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Ehrle A, Lilge S, Clegg PD, Maddox TW. Equine flexor tendon imaging part 2: Current status and future directions in advanced diagnostic imaging, with focus on the deep digital flexor tendon. Vet J 2021; 278:105763. [PMID: 34678501 DOI: 10.1016/j.tvjl.2021.105763] [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: 01/30/2021] [Revised: 09/17/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022]
Abstract
Flexor tendon injuries are a common cause of lameness and early retirement in equine athletes. While ultrasonography is most frequently utilised, advanced diagnostic imaging modalities are becoming more widely available for detection and monitoring of flexor tendon lesions. Part two of this literature review details current experience with low- and high-field magnetic resonance imaging (MRI) and computed tomography (CT) for the diagnosis of equine flexor tendinopathy with a focus on the deep digital flexor tendon. Implications of the 'magic angle' artefact as well as injection techniques and the use of contrast media are discussed. Future developments in tendon imaging aim to gain enhanced structural information about the tendon architecture with the prospect to prevent injury. Techniques as described for the assessment of the human Achilles tendon including ultra-high field MRI and positron emission tomography are highlighted.
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Affiliation(s)
- Anna Ehrle
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK; Equine Clinic, Freie Universität Berlin, 10965 Berlin, Germany.
| | - Svenja Lilge
- Equine Clinic, Freie Universität Berlin, 10965 Berlin, Germany
| | - Peter D Clegg
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Thomas W Maddox
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston CH64 7TE, UK
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2
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Osborn ML, Cornille JL, Blas‐Machado U, Uhl EW. The equine navicular apparatus as a premier enthesis organ: Functional implications. Vet Surg 2021; 50:713-728. [PMID: 33710628 PMCID: PMC8251969 DOI: 10.1111/vsu.13620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 01/26/2021] [Accepted: 02/21/2021] [Indexed: 12/23/2022]
Abstract
Navicular syndrome has been traditionally characterized by progressive lameness with chronic degeneration of the navicular bone. Advances in imaging techniques have revealed that its associated soft tissue structures are also affected. This distribution of lesions is explained by conceptualizing the equine navicular apparatus as an enthesis organ that facilitates the dissemination of mechanical stress throughout the tissues of the foot. The navicular apparatus has the same structural adaptations to mechanical stress as the human Achilles tendon complex. These adaptations efficiently dissipate mechanical force away from the tendon's bony attachment site, thereby protecting it from failure. The comparison of these two anatomically distinct structural systems demonstrates their similar adaptations to mechanical forces, and illustrates that important functional insights can be gained from studying anatomic convergences and cross-species comparisons of function. Such a functional conceptualization of the equine navicular apparatus resolves confusion about the diagnosis of navicular syndrome and offers insights for the development of mechanically based therapies. Through comparison with the human Achilles complex, this review (1) re-conceptualizes the equine navicular apparatus as an enthesis organ in which mechanical forces are distributed throughout the structures of the organ; (2) describes the relationship between failure of the navicular enthesis organ and lesions of navicular syndrome; (3) considers the therapeutic implications of navicular enthesis organ degeneration as a form of chronic osteoarthritis; and based upon these implications (4) proposes a focus on whole body posture/motion for the development of prehabilitative and rehabilitative therapies similar to those that have already proven effective in humans.
