Quantitative ultrasound elastography and biometry of the bitch uterus in the early puerperium after vaginal delivery and caesarean section.

Elastography is an actual imaging method used to qualitatively and quantitatively evaluate the elastic properties of tissues. The aim of this study was to evaluate and compare uterine tissue biometry and stiffness during post-partum period in brachycephalic bitches (n = 12) after c-section (GCS; n = 8) or normal delivery (GNB; n = 4). These animals were evaluated daily by abdominal ultrasound from the day of delivery until the 10th day post-partum; measuring uterine diameter, myometrial and endometrial thickness (mm) and shear wave velocity (SWV; m/s), by B-mode and ARFI (acoustic radiation force impulse) elastography, respectively. Uterine diameter was higher (p = .012) in animals submitted to c-section (15.26 ± 4.73 mm) than in normal birth (12.53 ± 2.64 mm) during the first 7 days post-partum. Uterine thickness gradually involuted in both groups (p < .0001), the myometrium during the first 9 days (p = .005) and the endometrium during the first 6 days (p = .003). The myometrial and endometrial SWVs were similar between types of delivery (p = .7846 and .8273) and presented a gradual increase (p = .411; .0043, respectively), during the first 10 days post-partum. It was concluded that bitches with normal delivery had smaller uterine thickness and faster puerperal involution than submitted to c-section, while uterine tissue stiffness was similar between delivery types and increased gradually during post-partum.

Ultrasonography and elastography of the brain and cerebellum of English Bulldog fetuses.

The aim of this study was to evaluate B-mode ultrasonography and ARFI elastography of the central nervous system of canine fetuses as complementary methods to predict gestational age, monitor fetal development and establish standards. Ultrasound examinations were performed on 26 English Bulldog bitches at 34, 49 and 60 days of gestation. The circumference (C), area (A) and diameters of the short (D1) and long (D2) axis of the two cerebral hemispheres of the fetuses in cross-section were measured. Fetal cerebellum shape, echotexture, echogenicity, and transverse diameter (TCD) were evaluated in cross-section. Elastography was performed obtaining color elastograms and mean shear wave velocity (SWV m/s) of the fetal brain and cerebellar tissues. Ultrasound variables were correlated with gestational day (GD). Brain masses had a circular to oval shape, hyperechoic echogenicity, and homogeneous echotexture. C and D1 were the more accurate variables to predict gestational day, with the formulas: GD = 19.38 + 2,06∗C (R2 = 81%) and GD = 18.93 + 7.45∗D1 (R2 = 82%). Cerebellum had a "banana" shape, with hyperechogenic edges, hypoechoic echogenicity, and homogeneous echotexture. The TCD (P = 0.0001) and cerebellar stiffness (P = 0.0006) were greater at 60 days than at 49 days of gestation. The brain mass SWV was correlated positively with GD (P = 0.0001) and showed a gradual increase (P = 0.0001) in the three gestational timepoints evaluated. According to qualitative elastography, both brain mass and cerebellum became more rigid over the course of gestational days. It was possible to verify the development of the brain and cerebellum of canine fetuses during pregnancy by ultrasonographic characteristics and B-mode dimensions, as well as by evaluating the elasticity of these tissues through elastography. These unpublished findings allow a better follow-up of the central nervous system development in the prenatal period and may help in future studies with canine fetuses that present cerebral and cerebellar abnormalities.

Accuracy of B-mode ultrasound and ARFI elastography in predicting malignancy of canine splenic lesions.

The objective was to evaluate the accuracy of B-mode ultrasonography and ARFI elastography in detecting malignancy in canine splenic lesions. Thirty-seven spleens with abnormalities (16 benign and 21 malignant) from dogs of different breeds and ages were evaluated. Echogenicity, echotexture, organ length and height were evaluated using B-mode. By ARFI elastography, tissue stiffness was evaluated qualitatively (elastogram) and quantitatively (measuring the shear wave velocity-SWV). Lesions were classified as diffuse, focal or multifocal (cranial, medial or caudal portion) and comparisons of the SWV between the injured and non-injured areas were performed. In the B-mode, no features were associated to malignancy (P > 0.05). In the elastogram, 35 spleens were non-deformable and 2 deformable, having no association with malignancy. The greater SWV was observed in malignant lesions (3.4 ± 0.6 m/s), followed by areas free from alterations (2.1 ± 0.3 m/s) and benign lesions (1.7 ± 0.5 m/s), with difference between groups (P < 0.0001). It was found that a SWV > 2.6 m/s indicates malignancy of canine splenic lesions (sensitivity of 95%, specificity of 100%, PPV of 100%, NPV of 94% and accuracy of 97%), concluding that ARFI elastography is a promising technique for differentiating malignancy in these lesions.

