Imaging techniques in veterinary medicine. Part II: Computed tomography, magnetic resonance imaging, nuclear medicine.

Radiography and ultrasonography are the most used techniques in veterinary clinical practice, due to organizational, managerial and, mostly, economic reasons. However, in the last decades, Computed tomography (CT), Magnetic Resonance Imaging (MRI) and, to a lesser extent, Nuclear Medicine (MN) are increasingly used. As we said in the previous article, all the Diagnostic Imaging techniques are actually "indispensable" in Veterinary Medicine, where many patients do not show any symptoms.This second part describes Computed Tomography (CT), Magnetic Resonance (MRI) and Nuclear Medicine techniques in Veterinary Medicine are described.

Imaging techniques in Veterinary Medicine. Part I: Radiography and Ultrasonography.

In Veterinary Medicine all the Imaging techniques are used and described but, due to organizational, managerial and, mostly, economical reasons, Radiography and Ultrasonography are the most used. Veterinary Radiology teaching has a relatively small number of educational credits in the degree courses but, nowday, educational opportunities are remarkably increased thanks to a number of post-degree courses and masters, organized both by the universities and private veterinary associations. The relevance of Diagnostic Imaging is particularly true in Veterinary Medicine, in which Radiology could be considered "indispensable" for diagnosis, prognosis and follow up. Furthermore, it should not be forgotten that the diagnostic image represents a "document" and, has a relevant role in legal medical debats. In this first part, Radiography and Ultrasonography are described.

A combined protocol with piroxicam, chemotherapy, and whole pelvic irradiation with simultaneous boost volumetric modulated arc radiotherapy for muscle-invasive canine urinary transitional cell carcinoma: First clinical experience.

The aims of this pilot study were to evaluate the feasibility and efficacy of high-dose hypofractionated volumetric modulated arc radiotherapy (VMAT) applied to whole pelvic region radiotherapy (WPRT) with multilevel simultaneous integrated boost (MLSIB) combined with piroxicam and chemotherapy for the treatment of canine transitional cell carcinoma (TCC) of the lower urinary tract with muscle invasion TCC. Twelve dogs were enrolled, according to stage, in two groups: group 1, TCC confined to the urinary tract; group 2, TCC with metastasis. The planning target volume dose was tailored from 36 to 42 Gy in 6 fractions. All dogs were prescribed piroxicam and radiosensitizing carboplatin, and six received chemotherapy after radiotherapy. Serial follow-ups with computed tomography and magnetic resonance imaging were performed. Disease control and toxicity effects were evaluated according to the Response Evaluation Criteria in Solid Tumors and Veterinary Radiation Therapy Oncology Group criteria. The treatment was well tolerated, and no high-grade side effects were reported. The median overall survival times for groups 1 and 2 were 1,230 and 150 days, respectively. A considerable percentage of patients in group1 (50%) were still alive at the time of writing this paper, and a longer follow-up could enable a more accurate survival analysis. This preliminary analysis shows that VMAT applied to the WPRT with MLSIB is an effective and safe option for dogs with lower urinary TCC, although the presence of metastases worsens the prognosis.

Efficacy of imidacloprid 10%/moxidectin 2.5% spot on (Advocate®, Advantage Multi®) and doxycycline for the treatment of natural Dirofilaria immitis infections in dogs.

