EFFECT OF DELAYED ACQUISITION TIMES ON GADOLINIUM-ENHANCED MAGNETIC RESONANCE IMAGING OF THE PRESUMABLY NORMAL CANINE BRAIN

Magnetic resonance imaging findings in dogs with steroid-responsive meningitis-arteritis in the UK and their clinical significance: 53 cases (2013-2021)

OBJECTIVES

To describe the MRI findings in a UK referral population of dogs with steroid-responsive meningitis-arteritis and to determine if they were associated with any specific clinical features or outcomes.

MATERIALS AND METHODS

We performed a multi-centre retrospective case series of dogs diagnosed with steroid-responsive meningitis-arteritis in the UK that underwent MRI. Blinded consensus review of the MRI studies was performed and the findings described. The presence or absence of specific MRI abnormalities were analysed for significant associations with presenting signs, results of investigations or case outcomes.

RESULTS

Fifty-three dogs were included. The most common MRI findings were paravertebral muscle changes (30/53; 56.6%), meningeal contrast enhancement (13/41; 31.7%) and spinal cord parenchymal T2-W hyperintensity (15/53; 28.3%). Haemorrhage was observed in five of 53 (9.4%) cases - three intradural-extramedullary, one intramedullary and one extradural. Following binary logistic regressions, T2-W spinal cord parenchymal hyperintensity had a significant positive association with paresis/paralysis (odds ratio 14.86, 95% confidence interval 1.42 to 154.99) as did haemorrhage (odds ratio 16.12, confidence interval 2.05 to 126.73). Fifty-two (98.1%) dogs survived to discharge. Relapse occurred in nine of 29 (31.0%) dogs with sufficient follow-up, and no MRI finding had a significant relationship with its occurrence.

CLINICAL SIGNIFICANCE

Magnetic resonance imaging findings for steroid-responsive meningitis-arteritis can be severe and extensive, as can the clinical presentation. The presence of paresis/paralysis should raise concern for haemorrhage, though most dogs still have a good prognosis.

Microanatomical findings with relevance to trigeminal ganglion enhancement on post-contrast T1-weighted magnetic resonance images in dogs

Introduction

Trigeminal ganglion contrast enhancement (TGCE) is reported to be a normal and a common finding on magnetic resonance imaging studies of dogs, cats and humans. The intent of the present study was to describe the anatomical characteristics of the trigeminal ganglion, its surrounding structures, and histological features that are relevant to explain or hypothesize on the reason for TGCE on T1-weighted post-contrast MRI studies of the brain in dogs.

Methods

Eight dog cadavers were dissected to study the anatomy of the trigeminal ganglion. The presence and anatomy of vessels was studied by dissection and by histological techniques. Two trigeminal ganglia were isolated and stained with hematoxylin-eosin (HE). Two other trigeminal ganglia included in the trigeminal canal and trigeminal cavity were decalcified with formic acid/formalin for 12 weeks and stained with HE to study the related vessels. Additionally, a corrosion cast was obtained from a separate canine specimen.

Results

Leptomeninges and a subarachnoid space were identified at the level of the trigeminal nerve roots and the trigeminal ganglion. No subarachnoid space was identified and leptomeninges were no longer present at the level of the three trigeminal nerve branches. Small arterial vessels ran to and supplied the trigeminal ganglion, passing through the dura mater. No venous plexus was visualized at the level of the trigeminal ganglion in the dissections. A complex arterial vascular network was identified within the leptomeningeal covering of the trigeminal ganglion and was best appreciated in the corrosion cast. Histological examination revealed small-to moderate-sized blood vessels located in the epineurium around the ganglion; from there a multitude of arterioles penetrated into the perineurium. Small endoneurial branches and capillaries penetrated the ganglion and the trigeminal nerve branches.

Discussion

Limitations to this study include the limited number of canine specimens included and the lack of electron microscopy to further support current hypotheses included in our discussion. In conclusion, this study provides further support to the theory that TGCE in dogs may be due an incomplete blood-nerve barrier or blood-ganglion barrier at the interface between the central nervous system and the peripheral nervous system.

MRI of CNS lymphoma with choroid plexus involvement in five dogs and one cat

OBJECTIVES

To describe the clinical features, magnetic resonance imaging (MRI) findings, and outcome of dogs and cats with central nervous system (CNS) lymphoma that involved the choroid plexus.

