Feline abdominal ultrasonography: What's normal? What's abnormal? The diseased gastrointestinal tract

Recasting the gold standard - part I of II: delineating healthcare options across a continuum of care

AIM

This is the first part of a two-part series on spectrum of care that encourages practitioners to embrace a non-binary approach to healthcare delivery. When care is not framed as all-or-none, either/or or best versus lesser, the provider and client can agree to diagnostic and/or treatment plans that individualize the practice of veterinary medicine. Care is tailored to the patient along a continuum of acceptable options. Care may also be intentionally incremental, with plans to reassess the patient and revise case management as needed.

RELEVANCE

Acknowledgment and ultimately acceptance that patient care journeys can be distinct, yet equitably appropriate, offers providers the flexibility to adapt case management competently and confidently to the patient based upon contextualized circumstances including client needs, wants and expectations for healthcare outcomes. Thinking outside the box to recast the historic gold standard with a continuum of care strategically offers feline practitioners a means by which they can overcome barriers to healthcare delivery.

SERIES OUTLINE

This first article introduces spectrum of care as an appropriate approach to case management and broadens its definition beyond cost of care. Part II explores communication strategies that enhance veterinary professionals' delivery of spectrum of care through open exchange of relationship-centered dialogue.

Combining ultrasound radiomics, complete blood count, and serum biochemical biomarkers for diagnosing intestinal disorders in cats using machine learning

This retrospective analytical observational cohort study aimed to model and predict the classification of feline intestinal diseases from segmentations of a transverse section from small intestine ultrasound (US) image, complete blood count (CBC), and serum biochemical profile data using a variety of machine-learning approaches. In 149 cats from three institutions, images were obtained from cats with biopsy-confirmed small cell epitheliotropic lymphoma (lymphoma), inflammatory bowel disease (IBD), no pathology ("healthy"), and other conditions (warrant a biopsy for further diagnosis). CBC, blood serum chemistry, small intestinal ultrasound, and small intestinal biopsy were obtained within a 2-week interval. CBC and serum biomarkers and radiomic features were combined for modeling. Four classification schemes were investigated: (1) normal versus abnormal; (2) warranting or not warranting a biopsy; (3) lymphoma, IBD, healthy, or other conditions; and (4) lymphoma, IBD, or other conditions. Two feature selection methods were used to identify the top 3, 5, 10, and 20 features, and six machine learning models were trained. The average (95% CI) performance of models for all combinations of features, numbers of features, and types of classifiers was 0.886 (0.871-0.912) for Model 1 (normal vs. abnormal), 0.751 (0.735-0.818) for Model 2 (biopsy vs. no biopsy), 0.504 (0.450-0.556) for Model 3 (lymphoma, IBD, healthy, or other), and 0.531 (0.426-0.589), for Model 4 (lymphoma, IBD, or other). Our findings suggest model accuracies above 0.85 can be achieved in Model 1 and 2, and that including CBC and biochemistry data with US radiomics data did not significantly improve accuracy in our models.

Diagnostic effectiveness of stress biomarkers in cats with feline interstitial and bacterial cystitis

BACKGROUND

Although bacterial cystitis (BC) and feline interstitial cystitis (FIC) are categorized under feline lower urinary tract disease (FLUTD) due to their similar clinical manifestations, stress is an important factor for FIC. Therefore, the investigation of stress biomarkers might be important in the differentiation and elucidation of these conditions.

OBJECTIVES

We aimed to evaluate the diagnostic effectiveness of serum and urine cortisol, serotonin, and dopamine concentrations and their relationship with stress in cats with FIC and BC.

METHODS

Twelve healthy cats (Control group) and 24 cats with FLUTD were used. The cats with FLUTD were divided into FIC and BC groups.

RESULTS

Multimodal environmental modification (MEMO) scores were found to be higher in the FIC group than in the BC and Control groups (P < .001). Urine serotonin concentrations were higher in cats with FIC and BC compared with those in the Control group. Based on ROC analyses, the sensitivity, specificity, and accuracy of urine serotonin and dopamine were found to be statistically significant in being able to differentially diagnose cats in the FIC group vs the Control group. The sensitivity, specificity, and accuracy of serum dopamine were also found to be statistically significant for the differential diagnosis of FIC and BC.

CONCLUSIONS

High urine serotonin concentrations were found in cats with FLUTD compared with healthy controls and interpreted as the presence of stress not only in cats with FIC but also in cats with BC. Also, based on the ROC-based diagnostic performance evaluation of these stress biomarkers, urine serotonin, and dopamine concentrations can be used to diagnose FIC, and serum dopamine concentrations can be used to differentiate FIC and BC in cats.

