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Simon H, Hecht S, Fazio C, Sun X. Magnetic resonance imaging subtraction vs. pre- and post-contrast 3D gradient recalled echo fat suppressed imaging for evaluation of the canine and feline brain. Front Vet Sci 2024; 11:1346617. [PMID: 38322167 PMCID: PMC10844400 DOI: 10.3389/fvets.2024.1346617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/11/2024] [Indexed: 02/08/2024] Open
Abstract
Subtraction magnetic resonance imaging (MRI) has been reported to increase accuracy in the diagnosis of meningeal and inflammatory brain diseases in small animals. 3D T1W gradient recalled echo (GRE) techniques have been proposed as a suitable alternative to conventional spin echo sequences in imaging the canine brain. The aim of this study was to compare subtraction images and paired pre- and post-contrast 3D T1W GRE fat suppressed (FS) images in canine and feline MRI studies using clinical diagnosis as the gold standard. Paired pre- and post-contrast T1W 3D FS GRE images and individual subtraction images of 100 small animal patients were randomized and independently evaluated by 2 blinded observers. Diagnosis categories were "normal," "inflammatory," "neoplastic," and "other." Clinical diagnosis was made in the same categories and served as the gold standard. Image interpretation results were compared to the clinical diagnosis. Interobserver agreement was determined. Clinically, 41 studies were categorized as "normal," 18 as "inflammatory," 28 as "neoplastic," and 13 as "other." The agreement of the pre- and post-contrast GRE images with the gold standard was significantly higher than that of the subtraction images (k = 0.7491 vs. k = 0.5924; p = 0.0075). The largest sources of error were misinterpretation of "other" as "normal" and "normal" as "inflammatory." There was no significant difference between the two observers (p = 0.8820). Based on this study, subtraction images do not provide an advantage to paired pre- and post-contrast FS GRE images when evaluating the canine and feline brain.
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Affiliation(s)
- Heather Simon
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States
| | - Silke Hecht
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States
| | - Constance Fazio
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States
| | - Xiaocun Sun
- Office of Information Technology, University of Tennessee, Knoxville, TN, United States
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Dutil GF, Guevar J, Schweizer D, Roosje P, Kajin F, Volk HA, Grapes NJ, De Decker S, Gutierrez-Quintana R, Abouzeid J, Freeman P, Faller KME, Stein VM, Maiolini A. Otitis media and interna with or without polyps in cats: association between meningeal enhancement on postcontrast MRI, cerebrospinal fluid abnormalities, and clinician treatment choice and outcome. J Feline Med Surg 2022; 24:e481-e489. [PMID: 36409551 PMCID: PMC10812352 DOI: 10.1177/1098612x221125573] [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] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the association between meningeal enhancement (MgE) and cerebrospinal fluid (CSF) analysis results, their individual association with bacteriology results from affected ear samples and whether these test results influenced clinicians' therapeutic choice in cats with otitis media and interna (OMI). METHODS This was a multicentre retrospective study carried out over an 8-year period. Cats diagnosed with OMI, with or without a nasopharyngeal polyp, leading to peripheral vestibular signs were included. Only cats for which MRI with postcontrast T1-weighted sequences and CSF analyses available were included. Cats with intra-axial MRI lesions or empyema were excluded. RESULTS Fifty-eight cats met the inclusion criteria. MgE was reported in 26/58 cases, of which nine had an abnormal CSF result (increased total nucleated cell count [TNCC] or total protein); 32/58 cases had no MgE, of which 10 showed abnormal CSF results. There was no association between bacteriology results (external ear canal or bulla) and MgE or abnormal CSF results. CSF abnormalities were statistically significantly more common in acute cases (n = 16/37) than in chronic cases (n = 3/21; Fischer's test P = 0.04). Prednisolone was prescribed in 10/16 cases with increased TNCC. Among the 42 cases with normal TNCC, 15 received prednisolone and 13 received non-steroidal anti-inflammatory drugs. Various antimicrobial drugs were prescribed in 53/58 cats. Duration of antimicrobial treatment was similar, regardless of positive bacterial culture (5.58 vs 4.22 weeks), abnormal CSF (5.83 vs 4.76 weeks) or MgE (5.33 vs 4.90 weeks). CONCLUSIONS AND RELEVANCE No association was found between the CSF and MgE results. Furthermore, no association was found between MgE, CSF or bacteriology findings. In addition, abnormal CSF results might lead the clinician to treat with corticosteroids, but they did not have any impact on duration of antimicrobial treatment. CSF abnormalities were seen significantly less frequently in chronic cases. The outcome tended to be poorer when MgE was detected on MRI.
