Correlation of cytologic and histopathologic findings with perinodal echogenicity of abdominal lymph nodes in dogs and cats.

Abdominal lymphadenopathy in dogs and cats is routinely investigated with ultrasound. As the determination between benign and neoplastic etiologies of lymphadenopathy affects patient management, specific sonographic characteristics associated with both benign and neoplastic lymph nodes have been suggested. However, a significant overlap between these characteristics exists, necessitating a cytologic or histopathologic diagnosis in most instances. The objectives of this retrospective, cross-sectional study were to evaluate whether echogenicity of perinodal fat could be a discriminator between benign and neoplastic abdominal lymphadenopathy and to assess if additional sonographic features associated with malignancy could be identified in lymph nodes with hyperechoic perinodal fat. Small animal patients (257 dogs and 117 cats) with sonographic evidence of abdominal lymphadenopathy and a cytological or histopathological diagnosis were evaluated for differences in the proportions of sonographic features between benign and neoplastic groups. Greater maximum long axis diameter (in dogs and cats) and a greater number of abnormal lymph nodes (in cats) were associated with malignancy in lymph nodes with hyperechoic perinodal fat. Canine lymph nodes with round cell neoplasia were significantly more likely to have hyperechoic perinodal fat. Lymph nodes affected with other neoplasia or with lymphadenitis were equally likely to have normal or hyperechoic perinodal fat. Reactive lymph nodes were significantly less likely to have hyperechoic perinodal fat in both species. These results suggest that though echogenicity of perinodal fat is a nonspecific finding, abdominal lymph nodes with hyperechoic perinodal fat are less likely to be reactive and sampling of these lymph nodes may be indicated.

Equine Dental Pulp Connective Tissue Particles Reduced Lameness in Horses in a Controlled Clinical Trial.

OBJECTIVE: To assess if injection of allogeneic dental pulp tissue particles would improve lameness in horses with naturally occurring osteoarthritis (OA) or soft tissue (ST) injury. DESIGN: Prospective, randomized, blinded, and controlled clinical trial and client survey assessment. ANIMALS: Forty lame client-owned horses. PROCEDURES: Sterile dental pulp, recovered from otherwise healthy foals that perish during dystocia, was processed under good manufacturing processing to produce mechanically manipulated, unexpanded pulp tissue particles containing viable cells surrounded in extracellular matrix. Forty lame client-owned horses with confirmed OA (n = 20), or ST injury (desmitis or tendonitis) received a 2 mL intra-articular (n = 20 OA) or intra-lesional (n = 20) injection of control transport vehicle (n = 20) or 10 × 106 dental pulp tissue particles (n = 20). Acclimatized horses had baseline measurements performed and were then injected on day 0. Horses were treadmill exercised for 2 weeks, evaluated by clinical parameters, lameness score, edema (score and circumference), pain on flexion (OA) or pressure (ST), and clients' scores for pain and discomfort before and through 45 days after pulp injection. Twenty horses were available for >2.5-year follow-up. RESULTS: Pulp-treated horses showed decrease in lameness compared to baseline (P < 0.009) or placebo controls (P < 0.013) for at least 2 weeks. Client assessments of comfort were improved between before and 45 days after pulp injection (P < 0.001). Clinical improvement with ST injury was significantly greater than OA (P < 0.001). At >2.5-year follow-up, at least 10 horses were in work. CONCLUSION AND CLINICAL RELEVANCE: Dental pulp tissue particles can be considered as a treatment option for equine lameness due to OA, desmitis, or tendonitis.

Evaluation of a Single Intra-Articular Injection of Autologous Protein Solution for Treatment of Osteoarthritis in a Canine Population.