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Affiliation(s)
- Michelle L. Osborn
- Department of Comparative Biomedical SciencesSchool of Veterinary Medicine, Louisiana State UniversityBaton RougeLouisianaUSA
| | | | - Uriel Blas‐Machado
- Department of PathologyCollege of Veterinary Medicine, University of GeorgiaAthensGeorgiaUSA
| | - Elizabeth W. Uhl
- Department of PathologyCollege of Veterinary Medicine, University of GeorgiaAthensGeorgiaUSA
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Berner D, Mader D, Groß C, Gerlach K. Effect of Scan Plane and Arthrography on Visibility and Interobserver Agreement of the Equine Distal Sesamoidean Impar Ligament on Magnetic Resonance Images. J Equine Vet Sci 2020; 94:103227. [PMID: 33077088 DOI: 10.1016/j.jevs.2020.103227] [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: 02/07/2020] [Revised: 06/29/2020] [Accepted: 08/10/2020] [Indexed: 11/27/2022]
Abstract
In magnetic resonance imaging (MRI) examinations, moderate to severe changes of the distal sesamoidean impar ligament (DSIL) were found in horses with lameness localized to their feet. Histologic abnormalities were detected more commonly in lame horses. Because of its heterogeneity and small thickness, evaluation of the DSIL in MRI can be challenging. The aim of the study was to determine the optimal sequence and the ideal transverse perpendicular angle for visualization of the DSIL before and after arthrography of the distal interphalangeal joint (DIPJ). Twenty-five cadaver forelimbs were examined with low-field MRI. Sagittal, frontal, and three different angled transverse planes were obtained before and after arthrography of the DIPJ. All planes were acquired in T1w (weighted) Gradient Recall Echo (GRE), T2∗w GRE, T2w Fast Spin Echo (FSE), and Short Tau Inversion Recovery (STIR) FSE and visualization of the DSIL was scored by two observers. Visualization of the DSIL was best on sagittal T2w FSE and STIR FSE images. All transverse planes were inferior compared with sagittal sequences. After arthrography of the DIPJ, visualization of the DSIL origin improved in sagittal T2w FSE sequences, and agreement between observers increased for sagittal T2w FSE and STIR FSE images. Sagittal T2w FSE and STIR FSE images allowed good visualization of the DSIL in low-field MRI. Visualization of the DSIL did not improve for altered angled transverse sequences but increased with arthrography of the DIPJ. Subjective influence between different observers was found but decreased with DIPJ arthrography.
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Affiliation(s)
- Dagmar Berner
- Department for Horses, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany; Equine Referral Hospital, Department of Clinical Science and Services, Royal Veterinary College, University of London, Hertfordshire, UK.
| | - Daniela Mader
- Department for Horses, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Claudia Groß
- Department for Horses, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Kerstin Gerlach
- Department for Horses, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
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van Zadelhoff C, Schwarz T, Smith S, Engerand A, Taylor S. Identification of Naturally Occurring Cartilage Damage in the Equine Distal Interphalangeal Joint Using Low-Field Magnetic Resonance Imaging and Magnetic Resonance Arthrography. Front Vet Sci 2020; 6:508. [PMID: 32064268 PMCID: PMC6999043 DOI: 10.3389/fvets.2019.00508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/20/2019] [Indexed: 01/30/2023] Open
Abstract
Objectives: To describe detectable and non-detectable naturally occurring cartilage damage of the equine distal interphalangeal (DIP) joint using plain magnetic resonance (MR) imaging and gadolinium and saline MR arthrography. The second objective was to quantify the sensitivity, specificity and accuracy in detection of cartilage damage. Methods: In a pilot study, the distal limbs of two horses with confirmed osteoarthritis of the DIP joint were imaged with low-field MR. Magnetic resonance images were assessed in consensus by three observers and compared to gross pathological findings. Subsequently, a prospective analytical cross-sectional study design was created to compare pre-contrast MR imaging and saline and gadolinium MR arthrography of isolated equine distal limbs to gross observation findings. Hallmarq® low-field MR (0.27T) scans were performed prior to DIP joint injection, saline/gadolinium post-injection scans were performed at 15 min intervals for 2 h. Joints were inspected and the articular cartilage graded subjectively for cartilage damage (0–3). The presence of detectable or non-detectable cartilage damage on MR images was identified, characterized and recorded in consensus by three observers. Sensitivity, specificity and accuracy in detection of cartilage damage related to gross pathology were calculated. Results: The two clinical cases from the pilot study with confirmed osteoarthritis had full thickness cartilage defects; however, only one of these was correctly identified using low-field MRI. In the prospective study, the majority of naturally occurring cartilage damage could not be identified on plain MR or MR arthrography including extensive partial thickness cartilage erosions. Saline and gadolinium MR arthrography did not improve the detection of cartilage damage. The accuracy of cartilage damage detection was 0.63 with a sensitivity of 0.14 and specificity of 0.92. Clinical Relevance: Both, plain low-field MRI and MR arthrography are not sensitive in detection of naturally occurring cartilage damage of the DIP joint. However, if an abnormal contour is seen in the articular cartilage, cartilage damage is likely to be present.