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Affiliation(s)
- Guillaume F Dutil
- Division of Clinical Neurology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Julien Guevar
- Division of Small Animal Surgery, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Daniela Schweizer
- Division of Radiology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Petra Roosje
- Division of Dermatology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Filip Kajin
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany
| | - Holger A Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany
| | - Nick J Grapes
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Steven De Decker
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | | | - Jad Abouzeid
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Paul Freeman
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Kiterie ME Faller
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Roslin, UK
| | - Veronika M Stein
- Division of Clinical Neurology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Arianna Maiolini
- Division of Clinical Neurology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Jang M, Hwang J, Nam J, Kim D, Son W, Lee I, Choi M, Yoon J. Proper fraction of inspired oxygen for reduction of oxygen-induced canine cerebrospinal fluid hyperintensity on fluid attenuation inversion recovery sequence using low-field magnetic resonance imaging. J Vet Med Sci 2020; 82:1321-1328. [PMID: 32684615 PMCID: PMC7538315 DOI: 10.1292/jvms.20-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Oxygen-induced cerebrospinal fluid (CSF) hyperintensity artifact is inevitable in fluid attenuation inversion recovery (FLAIR) magnetic resonance (MR) images
of anesthetized animals. This experimental study aimed to confirm the occurrence of this artifact on low-field magnetic resonance imaging (MRI), and to
determine the fraction of inspired oxygen (FiO2) that is safe and does not induce this artifact in canine brain MRI. Six healthy dogs underwent brain
FLAIR MR scans under general anesthesia with 21%, 30%, 50%, 70%, and 100% FiO2. The signal intensity (SI) ratio was calculated as the SI of CSF
spaces divided by that of normalizing regions. The SI ratios of 21% FiO2 images were significantly different from those of 100% FiO2
images, indicating the presence of artifacts on 100% FiO2 images. The SI ratios of 30% FiO2 images were not significantly different from
those of 21% FiO2 images for any of CSF spaces. However, they were significantly different from those of 100% FiO2 images in the cerebral
sulci, third ventricle, interpeduncular cistern, mesencephalic aqueduct, and subarachnoid space at the level of the first cervical vertebra
(P<0.05). All dogs had normal partial pressure of arterial oxygen (PaO2) during inhalation of 30% FiO2, while two dogs
had low PaO2 during inhalation of 21% FiO2. Our findings support the hypothesis that high FiO2 induces CSF hyperintensity
artifact on low-field FLAIR MR images in dogs. FiO2 of 30% is appropriate for obtaining brain FLAIR MR images with fewer artifacts in dogs.