OBJECTIVE: To evaluate the safety and efficacy of an intra-articular injection of autologous protein solution (APS) for treatment of canine osteoarthritis (OA). STUDY DESIGN: Prospective, randomized, blinded, placebo-controlled pilot clinical trial. ANIMALS: Client-owned dogs with single limb lameness because of OA in a stifle or elbow joint (n=21). METHODS: Lame dogs, confirmed with OA by physical and lameness examination and imaging, were randomly assigned to control or treatment groups. Owners, blinded to treatment, scored pain (University of Pennsylvania Canine Brief Pain Inventory) and lameness severity (Hudson Visual Analogue Scale [HVAS]). Weight-bearing was assessed by kinetic gait analysis. Dogs were injected intra-articularly with APS (treatment group) or saline solution (control group). Evaluations were performed before injection, and 2 and 12 weeks post-injection. RESULTS: Compared to pretreatment values, APS treatment data showed a significant improvement in week 12 pain scores (improved 25.6% over baseline), lameness scores (improved 15% over baseline) and peak vertical force (PVF; N/kg; increased 14.9% of baseline), as well as vertical impulse (Ns/kg) and PVF normalized to stance time (N/kg/s). Control group dogs improved at week 2 in owner assigned indices, but not force plate values and had no significant improvement in scores or force plate values from pretreatment values at 12 weeks. CONCLUSION: APS injection reduced pain and lameness scores and increased weight-bearing associated with the OA-affected joint in dogs at 12 weeks providing preliminary evidence that APS therapy may be beneficial in the treatment of OA in dogs and supporting pursuit of additional studies.

COMPARISON OF COMPUTED TOMOGRAPHY AND ABDOMINAL RADIOGRAPHY FOR DETECTION OF CANINE MECHANICAL INTESTINAL OBSTRUCTION.

Vomiting, often caused by mechanical intestinal obstruction, is common in dogs. Equivocal radiographic signs often necessitate repeat radiographs or additional imaging procedures. For our prospective, case-controlled, accuracy study, we hypothesized the following: (1) using computed tomography (CT), radiologists will be more sensitive and specific for detecting mechanical intestinal obstruction and recommending surgery compared to using radiographs; and (2) using measurements, radiologists will be more sensitive and specific using radiographs or CT for detecting mechanical intestinal obstruction and recommending surgery. Twenty dogs had abdominal radiographs and abdominal CT. Seventeen dogs had abdominal surgery and three dogs were not obstructed based on clinical follow-up. Confidence levels (five-point scale) of three experienced radiologists for mechanical intestinal obstruction and recommending surgery were recorded before and after making selected measurements. Eight dogs had surgically confirmed mechanical intestinal obstruction, and 12 dogs did not have obstruction. For detecting mechanical intestinal obstruction, CT was more sensitive (95.8% vs. 79.2%) and specific (80.6% vs. 69.4%) compared to radiographs, but the difference was not statistically significant. For recommending surgery, radiography was more sensitive (91.7% vs. 83.3%) and specific (83.3% vs. 72.2%) than using CT, but differences were not statistically significant. We reported objective CT measurements for predicting small mechanical intestinal obstruction. By incorporating these objective data, the diagnosis of mechanical intestinal obstruction changed in five of 120 instances (radiographs and CT). In no instance (0/120), did the objective data change the recommendation for surgery. Using CT or abdominal radiographs for the detection of canine mechanical intestinal obstruction is sensitive and specific when evaluated by experienced veterinary radiologists.

Analgesic effects of intraneural injection of ethyl alcohol or formaldehyde in the palmar digital nerves of horses.