MATERIALS AND METHODS

A bi-institutional retrospective study of MRI of dogs and cats with CNS lymphoma, in which the choroid plexus was affected on MRI. Signalment, clinical, MRI, clinicopathologic and histopathologic findings were recorded and evaluated.

RESULTS

CNS lymphoma with choroid plexus involvement on the MRI was identified in five dogs and one cat. MRI revealed diffuse enlargement and multifocal nodularity in the choroid plexus in most cases, with the fourth ventricle the most common site affected. Five of the cases had signs of extraneural involvement (including the cat), while the sixth case was not staged. Four of five CSF samples analysed provided a diagnosis of lymphoma.

CLINICAL SIGNIFICANCE

We report MRI findings of CNS lymphoma involving the choroid plexus. These results show the importance of recognising novel imaging patterns and the potential utility of CSF collection in diagnosing CNS lymphoma involving the choroid plexus ante mortem.

Three-dimensional T1-weighted gradient echo is a suitable alternative to two-dimensional T1-weighted spin echo for imaging the canine brain

Volumetric imaging (VOL), a three‐dimensional magnetic resonance imaging (MRI) technique, has been described in the literature for evaluation of the human brain. It offers several advantages over conventional two‐dimensional (2D) spin echo (SE), allowing rapid, whole‐brain, isotropic imaging with submillimeter voxels. This retrospective, observational study compares the use of 2D T1‐weighted SE (T1W SE), with T1W VOL, for the evaluation of dogs with clinical signs of intracranial disease. Brain MRI images from 160 dogs who had T1W SE and T1W VOL sequences acquired pre‐ and postcontrast, were reviewed for presence and characteristics of intracranial lesions. Twenty‐nine of 160 patients were found to have intracranial lesions, all visible on both sequences. Significantly better grey‐white matter (GWM) differentiation was identified with T1W VOL (P < .001), with fair agreement between the two sequences (weighted κ = 0.35). Excluding a mild reduction in lesion intensity in three dogs precontrast on the T1W VOL images compared to T1W SE, and meningeal enhancement noted on the T1W VOL images in one dog, not identified on T1W SE, there was otherwise complete agreement between the two sequences. The T1W VOL sequence provided equivalent lesion evaluation and significantly improved GWM differentiation. Images acquired were of comparable diagnostic quality to those produced using a conventional T1W SE technique, for assessment of lesion appearance, number, location, mass effect, and postcontrast enhancement. T1W VOL, therefore, provides a suitable alternative T1W sequence for canine brain evaluation and can facilitate a reduction in total image acquisition time.

Consensus recommendations on standardized magnetic resonance imaging protocols for multicenter canine brain tumor clinical trials

The National Cancer Institute Comparative Brain Tumor Consortium, Patient Outcomes Working Group, propose a consensus document in support of standardized magnetic resonance imaging protocols for canine brain tumor clinical trials. The intent of this manuscript is to address the widely acknowledged need to ensure canine brain tumor imaging protocols are relevant and have sufficient equivalency to translate to human studies such that: (1) multi-institutional studies can be performed with minimal inter-institutional variation, and (2) imaging protocols are consistent with human consensus recommendations to permit reliable translation of imaging data to human clinical trials. Consensus recommendations include pre- and postcontrast three-dimensional T1-weighted images, T2-weighted turbo spin echo in all three planes, T2*-weighted gradient recalled echo, T2-weighted fluid attenuated inversion recovery, and diffusion weighted imaging/diffusion tensor imaging in transverse plane; field of view of ≤150 mm; slice thickness of ≤2 mm, matrix ≥ 256 for two-dimensional images, and 150 or 256 for three-dimensional images.

Generalized myoclonic epilepsy with photosensitivity in juvenile dogs caused by a defective DIRAS family GTPase 1

The clinical and electroencephalographic features of a canine generalized myoclonic epilepsy with photosensitivity and onset in young Rhodesian Ridgeback dogs (6 wk to 18 mo) are described. A fully penetrant recessive 4-bp deletion was identified in the DIRAS family GTPase 1 (DIRAS1) gene with an altered expression pattern of DIRAS1 protein in the affected brain. This neuronal DIRAS1 gene with a proposed role in cholinergic transmission provides not only a candidate for human myoclonic epilepsy but also insights into the disease etiology, while establishing a spontaneous model for future intervention studies and functional characterization.