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Affiliation(s)
- Moonjung Jang
- College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Republic of Korea
| | - Jaewoo Hwang
- College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Republic of Korea
| | - Jihye Nam
- College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Republic of Korea
| | - Dalhae Kim
- College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Republic of Korea
| | - Wongyun Son
- College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Republic of Korea
| | - Inhyung Lee
- College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Republic of Korea
| | - Mincheol Choi
- College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Republic of Korea
| | - Junghee Yoon
- College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Republic of Korea
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Kohler RJ, Arnold SA, Eck DJ, Thomson CB, Hunt MA, Pluhar GE. Incidence of and risk factors for major complications or death in dogs undergoing cytoreductive surgery for treatment of suspected primary intracranial masses. J Am Vet Med Assoc 2019; 253:1594-1603. [PMID: 30668253 DOI: 10.2460/javma.253.12.1594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine incidence of and risk factors for major complications occurring in dogs within 30 days after cytoreductive surgery performed by a single pair of surgeons for treatment of suspected primary intracranial masses. DESIGN Retrospective cohort study. ANIMALS 160 client-owned dogs that underwent cytoreductive surgery for treatment of suspected primary intracranial masses between January 2009 and December 2015 at a veterinary teaching hospital. PROCEDURES Medical records were retrospectively reviewed for complications occurring within 30 days after surgery. Data (eg, signalment, clinical signs, previous treatments, preoperative neurologic examination findings, neuroanatomical location, time from onset of clinical signs to surgery, surgical approach, and histopathologic diagnosis) were analyzed for associations with death and with development of major complications other than death. RESULTS 21 (13.1%) dogs died (11 during hospitalization and 10 after discharge) and 30 (18.8%) developed major complications other than death during the first 30 days after surgery. Dogs with abnormal preoperative neurologic examination findings were more likely to develop complications or die. Dogs undergoing a suboccipital approach were more likely to die. The most common postoperative complications other than death were seizures (n = 18 [11.3%]), worsening of neurologic status (6 [3.8%]), and aspiration pneumonia (6 [3.8%]). CONCLUSIONS AND CLINICAL RELEVANCE Results of the present study provided valuable information on predisposing factors, odds of major complications or death, and incidences of major complications or death in dogs during the first 30 days after undergoing cytoreductive surgery for treatment of suspected primary intracranial masses. Careful case selection may help improve outcomes and minimize complications.
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Moioli M, Levionnois O, Stein VM, Schüpbach G, Schmidhalter M, Schweizer-Gorgas D. Hyperintensity of Cerebrospinal Fluid on T2-Weighted Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging Caused by High Inspired Oxygen Fraction. Front Vet Sci 2017; 4:219. [PMID: 29326953 PMCID: PMC5741608 DOI: 10.3389/fvets.2017.00219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/04/2017] [Indexed: 11/13/2022] Open
Abstract
In veterinary medicine, patients undergo magnetic resonance imaging (MRI) under general anesthesia to enable acquisition of artifact-free images. The fraction of inspired oxygen (FiO2) ranges between 30 and 95%. In humans, a high FiO2 is associated with incomplete signal suppression of peripheral cerebrospinal fluid (CSF) spaces on T2-weighted fluid-attenuated inversion recovery (T2w-FLAIR) sequences. The influence of FiO2 on T2w-FLAIR images remains unreported in small animals. The aim of this prospective study was to investigate whether a high FiO2 is associated with hyperintensity in peripheral CSF spaces on T2w-FLAIR images in dogs and cats. Client-owned patients undergoing brain MRI were prospectively enrolled. Animals with brain parenchymal abnormalities and/or meningeal contrast enhancement on MRI images and/or abnormal CSF analysis were excluded. Consequently, twelve patients were enrolled. Anesthesia was maintained by isoflurane 0.5-1 minimal alveolar concentration in 30% oxygen. After acquisition of transverse and dorsal T2w-FLAIR images, the FiO2 was increased to 95%. The T2w-FLAIR sequences were then repeated after 40 min. Arterial blood gas analysis was performed in six patients at the same time as T2w-FLAIR sequence acquisition. Plot profiles of the signal intensity (SI) from CSF spaces of three cerebral sulci and adjacent gray and white matter were generated. SI ratios of CSF space and white matter were compared between the T2w-FLAIR images with 30 and 95% FiO2. An observer blinded to the FiO2, subjectively evaluated the SI of peripheral CSF spaces on T2w-FLAIR images as high or low. There was significant difference in the partial pressure of oxygen between the two arterial samples (P < 0.001). The SI ratios obtained from the T2w-FLAIR images with 95% FiO2 were significantly higher compared with those obtained from the T2w-FLAIR images with 30% FiO2 (P < 0.05). The peripheral CSF spaces were subjectively considered hyperintense in 11 of 12 cases on T2w-FLAIR images with 95% FiO2 (P < 0.005). A clear difference in SI, dependent on the FiO2 was seen in the peripheral CSF spaces on T2w-FLAIR images. In conclusion, the influence of FiO2 must be considered when differentiating pathological and normal CSF spaces on T2w-FLAIR images in dogs and cats.
