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Walter LJ, Stack JD, Winderickx K, Davies HMS, Simon O, Franklin SH. Review of the clinical diagnosis of sacroiliac dysfunction in horses - Challenges and limitations. Vet J 2024; 305:106106. [PMID: 38556191 DOI: 10.1016/j.tvjl.2024.106106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/06/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
Sacroiliac dysfunction (SID) is a condition seen in horses associated with poor performance that affects hind limb gait and impulsion. The condition comprises pain and dysfunction but there lacks clarity around the aetiopathogenesis and whether SID encompasses abnormal joint pathology, abnormal joint movement, abnormal regional biomechanical function, joint laxity and pain, or various combinations of these that may vary over time. Clinical assessment remains challenging for equine clinicians due to the deep location of the sacroiliac joint (SIJ) and surrounding structures which limits access for palpation, diagnostic imaging and joint-specific injection. There is no recognised single reference standard diagnostic test for SID. Clinical diagnosis has been based on ruling out other causes of hind limb lameness, along with combinations of ultrasonography, scintigraphy and periarticular anaesthesia of the SIJ. Recent studies have highlighted the lack of specificity of injections targeting the SIJ, with significant dispersal of injectate into surrounding structures including around the lumbosacral joint (LSJ). Advanced imaging modalities such as computed tomography offers promise for assessment of the structure and pathology of the SIJ and surrounding bony structures. However, there is a need to improve the understanding of the significance of anatomic variation of the sacroiliac region structures, with recent studies reporting detailed anatomic variation in groups of horses with and without SID. There are also limitations around functional assessment of the joint which is still largely reliant on a thorough clinical examination. This review aims to present an update on clinical approaches to the diagnosis of horses with SID, and to consider the challenges and limitations.
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Affiliation(s)
- L J Walter
- School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy Campus, 5371 SA, Australia.
| | - J D Stack
- Phillip Leverhulme Equine Hospital, Department of Equine Clinical Science, University of Liverpool, Wirral CH64 7TE, UK
| | - K Winderickx
- Lingehoeve Diergeneeskunde, Veldstraat 3a, Lienden 4033 AK, the Netherlands
| | - H M S Davies
- Department of Veterinary BioSciences, University of Melbourne, Parkville, VIC 3010, Australia
| | - O Simon
- School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy Campus, 5371 SA, Australia
| | - S H Franklin
- School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy Campus, 5371 SA, Australia
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Harding PG, Tually P, Cullimore AM, Peremans K. Single‐photon emission computed tomography of the pelvis and lumbar spine contributes to the diagnosis of injury in two horses. EQUINE VET EDUC 2022. [DOI: 10.1111/eve.13504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P. G. Harding
- Ascot Equine Veterinarians Ascot Western AustraliaAustralia
| | - P. Tually
- TeleMedVET Ascot Western Australia Australia
| | | | - K. Peremans
- Department of Medical Imaging Faculty of Veterinary Medicine University Ghent Merelbeke Belgium
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Ellis KL, Seabaugh K, King MR. Retrospective analysis of horses with ultrasound evaluation of the sacroiliac region and response to local corticosteroid injection: 42 cases. J Equine Vet Sci 2021; 102:103634. [PMID: 34119197 DOI: 10.1016/j.jevs.2021.103634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/22/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
Local injection of corticosteroids is commonly performed in horses with sacroiliac (SI) region pain and/or dysfunction, ,and ultrasound findings of normal horses and those with SI pain have also been well described. However, no studies have been performed that have evaluated if ultrasound findings, injection technique, or medications injected affect prognosis for return to function. The objectives of the current study are to determine if findings on ultrasound, injection technique, or medications injected are predictive of return to function in horses with SI region pain and/or dysfunction. Medical records were evaluated for horses that had ultrasound exam of the SI region as well as local injection with corticosteroids. A client survey was sent to determine the horse's return to performance. Logistic regression was performed to determine which variables were predictive of horses with SI pain and/or dysfunction returning to performance. A return to the same or higher level of work was found in 26 of 42 (62%) of horses after SI injections, 4 of 42 (10%) of horses returned to a lower level of work, and 12 of 42 (28%) did not return to work at any level. Horses that were injected with methylprednisolone were 4.2 times more likely to return to performance than horses injected with triamcinolone. Factors evaluated on ultrasound of the SI region did not predict whether a horse would return to performance following SI region injection.
