Diagnosis of medial meniscal lesions in the canine stifle using multidetector computed tomographic positive-contrast arthrography.

OBJECTIVE: To assess diagnostic value and clinical utility of multidetector computed tomographic positive contrast arthrography (CTA) for meniscal lesions in dogs. STUDY DESIGN: Prospective case series. STUDY POPULATION: Client-owned dogs (n = 55) with cranial cruciate ligament injuries. METHODS: Sedated dogs underwent CTA using a 16-slice scanner, and subsequently received mini-medial arthrotomy for meniscal assessment. Scans were anonymized, randomized, and reviewed twice for meniscal lesions by three independent observers with varying experience. Results were compared with surgical findings. Reproducibility and repeatability were assessed with kappa statistics, intraobserver changes in diagnosis by McNemar's test, and interobserver differences using Cochran's Q test. Test performance was calculated using sensitivity, specificity, proportion correctly identified, and positive and negative predictive values and likelihood ratios. RESULTS: Analysis was based on 52 scans from 44 dogs. Sensitivity for identifying meniscal lesions was 0.62-1.00 and specificity was 0.70-0.96. Intraobserver agreement was 0.50-0.78, and interobserver agreement was 0.47-0.83. There was a significant change between readings one and two for the least experienced observers (p < .05). The sum of sensitivity and specificity exceeded 1.5 for both readings and all observers. CONCLUSION: Diagnostic performance was suitable for identifying meniscal lesions. An effect of experience and learning was seen in this study.

Quantifying the variability between multiple multiplanar reconstructions of computed tomography scans.

BACKGROUND: Multiplanar reconstructions of computed tomography (CT) scans can alleviate issues with bone or joint positioning during scan acquisition. The repeatability of these reconstructions is dependent on human operators applying reconstruction criteria, and therefore is subject to error, which could affect measurement reliability for angular or spatial measurements made for orthopaedic surgery. We describe a method for quantifying inter-reconstruction variability numerically and graphically using metadata from the CT header to find vectors describing reconstruction axis alignment. The approach is demonstrated using 3 sets of computed tomographic reconstructions of 24 vulpine femorotibial joints. RESULTS: Vectors describing axis alignments permitted identification and subsequent analysis of deviations from optimal alignment between reconstruction sets. For the worked example, alignment deviations equivalent to femoral abduction/adduction were nearly twice those for extension/flexion, and simulation of the effects of these deviations on measurements closely matched published data. CONCLUSIONS: The method presented here is straightforward and permits numerical and graphical analysis of reconstruction variability. Reconstruction alignment variability should be considered before adopting new reconstruction criteria for clinical use, and evaluated whenever there is suspicion that reconstruction variability could unduly influence subsequent measurements. These evaluations may help drive improvements in reconstruction criteria. The methods described here could also be employed for comparing patient positioning between scans and between different scan modalities.

Stifle Joint Rotational Variation in Extended Stifles in Healthy Dogs Undergoing Computed Tomography Examinations.

OBJECTIVES: The aim of this study was to evaluate stifle joint rotational stability in response to body position and repositioning in dogs undergoing computed tomography (CT). MATERIALS AND METHODS: Nine dogs (18 stifles) with no history or clinical signs of stifle injury undergoing CT examinations for other reasons were included in the study. Dogs were positioned in alternating dorsal and sternal recumbency with the pelvic limbs extended caudally and unrestrained, for a total of four examinations. Scans included the entire tibia and distal femur. Using defined landmarks on the tibia and femur, stifle joint rotational angles were measured from multiplanar reconstructions made by two independent observers, and repositioning effects and intra- and interobserver agreement evaluated. RESULTS: Repositioning produced repeatable stifle joint rotational angles (pooled within-subject standard deviations of 0.9° and 1.4°) and intraobserver repeatability was good (within-subject standard deviations 1.4°), but interobserver agreement was poor. Dorsal and sternal positioning produced equivalent results. CLINICAL SIGNIFICANCE: The results indicate that little rotation occurs in the healthy extended canine stifle joint during positioning for CT and support CT as a method for assessing limb alignment around the stifle joint, provided that the limb distal to the femorotibial joint is unrestrained. Clinically, it is likely that measured changes in rotational angles across (and distant to) the stifle joint are real, rather than being due to rotation artefact during imaging.

