Intra- and inter-observer variability in ultrasonographical measurements of the uterus and ovaries in healthy, non-pregnant queens

Uterine issues in infertile queens: nine cases

This prospective case series investigated potential uterine causes of infertility in queens. Purebred queens with infertility (failure to conceive, embryonic death, or failure to maintain pregnancy and produce viable kittens), but no other reproductive disorders were examined approximately 1-8 weeks before mating (Visit 1), 21 days after mating (Visit 2), and 45 days after mating (Visit 3) if pregnant at Visit 2. Investigations included vaginal cytology and bacteriology, urine bacteriology, and ultrasonography. At Visit 2 or 3, uterine biopsy or ovariohysterectomy was performed for histology. Of nine eligible queens, seven were non-pregnant by ultrasound at Visit 2 and two had lost pregnancies by Visit 3. Ovulation was confirmed by serum progesterone concentration in all queens. Ultrasonic appearance of the ovaries and uterus was compatible with a healthy status except for one queen with signs of cystic endometrial hyperplasia (CEH) and pyometra, a follicular cyst in another, and fetal resorptions in two queens. Six cats had histologic lesions of endometrial hyperplasia, including CEH (n=1). Only one cat had no histologic uterine lesions. Bacteria were cultured from vaginal samples in seven queens at Visit 1, (two were non-evaluable), and in five of seven queens sampled at Visit 2. Uterine cultures were negative except for the cat with pyometra. All urine cultures were negative. In summary, the most frequent pathology observed in these infertile queens was histologic endometrial hyperplasia, which can potentially inhibit embryo implantation and healthy placental development. This suggests that uterine disease might contribute substantially to infertility in purebred queens.

Ovarian and uterine two-dimensional and Doppler ultrasonographic changes in the feline peri-estrus period

OBJECTIVES

The aim of this study was to evaluate two-dimensional and Doppler ultrasonographic changes of the ovary and uterus during estrus and the early post-estrus period in domestic cats.

METHODS

Two-dimensional and Doppler ultrasonographic evaluations of the ovaries and uterus were performed in seven queens on days 1, 3 and 5 of estrus, and 5 days after estrus (AE5).

RESULTS

On day 1, 5.4 ± 0.5 follicles of 2.1 ± 0.1 mm were detected progressively increasing in number and size up to day 5 and then decreased on AE5 (P <0.05). A maximum follicular diameter of 4.1 ± 0.1 mm was achieved on day 5. Both during and after estrus, the uterus was generally hypoechoic compared with the surrounding tissues and delineated by a thin hyperechoic line corresponding to the serosa. In some animals, the uterine layers were distinguished during and after estrus. The blood flow waveforms of the intraovarian and uterine arteries were characterized by a systolic peak and diastolic flow extending throughout the remainder of the cardiac cycle to the next systole. In the uterine artery waveforms, the early diastolic notch was mild or absent during most estrous observations. The resistance index of the intraovarian arteries decreased up to day 5, and then increased on AE5 (P <0.05). The resistance index of the uterine arteries was lower during estrus than in the post-estrus period (P <0.05).

CONCLUSIONS AND RELEVANCE

It is concluded that in the domestic cat, follicular number and diameter as well as ovarian and uterine blood flow changed during and immediately after estrus. Doppler ultrasound proved suitable to evaluate the hemodynamic changes involved in the cyclic remodeling of ovarian and uterine tissues that occurs during and after follicular growth in domestic cats.

High-definition ultrasonography in the evaluation of the reproductive tract of bitches during the follicular phase of the estrous cycle