Heartworm infection (also known as dirofilariosis due to Dirofilaria immitis) in dogs causes chronic pulmonary disease that, if left untreated, can lead to right-side congestive heart failure. Currently, the only registered drug for adulticide therapy in dogs with heartworm disease (HWD) is melarsomine dihydrochloride. The recent targeting of the bacterial endosymbiont Wolbachia, through antibiotic therapy of the infected host, has offered an interesting alternative for the treatment of HWD. Recent reports of the adulticide activity of an ivermectin/doxycycline combination protocol has lead the American Heartworm Society (AHS) to include in its guidelines that, in cases where arsenical therapy is not possible or is contraindicated, a monthly heartworm preventive along with doxycycline for a 4-week period might be considered. In the present study, 20 dogs with confirmed natural D. immitis infection were included following owner consent. Fourteen dogs were treated with a topical formulation containing 10% w/v imidacloprid and 2.5% w/v moxidectin (Advocate®, Advantage Multi®, Bayer), monthly for nine months, associated to doxycycline (10 mg/kg/BID) for the first 30 days. Six dogs were treated with melarsomine (Immiticide®, Merial) (2.5 mg/kg) at enrollment, followed one month later by two injections 24 h apart. The presence of circulating antigens and the number of microfilariae (mf) were evaluated at the moment of enrollment and then at 1, 2, 3, 4, 5, 6, 7, 8, 12, 18, 24 months post enrollment. Echocardiogram and radiographs were performed at month 0, 6, 12, 18, 24. Monthly moxidectin combined with 30 days of doxycycline eliminated circulating microfilariae within one month, thus breaking the transmission cycle very quickly. Furthermore, dogs treated with the combination protocol started to become negative for circulating antigens at 4 months from the beginning of treatment and all except one were antigen negative at 9 months. All dogs treated with melarsomine were antigen negative by 5 months from the beginning of the treatment. No dogs showed worsening of pulmonary patterns or criteria indicative of pulmonary hypertension 12 to 24 months after. For the criteria mf concentration, antigen concentration, radiography and echocardiography at 12, 18 and 24 months the non-inferiority for the moxidectin group could be proven for a non-inferiority margin of 15% for the rate difference. Dogs treated with moxidectin and doxycycline became negative for microfilariae and antigens sooner when compared to melarsomine in the present study and to dogs treated with doxycycline combined with ivermectin in studies previously published.

Ultrasonographic differentiation between portal venous and parenchymal gas may be important for the prognosis of canine and feline hepatic emphysema: 37 cases.

The aim of this retrospective, cross-sectional, study was to evaluate clinical findings and outcomes for different ultrasonographic patterns of hepatic emphysema in dogs and cats. Dogs and cats with an ultrasonographic diagnosis of hepatic emphysema and a known outcome, from January 2010 to January 2018, were enrolled. The following data were recorded from medical and ultrasonographic records: ultrasonographic patterns of hepatic emphysema (parenchymal, portal venous, biliary), clinical signs, laboratory findings, and outcomes (favorable, poor). A total of 33 dogs and four cats met the inclusion criteria. Among these, 23 cases were classified as hepatic portal venous gas, 10 as parenchymal emphysema, and four as biliary emphysema. Clinical diagnosis categories were as follows: infection/sepsis (9), gastro-intestinal disease (9), iatrogenic (9), trauma (5), and liver neoplasia (5). An increase in serum liver enzymes was significantly associated with parenchymal emphysema (P = .03). Other clinical and laboratory findings were not associated with the type of hepatic emphysema. Hepatic portal venous gas was mostly transient in patients with ultrasonographic follow-up. The overall mortality was 40.5%. A significant difference was found between mortality by portal venous gas (21.7%) and mortality by parenchymal emphysema (90%) (P = .003). In conclusion, the ultrasonographic differentiation of hepatic emphysema between hepatic portal venous gas and parenchymal emphysema may be important for the prognosis of hepatic emphysema. The presence of parenchymal emphysema may be a poor prognostic indicator, while hepatic portal venous gas may be more benign. However, ultrasound findings should be carefully evaluated in the context of clinical findings.

Lead and copper in hunted wild boars and radiographic evaluation of bullet fragmentation between ammunitions.

The purpose of the present study was to evaluate the content of lead in carcasses of wild boars shot with lead bullets, in comparison with that of copper caused by lead-free ammunitions. Radiographic images of hunted boars were obtained in order to assess the degree of bullet fragmentation in the carcasses. Samples of meat were collected from different body areas at increasing distance from bullet trajectory, to be analysed by ICP-MS for lead and copper levels. In wild boars shot with lead ammunitions, a massive dispersion of bullet fragments and very high lead levels were detected. By contrast, in wild boars killed with copper ammunitions no radiographic signs of bullet fragmentation were observed. Copper ammunitions seem therefore a safer alternative to standard lead-core ones, due to their minimal fragmentation and the relatively low toxicity of this metal.

