Use of manual alveolar recruitment maneuvers to eliminate atelectasis artifacts identified during thoracic computed tomography of healthy neonatal foals.

OBJECTIVE To evaluate use of single manual alveolar recruitment maneuvers (ARMs) to eliminate atelectasis during CT of anesthetized foals. ANIMALS 6 neonatal Standardbred foals. PROCEDURES Thoracic CT was performed on spontaneously breathing anesthetized foals positioned in sternal (n = 3) or dorsal (3) recumbency when foals were 24 to 36 hours old (time 1), 4 days old (time 2), 7 days old (time 3), and 10 days old (time 4). The CT images were collected without ARMs (all times) and during ARMs with an internal airway pressure of 10, 20, and 30 cm H2O (times 2 and 3). Quantitative analysis of CT images measured whole lung and regional changes in attenuation or volume with ARMs. RESULTS Increased attenuation and an alveolar pattern were most prominent in the dependent portion of the lungs. Subjectively, ARMs did not eliminate atelectasis; however, they did incrementally reduce attenuation, particularly in the nondependent portion of the lungs. Quantitative differences in lung attenuation attributable to position of foal were not identified. Lung attenuation decreased significantly (times 2 and 3) and lung volume increased significantly (times 2 and 3) after ARMs. Changes in attenuation and volume were most pronounced in the nondependent portion of the lungs and at ARMs of 20 and 30 cm H2O. CONCLUSIONS AND CLINICAL RELEVANCE Manual ARMs did not eliminate atelectasis but reduced attenuation in nondependent portions of the lungs. Positioning of foals in dorsal recumbency for CT may be appropriate when pathological changes in the ventral portion of the lungs are suspected.

SALINE ARTHROGRAPHY OF THE DISTAL INTERPHALANGEAL JOINT FOR LOW-FIELD MAGNETIC RESONANCE IMAGING OF THE EQUINE PODOTROCHLEAR BURSA: FEASIBILITY STUDY.

Abnormalities of the deep digital flexor tendon, navicular bone, and collateral sesamoidean ligament can be difficult to visualize using magnetic resonance imaging (MRI) if bursal fluid is absent. The use of saline podotrochlear bursography improves podotrochlear apparatus evaluation, however, the technique has disadvantages. The objective of this prospective feasibility study was to describe saline arthrography of the distal interphalangeal joint as an alternative technique for improving MRI visualization of the deep digital flexor tendon, navicular bone, collateral sesamoidean ligament, and podotrochlear bursa, and to compare this technique with saline podotrochlear bursography. Eight paired cadaver forelimbs were sampled. Saline podotrochlear bursography or saline arthrography techniques were randomly assigned to one limb, with the alternate technique performed on the contralateral limb. For precontrast and postcontrast studies using each technique, independent observers scored visualization of the dorsal aspect of the deep digital flexor tendon, palmar aspect of the navicular bone, collateral sesamoidean ligament, and podotrochlear bursa. Both contrast techniques improved visualization of structures over precontrast MR images and visualization scores for both techniques were similar. Findings from this study demonstrated that saline arthrography is feasible and comparable to saline podotrochlear bursography for producing podotrochlear bursa distension and separation of the structures of the podotrochlear apparatus on nonweight bearing limbs evaluated with low-field MRI. Clinical evaluation of saline arthrography on live animals is needed to determine if this technique is safe and effective as an alternative to saline podotrochlear bursography in horses with suspected pathology of the podotrochlear apparatus.

Comparison of radiographic and computed tomographic images of the lungs in healthy neonatal foals.

OBJECTIVE: To compare CT and radiographic images of the lungs in sedated healthy foals positioned in sternal recumbency and to investigate whether a relationship exists between CT-derived measurements of lung attenuation and Paco2 and Pao2. ANIMALS: 6 healthy Standardbred foals < 14 days of age. PROCEDURES: Thoracic CT images were acquired followed by radiographic views with each foal sedated and positioned in sternal recumbency. For each foal, both CT and radiographic images were evaluated for severity and extent of changes by lung regions on the basis of a subjective scoring system by 3 investigators. Quantitative analysis of CT images was also performed. Assessments of Pao2 and Paco2 were performed before sedation, following sedation prior to CT, and after CT prior to radiography. RESULTS: Interobserver agreement for CT and radiographic image scoring was strong (0.73) and fair (0.65), respectively; intraobserver agreement was near perfect for CT (0.97) and radiographic (0.94) image scoring. Increased CT attenuation and radiographic changes were identified for all foals and were preferentially distributed in the caudoventral portion of the lungs. Radiographic scores were significantly lower than CT image scores. A positive correlation (r = 0.872) between lung attenuation and CT image score was identified. A significant increase in Paco2 was not considered clinically relevant. Significant changes in Pao2 were not observed. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that interpretation of CT images may be less subjective, compared with interpretation of radiographic images. These findings may aid in the evaluation of CT and radiographic images of neonatal foals with respiratory tract disease.