Contrast-enhanced ultrasound evaluation of placental perfusion in brachicephalic bitches.

The present study aimed to investigate placental hemodynamics to determine quantitative and qualitative parameters for pregnant brachycephalic bitches as well as describe placental vascularization and perfusion in females with fetal abnormalities close to delivery. Forty-four healthy fetuses from 22 brachycephalic bitches and 9 fetuses with gestational abnormalities (anasarca and hydrocephalus) from 8 brachycephalic bitches were evaluated. All female dogs were artificially inseminated intravaginally and underwent cesarean section at the end of gestation. Pregnancy diagnosis was made on the 25th day and experimental evaluations were performed on Days 25 (M1), 45 (M2), and 58 (M3) of gestation in normal pregnancies. Fetuses with gestational abnormalities were evaluated at the last time point. Biometric values of the fetuses were determined by B-mode and vascular indices by Doppler fluxometry of the umbilical artery, whereas qualitative assessment of contrast filling and quantitative parameters of placental perfusion were performed using CEUS. Parameter comparisons among the examined fetuses (normal and abnormal) and between the moments (M1, M2, and M3) were performed by Student's t-test and ANOVA tests, and then correlated using the Spearman test. In healthy fetuses, systolic and diastolic velocities as well as the time averages of minimum and maximum velocities increased significantly from M2 to M3 (P < 0.05), whereas the pulsatility index (P < 0.043) and vascular resistance (P < 0.001) decreased. Contrast distribution was always homogeneous in placental tissues and CEUS filling parameters remained constant during the evaluated periods (P < 0.05). In fetuses with hydrops, Doppler values were similar to those obtained in healthy subjects (P > 0.05), but CEUS evaluation demonstrated a heterogeneous distribution with lower intensity of placental tissue filling and a delay in perfusion time (P < 0.05) with a diagnostic accuracy of 75%. The association of dopplerfluxometry and CEUS allowed evaluation of qualitative and quantitative parameters of physiological pregnancy hemodynamics in all gestational thirds without evidence of significant changes in the physiology of the maternal-fetal binomial, and CEUS was shown to be applicable in the detection of failures in placental vascular filling (tissue dysfunction) in fetuses with anasarca and hydrocephaly.

Ultrasonography of the nuchal translucency of healthy and abnormal English Bulldog fetuses.

The aim of this study was to measure the nuchal translucency (NT) of canine fetuses to establish reference values ​​for healthy gestational processes and to verify its effectiveness in the diagnosis of congenital abnormalities. On day 34 of gestation, the NT of three fetuses from each of the 26 English bulldog female dogs was measured. The first fetus was the one located immediately cranial to the bladder, the second was selected from the left side of the abdomen, and the third from the right side. The reference values for healthy animals were offset using descriptive statistics. The diagnostic ability of the test to identify fetal malformations was studied using receiver operating characteristic curve analysis. Of the 26 litters, only 18 had healthy fetuses, 4 had fetuses with anasarca, 3 had fetuses with abdominal wall defects, and 1 had both types of abnormalities. The NT was higher in canine fetuses that presented anasarca in the litter than in normal litters (1.8 ± 0.77 mm vs. 1.4 ± 0.48 mm; P = 0.0249), with a cut-off value of NT > 1.45 mm (sensitivity = 61.54%, specificity = 70.18%). NT greater than 1.45 mm seems to be a diagnostic tool for the identification of anasarca during gestation of bulldogs. Considering the unprecedented use of this parameter in canine species and the limitations found during the study, further studies will be needed in order to use it on clinical practice.

Ultrasonographic assessment of renal perfusion in bitches with mammary carcinoma treated with long-term carprofen.