Effect of a commercially available fish-based dog food enriched with nutraceuticals on hip and elbow dysplasia in growing Labrador retrievers.

The aim of this study was to evaluate the prevalence of hip and elbow dysplasia in a group of growing Labrador retrievers fed a fish-based diet enriched with nutraceuticals with chondroprotective properties. The puppies ranged from 3 to 12 mo of age and were divided into 2 groups, each fed a different diet. The control diet consisted of a high quality, chicken-based dog food, while the test diet was a fish-based dog food, enriched with nutraceuticals. Hip and elbow joints were radiographed and scored at 6 and 12 mo of age. Overall, 42 dogs completed the study. At 12 mo of age, no differences were found between the groups in the prevalence of hip and elbow dysplasia, although dogs fed the fish-based food enriched with nutraceuticals had a less severe grade of osteoarthritis at 12 mo. It was concluded that the fish-based diet with nutraceuticals did have beneficial effects on the development of severe osteoarthritis.

L'objectif de la présente étude était d'évaluer la prévalence de dysplasie de la hanche et du coude dans un groupe de chiens Labrador en croissance nourris avec une diète à base de poisson enrichie de neutraceutiques ayant des propriétés chondroprotectrices. L'âge des chiots variait de 3 à 12 mois et ils ont été divisés en deux groupes, chacun étant nourri avec une diète différente. La diète témoin consistait d'un aliment de haute qualité pour chien à base de poulet, alors que la diète test était un aliment pour chien à base de poisson et enrichi avec des neutraceutiques. Les articulations des hanches et des coudes ont été radiographiées à 6 et 12 mois d'âge. Un total de 42 chiens a complété l'étude. À 12 mois d'âge, aucune différence n'a été trouvée entre les groupes dans la prévalence de dysplasie de la hanche et du coude, bien que les chiens nourris avec la diète à base poisson enrichie de neutraceutiques avaient un score d'ostéoarthrite moins sévère à 12 mois. Il a été conclu que la diète à base de poisson enrichie de neutraceutiques avait des effets bénéfiques sur le développement d'ostéoarthrite sévère.(Traduit par Docteur Serge Messier).

The Contribution of Adipose Tissue-Derived Mesenchymal Stem Cells and Platelet-Rich Plasma to the Treatment of Chronic Equine Laminitis: A Proof of Concept.

Laminitis, a highly debilitating disease of the foot in ungulates, is characterized by pathological changes of the complex lamellar structures that maintain the appendicular skeleton within the hoof. Laminitis is a multifactorial disease that involves perturbation of the vascular, hematological, and inflammatory homeostasis of the foot. Interestingly, the pathogenesis of the disease resembles what is observed in metabolic syndromes and sepsis-induced organ failure in humans and animals. We hypothesized that local administration of mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) might contribute to establishing an anti-inflammatory and pro-angiogenic environment, and could stimulate the injured tissue in order to restore its functional integrity. According to this assumption, an experimental protocol based on the local intravenous administration of adipose tissue-derived MSCs (aMSCs) in combination with PRP was developed for the treatment of horses affected by chronic laminitis. Nine horses with severely compromised venograms (showing grade III and IV laminitis) that had been unsuccessfully treated with conventional therapies were enrolled. aMSCs and PRP (15 × 106 cells resuspended in 15 mL of PRP) were injected into the lateral or medial digital vein three times, at one-month intervals. The first administration was performed with allogeneic aMSCs, while for the following administrations, autologous aMSCs were used. There was no adverse short-term reaction to the intravenous injection of aMSCs. In the long term, venograms outlined, in all subjects, a progressive amelioration of the vascularization of the foot. An improvement in the structure and function of the hoof was also observed. No adverse events were reported during the follow-up, and the horses returned to a comfortable quality of life. Although the number of animals enrolled in the study is limited, both clinical observations and venography demonstrated an enhancement in the condition of all horses, suggesting that the regenerative therapies in chronic laminitis could be useful, and are worthy of further investigation.

COMPUTED TOMOGRAPHIC FEATURES OF INCISOR PSEUDO-ODONTOMAS IN PRAIRIE DOGS (CYNOMYS LUDOVICIANUS).