The aim was to sonographically evaluate the reproductive tract of bitches during the follicular phase of the estrous cycle using High Density (HD) ultrasonic techniques. Females (n = 8) were evaluated at five different times throughout the follicular phase, as determined by vaginal cytology and blood progesterone concentrations. Ultrasonic exams were performed using the ACUSON S2000/SIEMENS device utilizing a multifrequency HD transducer (5.5-18 MHz). Videos of the ovaries were obtained and recordings were evaluated using a DICOM viewer software for counting and measuring the ovarian structures, which were assigned to groups based on diameter in mm: G1: ≤ 1; G2: from 1.01 to 3.5; G3 from 3.51 to 5.5; G4: from 5.51 to 10. There was a greater uterine thickness with the progression of the follicular phase (P < 0.05). Six distinct regions were identified in the uterine wall. The ovarian dimensions increased (P < 0.05) as stage of the follicular phase advanced. There was fluid detected around the ovaries after ovulation. There was a characteristic fat tissue hyperechogenicity around the ovaries at all timepoints. There was a difference in the number of ovarian structures of each dimension group at each time there were assessments (P < 0.05). There was a difference in diameter of the largest ovarian structure and in average value of wall thickness at all timepoints when there were evaluations (P < 0.05). The HD ultrasonography technique provides for excellent image resolution, allowing for a more precise characterization of the bitch's reproductive structures and changes occurring during the follicular phase of the estrous cycle.

Ultrasonography of the normal reproductive tract of the female domestic cat

The objective of this study was (1) to describe the US appearance and obtain reference values for the uterus and ovaries in nongravid and gravid queens with histologically confirmed reproductive tracts without disorders, (2) to provide US measurements of the reproductive tract compared to gross macroscopic and water-bath post-OVH US measurements in nongravid queens, and (3) to describe the sonographic appearance of the female reproductive tract during the different histopathologic phases of the reproductive cycle in nongravid and gravid queens. Ninety-three queens from a "trap, neuter, return" program were included in this study. Sonographic evaluation of the reproductive tract was performed in all queens, and measurements of the corpus uteri, uterine horns, and ovaries were recorded. Following OVH, macroscopic measurements were obtained, and a water-bath US evaluation of these tissues and measurements was recorded. Samples from the corpus uteri and both the uterine horns and ovaries were collected for histopathologic examination after all measurements had been recorded. Seventy-two reproductive tracts met the inclusion criteria by having a histopathologically confirmed normal reproductive tract. Sixty-three queens were nonpregnant and 9 were pregnant. The ovaries and uterus were sonographically visible in all queens regardless of reproductive status. The ovaries were ovoid in shape, and the uterus appeared as a tubular structure with distinct wall layers (serosa and indistinct myometrium and myometrium, or serosa, myometrium, and endometrium), with variable echogenicity of the inner layers. The layering of the uterine wall, observed during the second half of pregnancy, was described. Ovarian follicles were visible in 66/72 (92%) cats. However, the CL was only visible in 40/72 (55%) cats. The reference values of the left ovarian length, right ovarian length, uterine horn diameter, and uterine body are 7.1-13.9, 7.3-13.6, 1-5.8, and 1.5-5.3 mm, respectively, in a nongravid uterus. The uterine wall thickness during pregnancy varied from 2.4 to 6.8 mm. There was a significant positive correlation between US measurements obtained in vivo and those obtained macroscopically and in a water bath post-OVH. The body weight, follicular size, sonographic visibility of the uterine wall layering, the histopathologic luteal phase, and the active/inactive status on histopathology had a significant effect on the uterine measurements (p < 0.05). It was not possible to describe the exact US features of the reproductive tract during the different histopathologic phases. In conclusion, ultrasonographic reference values for the normal female reproductive tract in cats were determined. The results of this study indicated that the ovaries and uterus were visible in cats regardless of reproductive status.

High-frequency ultrasound, computed tomography and computed tomography arthrography of the cranial cruciate ligament, menisci and cranial meniscotibial ligaments in 10 radiographically normal canine cadaver stifles

BACKGROUND

Bilateral non-traumatic cranial cruciate disease is frequently seen in originally unilateral cruciate pathology. Untreated cranial cruciate ligament disease and concurrent meniscal lesions cause progressive osteoarthritis and pain of the stifle joint. Early presurgical diagnosis is important, but remains difficult. The purpose of this ex vivo study was (1) to describe the ultrasonographic appearance of the canine cranial cruciate ligament (CrCrL), menisci and meniscal ligaments using a high-frequency linear transducer, (2) to determine the length of the CrCrL seen on ultrasonography (US) and (3) to describe and compare the appearance of the CrCrL, menisci and meniscal ligaments on US, computed tomography (CT) and computed tomography arthrography (CTA).