Comparative evaluation of selected serum and urine biomarkers in cats with interstitial and bacterial cystitis

BACKGROUND

Although feline urine is increasingly submitted for bacterial culture and susceptibility testing in veterinary practice, bacterial cystitis (BC) is relatively uncommon compared with feline interstitial cystitis (FIC), which shares similar clinical manifestations. Therefore, an investigation of certain urothelial (glycosaminoglycan [GAG], tissue inhibition metalloproteinase-2 [TIMP-2]), cytokine (interleukin 12 [IL-12]), and neurotrophic factor (nerve growth factor [NGF]) markers may aid diagnosis.

OBJECTIVES

We aimed to evaluate the diagnostic effectiveness of selected serum/urine biomarkers in the diagnosis of cats with FIC and BC.

METHODS

Twelve healthy cats (Control group) and 24 cats with feline lower urinary tract disease (FLUTD) were used, and the cats with FLUTD were divided into FIC and BC groups.

RESULTS

When comparing the three groups, serum GAG, IL-12, NGF, and TIMP-2 concentrations were highest in the FIC group; urine GAG, IL-12, NGF, and TIMP-2 concentrations were higher in the FIC and BC groups than those in the Control group. Serum NGF concentrations were higher in the FIC group than in all other groups. Also, serum GAG, IL-12, NGF, and TIMP-2 concentrations were found to be effective in the differential diagnosis of FIC vs BC.

CONCLUSIONS

We showed that serum NGF is a candidate biomarker that could be used in the diagnosis and differentiation of FIC. Urine GAG, IL-12, NGF, and TIMP-2 concentrations might be helpful in determining urinary bladder inflammation and/or damage in cats with FIC and BC. ROC analyses revealed that serum and urine biomarkers were effective for diagnosing FIC and that serum biomarkers rather than urine biomarkers were effective for the differential diagnosis of FIC and feline BC.

Ultrasonographic Detected Adrenomegaly in Clinically Ill Cats: A Retrospective Study

This retrospective study aimed to assess the prevalence of ultrasonographic detected adrenomegaly in clinically ill cats, evaluating the final established diagnosis, describe adrenal ultrasound findings and if the adrenomegaly was suspected or incidental. Abdominal ultrasonography reports of cats presenting to a veterinary teaching hospital between October 2018 and February 2021 were retrospectively reviewed. Cats showing adrenomegaly (one or both glands having a dorsoventral axis >4.8 mm) were selected and medical records respectively evaluated. Nine-hundred and eighty-three ultrasonographical reports were selected, of which, 68 (7%) disclosed adrenomegaly. European/Domestic Short-Hair (62/68; 91%) male (44/68; 65%) castrated (35/44; 80%) cats were overrepresented. Adrenomegaly was an incidental finding in 62/68 (91%) cats while in 6/68 (9%) it was identified in the context of investigating a potential adrenal disease. Concerning established diagnosis, chronic kidney disease was overrepresented (25/68; 37%), followed by endocrinopathies (20/68; 29%). Adrenomegaly was bilateral in 53% (36/68) of cases. In unilateral cases (32/68; 47%), it was more prevalent on the left side (23/32; 72%), with a normal-sized contralateral adrenal gland. Left adrenal demonstrated a larger size and a tendency to oval shape. This study assesses the prevalence of adrenomegaly in clinically ill cats, reinforcing it can be an incidental ultrasound finding.

Cyclosporine Treatment in Cats with Presumed Chronic Pancreatitis-A Retrospective Study

Simple Summary

Chronic pancreatitis (CP) is a common disease in middle-aged to older cats. Cyclosporine, an immunosuppressive drug, has been suggested as an alternative treatment when other drugs that suppress inflammation are ineffective or unsuitable. However, no published studies have investigated its efficacy in cats with CP. The aim of this retrospective study was to evaluate the efficacy of cyclosporine as a treatment for pancreatitis in cats with presumed CP. All cats had a history and clinical signs suggestive of CP and blood samples showed abnormally high concentrations of feline pancreas-specific lipase (Spec fPL) on at least two occasions. This is common in CP. All cats were treated with cyclosporine for at least three weeks. Nineteen cats, aged 6.9–17.5 years, were included. Daily treatment with cyclosporine resulted in an improvement of serum Spec fPL concentrations which indicates that the pancreatic inflammation likely had improved. The study has several limitations, including different treatment durations and doses, lack of biopsies to confirm CP and the treatment effect was not compared with an untreated control group. Despite the limitations, our results suggest that cyclosporine treatment decreases serum Spec fPL concentrations and may be effective in the management of feline chronic pancreatitis.