Contrast-enhanced multidetector computed tomography to diagnose pulmonary thromboembolism in an awake dog with pyothorax.

OBJECTIVES: To (1) describe the use of contrast-enhanced multidetector computed tomography (CE-MDCT) for identifying pulmonary thromboembolism (PTE) in an awake dog with pyothorax, (2) report the first documented case of PTE associated with pyothorax in veterinary medicine, and (3) review diagnostic imaging modalities and therapeutic options for PTE. CASE SUMMARY: A 5-year, 4-month-old female neutered Labrador Retriever was presented for respiratory distress secondary to a pyothorax. The dog underwent thoracic exploratory surgery in which no underlying etiology was identified. Aerobic bacterial culture grew Streptococcus canis. The patient remained hypoxemic despite thoracocentesis and surgery. CE-MDCT was performed without general anesthesia and showed luminal-filling defects in the right cranial and right and left caudal lobar primary pulmonary arteries consistent with PTE. Anticoagulant therapy using unfractionated heparin was initiated. The dog responded well and was discharged 3 days postoperatively. NEW OR UNIQUE INFORMATION PROVIDED: To the authors' knowledge, this is the first reported case of PTE diagnosed in a dog with pyothorax using CE-MDCT.

Microdose computed tomographic cardiac angiography in normal cats.

OBJECTIVES: To determine if microdose contrast-enhanced multi-detector computed tomographic angiography (MDCTA) allows characterization of cardiac chambers in lightly sedated normal cats. ANIMALS: Seven healthy domestic cats. METHODS: Lightly sedated normal cats were imaged pre-contrast and with microdose (0.22 ml/kg of non-ionic iodinated contrast medium, 300 mg I/ml) triple-phase MDCTA in a motion restriction device. RESULTS: On pre-contrast images, the aorta (median: 52.43 Hounsfield units [HU], range 27.35-76.74 HU) was outlined by significantly (p = 0.015) lower attenuating periaortic fat (-66.16 HU, -42.62 to -92.77 HU). On post-contrast images, median peak contrast enhancement in the right ventricle (111.77 HU, 36.09-141.60 HU) was achieved in 3.1 s (range 2.9-7.3 s), in the aorta (149.30 HU, 99.43-319.60 HU) and left atrium (180.83 HU, 88.53-266.84 HU) in 6.4 s (range 5.6-7.7 s) and in the left ventricle (147.89 HU, 57.23-245.77 HU) in 7.10 s (range 6.2-11.2 s). Significantly higher attenuation was measured between all chambers and walls, the right ventricular lumen and interventricular septum (median ratio 53.78 HU, range 0.21-83.20 HU), left ventricular lumen and left ventricular free wall (89.32 HU, 38.81-185.95 HU) and aorta and periaortic fat (190.43 HU, 143.22-425.44 HU) on post-contrast images. CONCLUSIONS: Sufficient biological contrast is available on survey CT to discriminate between the aorta and the left atrium, and microdose MDCTA provides sufficient contrast enhancement for adequate visualization of the heart chambers in normal cats.

Qualitative and quantitative interpretation of computed tomography of the lungs in healthy neonatal foals.