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Affiliation(s)
- Katherine L Ellis
- Department of Clinical Sciences, Gail Holmes Equine Orthopedic Research Center, Colorado State University, Fort Collins, CO; Department of Clinical Sciences, Colorado State University, College of Veterinary Medicine and Biomedical Sciences, Fort Collins, CO.
| | - Kathryn Seabaugh
- Department of Clinical Sciences, Gail Holmes Equine Orthopedic Research Center, Colorado State University, Fort Collins, CO; Department of Clinical Sciences, Colorado State University, College of Veterinary Medicine and Biomedical Sciences, Fort Collins, CO
| | - Melissa R King
- Department of Clinical Sciences, Gail Holmes Equine Orthopedic Research Center, Colorado State University, Fort Collins, CO; Department of Clinical Sciences, Colorado State University, College of Veterinary Medicine and Biomedical Sciences, Fort Collins, CO
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Vautravers G, Coudry V, Denoix J. Review of the use of transrectal ultrasonography for evaluation of the caudal lumbar – including lumbosacral – intervertebral discs and symphyses: Normal and abnormal ultrasonographic appearance. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- G. Vautravers
- CIRALE INRA USC 957 BPLC ENVA‐UPEC Normandie Equine Vallée Goustranville France
| | - V. Coudry
- CIRALE INRA USC 957 BPLC ENVA‐UPEC Normandie Equine Vallée Goustranville France
| | - J.‐M. Denoix
- CIRALE INRA USC 957 BPLC ENVA‐UPEC Normandie Equine Vallée Goustranville France
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Pallandre JP, Cornette R, Placide MA, Pelle E, Lavenne F, Abad V, Ribaud M, Bels VL. Iliac auricular surface morphofunctional study in felidae. ZOOLOGY 2019; 138:125714. [PMID: 31756647 DOI: 10.1016/j.zool.2019.125714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 11/19/2022]
Abstract
Felids show remarkable phenotypic similarities and are conservative in behavioral and ecological traits. In contrast, they display a large range in body mass from around 1kg to more than 300kg. Body size and locomotory specializations correlate to skull, limb and vertebral skeleton morphology. With an increase in body mass, felids prey selection switches from small to large, from using a rapid skull or spine lethal bite for small prey, to sustained suffocating bite for large prey. Dietary specialization correlates to skull and front limbs morphology but no correlation was found on the spine or on the hind limb. The morphology of the sacroiliac junction in relation to ecological factors remained to be described. We are presenting a study of the overall shape of the iliac auricular surface with qualitative and quantitative analyses of its morphology. Our results demonstrate that body mass, prey selection, and bite type, crucially influence the auricular surface, where no significant effect of locomotor specialization was found. The outline of the surface is significantly more elevated dorso-caudally and the joint surface shows an irregular W-shape topography in big cats whereas the surface in small cats is smoother with a C-shape topography and less of an elevated ridge. Biomechanically, we suggest that a complex auricular surface increases joint stiffness and provides more support in heavier cats, an advantage for subduing big prey successfully during a sustained bite.
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Affiliation(s)
- Jean-Pierre Pallandre
- Sorbonne Université, Muséum national d'Histoire naturelle, Institut de Systématique Evolution Biodiversité (UMR 7205 MNHN/CNRNS/UPMC/EPHE), 57 Rue Cuvier, 75005, Paris, France.