OBJECTIVE: To determine analgesic effects of intraneural injection of ethyl alcohol or formaldehyde in the palmar digital nerves of horses. ANIMALS: 6 horses. PROCEDURES: Ethyl alcohol was injected in the medial palmar digital nerve of 1 forelimb, and formaldehyde was injected in the contralateral nerve. The lateral palmar digital nerve in 1 forelimb was surgically exposed, but not injected, and the contralateral lateral palmar digital nerve was not treated. For each heel, severity of lameness in response to experimentally induced heel pain (lameness score and peak vertical force), thermal reaction time, and heel skin sensitivity scores were recorded. Heel pain was experimentally induced by advancing a threaded bolt through a custom-made horseshoe to apply pressure to the palmar horned aspect of the hoof. Horses were followed up for 112 days, when a subset of nerves was sampled for histologic analysis. RESULTS: Alcohol and formaldehyde significantly reduced all measures of heel pain, and analgesia was evident over the 112 days of the study. Pastern circumference was significantly greater for formaldehyde-treated than for alcohol-treated limbs. Histologic evaluation showed preservation of nerve fiber alignment with an intact epineurium, loss of axons, axon degeneration, fibrosis, and inflammation in alcohol-treated and formaldehyde-treated nerves. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that intraneural injection of either ethyl alcohol or formaldehyde in the palmar digital nerves of horses resulted in substantial, but partial, heel analgesia that persisted for at least 112 days. No advantage of formaldehyde over alcohol was found, and formaldehyde resulted in greater soft tissue inflammation.

Evaluation of a single intra-articular injection of autologous protein solution for treatment of osteoarthritis in horses.

OBJECTIVE: To evaluate intra-articular autologous protein solution (APS) for the treatment of osteoarthritis in horses. Animals-40 client-owned horses with naturally occuring osteoarthritis. PROCEDURES: APS was generated from a dual-device system that concentrated plasma and WBC proteins and enriched platelet growth factors. Horses were randomly assigned to receive an intra-articular injection of 5 mL of saline (0.9% NaCl) solution (n = 20) or APS (20), exercised on a treadmill, and evaluated on the basis of lameness grades, kinetic gait analysis, joint circumference, and range of motion for 14 days. Horses that received saline solution were administered APS at termination of the study, and clients scored horses for lameness and discomfort before, 12 weeks after, and 52 weeks after the APS injection. RESULTS: The APS group had significant improvements in lameness grade, asymmetry indices of vertical peak force, and range of joint motion by 14 days, compared with baseline or control group values. No adverse effects associated with APS treatment were evident. Clients assessed lameness and comfort as improved at 12 and 52 weeks. The APS had greater likelihood (OR, 4.3 to 30.0) of a therapeutic response in horses with a lameness score < 4, < 10% vertical force asymmetry, or absence of marked osteophyte formation, subchondral sclerosis, or joint space narrowing. Concentration of interleukin-1 receptor antagonist in APS was 5.8 times that in blood. CONCLUSIONS AND CLINICAL RELEVANCE: Intra-articular administration of APS can be considered an effective treatment option for equine osteoarthritis, with the potential for disease-modifying effects.

Effect of sevoflurane anesthesia and blood donation on the sonographic appearance of the spleen in 60 healthy cats.

The aims of this prospective study were to describe the normal sonographic size and appearance of the feline spleen, and to test effects of sevoflurane anesthesia and blood collection on sonographic characteristics. Sonographic evaluations were performed in 60 healthy blood donor cats prior to anesthesia and blood collection (baseline), after anesthesia induction, after completion of blood collection while under anesthesia, and 7-10 days after blood collection. Transverse sonographic images of the splenic mid-body were made. Splenic height, width, cross-sectional area, echogenicity relative to the left renal cortex, and echotexture were recorded. Height, width, and cross-sectional area were compared across time periods using linear-mixed effects models. Holm's method was applied to adjust for multiplicity and control the overall Type 1 error rate at α = 0.05. Normal transverse sonographic splenic measurements (mean ± standard deviation) at baseline were: height 8.2 ± 1.4 mm; width 26.7 ± 4.4 mm; and CSA 1.6 ± 0.5 cm(2) . While there were statistically significant differences in splenic height, width, and cross-sectional area after sevoflurane anesthesia and/or blood collection, differences were of low magnitude. The spleen was diffusely homogenous and subjectively isoechoic or mildly hyperechoic relative to the left renal cortex. In 77% of castrated male cats, the spleen was isoechoic to the left renal cortex. We conclude that sevoflurane anesthesia and blood donation do not subjectively alter splenic dimensions, echogenicity and echotexture in normal cats.