Modelling the Effects of Cranial Cruciate Ligament Transection, Medial Meniscal Release and Triple Tibial Osteotomy on Stability of the Canine Stifle Joint.

OBJECTIVE: The aim of this study was to evaluate the ex vivo effects of sequential cranial cruciate ligament transection (CCLx), medial meniscal release (MMR) and triple tibial osteotomy (TTO) on canine stifle stability compared with the intact state, across a wide range of joint angles. STUDY DESIGN: Nine right hind limb preparations were instrumented to provide constant quadriceps and gastrocnemius loads in a 3:1 ratio, and extended from full flexion during fluoroscopic recording. Recordings were repeated after each of CCLx, MMR and TTO. Fluoroscopic landmarks were used to calculate tibial subluxation and patellar ligament angle. RESULTS: Medial meniscal release resulted in additional cranial tibial subluxation compared with CCLx. Triple tibial osteotomy restored stifle stability up to a joint angle of 125 degrees. The presence of the crossover angle could be inferred from the patellar ligament angle and subluxation curves. CONCLUSION: Our results suggest that in the cranial cruciate ligament-deficient stifle, the crossover angle at which loading shifts between the caudal and cranial cruciate ligaments is dependent on both loading and integrity of the medial meniscus. Triple tibial osteotomy improves stifle stability over a wide range of joint angles under a quadricep to gastrocnemius loading ratio of 3:1 by converting cranial tibial thrust to caudal tibial thrust, due to TTO increasing the amount of joint extension required to reach the crossover angle.

Online Radiology Reporting with Peer Review as a Learning and Feedback Tool in Radiology; Implementation, Validity, and Student Impressions.

Communicating radiological reports to peers has pedagogical value. Students may be uneasy with the process due to a lack of communication and peer review skills or to their failure to see value in the process. We describe a communication exercise with peer review in an undergraduate veterinary radiology course. The computer code used to manage the course and deliver images online is reported, and we provide links to the executable files. We tested to see if undergraduate peer review of radiological reports has validity and describe student impressions of the learning process. Peer review scores for student-generated radiological reports were compared to scores obtained in the summative multiple choice (MCQ) examination for the course. Student satisfaction was measured using a bespoke questionnaire. There was a weak positive correlation (Pearson correlation coefficient = 0.32, p < 0.01) between peer review scores students received and the student scores obtained in the MCQ examination. The difference in peer review scores received by students grouped according to their level of course performance (high vs. low) was statistically significant (p < 0.05). No correlation was found between peer review scores awarded by the students and the scores they obtained in the MCQ examination (Pearson correlation coefficient = 0.17, p = 0.14). In conclusion, we have created a realistic radiology imaging exercise with readily available software. The peer review scores are valid in that to a limited degree they reflect student future performance in an examination. Students valued the process of learning to communicate radiological findings but do not fully appreciated the value of peer review.

Measurement of body composition in cats using computed tomography and dual energy X-ray absorptiometry.

Dual energy X-ray absorptiometry (DEXA) is a reference method for assessing body composition but is seldom `accessible in veterinary settings. Computed tomography (CT) can provide similar body composition estimates and we propose that it can be used in body composition studies in animals. We compared CT and DEXA data from 73 healthy adult neutered domestic cats. Three approaches for measuring adipose tissue percentage from full-body CT scans were explored. By examining the frequency distribution of voxels by Hounsfield unit (HU) value, it is possible to calculate a fat index (Fat%) that is in close agreement with the fat percentages obtained from DEXA scans. Fat% values obtained by the best of the methods had a mean difference of 0.96% (95% confidence interval 0.33-1.59%) from the DEXA results. Fat% obtained by the other two methods were characterized by good correlation but poor agreement and in one of the methods, the difference between the values from the two modalities was proportional to their mean. By using CT, it is possible to obtain body composition estimates that are in close agreement with those available using DEXA. While the significance of individual Fat% measurements obtained from CT can be difficult to interpret and to compare between centers, CT can contribute to research studies concerned either with nutrition or with obesity-related disorders.