| | - Raphaël Cornette
- Sorbonne Université, Muséum national d'Histoire naturelle, Institut de Systématique Evolution Biodiversité (UMR 7205 MNHN/CNRNS/UPMC/EPHE), 57 Rue Cuvier, 75005, Paris, France
| | - Marie-Ange Placide
- Sorbonne Université, Muséum national d'Histoire naturelle, Institut de Systématique Evolution Biodiversité (UMR 7205 MNHN/CNRNS/UPMC/EPHE), 57 Rue Cuvier, 75005, Paris, France
| | - Eric Pelle
- Sorbonne Université, Muséum national d'Histoire naturelle, Direction Générale des collections, 57 Rue Cuvier, 75005, Paris, France
| | - Franck Lavenne
- Centre d'Etude et de Recherche Multimodale Et Pluridisciplinaire en imagerie du vivant (CNRS, INSB), 16-18 avenue Doyen Lépine, 69500, Bron, France
| | - Vincent Abad
- R & D, Manufacture des pneumatiques Michelin, 23 place des Carmes Dechaux, 63040, Clermont-Ferrand, France
| | - Mélina Ribaud
- Université Lyon, Ecole Centrale de Lyon, Institut Camille Jordan, 36 avenue Guy de Collonge, 69134, Ecully, France
| | - Vincent L Bels
- Sorbonne Université, Muséum national d'Histoire naturelle, Institut de Systématique Evolution Biodiversité (UMR 7205 MNHN/CNRNS/UPMC/EPHE), 57 Rue Cuvier, 75005, Paris, France
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Comparison of two ultrasound-guided injection techniques targeting the sacroiliac joint region in equine cadavers. Vet Comp Orthop Traumatol 2017; 29:386-93. [DOI: 10.3415/vcot-16-03-0041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/21/2016] [Indexed: 11/17/2022]
Abstract
Summary
Objectives: To compare the accuracy and distribution of injectate for cranial (CR) and caudomedial (CM) ultrasound-guided injections of equine sacroiliac joints.
Methods: Both sacroiliac joints from 10 lumbo sacropelvic specimens were injected using cranial parasagittal (CR; curved 18 gauge, 25 cm spinal needles) and caudomedial (CM; straight 18 gauge, 15 cm spinal needles) ultrasound-guided approaches. Injectate consisted of 4 ml iodinated contrast and 2 ml methylene blue. Computed tomo-graphical (CT) scans were performed before and after injections. Time for needle guidance and repositioning attempts were recorded. The CT sequences were analysed for accuracy and distribution of contrast.
Results: Intra-articular contrast was detected in sacroiliac joints following 15/40 injections. The CR and CM approaches deposited injectate ≤ 2 cm from sacroiliac joint margins following 17/20 and 20/20 injections, respectively. Median distance of closest contrast to the sacroiliac joint was 0.4 cm (interquartile range [IQR]: 1.5 cm) for CR approaches and 0.6 cm (IQR: 0.95 cm) for CM approaches. Cranial injections resulted in injectate contacting lumbosacral intertrans-verse joints 15/20 times. Caudomedial injections were perivascular 16/20 times.
Limitations: Safety and efficacy could not be established.
Clinical relevance: Cranial and CM ultra-sound-guided injections targeting sacroiliac joints were very accurate for periarticular injection, but accuracy was poor for intra- articular injection. Injectate was frequently found in contact with interosseous sacroiliac ligaments, as well as neurovascular and synovial structures in close vicinity of sacroiliac joints.