Maxillary incisor pseudo-odontomas are common in pet prairie dogs and can cause progressive respiratory obstruction, while mandibular pseudo-odontomas are rarely clinically significant. The aim of this retrospective cross-sectional study was to describe CT features of maxillary and mandibular incisor pseudo-odontomas vs. normal incisors in a group of pet prairie dogs. All pet prairie dogs with head CT scans acquired during the period of 2013-2015 were included. A veterinary radiologist who was aware of final diagnosis reviewed CT scans and recorded qualitative features of affected and normal incisors. Mean density values for the pulp cavity and palatal and buccal dentin were also recorded. A total of 16 prairie dogs were sampled (12 normal maxillary incisors, 20 confirmed maxillary incisor pseudo-odontomas, 20 normal mandibular incisors, 12 presumed mandibular incisor pseudo-odontomas). Maxillary incisors with confirmed pseudo-odontomas had a significantly hyperattenuating pulp and dentin in the reserve crown and apical zone, when compared to normal maxillary incisors. Pseudo-odontomas appeared as enlargements of the apical zone with a globular/multilobular hyperattenuating mass formation haphazardly arranged, encroaching on midline and growing caudally and ventrally. Presumed mandibular incisor pseudo-odontomas had similar CT characteristics. In 60% of prairie dogs with maxillary incisor pseudo-odontomas, the hard palate was deformed and the mass bulged into the oral cavity causing loss of the palatine bone. The common nasal meatus was partially or totally obliterated in 81.8% of prairie dogs with maxillary pseudo-odontomas. Findings supported the use of CT for characterizing extent of involvement and surgical planning in prairie dogs with pseudo-odontomas.

IMAGING DIAGNOSIS-ULTRASONOGRAPHIC APPEARANCE OF SKELETAL MUSCLE METASTASES IN A DOG WITH HEMANGIOSARCOMA.

A 13-year-old spayed female German shepherd dog was presented for acute onset of lethargy, anorexia, and disseminated erythematous skin lesions. Thoracic radiographs and abdominal ultrasonographic findings were consistent with metastatic hemangiosarcoma. Multiple, ill-defined, irregularly shaped hypoechoic nodules were also detected within the thoracic and abdominal wall. Hemangiosarcoma metastases to the skeletal muscle were confirmed based on histopathological examination. Multivisceral involvement was also confirmed by necropsy. Metastatic neoplasia should be considered as a differential diagnosis for dogs with ill-defined, irregular, hypoechoic, intramuscular nodules.

Emphysematous pyelitis and cystitis associated with vesicoureteral reflux in a diabetic dog.

A 12-year-old female dog with a 3-month history of poor response to diabetes treatment had an acute worsening of symptoms, including weakness and blindness. The dog had elevated blood glucose, alkaline phosphatase and urea concentration, hyposthenuria, glycosuria, hematuria, and pyuria. Escherichia coli was isolated from the urine. Radiographs and ultrasound examination showed that the dog had unilateral emphysematous pyelitis and concurrent cystitis associated with vesicoureteral reflux.

Pyélite emphysémateuse et cystite associées au reflux vésico-urétéral chez une chienne diabétique. Une chienne âgée de 12 ans avec une anamnèse de 3 mois de mauvaise réponse au traitement du diabète a présenté un aggravement aigu des symptômes, y compris de la faiblesse et de la cécité. La chienne avait une glycémie élevée, ainsi que des concentrations sériques élevées de la phosphatase alcaline et d'urée, de l'hyposthénurie, de la glycosurie, de l'hématurie et de la pyurie. Escherichia coli a été isolé de l'urine. Des radiographies et des échographies ont montré que la chienne était atteinte de pyélite emphysémateuse unilatérale et de cystite concomitante associées au reflux vésico-urétéral.(Traduit par Isabelle Vallières).

Combination of radiation therapy and firocoxib for the treatment of canine nasal carcinoma.