The aim of this study was to evaluate renal hemodynamics, routine clinical and laboratory parameters used to estimate renal function, and clinical evolution during six months in bitches with mammary carcinomas that underwent mastectomy and were treated (TG) or not (CG) with carprofen for three months after surgery. Twenty-six bitches with mammary carcinoma were equally distributed into TG that received carprofen 4.4 mg/kg/day for 90 days and CG that did not receive anti-inflammatory medication. Renal artery Doppler flowmetry, contrast-enhanced ultrasound (CEUS) of renal parenchyma, haematological, biochemical and clinical analyses were obtained once a month. These data were compared between groups and time via analysis of variance (ANOVA) in a completely randomized design with repeated measures (P < 0.05). On B-mode ultrasound, the area of the renal artery was greater (P = 0.0003) in the TG. Regarding laboratory findings, haematocrit and haemoglobin were similar in both groups, showing a significant and gradual increase after three months of treatment; MCV, MHC, and MCHC were increased (P < 0.05) and lymphocyte and band counts decreased (P < 0.05) in the TG. Regarding biochemical tests, ALT was the only parameter with a significant difference, being higher (P = 0.0272) in the treated group. It can be concluded that the use of carprofen for 90 days causes minimal changes in renal perfusion, erythrocyte parameters and ALT activity, and reduces the proportion of blood inflammatory cells. Therefore, use of this medication can be carried out safely in patients who require auxiliary cancer treatment.

Liver and spleen elastography of dogs affected by brachycephalic obstructive airway syndrome and its correlation with clinical biomarkers.

The purpose of this study is to determine whether the brachycephalic obstructive airway syndrome (BOAS) is correlated to alterations in liver and spleen elasticity. Forty-eight brachycephalic and 22 mesocephalic dogs were submitted to a BOAS functional assessment, laboratory tests, abdominal ultrasound and liver and spleen Acoustic Radiation Force Impulse (ARFI) elastography. Dogs clinically affected by BOAS had higher values of liver stiffness (p < 0.001) than healthy dogs: medial lobes (1.57 ± 0.37 m/s), left and right lateral lobes (1.54 ± 0.50 m/s, 1.23 ± 0.28 m/s, respectively) and caudate lobe (1.28 ± 0.42 m/s). Compared to the mesocephalic group, the brachycephalic group (BOAS clinically affected and unaffected dogs) had higher spleen (2.51 ± 0.45 m/s; p < 0.001) and liver stiffness (p < 0.001): medial lobes (1.53 ± 0.37 m/s), left and right lateral lobes (1.47 ± 0.47 m/s, 1.20 ± 0.30 m/s, respectively) and caudate lobe (1.23 ± 0.40 m/s). Principal component analysis explained 70% of the variances composed by liver stiffness increase, erythrocytes and alanine aminotransferase reduction. Brachycephalic dogs had higher spleen and liver stiffness and a subacute inflammatory state, which represent another BOAS systemic effect. Consequently, these dogs can be at higher risk of hepatic disorders compared with mesocephalic dogs, similarly to humans affected by sleep apnea syndrome.

Clinical and ultrasound variables for early diagnosis of septic acute kidney injury in bitches with pyometra.

The aetiology of septic acute kidney injury (AKI) is not completely elucidated. Early identification of AKI in septic patients is considered to improve survival rate since it allows rapid treatment onset. We evaluated clinical, haematological, urinary, B-mode, spectral Doppler, and contrast-enhanced ultrasound variables in 20 bitches with pyometra as sepsis models and 12 healthy controls. All animals with pyometra presented some degree of renal damage on histological examination; however, sequential organ failure assessment (SOFA) classified only 40% cases with sepsis. AKI derived from systemic infection was identified in 57% of cases with hypoperfusion and in 22% with inflammation, being an affection of multifactorial origin. Among the evaluated parameters, urinary protein/creatinine ratio >0.15, serum albumin <2.94 mg/dL, time-averaged minimum velocity <21.5 cm/s, renal length/aorta diameter ratio >5.93, pulsatility index >1.53, haematocrit <45%, time-averaged maximum velocity <45.7 cm/s, haemoglobin <16 g/dL, leukocytes >12.53 × 103/uL, and cortical contrast peak intensity <69%, in the order of accuracy, are significant indicators of septic AKI with an accuracy >80%. Thus, AKI is a very prevalent condition in septic patients, derived mainly from changes in renal perfusion and inflammation. Additionally, reviewing the SOFA score parameters is suggested to identify renal failure.