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Affiliation(s)
- Claudia van Zadelhoff
- Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Roslin, United Kingdom
| | - Tobias Schwarz
- Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Roslin, United Kingdom
| | - Sionagh Smith
- Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Roslin, United Kingdom
| | | | - Sarah Taylor
- Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Roslin, United Kingdom
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Hontoir F, Rejas E, Falticeanu A, Nisolle JF, Simon V, Nicaise C, Clegg PD, Vandeweerd JME. Communication between the distal interphalangeal joint and the navicular bursa in the horse at Computed Tomography Arthrography. Anat Histol Embryol 2019; 48:133-141. [DOI: 10.1111/ahe.12421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Fanny Hontoir
- Faculty of Sciences, Department of Veterinary Medicine, Integrated Veterinary Research Unit (IVRU) - Namur Research Institute for Life Sciences (NARILIS); University of Namur; Namur Belgium
| | - Erika Rejas
- Faculty of Sciences, Department of Veterinary Medicine, Integrated Veterinary Research Unit (IVRU) - Namur Research Institute for Life Sciences (NARILIS); University of Namur; Namur Belgium
| | - Ana Falticeanu
- Centre Hospitalier Universitaire (CHU) UCL Namur-Mont Godinne; Université Catholique de Louvain; Yvoir Belgium
| | - Jean-François Nisolle
- Centre Hospitalier Universitaire (CHU) UCL Namur-Mont Godinne; Université Catholique de Louvain; Yvoir Belgium
| | - Vincent Simon
- Faculty of Sciences, Department of Veterinary Medicine, Integrated Veterinary Research Unit (IVRU) - Namur Research Institute for Life Sciences (NARILIS); University of Namur; Namur Belgium
| | - Charles Nicaise
- LabCeTi - Laboratoire des Cellules et Tissus - Faculty of Medicine; University of Namur; Namur Belgium
| | - Peter D. Clegg
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic disease; University of Liverpool; Liverpool UK
| | - Jean-Michel E. Vandeweerd
- Faculty of Sciences, Department of Veterinary Medicine, Integrated Veterinary Research Unit (IVRU) - Namur Research Institute for Life Sciences (NARILIS); University of Namur; Namur Belgium
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Zani DD, Rabbogliatti V, Ravasio G, Pettinato C, Giancamillo MD, Zani DD. Contrast enhanced magnetic resonance imaging of the foot in horses using intravenous versus regional intraarterial injection of gadolinium. Open Vet J 2018; 8:471-478. [PMID: 30775287 PMCID: PMC6356101 DOI: 10.4314/ovj.v8i4.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 11/20/2018] [Indexed: 12/27/2022] Open
Abstract
The use of contrast enhanced magnetic resonance imaging (MRI) for the detection of orthopedic pathologies in equine patients is poorly described. In few studies, enhanced MRI allowed to differentiate active lesions from chronic ones and to classify ambiguous lesions. The aim of this clinical prospective pilot study is to describe and compare the MRI lesions observed in horses with lameness localized to the foot using a single intravenous bolus dose of gadolinium contrast versus regional intraarterial bolus of contrast agent. Ten horses that underwent contrast enhanced MRI were included in the study. Gadolinium was injected intravenously in 3 patients and in 7 horses contrast agent was administered by intraarterial regional delivery. Regions of interest (ROI) were collected from both pre- and post-contrast images and ratios between pre- and post-contrast ROIs were calculated. No adverse reactions were noted after contrast agent injection. Injured structures that revealed greater increase in signal in post-contrast images were the deep digital flexor tendon (DDFT), the navicular spongiosa and the peritendinous tissues. Regional intraarterial administration of gadolinium provided higher ratio of contrast enhancement. Enhanced MRI using both intravenous or intraarterial injection of gadolinium, increased the diagnostic capability of MRI in horses with foot lesions. Nevertheless, regional intraarterial administration of gadolinium was considered the best choice due to the higher signal and lower volumes of contrast agent required.
