeds, although some differences were observed.

Ultrasonographic assessment of the superficial digital flexor tendons of National Hunt racehorses in training over two racing seasons.

REASONS FOR PERFORMING STUDY: It is important to ascertain the prevalence of superficial digital flexor tendon (SDFT) injuries and to improve methods of predicting injury in National Hunt (NH) racehorses. OBJECTIVES: To establish: 1) the prevalence of SDFT tendinopathy in NH horses; 2) whether routine ultrasonography can be used to predict SDFT injuries; 3) whether previous tendinopathy predisposes to reinjury; 4) a normal range for the SDFT cross-sectional area (CSA); and 5) the effects of gender, age, background (ex-flat or ex-store), limb, training and rest periods on SDFT CSA. METHODS: Routine ultrasound assessment of the palmar metacarpal soft tissues of 263 NH racehorses was performed on up to 6 occasions over 2 NH racing seasons. RESULTS: The prevalence of SDFT pathology detected using ultrasonography was 24% (n = 148), with a nonsignificant variation between yards of 10-40%. No changes in SDFT CSA or ultrasonographic appearance were detected prior to injury. Older horses had a significantly higher prevalence of SDFT pathology compared to younger horses, and horses with tendinopathy were more likely to suffer an acute injury compared to horses with no evidence of pathology. A reference range for normal CSA measurements was established as 77-139 mm2 at level 4, from 142 horses with no ultrasonographic evidence of SDFT pathology. The CSA of normal horses did not vary significantly with age, limb or over 2 racing seasons, but did with sex and background. CONCLUSIONS: The study confirms that SDFT tendinopathy is common in NH horses, with substantial variation between training yards. Ultrasonography at 3 month intervals did not seem to predict acute SDFT injuries. POTENTIAL RELEVANCE: Variation in the prevalence of tendinopathy between yards suggests that training methods may influence injury rate. It was not possible to predict injury using routine ultrasonography and therefore other methods must be identified. A normal reference range for SDFT CSA is provided.

Use of reconstructed computed tomography for the assessment of joint spaces in the canine elbow.

OBJECTIVES: To assess the accuracy of reconstructed computed tomography for imaging canine elbow joint spaces. METHODS: Computed tomography scans of eight cadaveric elbows were obtained and reconstructed computed tomography images were formatted in the dorsal and sagittal planes. Humeroradial and humeroulnar joint space measurements were obtained from these images. Intra-observer and inter-observer variations in joint space measurements were assessed, as was the effect of specimen positioning (inter-image variation). After freezing, four elbows were sectioned in the dorsal plane and four in the sagittal plane. In addition to visual comparison of the frozen sections with reconstructed computed tomography images, joint space measurements were obtained from frozen sections and compared with those from reconstructed computed tomography images. Variation was assessed using statistical calculations and graphical techniques. RESULTS: Both inter-image and intra-observer analyses revealed good agreement and low variation between data sets. Inter-observer correlation was only moderate, though variation was low. Visually, the reconstructed computed tomography images accurately reflected the frozen section anatomy. Agreement between frozen section and reconstructed computed tomography joint space measurements was good, with minimal variation. CLINICAL SIGNIFICANCE: These results indicate that reconstructed computed tomography is capable of accurately imaging elbow joint spaces and precise joint space measurements can be obtained. Reconstructed computed tomography may be useful for determining joint space measurements and detecting elbow incongruencies in dogs with elbow dysplasia.

Repeatability of diagnostic ultrasonography in the assessment of the equine superficial digital flexor tendon.

A quantitative investigation of the variation that can occur during the course of ultrasonography of the equine superficial digital flexor tendons (SDFT) was undertaken. The aim of this investigation was to use an objective measure, namely the measurement of CSA, to quantify the variability occurring during the course of the ultrasonographic assessment of the equine SDFT. The effects of 3 variables on the CSA measurements were determined. 1) Image acquisition operator (IAc): two different operators undertaking the ultrasonographic examination; 2) image analysis operator (IAn): two different operators undertaking the calculation of CSA values from previously stored images; and 3) analytical equipment (used during CSA measurement) (IEq): the use of 2 different sets of equipment during calculation of CSA values. Tendon cross-sectional area (CSA) measurements were used as the comparative variable of 3 potential sources: interoperator, during image acquisition; interoperator, during CSA measurement; and intraoperator, when using different analytical equipment. Two operators obtained transverse ultrasonographic images from the forelimb SDFTs of 16 National Hunt (NH) Thoroughbred (TB) racehorses, each undertaking analysis of their own and the other operator's images. One operator undertook analysis of their images using 2 sets of equipment. There was no statistically significant difference in the results obtained when different operators undertook image acquisition (P>0.05). At all but the most distal level, there was no significant difference when different equipment was used during analysis (P>0.05). A significant difference (P<0.01) was reported when different operators undertook image analysis, one operator consistently returning larger measurements. Different operators undertaking different stages of an examination can result in significant variability. To reduce confounding during ultrasonographic investigations involving multiple persons, one operator should undertake image analysis, although different operators may undertake image acquisition.