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Tallaj A, Coudry V, Denoix J. Transrectal ultrasonographic examination of the sacroiliac joints of the horse: Abnormal findings and lesions. EQUINE VET EDUC 2017. [DOI: 10.1111/eve.12858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- A. Tallaj
- INRA USC BPLC 957 ENVA‐UPEC CIRALE Goustranville France
| | - V. Coudry
- INRA USC BPLC 957 ENVA‐UPEC CIRALE Goustranville France
| | - J.‐M. Denoix
- INRA USC BPLC 957 ENVA‐UPEC CIRALE Goustranville France
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Tallaj A, Coudry V, Denoix J. Transrectal ultrasonographic examination of the sacroiliac joints of the horse: Technique and normal images. EQUINE VET EDUC 2017. [DOI: 10.1111/eve.12845] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A. Tallaj
- INRA USC BPLC 957 ENVA‐UPEC CIRALE Goustranville France
| | - V. Coudry
- INRA USC BPLC 957 ENVA‐UPEC CIRALE Goustranville France
| | - J.‐M. Denoix
- INRA USC BPLC 957 ENVA‐UPEC CIRALE Goustranville France
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9
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Dyson S. Evaluation of poor performance in competition horses: A musculoskeletal perspective. Part 2: Further investigation. EQUINE VET EDUC 2015. [DOI: 10.1111/eve.12498] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- S. Dyson
- Centre for Equine Studies; Animal Health Trust; Newmarket Suffolk UK
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Mathis MG, Ley C, Berger M, Hansson K. Evaluation of a positioning method for equine lateral stifle scintigrams. Acta Vet Scand 2012; 54:38. [PMID: 22703542 PMCID: PMC3502362 DOI: 10.1186/1751-0147-54-38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 06/15/2012] [Indexed: 11/26/2022] Open
Abstract
Background The current lack of a standardized protocol for positioning of the gamma camera relative to the horse limb in a lateral stifle scintigram, and thus the reliance on subjective positioning, may be a cause of diagnostic error and inter-operator variability due to variations of the view angle. The aims of this study were to develop a reliable method to obtain a lateral scintigram of the equine stifle based on fixed anatomical landmarks and measure the resulting foot to gamma camera angle on sequential measurements of the same horse and of different horses Methods Technetium filled capsules were glued on the skin on sites adjacent to the origin of the medial and lateral femorotibial collateral ligaments in 22 horses using ultrasound guidance. A lateral view of the stifle was defined as the image where the two radioactive point sources were aligned vertically (point sources guided method). Five sequential lateral acquisitions (one to five) of the stifle with the point sources vertically aligned were acquired in each horse, and the angle between the mid-sagittal foot-axis and the vertical axis of the gamma camera (FC angle) was measured for each of these acquisitions Results For acquisition group one to five, the mean of the means FC angle was 91.6 ± 2° (2SD) and the coefficient of variation (COV) was 1.1%. In the 22 horses the 95% CI for the mean FC angles was 91.6° ± 12.1° (2SD) and the COV was 6.6%. Conclusions The use of point sources to guide gamma camera position results in less variation in the lateral scintigram than if the distal limb is used as guidance due to a difference in FC angle between horses. The point source guided positioning method is considered suitable as a reference standard method to obtain lateral scintigrams of the equine stifle, and it will be of value in clinical scintigraphy and research. The use of alignment of specifically located point sources may also be applied in other regions to standardize scintigraphic views.
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12
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Engeli E, Haussler KK. Review of injection techniques targeting the sacroiliac region in horses. EQUINE VET EDUC 2011. [DOI: 10.1111/j.2042-3292.2011.00313.