Abstract

Chronic pancreatitis (CP) is a common disease in middle-aged to older cats. Cyclosporine has been suggested as an alternative treatment when other immunosuppressive treatments are insufficient or contraindicated. However, no published studies have investigated its efficacy on feline CP. The aim of this retrospective study was to evaluate the efficacy of cyclosporine on supranormal serum feline pancreas-specific lipase (Spec fPL) concentrations in cats with presumed CP. Inclusion criteria were history and clinical signs suggestive of CP, serum Spec fPL concentrations above 5.3 μg/L (reference range 0–3.5 μg/L, equivocal range 3.6–5.3 μg/L) on at least two occasions and treatment with cyclosporine for at least three weeks. Serum Spec fPL was analyzed at Idexx Laboratories, Kornwestheim, Germany. Nineteen cats, aged 6.9–17.5 years (median 11.6), were included. No pancreatic biopsies were available. Median (range) serum Spec fPL concentration was 14.2 μg/L (6.1–43.3) at baseline and 6.7 μg/L (0.9–23.6) at follow-up. Cyclosporine treatment (5.0–7.9 mg/kg orally SID) was associated with a significant reduction in serum Spec fPL concentrations (p < 0.001) at follow-up after 23–206 days (median 35). Body weight decreased significantly between inclusion and follow-up (p = 0.013). Significant improvement of clinical signs could not be measured (p = 0.781). This study has several limitations, including unstandardized treatment length and dose, no control group and lack of pancreatic biopsies. Despite the limitations, our results suggest that cyclosporine treatment reduces supranormal serum Spec fPL concentrations in cats with presumed CP.

B-Mode and Contrast Enhanced Ultrasonography Features of Gastric Inflammatory and Neoplastic Diseases in Cats

Simple Summary

Alimentary lymphoma is the most common neoplasm of the feline gastrointestinal tract. In most cases, standard ultrasonography may not be able to discriminate between a neoplastic and inflammatory infiltrate at this level. The aim of this prospective study is to establish the value of conventional ultrasound and contrast enhanced ultrasonography in describing specific features of normal, inflammatory, and neoplastic gastric diseases in feline species. A total of 29 cats were included in the study: six healthy cats as the control group; nine with gastric inflammation; three with low-grade alimentary lymphoma; 10 with high grade alimentary lymphoma. High-grade lymphoma usually appears as a severe wall thickening with absent layer definition, regional lymphadenopathy and local steatitis on a conventional ultrasound and shows a high-contrast uptake and a homogeneous enhancement with comb teeth-like vessels on contrast-enhanced ultrasound, while gastric inflammation and low-grade alimentary lymphoma showed a large overlap on both of those two ultrasonographic techniques. Diagnostic accuracy and cut-off value were calculated and found to be relevant for thickness (3.8 mm) for inflammation vs. low-grade lymphoma and “benign” vs. “malignant” as well as peak enhancement (34.87 dB) for “benign” vs. “malignant”. Thickness and peak enhancement can be useful parameters in the characterization of gastric infiltrates in cats.

Abstract

Alimentary lymphoma (AL) is the most common malignancy of the feline gastrointestinal tract and may cause variable mild to severe alteration of the gastric wall on ultrasonography (US) that can be very similar to those caused by inflammation (INF). The aim of this prospective study is to establish the value of B-mode and contrast-enhanced US (CEUS) in describing specific features of normal, inflammatory, and neoplastic gastric diseases in feline species. B-mode US and CEUS of the stomach were performed in anesthetized cats with or without gastric disorders. Gastric wall qualitative and quantitative parameters were evaluated on B-mode US and CEUS examination. A total of 29 cats were included: six healthy (HEA) cats as the control group; nine INF; three low-grade lymphoma (LGAL); 10 high-grade lymphoma (HGAL). On B-mode US, there were significant differences in thickness, the wall’s layer definition and echogenicity between HGAL and all the other groups (<0.001). For CEUS, statistical differences between groups were found in the following: HGAL vs. HEA, HGAL vs. INF; HGAL vs. LGAL; INF vs. HEA. Diagnostic accuracy (AUC) and cut-off value were calculated and found to be significant for thickness (3.8 mm) for INF vs. LGAL (AUC > 0.70) and “benign” vs. “malignant” (AUC > 0.90) as well as peak enhancement (34.87 dB) for “benign” vs. “malignant” (AUC > 0.70). INF and LGAL showed an overlap of qualitative and quantitative parameters both on B-mode and CEUS, while HGAL usually appears as a severe wall thickening with absent layer definition, high-contrast uptake, a specific enhancement pattern, regional lymphadenopathy and local steatitis. Thickness and peak enhancement can be useful parameters in the characterization of gastric infiltrates in cats.