Ultrasonography for lymph nodes metastasis identification in bitches with mammary neoplasms.

The aim of this study was to evaluate and compare the diagnostic accuracy of B-mode, Doppler ultrasonography and Acoustic Radiation Force Impulse (ARFI) elastography in the identification of axillary and inguinal lymph nodes metastasis in bitches with mammary neoplasms. The axillary (n = 96) and inguinal (n = 100) lymph nodes of 100 bitches were evaluated using B-Mode, Colour Doppler and ARFI-elastography. After this evaluation, mastectomy and lymph nodes excision were performed and these structures were histologically classified as free, reactive or metastatic. Ultrasonographic parameters were compared by Chi-Square or ANOVA tests and if they are significant, discriminative power analysis according to histopathological classification was performed (ROC analysis). The ARFI-elastography shear wave velocity (SWV) enabled metastasis identification in inguinal (sensitivity 95% specificity 87%) and axillary lymph nodes (sensitivity 100% specificity 94%). While B-Mode ultrasound Short/Long axis ratio evaluation of inguinal and axillary lymph nodes only resulted in a sensitivity around of 71% and specificity of 55%. In conclusion, B-Mode ultrasonography may contribute to diagnosis of metastasis in axillary and inguinal lymph nodes of bitches affected by mammary neoplasm with limited accuracy, while SWV evaluation proved to be an excellent diagnosis tool, which allows differentiation between free, reactive and tumour metastatic lymph nodes.

Ultrasonography methods for predicting malignancy in canine mammary tumors.

The aim of this study was to evaluate and compare the efficacy of B-mode, Doppler, contrast-enhanced ultrasonography (CEUS), and Acoustic Radiation Force Impulse (ARFI) elastography in predicting malignancy in canine mammary masses. This was a prospective cohort study from 2014 to 2016, which included 153 bitches with one or more mammary masses. A total of 300 masses were evaluated by ultrasonography (B-mode, Doppler, CEUS, and ARFI) and subsequently classified as benign or malignant by histopathology. Each ultrasound parameters studied were compared between benign and malignant masses by Chi-square or Student tests and differences were considered significant when P < 0.01. For the variables that proved significant differences were estimated the cut-off point, sensitivity, specificity, accuracy, and area under curve (AUC) by receiver-operating characteristic curve (ROC) analysis in a logistic regression model using histopathological classification as reference, to assess and compare diagnostic performance of each technique. Out of 300 mammary masses evaluated 246 were classified as malignant and 54 as benign. B-mode measurements showed sensitivity 67.9%, and specificity 67.6% as malignancy predictors on canine mammary masses; Doppler indexes systolic (>21.2 m/s) and diastolic velocity (>4.8 m/s) sensitivity 79.2% and specificity 70.8%; CEUS wash-out time (<80.5 s) sensitivity 80.2% and specificity 16.7%; and ARFI elastography shear velocity (SWV > 2.57 m/s) sensitivity 94.7% and specificity 97.2% In conclusion B-mode and Doppler ultrasound evaluations may assist in malignancy prediction of canine mammary masses with moderate sensitivity and specificity, already the SWV was an great accurate predictor. Therefore, ARFI elastography exam inclusion in veterinary clinic oncology and research is highly recommended, since it allows fast, non-invasive, and complication-free malignancy prediction of canine mammary masses.

Gestational echobiometry in brachycephalic bitches using high-definition ultrasonography

ABSTRACT: The objective of the present study was to obtain echobiometric values for the most important canine maternal-fetal tissues using high-definition ultrasonography (HDUS) trying to update the formulas for predicting gestational age. Twelve healthy bitches of brachycephalic breeds weighing 7-13kg and aged one to four years were included. The fetuses were analyzed every day using conventional and high-definition ultrasonography from the eighth day after artificial insemination until the day of delivery, using the ACUSON S2000/SIEMENS ultrasound equipment and specific software. Embryonic and fetal structures; diameter of the embryonic vesicle; length of the embryo; biparietal diameter, abdominal length and kidney height; length of the femur, humerus, scapula, radius, and tibia; thickening of the stomach wall; adrenal length; and cardiac size were measured. These variables were correlated with gestational and adjusted tested according to regression models. The results obtained (P 0.001) for: lateral diameter of the gestational sac (R2=81.8%); length of the embryo (R2=85.7%); biparietal (R2=99.1%) and abdominal diameter (R2=97.2%); thickness of the gastric wall (R2=86.9%); length of the femur (R2=96.6%), radius (R2=97.5%), humerus (R2=96.5%), scapula (R2=95.8%) and tibia (R2=97.3%); kidney length (R2=95.8%) and height (R2=96.0%); adrenal length (R2=89.6%); heart length (R2=93.0%) and height (R2=91.5%) of the canine fetuses showed significant correlation with gestational days. This allowed monitoring fetal growth and estimation of age with high accuracy in different gestational periods.