Digital radiography for the equine practitioner: basic principles and recent advances.

As availability increases and cost decreases, digital radiograph systems become more common in equine practice. Technological advances provide an array of choices for the equine practitioner considering purchase. Two classes of systems are available: computed radiography and flat-panel systems (direct radiography). Image processing encompasses all manipulations performed on an image at acquisition and can have a profound effect on the final digital radiograph. Consideration should be given to the type of display monitor because many options are now available. The type of display monitor and the viewing environment have an effect on interpretation performance.

Effects of treatment on respiratory rate, serum natriuretic peptide concentration, and Doppler echocardiographic indices of left ventricular filling pressure in dogs with congestive heart failure secondary to degenerative mitral valve disease and dilated cardiomyopathy.

OBJECTIVE: To evaluate the effects of treatment on respiratory rate, serum natriuretic peptide concentrations, and Doppler echocardiographic indices of left ventricular filling pressure in dogs with congestive heart failure (CHF) secondary to degenerative mitral valve disease (MVD) and dilated cardiomyopathy (DCM). DESIGN: Prospective cohort study. ANIMALS: 63 client-owned dogs. PROCEDURES: Physical examination, thoracic radiography, analysis of natriuretic peptide concentrations, and Doppler echocardiography were performed twice, at baseline (examination 1) and 5 to 14 days later (examination 2). Home monitoring of respiratory rate was performed by the owners between examinations. RESULTS: In dogs with MVD, resolution of CHF was associated with a decrease in respiratory rate, serum N-terminal probrain natriuretic peptide (NT-proBNP) concentration, and diastolic functional class and an increase of the ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic lateral mitral annulus motion (E:Ea Lat). In dogs with DCM, resolution of CHF was associated with a decrease in respiratory rate and serum NT-proBNP concentration and significant changes in 7 Doppler echocardiographic variables, including a decrease of E:Ea Lat and the ratio of peak velocity of early diastolic transmitral flow to isovolumic relaxation time. Only respiratory rate predicted the presence of CHF at examination 2 with high accuracy. CONCLUSIONS AND CLINICAL RELEVANCE: Resolution of CHF was associated with predictable changes in respiratory rate, serum NT-proBNP concentration, and selected Doppler echocardiographic variables in dogs with DCM and MVD. Home monitoring of respiratory rate was simple and was the most useful in the assessment of successful treatment of CHF.

Intra- and interobserver variability of board-certified veterinary radiologists and veterinary general practitioners for pulmonary nodule detection in standard and inverted display mode images of digital thoracic radiographs of dogs.

OBJECTIVE: To determine intra- and interobserver variability of 2 veterinary radiologists and 2 veterinary general practitioners for detection of pulmonary nodules in standard and inverted (reversed grayscale) displays of digital thoracic radiographs of dogs. DESIGN: Evaluation study. SAMPLE: 114 sets of 3-view (right lateral, left lateral, and ventrodorsal or dorsoventral views) digital thoracic radiographs from 114 dogs. PROCEDURES: 2 experienced board-certified veterinary radiologists and 2 experienced veterinary general practitioners individually evaluated 114 randomized sets of radiographs. Pulmonary nodules were present in radiographs of 60 of 114 dogs. Each reviewer examined all images in standard or inverted display mode and scored nodule detection on a confidence scale of 1 to 5. After ≥ 2 months, the same individuals evaluated the same images in the remaining display mode. Intraobserver agreement for each display mode was determined via a κ statistic; results between the 2 groups of reviewers were compared via receiver operator curve analysis. RESULTS: There was no significant intraobserver variability in pulmonary nodule detection between the 2 display modes. Detection accuracy for board-certified radiologists was significantly greater than that of veterinary general practitioners for both display modes. Near-perfect intraobserver agreement was detected between the 2 display modes for board-certified radiologists, whereas moderate to slight intraobserver agreement was detected for the veterinary general practitioners. CONCLUSIONS AND CLINICAL RELEVANCE: Detection of pulmonary nodules in digital thoracic radiographs was comparable, whether a standard or inverted mode was used for evaluations. However, the board-certified radiologists had greater detection accuracy than did veterinary general practitioners.