Carcinomas represent two-thirds of canine nasosinal neoplasms. Although radiation therapy (RT) is the standard of care, the incidence of local recurrence following treatment is high. Cyclooxygenase-isoform-2 (COX-2) is expressed in 71-95% of canine nasal carcinomas and has been implicated in tumor growth and angiogenesis. Accordingly, COX-2 inhibition seems rational to improve outcome. Dogs with histologically confirmed, previously untreated nasal carcinomas were randomized to receive the combination of a selective COX-2 inhibitor (firocoxib) and palliative RT (Group 1) or RT and placebo (Group 2). Patients were regularly monitored with blood tests, urinalysis, and computed tomography. Pet owners were asked to complete monthly a quality-of-life questionnaire. Twenty-four dogs were prospectively enrolled. According to Adams modified system, there were five stage 1, five stage 2, three stage 3, and 11 stage 4 tumors. Two dogs had metastases to regional lymph nodes. Median progression-free interval and overall survival were 228 and 335 days in Group 1 (n = 12) and 234 and 244 days in Group 2 (n = 12). These differences were not statistically significant. The involvement of regional lymph nodes was significantly associated with progression-free interval and overall survival (P = 0.004). Quality of life was significantly improved in Group 1 (P = 0.008). In particular, a significant difference was observed for activity and appetite. Although not providing a significant enhancement of progression-free interval and overall survival, firocoxib in combination with RT is safe and improved life quality in dogs with nasal carcinomas.

Diagnostic sensitivity of ultrasound, radiography and computed tomography for gender determination in four species of lizards.

Gender determination is frequently requested by reptile breeders, especially for species with poor or absent sexual dimorphism. The aims of the current study were to describe techniques and diagnostic sensitivities of ultrasound, radiography, and computed tomography for gender determination (identification of hemipenes) in four species of lizards. Nineteen lizards of known sex, belonging to four different species (Pogona vitticeps, Uromastyx aegyptia, Tiliqua scincoides, Gerrhosaurus major) were prospectively enrolled. With informed owner consent, ultrasound, noncontrast CT, contrast radiography, and contrast CT (with contrast medium administered into the cloaca) were performed in conscious animals. Imaging studies were reviewed by three different operators, each unaware of the gender of the animals and of the results of the other techniques. The lizard was classified as a male when hemipenes were identified. Nineteen lizards were included in the study, 10 females and nine males. The hemipenes were seen on ultrasound in only two male lizards, and appeared as oval hypoechoic structures. Radiographically, hemipenes filled with contrast medium appeared as spindle-shaped opacities. Noncontrast CT identified hemipenes in only two lizards, and these appeared as spindle-shaped kinked structures with hyperattenuating content consistent with smegma. Hemipenes were correctly identified in all nine males using contrast CT (accuracy of 100%). Accuracy of contrast radiography was excellent (94.7%). Accuracy of ultrasound and of noncontrast CT was poor (64.3% and 63.1%, respectively). Findings from the current study supported the use of contrast CT or contrast radiography for gender determination in lizards.

Cholecystocutaneous fistula containing multiple gallstones in a dog.

A 7-year-old dog was presented with a history of an open lesion on the right thoracic wall, discharging honey-like fluid and small stones. Ultrasonography and computed tomographic fistulography identified a cholecystocutaneous fistula; cholecystectomy was curative. Veterinarians should consider this disease in patients with long-term discharging lesions on the right thoracic or abdominal wall.

Fistule cholécystocutanée contenant des cholélithes multiples chez un chien. Un chien âgé de 7 ans a été présenté avec une anamnèse de lésion ouverte sur la paroi thoracique droite, d'où s'écoulait un liquide ressemblant à du miel et de petits calculs. Une échographie et une fistulographie tomographique ont identifié une fistule cholécystocutanée et une cholécystectomie a guéri l'affection. Les vétérinaires devraient considérer cette maladie chez les patients ayant des lésions suppurantes de longue date sur la paroi thoracique ou abdominale droite.(Traduit par Isabelle Vallières).

Radiological analysis of gastrointestinal dysmotility in a model of central nervous dopaminergic degeneration: comparative study with conventional in vivo techniques in the rat.