RESUMO: O objetivo do presente estudo foi obter valores ecobiométricos para os tecidos materno-fetais caninos, usando a ultrassonografia de alta definição (HDUS), desenvolvendo fórmulas para prever a idade gestacional das cadelas. Doze cadelas saudáveis de raças braquicefálicas pesando 7-13kg e com idades entre um e quatro anos foram incluídas. Os fetos foram analisados diariamente com ultrassonografia convencional e de alta definição, do oitavo dia após a inseminação artificial até o dia do parto, utilizando o equipamento de ultrassom ACUSON S2000/SIEMENS e software específico. Estruturas embrionárias e fetais; diâmetro da vesícula embrionária; comprimento do embrião; diâmetro biparietal, comprimento abdominal e altura renal; comprimento do fêmur, úmero, escápula, rádio e tíbia; espessamento da parede do estômago; comprimento adrenal; e tamanho cardíaco foram medidos. Essas variáveis foram correlacionadas com o teste gestacional e ajustado de acordo com os modelos de regressão. Os resultados obtidos (P 0,001) para: diâmetro lateral do saco gestacional (R2=81,8%); comprimento do embrião (R2=85,7%); diâmetro biparietal (R2=99,1%) e abdominal (R2=97,2%); espessura da parede gástrica (R2=86,9%); comprimento do fêmur (R2=96,6%), rádio (R2=97,5%), úmero (R2=96,5%), escápula (R2=95,8%) e tíbia (R2=97,3%); comprimento do rim (R2=95,8%) e altura (R2=96,0%); comprimento adrenal (R2=89,6%); o comprimento do coração (R2=93,0%) e a altura (R2=91,5%) dos fetos caninos apresentaram correlação significativa com os dias gestacionais. Isso permitiu monitorar o crescimento fetal e estimar a idade com alta precisão em diferentes períodos gestacionais.

Gestational echobiometry in brachycephalic bitches using high-definition ultrasonography / Ecobiometria gestacional em cadelas braquicefálicas utilizando ultrassonografia de alta-definição

The objective of the present study was to obtain echobiometric values for the most important canine maternal-fetal tissues using high-definition ultrasonography (HDUS) trying to update the formulas for predicting gestational age. Twelve healthy bitches of brachycephalic breeds weighing 7-13kg and aged one to four years were included. The fetuses were analyzed every day using conventional and high-definition ultrasonography from the eighth day after artificial insemination until the day of delivery, using the ACUSON S2000/SIEMENS ultrasound equipment and specific software. Embryonic and fetal structures; diameter of the embryonic vesicle; length of the embryo; biparietal diameter, abdominal length and kidney height; length of the femur, humerus, scapula, radius, and tibia; thickening of the stomach wall; adrenal length; and cardiac size were measured. These variables were correlated with gestational and adjusted tested according to regression models. The results obtained (P<0.001) for: lateral diameter of the gestational sac (R2=81.8%); length of the embryo (R2=85.7%); biparietal (R2=99.1%) and abdominal diameter (R2=97.2%); thickness of the gastric wall (R2=86.9%); length of the femur (R2=96.6%), radius (R2=97.5%), humerus (R2=96.5%), scapula (R2=95.8%) and tibia (R2=97.3%); kidney length (R2=95.8%) and height (R2=96.0%); adrenal length (R2=89.6%); heart length (R2=93.0%) and height (R2=91.5%) of the canine fetuses showed significant correlation with gestational days. This allowed monitoring fetal growth and estimation of age with high accuracy in different gestational periods.(AU)