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Engeli E, Haussler KK, Erb HN. Development and validation of a periarticular injection technique of the sacroiliac joint in horses. Equine Vet J 2010; 36:324-30. [PMID: 15163039 DOI: 10.2746/0425164044890599] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Sacroiliac joint osteoarthritis has been recognised as a significant cause of poor performance in competition and racehorses. Reliable diagnostic tools are currently lacking. The diagnosis has been based typically on exclusion of other possible causes of poor performance, back pain and hindlimb lameness. OBJECTIVES To develop a safe, reliable and minimally invasive periarticular or intra-articular injection technique of potential use for diagnosis and therapy of sacroiliac joint disease in horses. METHODS Twenty-six horses were used to develop and assess a medial approach to the sacroiliac joint with a 15 gauge, 25 cm long spinal needle. In Part I, the cadaveric study, the spinal needle was introduced cranial to the contralateral tuber sacrale and advanced along the medial aspect of the ipsilateral iliac wing until the dorsal surface of the sacrum was encountered. One ml methylene blue (MB) was injected in both sacroiliac joint regions of the sacropelvic specimens. The location of MB-stained tissues relative to the sacroiliac joints was recorded after dissection and disarticulation of the sacroiliac joint. In Part II, the in vivo study, 18 horses were used to validate the in vivo application of the sacroiliac joint injection technique. Horses were restrained in stocks and sedated in preparation for needle placement. One ml MB was injected bilaterally prior to euthanasia. Stained tissues were identified and recorded at necropsy. Successful joint injections were characterised as having MB located intra-articularly or < or = 2 cm periarticularly from the sacroiliac joint margin and localised to the middle or caudal third of the sacroiliac joint. RESULTS Intra-articular MB was not observed in any specimen. However, MB-stained tissue was identified periarticularly in all injection sites (n = 48). Based on the predetermined success criteria, 96% of the methylene blue depots were located at the middle or caudal third of the sacroiliac joint. Dye-stained tissue was located < or = 2 cm from the sacroiliac joint margins in 88% of the specimens. Median distance of the MB from the sacroiliac joint margins was 1.0 cm (range 0.2-3.8 cm). The overall success rate considering both location and distance of the MB-stained tissue relative to sacroiliac joint margins was 83% (40 of 48 joints). CONCLUSIONS The injection technique provides a reliable, easy to perform and consistent access to the medial periarticular aspect of the sacroiliac joint. POTENTIAL RELEVANCE The described injection technique has the potential for both diagnostic and therapeutic applications in the medical management of equine sacroiliac joint disease. Further investigation is necessary to evaluate clinical efficacy and potential adverse effects.
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Affiliation(s)
- E Engeli
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York 14853, USA
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Ultrasound-guided periarticular injections of the sacroiliac region in horses: A cadaveric study. Equine Vet J 2010; 40:160-6. [DOI: 10.2746/042516408x245252] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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GORGAS DANIELA, LUDER PATRIC, LANG JOHANN, DOHERR MARCUSG, UELTSCHI GOTTLIEB, KIRCHER PATRICK. SCINTIGRAPHIC AND RADIOGRAPHIC APPEARANCE OF THE SACROILIAC REGION IN HORSES WITH GAIT ABNORMALITIES OR POOR PERFORMANCE. Vet Radiol Ultrasound 2009; 50:208-14. [DOI: 10.1111/j.1740-8261.2009.01519.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Archer DC, Boswell JC, Voute LC, Clegg PD. Skeletal scintigraphy in the horse: Current indications and validity as a diagnostic test. Vet J 2007; 173:31-44. [PMID: 16359891 DOI: 10.1016/j.tvjl.2005.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Gamma scintigraphy is a well established imaging modality, which in equine practice is predominantly used in the investigation of lameness and suspected musculoskeletal problems. Whilst there is a growing literature on the indications for scintigraphy in the horse, there has been little emphasis so far on identifying the validity of scintigraphy as a diagnostic test. In particular, to what extent can the results of a scintigraphic examination be trusted? In this opinionated review the current indications for skeletal scintigraphy in the horse are considered and its validity as a diagnostic test reviewed. It is concluded that in the majority of published studies, inherent biases in study design make it difficult to assess accurately the validity of skeletal scintigraphy in the horse. Further well designed, prospective studies are required to assess the validity of skeletal scintigraphy as a diagnostic tool, particularly in horses with subtle alterations in radiopharmaceutical uptake.
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Affiliation(s)
- D C Archer
- Department of Clinical Studies, Philip Leverhulme Large Animal Hospital, University of Liverpool, Leahurst, Neston, The Wirral CH64 7TE, UK.