IMAGING DIAGNOSIS-MAGNETIC RESONANCE IMAGING FEATURES OF A MULTIFOCAL OLIGODENDROGLIOMA IN THE SPINAL CORD AND BRAIN OF A DOG

An 8-year-old neutered male Toy Poodle was presented with chronic, progressive tetraparesis, and possible seizures. Magnetic resonance images demonstrated an extensive, T1 and T2 hyperintense contrast enhancing mass in the cervical spinal cord. Three nodules were present on the surface of the thalamus, with enhancement most evident on delayed images. A diagnosis of high-grade oligodendroglioma was confirmed with postmortem histopathology and immunohistochemical labeling. Oligodendroglioma should be considered as a differential for T1 hyperintense intraaxial or intramedullary lesions with contrast enhancement. If enhancement is not visualized on postcontrast images, delayed images may be beneficial.

MAGNETIC RESONANCE IMAGING OF INTRACRANIAL INFLAMMATORY CONDITIONS IN DOGS: SENSITIVITY OF SUBTRACTION IMAGES VERSUS PRE- AND POST-GADOLINIUM T1-WEIGHTED IMAGE PAIRS

Ante mortem diagnosis of canine meningoencephalitis is usually based on the results of neurologic examination, cerebrospinal fluid analysis and magnetic resonance (MR) imaging. It has been hypothesized that subtraction MR imaging may increase the sensitivity of MR for intracranial inflammatory lesions compared to conventional post-gadolinium T1-weighted imaging. Sensitivity of pre- and post-gadolinium (C-/C+) image pairs and dynamic subtraction (DS) images was compared in a retrospective diagnostic accuracy study of 52 dogs with inflammatory cerebrospinal fluid and 67 dogs with idiopathic epilepsy. Series of transverse C-/C+ and DS images were reviewed independently for signs of abnormal enhancement affecting the pachymeninges, leptomeninges or intra-axial structures. Sensitivity of C-/C+ image pairs and DS images was 48% (95% CI: 35-61%) and 65% (95% CI: 52-77%), respectively (P = 0.01). Intra-axial lesions were observed more frequently than meningeal lesions in both C-/C+ (43% vs. 31%) and DS images (61% vs. 22%). The difference in sensitivities of C-/C+ and DS series was entirely due to increased sensitivity of DS images for intra-axial lesions. Eight (12%) dogs with epilepsy had evidence of intra-axial gadolinium accumulation affecting the cerebral cortex in DS images. This finding may represent a false-positive result or a true sign of pathology, possibly associated with a leaky blood-brain barrier in areas of the brain affected by neovascularization secondary to repeated seizures. Results suggest that DS imaging has higher sensitivity than comparison of pre- and post-gadolinium image pairs for inflammatory intra-axial lesions.

Appearance of the canine meninges in subtraction magnetic resonance images

The canine meninges are not visible as discrete structures in noncontrast magnetic resonance (MR) images, and are incompletely visualized in T1-weighted, postgadolinium images, reportedly appearing as short, thin curvilinear segments with minimal enhancement. Subtraction imaging facilitates detection of enhancement of tissues, hence may increase the conspicuity of meninges. The aim of the present study was to describe qualitatively the appearance of canine meninges in subtraction MR images obtained using a dynamic technique. Images were reviewed of 10 consecutive dogs that had dynamic pre- and postgadolinium T1W imaging of the brain that was interpreted as normal, and had normal cerebrospinal fluid. Image-anatomic correlation was facilitated by dissection and histologic examination of two canine cadavers. Meningeal enhancement was relatively inconspicuous in postgadolinium T1-weighted images, but was clearly visible in subtraction images of all dogs. Enhancement was visible as faint, small-rounded foci compatible with vessels seen end on within the sulci, a series of larger rounded foci compatible with vessels of variable caliber on the dorsal aspect of the cerebral cortex, and a continuous thin zone of moderate enhancement around the brain. Superimposition of color-encoded subtraction images on pregadolinium T1- and T2-weighted images facilitated localization of the origin of enhancement, which appeared to be predominantly dural, with relatively few leptomeningeal structures visible. Dynamic subtraction MR imaging should be considered for inclusion in clinical brain MR protocols because of the possibility that its use may increase sensitivity for lesions affecting the meninges.

Agreement between low-field MRI and CT for the detection of suspected intracranial lesions in dogs and cats

OBJECTIVE

To assess the agreement between CT and MRI for enabling detection of intracranial lesions in cats and dogs.