OBJECTIVE: To qualitatively describe lung CT images obtained from sedated healthy equine neonates (≤ 14 days of age), use quantitative analysis of CT images to characterize attenuation and distribution of gas and tissue volumes within the lungs, and identify differences between lung characteristics of foals ≤ 7 days of age and foals > 7 days of age. ANIMALS: 10 Standardbred foals between 2.5 and 13 days of age. PROCEDURES: Foals were sedated with butorphanol, midazolam, and propofol and positioned in sternal recumbency for thoracic CT. Image analysis software was used to exclude lung from nonlung structures. Lung attenuation was measured in Hounsfield units (HU) for analysis of whole lung and regional changes in attenuation and lung gas and tissue components. Degree of lung attenuation was classified as follows: hyperinflated or emphysema, -1,000 to -901 HU; well aerated, -900 to -501 HU; poorly aerated, -500 to -101 HU; and nonaerated, > -100 HU. RESULTS: Qualitative evidence of an increase in lung attenuation and patchy alveolar patterns in the ventral lung region were more pronounced in foals ≤ 7 days of age than in older foals. Quantitative analysis revealed that mean ± SD lung attenuation was greater in foals ≤ 7 days of age (-442 ± 28 HU) than in foals > 7 days of age (-521 ± 24 HU). Lung aeration and gas volumes were lower than in other regions ventrally and in the mid lung region caudal to the heart. CONCLUSIONS AND CLINICAL RELEVANCE-Identified radiographic patterns and changes in attenuation were most consistent with atelectasis and appeared more severe in foals ≤ 7 days of age than in older neonatal foals. Recognition of these changes may have implications for accurate CT interpretation in sedated neonatal foals with pulmonary disease.

Feasibility for using dual-phase contrast-enhanced multi-detector helical computed tomography to evaluate awake and sedated dogs with acute abdominal signs.

Canine patients with acute abdominal signs are often clinically unstable and need a rapid and accurate diagnosis. Contrast-enhanced multi-detector computed tomography (CT) is the current modality of choice for evaluating acute abdominal pain in people. We hypothesized that contrast-enhanced multi-detector CT would be a feasible and safe technique for use in awake and lightly sedated dogs with acute abdominal signs. Eighteen client-owned dogs were enrolled, all presenting with acute abdominal signs. Dogs were scanned using a dual-phase protocol that included precontrast, arterial, and portal venous phases. Eight dogs were scanned awake and ten were given light sedation as chosen by the primary care clinician. Two observers who were unaware of clinical findings and sedation status scored image quality for each scan by consensus opinion. Mean serum creatinine in the sedated group was higher than in the awake group but was within the normal reference range. Other laboratory and physiologic measures did not differ between awake and sedated groups. No IV contrast-related adverse reactions were seen. Median scan time for all patients was less than 10 min. Sixteen of 18 contrast-enhanced multi-detector CT scans were scored fair to excellent in diagnostic quality, with no statistical difference in diagnostic quality for awake vs. sedated patients. Causes for two poor quality diagnostic scans included severe beam hardening from previously administered barium contrast agent and severe motion artifacts. We conclude that dual-phase contrast-enhanced multi-detector CT is a feasible and safe technique for evaluating awake and minimally sedated dogs presenting with acute abdominal signs.

The VetMousetrap: a device for computed tomographic imaging of the thorax of awake cats.

The VetMousetrap, a novel device that allows computed tomography (CT) of awake cats and provides a clinically supportive environment, is described. Ten normal cats were used to test the device for ambient internal oxygen, carbon dioxide levels, and temperature. Twenty-two awake normal cats were imaged using a 16-multislice helical CT unit to evaluate dose-equivalent protocols. Two different X-ray tube potentials (kV), 80 and 120, and two different helical pitches, 0.562 and 1.75, were evaluated. The signal intensity of the pulmonary parenchyma (SIlung), signal intensity of background (SIbackgr), contrast, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were calculated. Three evaluators ranked the images for sharpness of liver margins, motion, helical, and windmill artifacts. CT was successfully completed in 20 of 22 cats. No artifacts directly related to the device were detected. Overall, 75 of 80 (94%) examinations were judged to have absent or minimal motion artifact. A statistically significant difference was found for SNR (P = 0.001) and CNR (P = 0.001) between all protocols. The higher pitch protocols had significantly lower noise and higher SNR and CNR, lower motion artifact but greater helical artifacts. A protocol using 80 kV, 130 mA, 0.5s, and 0.562 pitch with 1.25mm slice thickness, and 0.625 mm slice reconstruction interval is recommended. The VetMousetrap appears to provide the opportunity for diagnostic CT imaging of the thorax of awake cats.