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Affiliation(s)
- Melania Moioli
- Clinical Radiology, Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Olivier Levionnois
- Clinical Anesthesiology, Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Veronika M Stein
- Clinical Neurology, Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Gertraud Schüpbach
- Department of Clinical Research and Veterinary Public Health, Veterinary Public Health Institute, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Marta Schmidhalter
- Clinical Radiology, Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Daniela Schweizer-Gorgas
- Clinical Radiology, Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
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Posporis C, Grau-Roma L, Travetti O, Oliveira M, Polledo L, Wessmann A. Meningeal carcinomatosis and spinal cord infiltration caused by a locally invasive pulmonary adenocarcinoma in a cat. JFMS Open Rep 2017; 3:2055116917742812. [PMID: 29204290 PMCID: PMC5703112 DOI: 10.1177/2055116917742812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Case summary A 12-year-old domestic shorthair cat was presented with acute non-painful hindlimb proprioceptive ataxia localising to T3–L3 spinal cord segments. MRI revealed paravertebral muscular hyperintensity on T2-weighted images at the level of T7–T8 vertebrae. The cat improved on conservative management but deteriorated 3 months later. Repeated MRI showed meningeal enhancement at the same level and hyperintensity of the paravertebral musculature extending to the right thoracic wall and pleural space on short tau inversion recovery images. Thoracic CT showed mineralised lesions of the right lung, restricted pleural effusion and expansile bone lesions affecting multiple ribs. The cat had been treated for pyothorax 5 years earlier but manifested no current respiratory signs. Cerebrospinal fluid (CSF) examination showed lymphocytic pleocytosis but no neoplastic cells. Biopsy of the affected muscles and cytology of the lung and pleural lesions suggested a malignant epithelial cell tumour. Post-mortem examination confirmed a pulmonary adenocarcinoma locally infiltrating the thoracic wall, T7–T8 vertebrae and the spinal cord white matter. Meningeal carcinomatosis was detected with neoplastic cells invading the ventral median fissure of the spinal cord. No metastases were observed in other organs, indicating that neoplastic cells reached the spinal cord by direct extension. Relevance and novel information Spinal meningeal carcinomatosis has not been reported in dogs or cats with extraneural tumours but is a well-recognised condition in humans. A metastatic cause of meningeal enhancement should be considered in patients with neurological signs of unknown origin. Imaging findings and CSF results can be non-specific.
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Affiliation(s)
- Christoforos Posporis
- Department of Neurology / Neurosurgery, Pride Veterinary Centre, Derby, UK.,School of Veterinary Medicine and Science, University of Nottingham, UK
| | - Llorenç Grau-Roma
- School of Veterinary Medicine and Science, University of Nottingham, UK
| | - Olga Travetti
- Department of Radiology, Pride Veterinary Centre, Derby, UK
| | - Maria Oliveira
- School of Veterinary Medicine and Science, University of Nottingham, UK
| | - Laura Polledo
- School of Veterinary Medicine and Science, University of Nottingham, UK
| | - Annette Wessmann
- Department of Neurology / Neurosurgery, Pride Veterinary Centre, Derby, UK
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7
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Posporis C, Grau-Roma L, Travetti O, Oliveira M, Polledo L, Wessmann A. Meningeal carcinomatosis and spinal cord infiltration caused by a locally invasive pulmonary adenocarcinoma in a cat. JFMS Open Rep 2017. [PMID: 29204290 DOI: 10.1177/2055116917742812.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Case summary A 12-year-old domestic shorthair cat was presented with acute non-painful hindlimb proprioceptive ataxia localising to T3-L3 spinal cord segments. MRI revealed paravertebral muscular hyperintensity on T2-weighted images at the level of T7-T8 vertebrae. The cat improved on conservative management but deteriorated 3 months later. Repeated MRI showed meningeal enhancement at the same level and hyperintensity of the paravertebral musculature extending to the right thoracic wall and pleural space on short tau inversion recovery images. Thoracic CT showed mineralised lesions of the right lung, restricted pleural effusion and expansile bone lesions affecting multiple ribs. The cat had been treated for pyothorax 5 years earlier but manifested no current respiratory signs. Cerebrospinal fluid (CSF) examination showed lymphocytic pleocytosis but no neoplastic cells. Biopsy of the affected muscles and cytology of the lung and pleural lesions suggested a malignant epithelial cell tumour. Post-mortem examination confirmed a pulmonary adenocarcinoma locally infiltrating the thoracic wall, T7-T8 vertebrae and the spinal cord white matter. Meningeal carcinomatosis was detected with neoplastic cells invading the ventral median fissure of the spinal cord. No metastases were observed in other organs, indicating that neoplastic cells reached the spinal cord by direct extension. Relevance and novel information Spinal meningeal carcinomatosis has not been reported in dogs or cats with extraneural tumours but is a well-recognised condition in humans. A metastatic cause of meningeal enhancement should be considered in patients with neurological signs of unknown origin. Imaging findings and CSF results can be non-specific.
