Cervical Vertebral Lesions in Equine Stenotic Myelopathy.

Skeletal lesions in the articular processes of cervical vertebrae C2 to C7 were compared between Thoroughbred horses with cervical stenotic myelopathy (17 males, 2 females; age, 6-50 months) and controls (6 males, 3 females; age, 9-67 months). Lesions identified by magnetic resonance imaging occurred with an increased frequency and severity in diseased horses and were not limited to sites of spinal cord compression. Lesions involved both the articular cartilage and trabecular bone and were further characterized using micro-computed tomography and histopathology. The most common histologic lesions included osteochondrosis, osseous cyst-like structures, fibrous tissue replacement of trabecular bone, retained cartilage matrix spicules, and osteosclerosis. Osseous cyst-like structures were interpreted to be true bone cysts given they were a closed cavity with a cellular lining that separated the cyst from surrounding bone. This is the first report of bone cysts in the cervical articular processes of horses with cervical stenotic myelopathy. The morphology and distribution of the lesions provide additional support for the previously proposed pathogenesis that developmental abnormalities with likely secondary biomechanical influences on the cervical spine contribute to equine cervical stenotic myelopathy.

Comparison of magnetic resonance imaging with standing cervical radiographs for evaluation of vertebral canal stenosis in equine cervical stenotic myelopathy.

REASONS FOR PERFORMING STUDY: The sensitivity and specificity of lateral cervical radiographs to evaluate horses suspected of cervical stenotic myelopathy (CSM) are limited by the assessment being restricted to the sagittal plane. OBJECTIVE: To determine whether magnetic resonance imaging (MRI) allows for a more accurate identification of stenosis than lateral cervical radiographs in horses with CSM. STUDY DESIGN: Case control study. METHODS: Nineteen Thoroughbred horses with CSM (17 males, 2 females, age 6-50 months) were compared to 9 control Thoroughbreds (6 males, 3 females, age 9-67 months). Ante mortem, the subjects had neurological examinations and standing cervical radiographs with sagittal ratios calculated from C3 to C7. Intact cervical column MRI scans and histological examinations of the spinal cord were performed post mortem. Morphometric parameters were measured on the vertebral canal, spinal cord and intervertebral foramen. RESULTS: Radiographic cervical canal height measurements categorised by standard minimal sagittal diameter intravertebral and intervertebral ratios produced several false positive and false negative determinations of canal stenosis as defined by spinal cord histopathology. Post mortem MRI measurements of canal area and cord canal area ratio more accurately predicted sites of cord compression in CSM cases. No differences in spinal cord measurements were observed when comparing CSM to control horses, but each of the vertebral canal parameters achieved significance at multiple sites. CONCLUSIONS: Vertebral canal area and cord canal area ratio are better parameters to predict the location of cervical canal stenosis compared to only the sagittal plane of canal height. Additional visual planes and measurements obtained by MRI, specifically vertebral canal area and the cord canal area ratio, will provide a more accurate method to identify regions of canal stenosis than lateral cervical radiographs. The development of MRI or computed tomography equipment capable of evaluating the cervical column of mature horses may substantially enhance evaluation of CSM patients. The Summary is available in Chinese - see Supporting information.

Ultrasound features of arytenoid chondritis in Thoroughbred horses.

REASONS FOR PERFORMING STUDY: Laryngeal ultrasonography can provide valuable information when considering a diagnosis of arytenoid chondritis, but specific ultrasonographic parameters have not been defined. OBJECTIVES: To compare ultrasonographic findings of the arytenoid cartilages in horses with endoscopically diagnosed arytenoid chondritis with ultrasonographic findings of the arytenoid cartilages in normal horses. METHODS: Ultrasound images of the larynx were obtained at the level of the arytenoid cartilages in horses with endoscopically diagnosed arytenoid chondritis and horses with normal arytenoid cartilage structure and function. Information obtained from the ultrasound examination included arytenoid cartilage cross-sectional area, arytenoid cartilage echogenicity and arytenoid cartilage shape. Comparisons were performed between affected and unaffected arytenoid cartilages. For horses with multiple examinations, relationships between time point and arytenoid cartilage cross-sectional area were determined. RESULTS: Chondritic arytenoid cartilages were significantly larger and had abnormal shape and echogenicity when compared with normal arytenoid cartilages (P<0.001). For horses with multiple examinations, no significant changes were identified in arytenoid cartilage size over time. CONCLUSIONS: Chondritic arytenoid cartilages are increased in size and have abnormal echogenicity and contour in comparison with normal arytenoid cartilages when assessed using laryngeal ultrasonography. Once enlarged, the cartilage does not appear to return to normal size after the infection and/or inflammation has resolved. POTENTIAL RELEVANCE: Ultrasonography is a valuable diagnostic modality when investigating cases of possible arytenoid chondritis or abnormal arytenoid cartilage movement. It has additional benefit in determining the extent of disease when medial masses are present on the surface of arytenoid cartilages, aiding in surgical decision making.