Dermal fibroblast-mediated BMP2 therapy to accelerate bone healing in an equine osteotomy model.

This study evaluated healing of equine metacarpal/metatarsal osteotomies in response to percutaneous injection of autologous dermal fibroblasts (DFbs) genetically engineered to secrete bone morphogenetic protein-2 (BMP2) or demonstrate green fluorescent protein (GFP) gene expression administered 14 days after surgery. Radiographic assessment of bone formation indicated greater and earlier healing of bone defects treated with DFb with BMP2 gene augmentation. Quantitative computed tomography and biomechanical testing revealed greater mineralized callus and torsional strength of DFb-BMP2-treated bone defects. On the histologic evaluation, the bone defects with DFb-BMP2 implantation had greater formation of mature cartilage and bone nodules within the osteotomy gap and greater mineralization activity on osteotomy edges. Autologous DFbs were successfully isolated in high numbers by a skin biopsy, rapidly expanded without fastidious culture techniques, permissive to adenoviral vectors, and efficient at in vitro BMP2 protein production and BMP2-induced osteogenic differentiation. This study demonstrated an efficacy and feasibility of DFb-mediated BMP2 therapy to accelerate the healing of osteotomies. Skin cell-mediated BMP2 therapy may be considered as a potential treatment for various types of fractures and bone defects.

Imaging diagnosis--pulmonary metastases in New World camelids.

The radiographic appearance of pulmonary metastatic disease from carcinoma is described in a llama and an alpaca. In one, a diffuse miliary pattern was seen. In the other, a more atypical unstructured interstitial pattern was recognized. Metastatic pulmonary neoplasia in camelids may assume a generalized miliary or unstructured pattern.

Comparison of radiography and computed tomography to evaluate metacarpo/metatarsophalangeal joint pathology of paired limbs of thoroughbred racehorses with severe condylar fracture.

OBJECTIVE: To compare the orthogonal radiographic (OR) and computed tomographic (CT) appearance of paired Thoroughbred racehorse limbs with severe condylar fracture. STUDY DESIGN: In vitro study. SAMPLE POPULATION: Cadaveric paired limbs with severe condylar fracture (n=11 horses). METHODS: Four standard radiographic and multiple transverse CT images were obtained of the fractured and contralateral limbs centering on the metacarpo/metatarsophalangeal (fetlock) joints. Radiographs and CT images were graded by 4 raters, and interobserver agreement was calculated. Imaging evaluations were supplemented by fetlock joint dissection. A consensus description of actual injury and the detection accuracy of OR and CT for that injury was determined. Results- Rater agreement for OR and CT for most pathologic features was good or excellent. OR was similar to CT for the detection of condylar and diaphyseal third metacarpal and metatarsal (MC/MT3) fractures, diaphyseal fractures of the first phalanx (P1), and fracture location on the condyle. CT was superior to OR for detection of MC/MT3 proximal fissures and articular comminution, condylar small cracks and lucencies, and proximal sesamoid fractures. OR was superior to CT for detection of proximal P1 dorsal fractures. Both OR and CT were poor at detecting palmar/planter proximal P1 fractures and coalescing cracks in the subchondral bone of MC/MT3. CONCLUSIONS: CT is better than OR for detection of pathology in limbs with condylar fractures, but does not detect every pathologic feature. CLINICAL RELEVANCE: CT provides superior information of pathology in Thoroughbred racehorses with condylar fractures.