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Affiliation(s)
- Christoforos Posporis
- Department of Neurology / Neurosurgery, Pride Veterinary Centre, Derby, UK.,School of Veterinary Medicine and Science, University of Nottingham, UK
| | - Llorenç Grau-Roma
- School of Veterinary Medicine and Science, University of Nottingham, UK
| | - Olga Travetti
- Department of Radiology, Pride Veterinary Centre, Derby, UK
| | - Maria Oliveira
- School of Veterinary Medicine and Science, University of Nottingham, UK
| | - Laura Polledo
- School of Veterinary Medicine and Science, University of Nottingham, UK
| | - Annette Wessmann
- Department of Neurology / Neurosurgery, Pride Veterinary Centre, Derby, UK
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Flegel T. Breed-Specific Magnetic Resonance Imaging Characteristics of Necrotizing Encephalitis in Dogs. Front Vet Sci 2017; 4:203. [PMID: 29255715 PMCID: PMC5723069 DOI: 10.3389/fvets.2017.00203] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/17/2017] [Indexed: 11/13/2022] Open
Abstract
Diagnosing necrotizing encephalitis, with its subcategories of necrotizing leukoencephalitis and necrotizing meningoencephalitis, based on magnetic resonance imaging alone can be challenging. However, there are breed-specific imaging characteristics in both subcategories that allow establishing a clinical diagnosis with a relatively high degree of certainty. Typical breed specific imaging features, such as lesion distribution, signal intensity, contrast enhancement, and gross changes of brain structure (midline shift, ventriculomegaly, and brain herniation) are summarized here, using current literature, for the most commonly affected canine breeds: Yorkshire Terrier, French Bulldog, Pug, and Chihuahua.