DESIGN

Evaluation study.

ANIMALS

51 dogs and 7 cats with suspected intracranial lesions.

PROCEDURES

During a 2-year-period, dogs and cats with suspected intracranial pathological changes underwent MRI and CT (single slice) of the head. Radiologists evaluated images produced with both techniques without awareness of subject identity. Agreement between methods was assessed for allowing detection of solitary or multiple lesions, selected lesion characteristics (via the Cohen κ statistic), and lesion dimensions (via Bland-Altman plots).

RESULTS

CT and MRI had substantial agreement for allowing detection of lesions and identification of whether the lesions were solitary or multiple. The techniques agreed almost perfectly for allowing identification of a mass effect and contrast medium enhancement, which were considered principal diagnostic imaging signs. A lower degree of agreement was attained for allowing identification of enhancement patterns and aspects of lesion margins. Agreement was substantial to almost perfect for lesion visualization in most anatomic brain regions but poor for identification of lesion dimensions.

CONCLUSIONS AND CLINICAL RELEVANCE

Degrees of agreement between CT and MRI for allowing the detection and characterization of intracranial lesions ranged from poor to almost perfect, depending on the variable assessed. More investigation is needed into the relative analytic sensitivity and possible complementarities of CT and MRI in the detection of suspected intracranial lesions in dogs and cats.

Exclusion of a brain lesion: is intravenous contrast administration required after normal precontrast magnetic resonance imaging?

Background

No evidence‐based guidelines are available for the administration of gadolinium‐based contrast media to veterinary patients.

Objective

To investigate whether administration of intravenous (IV) contrast media alters the likelihood of identifying a brain lesion in dogs and cats.

Animals

Four hundred and eighty‐seven client‐owned animals referred for investigation of intracranial disease.

Methods

Two reviewers retrospectively analyzed precontrast transverse and sagittal T1‐weighted (T1W), T2‐weighted, and fluid‐attenuated inversion recovery low‐field MRI sequences from each patient for the presence of a clinically relevant brain lesion. All sequences subsequently were reviewed in the same manner with additional access to postcontrast T1W images.

Results

Of the 487 precontrast MRI studies, 312 were judged to be normal by 1 or both reviewers. Of these 312 studies, a previously undetected lesion was identified in only 6 cases (1.9%) based on changes observed on postcontrast sequences. Final diagnoses included meningoencephalitis of unknown origin (n = 1), feline infectious peritonitis (n = 1), and neoplasia (n = 2). All 4 of these cases had persistent neurological deficits suggestive of an underlying brain lesion. Contrast enhancement observed in the 2 other cases was considered falsely positive based on the results of further investigations.

Conclusions and Clinical Importance

In patients with normal neurological examination and normal precontrast MRI, the subsequent administration of IV gadolinium‐based contrast media is highly unlikely to disclose a previously unidentified lesion, calling into question the routine administration of contrast media to these patients. However, administration still should be considered in animals with persistent neurological deficits suggestive of an underlying inflammatory or neoplastic brain lesion.

Magnetic resonance imaging contrast enhancement of extra-ocular muscles in dogs with no clinical evidence of orbital disease

Enhancement of extra-ocular muscles has been reported in cases of orbital pathology in both veterinary and medical magnetic resonance imaging. We have also observed this finding in the absence of orbital disease. The purpose of this retrospective study was to describe extra-ocular muscle contrast enhancement characteristics in a group of dogs with no known orbital disease. Magnetic resonance images (MRI) from dogs with no clinical evidence of orbital disease and a reportedly normal MRI study were retrieved and reviewed. Contrast enhancement percentages of the medial, lateral, ventral, and dorsal rectus muscles were calculated based on signal-to-noise ratios that were in turn determined from hand-traced regions of interest in precontrast, immediate postcontrast and 10-min postcontrast scans. Comparison measurements were made in the pterygoid muscle. Contrast enhancement of the extra-ocular muscles was observed in all patients (median contrast enhancement percentage 45.0%) and was greater than that of pterygoid muscle (median contrast enhancement percentage 22.7%). Enhancement of the extra-ocular muscles persisted 10 min after contrast administration (median contrast enhancement percentage 43.4%). Findings indicated that MRI contrast enhancement of extra-ocular muscles is likely normal in dogs.