Comparison of results of scanning electron microscopy and magnetic resonance imaging before and after administration of a radiographic contrast agent in the tendon of the deep digital flexor muscle obtained from horse cadavers

Longitudinal tendon healing assessed with multi-modality advanced imaging and tissue analysis

BACKGROUND

The range of diagnostic modalities available to evaluate superficial digital flexor tendon (SDFT) injury includes magnetic resonance imaging (MRI), computed tomography (CT) and ultrasonography (US). Direct, comprehensive comparison of multi-modality imaging characteristics to end-point data has not previously been performed using a model of tendinopathy but is required to obtain a better understanding of each modality's diagnostic capabilities.

OBJECTIVE

To compare CT, MRI and US evaluation to outcome measures for histologic, biochemical and biomechanical parameters using an equine surgical model of tendinopathy.

STUDY DESIGN

Controlled experiment.

METHODS

Lesions were surgically created in both forelimb SDFTs of eight horses and imaged using MRI, CT and US at seven time points over 12 months. Imaging characteristics were then correlated to end point histologic, biochemical and biomechanical data using lasso regression. Longitudinal lesion size was compared between imaging modalities.

RESULTS

Lesion to tendon isoattenuation on CT evaluation correlated with the greatest levels of aggrecan deposition. A significant correlation between cellular density and percentage of tendon involvement on the T2-weighted sequence and signal intensity on the proton density fat saturated (PD FS) sequence was appreciated at the 12-month time point (P = .006, P = .02 respectively). There was no significant correlation between end-point data and US or contrast imaging characteristics. Cross sectional area lesion to tendon measurements were significantly largest on CT evaluation, followed by MRI and then US (P < .001).

MAIN LIMITATIONS

Experimentally induced tendon injury with singular end-point data correlation.

CONCLUSIONS

Lesion isoattenuation on CT evaluation suggested scar tissue deposition, while T2-weighted hyperintensity indicated hypercellular tendinopathy even in chronic stages of healing. Non contrast-enhanced MRI and CT evaluation correlated most closely to cellular characteristics of surgically damaged tendons assessed over a twelve month study period. Ultrasonographic evaluation underestimates true lesional size and should be interpreted with caution.

Impact of successive freezing-thawing cycles on 3-T magnetic resonance images of the digits of isolated equine limbs

OBJECTIVE

To assess the impact of cycles of freezing and thawing on magnetic resonance (MR) images (obtained by use of a 3-T magnet) of equine feet examined ex vivo.

SAMPLE

9 forelimbs from 9 horse cadavers.

PROCEDURES

9 forefeet underwent MR imaging first at ambient temperature within 12 hours after the horses' death and then after each freezing-thawing cycle. Three digits underwent freezing and thawing (at 4°C for 36 hours) 2 times, 3 digits underwent freezing and thawing (at 4°C for 36 hours) once and rescanning after 24 hours at ambient temperature, and 3 digits underwent freezing and thawing at ambient temperature for 24 hours once. Images of the digits obtained prior to freezing were subjectively compared with images obtained after freezing and thawing. Changes in the signal-to-noise ratio between examinations were assessed.

RESULTS

Overall image quality was considered unchanged except for the hoof capsule. Quantitative analysis revealed signal-to-noise ratio changes in bone marrow, soft tissues, and hoof capsule induced with both thawing processes. The signal-to-noise ratio in the synovial recess of the distal interphalangeal joint significantly increased as a result of thawing at 4°C.

CONCLUSIONS AND CLINICAL RELEVANCE

Although overall image quality was considered unchanged except for the hoof capsule, results suggested that changes induced in cadaver limbs following freezing and thawing, which are probably attributable both to modified and inhomogeneous temperature distribution and direct tissue damage, may alter the reliability of signal intensity in ex vivo MR examinations.

DEEP DIGITAL FLEXOR TENDONITIS IN THE EQUINE FOOT DIAGNOSED BY LOW-FIELD MAGNETIC RESONANCE IMAGING IN THE STANDING PATIENT: 18 CASES

Injury to the distal aspects of the deep digital flexor tendon (DDFT) is an important cause of lameness in horses. The purpose of this study was to review the magnetic resonance imaging (MRI) findings of 18 horses affected by DDFT injuries in the foot. The MRI was performed with the horses standing using an open low-field (0.21 T) MRI scanner. The results were compared with those previously reported for horses using high-field MRI. Eighteen of 84 horses (21%) with undiagnosed forefoot pain were found to have lesions affecting the DDFT. The history, clinical findings and results of radiography, diagnostic ultrasonography and nuclear scintigraphy of these horses were reviewed. The duration of lameness ranged from 1 to 12 months, and the severity varied from 1/10 to 6/10. Fifteen horses had unilateral lameness (right fore in nine, left fore in six), whereas three horses were bilaterally foreleg lame. Radiological changes, considered of equivocal significance, were found in six of 18 horses. Ultrasonographic changes involving the DDFT were identified in only one of nine horses. DDFT lesions were detected in both T1- and T2-weighted MRI sequences. Four different types of lesions were identified: core lesions, sagittal splits, dorsal border lesions, and insertional lesions. Combinations of different lesion types within the same horse were common. The types and locations of the DDFT lesions were similar to those previously reported using high-field MRI. The use of low-field standing MRI avoids the necessity for general anesthesia and access to conventional high-field MRI scanners. However, studies comparing the results of standing low-field MRI with high-field MRI (and other imaging procedures) are required before the sensitivity and specificity of the technique can be assessed.