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Affiliation(s)
- Thomas Flegel
- Department of Small Animal Medicine, University of Leipzig, Leipzig, Germany
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Lazzerini K, Gutierrez-Quintana R, José-López R, McConnell F, Gonçalves R, McMurrough J, De Decker S, Muir C, Priestnall SL, Mari L, Stabile F, De Risio L, Loeffler C, Tauro A, Rusbridge C, Rodenas S, Añor S, de la Fuente C, Fischer A, Bruehschwein A, Penderis J, Guevar J. Clinical Features, Imaging Characteristics, and Long-term Outcome of Dogs with Cranial Meningocele or Meningoencephalocele. J Vet Intern Med 2017; 31:505-512. [PMID: 28247440 PMCID: PMC5354015 DOI: 10.1111/jvim.14638] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/27/2016] [Accepted: 11/21/2016] [Indexed: 11/28/2022] Open
Abstract
Background The term meningoencephalocele (MEC) describes a herniation of cerebral tissue and meninges through a defect in the cranium, whereas a meningocele (MC) is a herniation of the meninges alone. Hypothesis/Objectives To describe the clinical features, magnetic resonance imaging (MRI) characteristics, and outcomes of dogs with cranial MC and MEC. Animals Twenty‐two client‐owned dogs diagnosed with cranial MC or MEC. Methods Multicentric retrospective descriptive study. Clinical records of 13 institutions were reviewed. Signalment, clinical history, neurologic findings and MRI characteristics as well as treatment and outcome were recorded and evaluated. Results Most affected dogs were presented at a young age (median, 6.5 months; range, 1 month – 8 years). The most common presenting complaints were seizures and behavioral abnormalities. Intranasal MEC was more common than parietal MC. Magnetic resonance imaging identified meningeal enhancement of the protruded tissue in 77% of the cases. Porencephaly was seen in all cases with parietal MC. Cerebrospinal fluid (CSF) analysis identified mild abnormalities in 4 of 11 cases. Surgery was not performed in any affected dog. Seventeen patients were treated medically, and seizures were adequately controlled with anti‐epileptic drugs in 10 dogs. Dogs with intranasal MEC and mild neurologic signs had a fair prognosis with medical treatment. Conclusion and clinical importance Although uncommon, MC and MEC should be considered as a differential diagnosis in young dogs presenting with seizures or alterations in behavior. Medical treatment is a valid option with a fair prognosis when the neurologic signs are mild.
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Affiliation(s)
- K Lazzerini
- Small Animal Hospital, University of Glasgow, Glasgow, UK
| | | | - R José-López
- Small Animal Hospital, University of Glasgow, Glasgow, UK
| | - F McConnell
- Small Animal Teaching Hospital, University of Liverpool, Liverpool, UK
| | - R Gonçalves
- Small Animal Teaching Hospital, University of Liverpool, Liverpool, UK
| | | | - S De Decker
- Queen Mother Hospital for Animals, Royal Veterinary College, London, UK
| | - C Muir
- Pathology and Pathogen Biology, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, UK
| | - S L Priestnall
- Pathology and Pathogen Biology, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, UK
| | - L Mari
- Animal Health Trust, Newmarket, UK
| | | | | | - C Loeffler
- Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - A Tauro
- Fitzpatrick Referrals, Eashing, Surrey, UK
| | | | - S Rodenas
- Hospital Veterinario Valencia Sur, Valencia, Spain
| | - S Añor
- Fundació Hospital Clínic Veterinari, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - C de la Fuente
- Fundació Hospital Clínic Veterinari, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - A Fischer
- Ludwig-Maximilian University Munich, Munchen, Germany
| | | | - J Penderis
- Vet Extra Neurology, Broadleys Veterinary Hospital, Stirling, UK
| | - J Guevar
- Small Animal Hospital, University of Glasgow, Glasgow, UK
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10
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Claßen AC, Kneissl S, Lang J, Tichy A, Pakozdy A. Magnetic resonance features of the feline hippocampus in epileptic and non-epileptic cats: a blinded, retrospective, multi-observer study. BMC Vet Res 2016; 12:165. [PMID: 27515840 PMCID: PMC4982318 DOI: 10.1186/s12917-016-0788-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hippocampal necrosis in cats has been reported to be associated with epileptic seizures. Magnetic resonance imaging (MRI) features of temporal lobe (TL) abnormalities in epileptic cats have been described but MR images from epileptic and non-epileptic individuals have not yet been systematically compared. TL abnormalities are highly variable in shape, size and signal, and therefore may lead to varying evaluations by different specialists. The aim of this study was to investigate whether there were differences in the appearance of the TL between epileptic and non-epileptic cats, and whether there were any relationships between TL abnormalities and seizure semiologies or other clinical findings. We also investigated interobserver agreement among three specialists. METHODS The MR images of 46 cats were reviewed independently by three observers, who were blinded to patient data, examination findings and the review of the other observers. Images were evaluated using a multiparametric scoring system developed for this study. Mann-Whitney U-tests and chi-square were used to analyse the differences between observers' evaluations. The kappa coefficient (k) and Fleiss' kappa coefficient were used to quantify interobserver agreement. RESULTS The overall interobserver agreement was moderate to good (k =0.405 to 0.615). The MR scores between epileptic and non-epileptic cats did not differ significantly. However, there was a significant difference between the MR scores of epileptic cats with and without orofacial involvement according to all three observers. Likewise, MR scores of cats with cluster seizures were higher than those of cats without clusters. CONCLUSION Cats presenting with recurrent epileptic seizures with orofacial involvement are more likely to have hippocampal pathologies, which suggests that TL abnormalities are not merely unspecific epileptic findings, but are associated with a certain type of epilepsy. TL signal alterations are more likely to be detected on FLAIR sequences. In contrast to severe changes in the TL which were described similarly among specialists, mild TL abnormalities may be difficult to interpret, thus leading to different assessments among observers.