O objetivo do presente estudo foi obter valores ecobiométricos para os tecidos materno-fetais caninos, usando a ultrassonografia de alta definição (HDUS), desenvolvendo fórmulas para prever a idade gestacional das cadelas. Doze cadelas saudáveis de raças braquicefálicas pesando 7-13kg e com idades entre um e quatro anos foram incluídas. Os fetos foram analisados diariamente com ultrassonografia convencional e de alta definição, do oitavo dia após a inseminação artificial até o dia do parto, utilizando o equipamento de ultrassom ACUSON S2000/SIEMENS e software específico. Estruturas embrionárias e fetais; diâmetro da vesícula embrionária; comprimento do embrião; diâmetro biparietal, comprimento abdominal e altura renal; comprimento do fêmur, úmero, escápula, rádio e tíbia; espessamento da parede do estômago; comprimento adrenal; e tamanho cardíaco foram medidos. Essas variáveis foram correlacionadas com o teste gestacional e ajustado de acordo com os modelos de regressão. Os resultados obtidos (P<0,001) para: diâmetro lateral do saco gestacional (R2=81,8%); comprimento do embrião (R2=85,7%); diâmetro biparietal (R2=99,1%) e abdominal (R2=97,2%); espessura da parede gástrica (R2=86,9%); comprimento do fêmur (R2=96,6%), rádio (R2=97,5%), úmero (R2=96,5%), escápula (R2=95,8%) e tíbia (R2=97,3%); comprimento do rim (R2=95,8%) e altura (R2=96,0%); comprimento adrenal (R2=89,6%); o comprimento do coração (R2=93,0%) e a altura (R2=91,5%) dos fetos caninos apresentaram correlação significativa com os dias gestacionais. Isso permitiu monitorar o crescimento fetal e estimar a idade com alta precisão em diferentes períodos gestacionais.(AU)

Mesenteric metastasis of granulosa cell tumor in a bitch: a case report / Metástasis mesentérica de tumor de células de granulosa en una perra: reporte de caso / Metástase mesentérica de tumor das células da granulosa em uma cadela: relato de caso

Abstract Anamnesis: A 5-year-old mixed breed entire bitch was presented with bloody vaginal discharge and abdominal distension. Clinical and laboratory findings: Physical examination and abdominal ultrasonography suggested the presence of a left ovarian tumor. At histopathological examination it was diagnosed as granulosa cell tumor. Treatment approach: An exploratory laparotomy was performed followed by ovariohysterectomy to remove the intra-abdominal mass. Conclusion: The clinical, ultrasonographic and histologic signs in this case support other literature reports. Ultrasonography, in combination with histopathologic analysis is a fundamental tool for detection of ovarian tumors, especially tumors of the granulosa cells.

Resumen Anamnesis: Una perra entera sin raza definida, con cinco años de edad, presentando secreción vaginal sanguinolenta con una distensión abdominal acentuada. Hallazgos clínicos y de laboratorio: El examen clínico y la ultrasonografía abdominal sugirieron la presencia de la neoformación ovárica izquierda. En el examen histopatológico fue diagnosticado como tumor de células de la granulosa. Aproximación terapéutica: Se realizó una laparotomía exploratoria seguida de ovariohisterectomía para eliminar la masa intra-abdominal. Conclusión: Los signos clínicos, ecográficos e histológicos en este caso respaldan otros informes de la literatura. La ecografía, en combinación con el análisis histopatológico, es una herramienta fundamental para la detección de tumores ováricos, especialmente tumores de las células de la granulosa.

Resumo Anamnese: Uma cadela sem raça definida, com cinco anos de idade, não castrada, apresentando secreção vaginal sanguinolenta com acentuada distensão abdominal. Achados clínicos e laboratoriais: O exame clínico e ultrassonografia abdominal sugeriram a presença de neoformação ovariana esquerda. No exame histopatológico foi diagnosticado como tumor de células da granulosa. Abordagem terapêutica: Foi realizada laparotomia exploratória seguida de ovariohisterectomia para remoção da massa intra-abdominal. Conclusão: Os sinais clínicos, ultrassonográficos e histológicos corroboram a literatura, concluindo que a modalidade ultrassonográfica, em associação a análise histopatológica é uma ferramenta fundamental na detecção de neoformações ovarianas, contribuindo significativamente no diagnóstico final.