RESULTS

US and CT examinations were performed on 10 radiographically normal cadaveric stifles of adult dogs weighing more than 15 kg, followed by macroscopic and histologic evaluations. The CrCrL had a parallel hyperechoic fibrillar pattern at the insertion on the tibia and a hypoechoic structure more proximally in all stifles. This pattern was visible over 35% (median) of the total length of the ligament, with 50% (median) of the total length CrCrL that could be outlined. All medial menisci and 8 out of 10 of the lateral menisci showed hypoechoic lines within their bodies oriented obliquely to the direction of the ultrasound beam. Fifteen of the 20 cranial meniscotibial ligaments were detected, showing a hyperechoic fibrillar pattern. Normal macro- and microscopic appearance was observed in all menisci, with the radial bundles of collagen fibers at the level of and with similar orientation as the intrameniscal hypoechoic lines on US. The CrCrL, menisci and meniscal ligaments were of intermediate density on CT, but marked improvement of the border detection was obtained using CTA. Contrast within the CrCrL was observed in 4/10 stifles using CT and confirmed in 3/4 stifles on histology. One of these ligaments had a partial tear (5-10%) on macroscopic evaluation. None of the menisci showed any abnormalities on CTA.

CONCLUSIONS

Normal canine menisci are heterogeneous on high-frequency US and a fibrillar pattern may be observed in the cranial meniscotibial ligaments and the distal portion of the CrCrL. Linear areas of contrast may be detected within the cranial cruciate ligament of radiographically normal stifles.

Effectiveness of a bipolar vessel sealant device for ovariohysterectomy in cats with pyometra

OBJECTIVES

The objective was to describe the use of a bipolar vessel sealant device for complete ovariohysterectomy in cats (ie, removal of both the ovarian pedicle and the uterine body and vessels) and to report on the feasibility of ovariohysterectomy in cats with pyometra.

METHODS

Cats with confirmed pyometra and whose owners agreed to the surgical procedure were prospectively included in the study. Ovaries were visualised and the vessel sealant device was used to coagulate and cut the suspensory ligament, the ovarian pedicle and the broad ligament up to the level of the uterine body. Once the uterine body was measured, it was grasped, coagulated and transected just proximal to the cervix using the vessel sealant device when its diameter was <0.9 cm. Immediate postoperative and short-term follow-up were evaluated by clinical examination.

RESULTS

Thirteen cases were initially included between November 2015 and February 2017. Three cases were subsequently excluded because of a uterine body diameter >0.9 cm. Of the 10 cats finally included, all were intact females, with a median age of 2.7 years (range 0.9-9 years). Median weight was 3.7 kg (range 2.6-6.7 kg). The median surgery time was 10.9 mins (range 9.8-15.2 mins). Median uterus diameter was 0.51 cm (range 0.45-0.64 cm) and median skin incision was 4.1 cm (range 3.6-5.1 cm). No complications during the procedures occurred in any patient. All cases were discharged from the hospital 1 day after surgery, without any abnormality. No complications were noted during the postoperative period.

CONCLUSIONS AND RELEVANCE

The findings suggest that the bipolar vessel sealant device used in this study is safe in performing ovariohysterectomy for pyometra in cats, when the uterine body is <0.9 cm in diameter, without short-term complications.

[Sonographic imaging of physiological ovaries in the cat]

Ultrasound evaluation of the ovaries is an important element of the gynaecological examination. Although it is a well-established method used for many domestic animals, it is an uncommon procedure in cats. This article describes the technical requirements, the examination procedure, and the sonographic appearance of the physiological ovary in the cat. The examination can be performed with the cat in lateral position or dorsal recumbency. Usually the ovaries are found caudal to the kidneys which serve as lead structure. The median size of an ovary in anestrous is 0.9 cm (length) x 0.5 cm (height) x 0.4 cm (width). The ovaries of cyclical (follicular and luteal phase) cats are easier to detect than ovaries of cats in interestrous or anestrous.