Computed tomography-guided fine-needle aspirate and tissue-core biopsy of intrathoracic lesions in thirty dogs and cats.

Medical records and computed tomography (CT) images were reviewed retrospectively for 30 animals (27 dogs, two cats, one cougar) in which CT-guided intrathoracic fine-needle aspirates (FNA) (12), core biopsies (10) or both (8) were performed. Sample interpretation was listed as diagnostic or nondiagnostic and nonneoplasia or neoplasia. Diagnostic results were inconclusive in 35% FNA and 17% biopsies. FNA and biopsy interpretations were in agreement in seven patients, one nonneoplasia, and six neoplasia. A clinical diagnosis was made in 65% FNA and 83% biopsies. When 18 patients with confirmed diagnoses were used, overall accuracy for diagnosis was 92% for FNA and biopsy and the sensitivity for neoplasia was 91% using fine needle aspirate and 80% using biopsy. Complications seen on CT images were noted in 43% of patients, four pneumothorax, five pulmonary hemorrhage, and four with both. No clinical manifestations were noted and treatment was not necessary. Significant correlation was noted between complications and penetration of aerated lung, but not with lesion location, type of disease, method of sampling, width of mass and depth of aerated lung penetrated. CT-guided sampling is relatively safe and useful in the diagnosis of intra-thoracic lesions, especially neoplasia. FNA samples are nondiagnostic more often than biopsy samples. Sub-clinical pneumothorax and hemorrhage are common when aerated lung is penetrated.

Effect of perineural anesthesia on the ultrasonographic appearance of equine palmar metacarpal structures.

The purpose of this study was to describe ultrasonographic changes of the equine palmar metacarpal area attributed to the infiltration of local anesthetic solution and to determine whether these changes were noted immediately or at 24 h. The palmar metacarpal region of one forelimb in each of six horses was examined ultrasonographically with a 10-MHz linear array transducer and a 7.5-MHz curvilinear transducer. Transverse and longitudinal images were recorded at 5-cm intervals distal to the accessory carpal bone. High and low palmar and palmar metacarpal nerve blocks were performed with a 2% mepivacaine hydrochloride solution. Ultrasonographic examinations similar to the initial examination then were performed immediately, 1 h and 24 h postinjection. Cross-sectional area and mean pixel value were determined for the superficial and deep digital flexor tendons, the accessory ligament of the deep digital flexor tendon, the suspensory ligament, and the suspensory branches at each level and time period. Subjective ultrasonographic changes also were noted. No significant difference was noted in the cross-sectional area or mean pixel value of any structure at any level or time period compared to baseline. Subjective changes in the tendons and ligaments were not noted. There was mild hypoechoic swelling of the surrounding soft tissues and gas in the region of the injections. Gas could interfere with the evaluation of the origin of the suspensory ligament and the proximal portion of the accessory ligament of the deep digital flexor tendon within the first hour but was not detectable ultrasonographically at 24 h. Based on these findings, if gas interferes with an ultrasonographic examination performed temporally close to perineural anesthesia, a repeat examination at 24 h is recommended.

Cranial mediastinal cysts in nine cats.

Nine cats, from 11 to 17 years of age (mean 13.6 years of age), were diagnosed with a cranial mediastinal cyst. Thoracic radiographs in all cats were characterized by an increased soft tissue opacity in the cranial mediastinum confirmed to be a cyst by ultrasonography or necropsy. Ultrasonographically cysts appeared as an anechoic mass. A low-cellularity clear fluid was obtained on aspiration. The majority of the cats (n = 8) presented for unrelated conditions with no signs of respiratory distress. No treatment for the cyst was pursued except for drainage during ultrasonographic-guided aspiration in several cats. On follow-up of eight cats, none were symptomatic for the cyst from 3-45 months after diagnosis. Mediastinal cyst should be considered when a cranial mediastinal mass is evident radiographically in an older cat. The majority of feline cranial mediastinal cysts are benign with no need for treatment.