INTRODUCTION: Gastrointestinal (GI) motility disorders include many clinical manifestations associated with various pathologies. They are widespread and can be considered a primary symptom or can be associated to other diseases, such as Parkinson's disease. Understanding the type and site of GI dysmotility is crucial to identify the functional abnormality and to unravel the underlying mechanisms, in order to design adequate therapeutic interventions. METHODS: In the present study, we applied radiological analysis, a common tool in clinical practice, to follow up in vivo the progression of GI dysmotility over time and along the entire GI tract in an animal model of central nervous dopaminergic degeneration and compared these results to those obtained with standard techniques commonly used to assess GI motor functions in small rodents. RESULTS: Our radiological data, showing delayed gastric emptying and constipation, agree with and expand previous information obtained with other functional assays in the same model, suggesting that radiological analysis can be an appropriate method to explore GI dysmotility in animal models of human pathologies. DISCUSSION: In this study we have applied for the first time the GI radiological analysis to an animal model of central nervous dopaminergic degeneration providing a non-invasive/animal-preserving approach, ethically more acceptable and useful to follow up the development of GI dysmotility in pathologies evolving over time.

Clinical assessment of post-adulticide complications in Dirofilaria immitis-naturally infected dogs treated with doxycycline and ivermectin.

This study shows that a combination of doxycycline (10mg/kg/sid for 30 days) and ivermectin (6 µg/kg/every 15 days for 6 months) is well tolerated for the treatment of canine heartworm disease (HWD). Monthly echocardiography showed that 84% of treated dogs either progressively improved parameters indicative of pulmonary hypertension or, following slight worsening, resolved all signs. Thoracic radiography showed the persistence of interstitial inflammation, even though also in this case, approximately 70% of the dogs steadily improved or worsened but then improved by the end of the study.

Radiological investigation of an over 2000-year-old Egyptian mummy of a cat.

A radiographical study of a cat mummy from the Egyptian collection of the National Archeological Museum in Parma, Italy was carried out in order to evaluate the content and to describe how cats were wrapped and mummified. The mummy contained the complete skeleton of a 4-5-month-old cat. Radiology revealed the position of the cat's body; it was wrapped to occupy the smallest space possible. In order to better position the cat, the ribs of the thorax were compressed cranio-caudally and the fore limbs were then positioned very close to the thorax. The hind limbs were flexed close to the lumbar spine and the tibio-tarsal joints were subluxated to allow the repositioning of the tarsal, metatarsal and phalanx bones cranio-caudally near the tibiae. A coccygeal vertebra was fractured in order to reposition the tail as close as possible to the body. Atlanto-occipital subluxation and a fracture/hole was present in the occipital region of the skull: whether this was made for draining skull contents as a mummification process and/or to euthanase the cat remains open for discussion.

Polycystic kidney disease in a Chartreux cat.

Polycystic kidney disease (PKD) is one of the most common genetic diseases in cats. It has been widely described in Persians and Persian-related cats and sporadically in other breeds. The purpose of the present paper is to describe the first reported case of PKD in a 12-year-old female Chartreux cat. The cat was referred with polyuria and polydipsia and enlarged and irregular kidneys at palpation. Multiple renal cysts and a single liver cyst were identified by ultrasound and the inherited pattern was confirmed by genetic test (polymerase chain reaction/restriction fragment length polymorphism (PCR/RFLP) assay). Chartreux cats should be included in the screening programme of PKD, and PKD should be always considered as a possible cause of chronic renal failure in this breed.

Use of ultrasonography and contrast radiography for snake gender determination.

The purpose of this paper is to characterize the sonographic and radiographic features of hemipenes in male snakes and to use these features for gender determination. The sonographic and radiographic examination of 17 male and 10 female snakes, whose gender was determined previously by probing, were evaluated by one examiner who was unaware of the gender. Sonographically, hemipenes appeared funnel shaped with an echogenic thin wall and hypo to anechoic contents. Radiographically, hemipenes filled by positive contrast medium appeared as funnel-shaped radiopacities pointing caudally. Snake gender was correctly determined in all snakes using sonography (accuracy = 100%). Radiographic accuracy was 81.4%. Interpretation of radiographic examinations was limited by poor distribution of the contrast medium within the hemipenes.