Prevalence and inheritance of and selection for elbow arthrosis in Bernese mountain dogs and Rottweilers in Sweden and benefit: cost analysis of a screening and control program.

OBJECTIVE: To determine the prevalence and charges over time in the prevalence of elbow arthrosis in Bernese Mountain Dogs and Rottweilers, to ascertain whether prevalence or severity of elbow arthrosis was associated with sex of the dogs, age at the time of elbow joint examination, or ancestral background, to determine the effects of selective breeding, and to conduct an economic evaluation of the elbow arthrosis program operated by the Swedish Kennel Club. DESIGN: Analysis of radiographic evaluations of elbow joint conformity. ANIMALS: 4,515 dogs from 2 breeds registered by the Swedish Kennel Club. PROCEDURE: All radiographs were scrutinized by a single radiologist (LA), and elbow joint conformation was classified as normal or arthrotic, with the degree of arthrosis classified as 1, 2, or 3. RESULTS: Decreasing prevalence of elbow arthrosis corresponding to selection of breeding stock and high heritabilities was found. Sex differences were documented in both breeds, but with contradictory directions. This was interpreted as breed differences in the distribution of genes related to elbow arthrosis. Economic analyses showed that costs of screening and registration of elbow joints was less than the value of dogs estimated to have been saved from moderate and severe elbow arthrosis in both breeds. CLINICAL IMPLICATIONS: Documented effects of age suggest that all dogs should be screened at the same age, rather than screening a few dogs at an older, more revealing age. In screening and control programs based on an open registry with access to family records, decreasing prevalence of elbow arthrosis can be expected, and related to selection of breeding stock.

Ultrasonographic assessment of the proximal digital annular ligament in the equine forelimb.

Ultrasonography was used with 6 normal cadaver forelimbs of Dutch Warmblood horses to delineate the ultrasonographic anatomy of the palmar pastern region, with emphasis on the proximal digital annular ligament. Using a 5.5 MHz sector scanner, the thin proximal digital annular ligament was not visible on offset sonograms. Only if the digital sheath in the normal limb was distended was the distal border of this ligament outlined. In all normal limbs the palmarodistal thickness of the combined skin-proximal digital annular ligament layer in the mid-pastern region was 2 mm. The flexor tendons and distal sesamoidean ligaments were easily identified as hyperechoic structures. Distension of the digital sheath in the normal limbs clearly outlined the anechoic digital sheath pouches. In 4 lame horses ultrasonography aided the diagnosis of functional proximal digital annular ligament constriction. In all 4 diseased forelimbs ultrasonography demonstrated thickening of the skin-proximal digital annular ligament layer and distension of the digital sheath. In one of these limbs the distended digital sheath was also thickened. The flexor tendons and distal sesamoidean ligaments were normal. There was no radiographic evidence of additional bone or joint lesions.

Radiographic assessment of navicular bones, based on changes in the distal nutrient foramina.

Radiographic examination of the navicular bones of 258 horses was carried out. Of these 258 horses, 83 were sound (Group A), 151 had been diagnosed clinically as having navicular disease (Group B), and 24 had a forefoot lameness of unknown aetiology (Group C). Seven basic shapes of distal nutrient foramina were identified from these radiographs. A scoring system was then developed based on these different types of distal nutrient foramina. When this scoring system was applied to the radiographs of the 258 horses examined significant differences were found between the mean navicular scores of the horses in Groups A, B and C. It is considered that this navicular scoring system could be very useful for comparing radiographs of the navicular bones of different horses and recording serial radiographs of navicular bones of the same horse.

Radiologic assessment of bone maturity and cortical thickness in experimental osteo-fluorosis in the young pig.

Radiographs of the left forelimb were obtained after slaughter in 16 14-month-old pigs. From age 8-14 months, eight pigs in the experimental group received 2 mg F-/kg body weight per day. Bone maturity in F-animals was the same as in controls. Cortical thickness was increased by 10 per cent in the fluorotic animals (p less than 0.01) and their plasma-fluoride levels increased throughout the experimental period to approximate those reported for man in endemic fluorosis areas. Thus fluoride given in the dose used and over that period, did not affect maturation in the long bones but increased cortical bone mass in the diaphyses.

Assessment of radiographic positioning for the diagnosis of navicular disease in the horse.

Three of the standard radiographic views of the navicular bone were assessed in normal horses and horses with navicular disease to determine the most effective radiographic positioning. Using the upright pedal view, a pastern angulation of 20 degrees from the vertical produced the optimum result when radiographs were taken using a grid. The best result using the high coronary view was obtained with an anode-film distance of 1 1000 mm, and a tube-head angle of 50 degrees from the vertical. When the special navicular view described by Morgan was examined, the most satisfactory projection was obtained using an anode-film distance of 900 mm, a tube-head angle of 55 degree and the primary beam centred between the bulbs of the heel, for the diagnosis of navicular disease, a combination of the upright pedal view and the special navicular view appears most effective.