Association of treadmill upper airway endoscopic evaluation with results of ultrasonography and resting upper airway endoscopic evaluation.

REASONS FOR PERFORMING STUDY: Assessment of arytenoid movement has traditionally been performed using upper airway (UA) endoscopy. However, recent work suggests that laryngeal ultrasonography may provide additional complementary information. OBJECTIVE: To determine the value of laryngeal ultrasonography for the diagnosis of recurrent laryngeal neuropathy in the horse. HYPOTHESES: Horses with abnormal arytenoid movement (AM) during treadmill UA endoscopy would have increased echogenicity of the left cricoarytenoideus lateralis muscle (CALM) and smaller left CALM and vocalis size while horses with normal AM during treadmill UA endoscopy would have normal echogenicity of the left CALM and similar left and right CALM and vocalis muscle size. Laryngeal ultrasonography would be more accurate than resting endoscopy at predicting abnormal AM. METHODS: Medical records were examined to identify Thoroughbred racehorses aged ≥2 years that had undergone resting and treadmill UA endoscopy and laryngeal ultrasonography. Resting and treadmill AM was graded using accepted scales. The treadmill examination was used as the criterion standard for AM. Laryngeal ultrasonography was performed and the relative echogenicity of the left and right CALM and the cross-sectional area (CSA) of the CALM and vocalis muscle determined. Data analysis included Chi-squared tests, paired t tests and one-way ANOVA. RESULTS: The presence of abnormal AM was associated with relative hyperechogenicity of the CALM while normal AM was not. Laryngeal ultrasonography had a sensitivity of 90% and specificity of 98% and resting UA endoscopy had a sensitivity of 80% and specificity of 81% for diagnosis of abnormal AM. CSA of the left CALM and vocalis muscle was not different between groups. CONCLUSIONS: Laryngeal ultrasonography has high accuracy for diagnosing abnormal AM. POTENTIAL RELEVANCE: Ultrasonography is a valuable addition to the diagnostic evaluation of the equine UA.

Diagnosis of laryngeal dysplasia in five horses using magnetic resonance imaging and ultrasonography.

REASONS FOR PERFORMING STUDY: Laryngeal dysplasia due to suspected maldevelopment of the fourth branchial arch has been reported previously in the horse and has been associated with rostral displacement of the palatopharyngeal arch and/or right laryngeal dysfunction. These studies all described the endoscopic and/or anatomical post mortem identification of the disease, but ultrasonography or magnetic resonance imaging (MRI) of this disease have not been described. HYPOTHESIS: MRI and ultrasound findings accurately reflect the anatomical features of presumptive fourth branchial arch abnormality and allow accurate ante mortem diagnosis of this condition and, therefore, appropriate management. METHODS: Between February 2008 and January 2009, all horses examined at Rood and Riddle Equine Hospital diagnosed with rostral displacement of the palatopharyngeal arch and/or right laryngeal dysfunction using upper airway endoscopy (n=5) underwent ultrasonography and MRI of the laryngeal region. RESULTS: All 5 horses that met the inclusion criteria were identified and all underwent laryngeal MRI and ultrasound examinations. Features consistent with laryngeal dysplasia, including lack of the cricothyroid articulation, dorsal extension of the thyroid cartilage lamina, and absence or hypoplasia of the cricopharyngeus muscle, were seen in all cases using both types of imaging. CONCLUSIONS AND POTENTIAL RELEVANCE: MRI and ultrasonography permit definitive premortem diagnosis of laryngeal dysplasia. Upper airway abnormalities identified using endoscopy can be more fully characterised using MRI and ultrasonography allowing more appropriate recommendations to be made. Preoperative imaging may also prevent inappropriate surgical intervention.