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Affiliation(s)
- Donatella De Zani
- Dipartimento di Medicina Veterinaria, Centro Clinico Veterinario e Zootecnico Sperimentale, Università degli Studi di Milano, Italy
| | - Vanessa Rabbogliatti
- Dipartimento di Medicina Veterinaria, Centro Clinico Veterinario e Zootecnico Sperimentale, Università degli Studi di Milano, Italy
| | - Giuliano Ravasio
- Dipartimento di Medicina Veterinaria, Centro Clinico Veterinario e Zootecnico Sperimentale, Università degli Studi di Milano, Italy
| | - Cinzia Pettinato
- Department of Medical Physics, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Mauro Di Giancamillo
- Dipartimento di Medicina Veterinaria, Centro Clinico Veterinario e Zootecnico Sperimentale, Università degli Studi di Milano, Italy
| | - Davide Danilo Zani
- Dipartimento di Medicina Veterinaria, Centro Clinico Veterinario e Zootecnico Sperimentale, Università degli Studi di Milano, Italy
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Aarsvold S, Solano M, Garcia-Lopez J. Magnetic resonance imaging following regional limb perfusion of gadolinium contrast medium in 26 horses. Equine Vet J 2018; 50:649-657. [PMID: 29417635 DOI: 10.1111/evj.12818] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 12/13/2017] [Accepted: 01/26/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Systemic administration of gadolinium contrast medium is common in small animals to increase lesion conspicuity and determine vascularisation of lesions identified with magnetic resonance imaging (MRI); however, the large volume required for systemic administration limits its use in horses. OBJECTIVES The purpose of this study was to assess the feasibility of administering a low dose of contrast medium via venous regional limb perfusion. STUDY DESIGN Prospective clinical study. METHODS Distal limbs of 26 horses (one limb per horse) were imaged with MRI before and after administration of 5 mL of gadopentetate dimeglumine (Magnevist® ) diluted with 5 mL of physiological saline via a palmar/plantar digital vein with a tourniquet in place at the level of the mid aspect of the third metacarpal/metatarsal bone. Commonly assessed structures of the equine distal limb were examined for normal and abnormal contrast enhancement. RESULTS Twenty-five of 26 horses had adequate contrast enhancement of their distal limb. The lack of adequate contrast enhancement in one limb was likely associated with failure of the tourniquet. No adverse reactions were identified in any horse. One hundred thirty-two lesions were detected, of which, 69 contrast enhanced. Twelve lesions were detected exclusively following contrast enhancement. MAIN LIMITATIONS Case numbers and lesion variability yielded insufficient data to perform statistical analyses. Histopathology was not performed on sound horses to determine if the imaged structures were normal. CONCLUSIONS Regional limb perfusion is a feasible method to administer gadolinium contrast material to the equine distal limb for MRI. The enhancement pattern of the equine distal limb in sound horses is described. Contrast enhanced MRI of the distal equine limb helps to further characterise lesions identified with precontrast images, including adhesions and deep digital flexor tendinopathy. Contrast enhanced MRI also aids in identification of additional lesions, such as neovascularisation.
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Affiliation(s)
- S Aarsvold
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | - M Solano
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | - J Garcia-Lopez
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
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Nelson BB, Goodrich LR, Barrett MF, Grinstaff MW, Kawcak CE. Use of contrast media in computed tomography and magnetic resonance imaging in horses: Techniques, adverse events and opportunities. Equine Vet J 2017; 49:410-424. [DOI: 10.1111/evj.12689] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 04/04/2017] [Indexed: 12/20/2022]
Affiliation(s)
- B. B. Nelson
- Gail Holmes Equine Orthopaedic Research Center, Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Colorado State University; Fort Collins Colorado USA
| | - L. R. Goodrich
- Gail Holmes Equine Orthopaedic Research Center, Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Colorado State University; Fort Collins Colorado USA
| | - M. F. Barrett
- Gail Holmes Equine Orthopaedic Research Center, Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Colorado State University; Fort Collins Colorado USA
- Department of Environmental and Radiological Health Sciences; Colorado State University; Fort Collins Colorado USA
| | - M. W. Grinstaff
- Departments of Biomedical Engineering, Chemistry, Materials Science & Engineering and Medicine; Boston University; Boston Massachusetts USA
| | - C. E. Kawcak
- Gail Holmes Equine Orthopaedic Research Center, Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Colorado State University; Fort Collins Colorado USA
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Wright S. Highlights of recent clinically relevant papers. EQUINE VET EDUC 2015. [DOI: 10.1111/eve.12503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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