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Erichsen C, Eksell P, Widström C, Berger M, Holm KR, Johnston C. SCINTIGRAPHY OF THE SACROILIAC JOINT REGION IN ASYMPTOMATIC RIDING HORSES: SCINTIGRAPHIC APPEARANCE AND EVALUATION OF METHOD. Vet Radiol Ultrasound 2003; 44:699-706. [PMID: 14703254 DOI: 10.1111/j.1740-8261.2003.tb00534.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The sacroiliac region in 33 clinically normal riding horses was examined with scintigraphy to determine the normal scintigraphic appearance, to evaluate a semiquantitative method used to calculate a sacroiliac joint (SI joint) ratio, and to identify factors that affect the scintigraphic appearance of the pelvis. The scintigraphic examination included dorsal views of each SI joint region and one lateral view of the urinary bladder. Two predefined areas (the SI joint and the area between the tuber sacrale and the SI joint) were evaluated subjectively by comparing the intensity in each area to the intensity in the tuber sacrale, and a semiquantitative method was applied on the images to calculate an SI joint ratio. The thickness of the muscle mass overlying each SI joint was measured by using ultrasound. A corrected ratio was calculated based on a corrected pixel count for each SI joint. Of 29 evaluated horses, 28 had normal radiotracer uptake in the SI joints and 10 horses had symmetric normal radiotracer uptake in the area between the tuber sacrale and the SI joint. The mean SI joint ratio was 0.53 on both the left and right sides, and the mean corrected SI joint ratio was 2.15 on the left side and 2.13 on the right side. Factors that affect the scintigraphic appearance of the pelvis were identified and included attenuation, radioactive urine, and muscle symmetry. The muscle thickness ranged from 8-11 cm, causing 71-82% attenuation. Radioactive urine in the urinary bladder was located ventral to the SI joint region in 16 horses, and four of these were excluded from further evaluation because of risk of misinterpretation. A visual assessment of symmetry of the horses' gluteal muscle mass was compared with the ultrasound measurements. Fourteen horses (14/33) were regarded symmetric by both techniques. Soft tissue attenuation was found to severely compromise the result and indicated that only lesions in the SI joint with severely increased radiotracer uptake can be detected with scintigraphy. Knowledge about presence of radioactive urine ventral to the SI joint region and assessment of muscle symmetry is essential for a correct subjective evaluation. Any situation with difference in muscle mass between the left and right side of the pelvis will give a false impression of increased radiotracer uptake on the side with lesser muscle mass.
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Affiliation(s)
- C Erichsen
- Department of Large Animal Clinical Sciences, Norwegian School of Veterinary Science, 0033 Oslo, Norway
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Dyson S, Murray R, Branch M, Whitton C, Donovan T, Harding E. The sacroiliac joints: evaluation using nuclear scintigraphy. Part 1: The normal horse. Equine Vet J 2003; 35:226-32. [PMID: 12755423 DOI: 10.2746/042516403776148219] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Sacroiliac (SI) disease is recognised as a cause of poor hindlimb action but differential diagnosis is often difficult. HYPOTHESES That in clinically normal horses there would be a significant difference in the ratio of radiopharmaceutical uptake (RU) between the fifth lumbar vertebra (L5) and each tuber sacrale (TS) and between L5 and each SI joint; and that these ratios would alter with age, but ratios would be bilaterally symmetrical. METHODS Dorsal scintigraphic images of the SI region of 15 horses, selected randomly from the clinic database, were analysed by 2 of the authors, comparing noncorrected and motion-corrected images. To determine scintigraphic anatomy, the scintigraphic images of 10 Thoroughbred horses were superimposed over a ventrodorsal radiographic image of an isolated pelvis. Dorsal scintigraphic images of 40 clinically normal horses age 3-16 years were evaluated using subjective examination, profile analysis and quantification using regions of interest. RESULTS The tubera sacrale were seen as 2 well-defined oval regions immediately to the left and right of the midline, abaxial to which were larger, approximately oval areas with less RU, representing uptake in the SI joints. The definition between the SI region and the TS was more obvious in younger horses. Nonmotion-corrected images were often not of diagnostic quality or could be misinterpreted as abnormal. There were significant differences in RU between the TS and SI joints compared to L5, and decreased RU in the tubera sacrale with increasing age, but no change of uptake in the SI joint region and no effect of gender on RU. There was a high degree of left-right symmetry of the TS and SI joint regions. CONCLUSIONS AND POTENTIAL RELEVANCE The scintigraphic images of horses with suspected sacroiliac joint disease should be compared with images of normal horses of comparable age. In normal horses, there was a high degree of symmetry; therefore, marked left-right asymmetry is likely to be abnormal.
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Affiliation(s)
- S Dyson
- Centre for Equine Studies and Epidemiology Unit, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk CB8 7UU, UK
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