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Affiliation(s)
| | - Sibylle Kneissl
- Clinical Unit of Diagnostic Imaging, University of Veterinary Medicine, A 1210, Vienna, Austria
| | - Johann Lang
- Division of Clinical Radiology, Vetsuisse Faculty, University of Bern, CH 3012, Bern, Switzerland
| | - Alexander Tichy
- Department of Biomedical Sciences, University of Veterinary Medicine, A 1210, Vienna, Austria
| | - Akos Pakozdy
- Clinic for Internal Medicine, University of Veterinary Medicine, A 1210, Vienna, Austria
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11
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Dirrig H, Lamb CR. MAGNETIC RESONANCE IMAGING OF INTRACRANIAL INFLAMMATORY CONDITIONS IN DOGS: SENSITIVITY OF SUBTRACTION IMAGES VERSUS PRE- AND POST-GADOLINIUM T1-WEIGHTED IMAGE PAIRS. Vet Radiol Ultrasound 2016; 57:410-6. [PMID: 27144775 DOI: 10.1111/vru.12371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 03/15/2016] [Indexed: 01/17/2023] Open
Abstract
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.
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Affiliation(s)
- Helen Dirrig
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hertfordshire, AL9 7TA, UK
| | - Christopher R Lamb
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hertfordshire, AL9 7TA, UK
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Lazzerini K, Erickson NA, Mundhenk L, Loderstedt S. Foreign body‐induced meningoencephalitis causing seizures in a dog. VETERINARY RECORD CASE REPORTS 2016. [DOI: 10.1136/vetreccr-2015-000271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Nancy Ann Erickson
- Department of Veterinary PathologyFreie Universitaet BerlinBerlinGermany
| | - Lars Mundhenk
- Department of Veterinary PathologyFreie Universitaet BerlinBerlinGermany
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Coates JR, Jeffery ND. Perspectives on Meningoencephalomyelitis of Unknown Origin. Vet Clin North Am Small Anim Pract 2014; 44:1157-85. [DOI: 10.1016/j.cvsm.2014.07.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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14
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Dickinson P. Advances in diagnostic and treatment modalities for intracranial tumors. J Vet Intern Med 2014; 28:1165-85. [PMID: 24814688 PMCID: PMC4857954 DOI: 10.1111/jvim.12370] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 02/24/2014] [Accepted: 03/25/2014] [Indexed: 12/23/2022] Open
Abstract
Intracranial neoplasia is a common clinical condition in domestic companion animals, particularly in dogs. Application of advances in standard diagnostic and therapeutic modalities together with a broad interest in the development of novel translational therapeutic strategies in dogs has resulted in clinically relevant improvements in outcome for many canine patients. This review highlights the status of current diagnostic and therapeutic approaches to intracranial neoplasia and areas of novel treatment currently in development.
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Affiliation(s)
- P.J. Dickinson
- Department of Surgical and Radiological SciencesSchool of Veterinary MedicineUniversity of California DavisDavisCA
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Lamb CR, Lam R, Keenihan EK, Frean S. Appearance of the canine meninges in subtraction magnetic resonance images. Vet Radiol Ultrasound 2014; 55:607-13. [PMID: 24833219 DOI: 10.1111/vru.12166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 01/27/2014] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Christopher R Lamb
- Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, North Mymms, Hertfordshire AL9 7TA, UK
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