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Equine MS > Radiology > Flashcards

Radiology Flashcards

1
Q

much more common to have foot pain in hindlimbs or forelimbs?

A

foot pain in the hindlimbs are musch LESS common than in the forelimb

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2
Q

How to place the hind foot for radiology

A
  • horses dont like to weight bear on a block. Can rest on their toe.
  • can try to put both hind feet on a block
  • techincally more difficult to take well positioned radiographs than in forelimb
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3
Q

Hind limb standard views:

A

same as forelimbs:

  • Laminitis: Lateromedial
  • Foot balance: Lateromedial and dorsoplantar
  • dorso45Lateral-plataromedial
  • Plantaro45Lateral-dorsomedial
  • dorsoproximal-plantarodistal oblique
  • plantaroproximal-plantarodistal oblique
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4
Q

Standard views for hind pastern

A
  • views as in the forelimbs
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5
Q

hindlimb

Fetlock standard view

A
  • standard views as for front fetlock
  • lateromedial, dorsoplantar, D45L-PIM oblique, Pl45L-DM oblique
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6
Q

Hock

  • frequent cause of laemenss
A

frequent cause of hindlimb lameness:

  • osteoarthritis in the distal tarsal joint

susceptible to trauma

  • kick wounds
  • infectious arthritis

Osteochondrosis dissecans

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7
Q

Hock

  • standard views
A
  • D45L-PlMO
  • PI45L-DMO
  • Lateromedial
  • Dorsoplantar
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8
Q

hock

  • additional views
A
  • flexed lateromedial
  • skyline
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9
Q

Hock

  • Distal tarsal joints - slight slope from dorsal to plantar and from lateral to medial, what to do?
A
  • tilt the X-ray machine 5-10*
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10
Q

Hock

  • fracture of the lateral malleolus, most commonly due to?
A

traumatic origin

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11
Q

Stifle

  • flexed lateromedial, what to look after?
A

Easier to take true lateromedial, some horses tolerate it better.

Easier to assess the proximal aspect of the trochlear ridges

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12
Q

Pelvis

  • indications
A
  • suspected fracture of the ischium
  • coxofemoral joint
  • diagnostic analgesia
  • clinical signs
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13
Q

Back

  • indications
A
  • back pain. Often secondary to lameness, ill fitting of saddle etc.
  • poor performance
  • dangerous behaviour
  • diagnostic analgesia
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14
Q

Back

  • to include on the radiology image
A
  • dorsal spinous processes (DSP´s) - latero-lateral images
  • vertebral bodies - latero-lateral images
  • articular process (facet) joints (APJ´s) - ventral to dorsal oblique views
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15
Q

forelimb

  • indications
A
  • lameness localised to the foot
  • penetating injuries
  • laminitis
  • navicular bursa injection
  • for the farrier - hoof balance, sole thickness
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16
Q

forelimb

  • preparation
A
  • show removal
  • thorough paring and cleaning
  • packing with radiolucent material to avoid air artefacts (play dough)
  • sedation, labelling, markers if needed
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17
Q

forelimb

  • standard views
A
  • for lameness examination:
  • LM, Dpa, DPrPaDiO of the pedal and navicular bones, oblique and skyline views
  • Laminits:
  • LM
  • For the farrier:
  • LM, DPa
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18
Q

Forelimb

  • Lateromedial view: preparation and what to see on the radiology image
A
  • straight limb
  • Xray beam parallel with the heel bulbs
  • centre in the region of the navicular bone
  • halfway between dorsal and palmar
  • 1 cm distal to the coronary band
  • orientation of the distal phalanz
  • distal interphalangeal joint margins
  • palmar processes / ossified cartilages
  • navicular bone
  • shape (elongation, modelling)
  • corticomedullar definition
  • thickness of the dorsal hoof wall and the sole
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19
Q

Forelimb

  • Dorsopalmar view: preparation and what to see at the image
A
  • foot on a block, pulled forward
  • limb straight from the front
  • centre midway between the coronary band and the ground
  • horizontal X-ray beam, at right angle to the heel bulbs.
  • orientation of the distal phalax, thickness of the sole
  • ungular cartilages
  • solar margin of distal phalanx
  • proximal border of the navicular bone
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20
Q

Forelimb

  • DPrPaDiO - distal phalanx
A
  • Upright pedal view
  • hoof wall vertical on the block
  • centre at the level of the coronary band
  • standing on a block
  • beam at 65* to horizontal
  • margins of the disal phalanx
  • ungular cartilages
  • insertion site of Cl DIP joint
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21
Q

Forelimb

  • DPrPaDiO - navicular bone
A
  • foot slightly pulled forward on the block
  • centre 1 cm distal to the coronary band
  • proximal border
  • distal border
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22
Q

Forelimb

  • Palmaroproximal-Palarodistal Oblique view, Skyline view
A

Horse stands on a tunnel with foot positioned backwards

  • centre between the heel bulbs
  • 45-70* to horizontal, depending on the slope of the pastern and positioning
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23
Q

Forelimb

  • Dorso60*Lateral-PalmaroMedial oblique and Dorso60*Medial-PalmaroLateral oblique views
A

Foot on a block, dorsal hoof wall vertical

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24
Q

Forelimb

  • Navicular disease
A
  • complex pathology, involves the navicular bone and associated structures
  • navicular bursa
  • deep digital flexor tendon
  • distal sesamoidean impar ligament
  • collateral ligaments of the navicular bone
  • chondrosesamoidean ligament
  • X-rays cannot provide a complete picture
  • but certain radiological changes suggest soft tissue involvment
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25
Q

Laminitis

  • Position and preparations
A
  • position of the distal phalanx
  • should be parallel with the dorsal hoof wall
  • rotation, sinking
  • dorsal hoof wall thickness
  • radiolucent line - (serum - necrotic tissue)
  • remodelling of the toe
  • distance between the tow and the sole
  • Dorsal hoof wall - palmar length of the distal phalanx ration should be <27%
  • dorsal hoof wall thickness
  • should be less than 20 mm
  • depends on the breed
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26
Q

Forelimb

  • the Pastern, indications
A
  • suspected fracture
  • ringbone (visible/palpable thickening assumed to be causing pain)
  • lameness localised to the pastern region
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27
Q

Forelimb

  • the Pastern, istandard views
A
  • Lateromedial, dorsopalmar, DL-PaMO, DM-PaLO
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28
Q

Forelimb

  • The Fetlock, indications
A
  • lameness localised to the region
  • distension of the joint capsule, any other swelling
  • suspected fracture
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29
Q

Forelimb

  • The Fetlock, standard views
A
  • (flexed) lateromedial - axis of the fetlock often not parallel with the heel bulbs
  • Dorsopalmar - from 10* proximal to “lift” the proximal sesamoid bones off the joint space
  • DL-PaMO and DM-PaLO
  • flexed dorsopalmar view to highlifht the meacarpal condyles
  • dorsal half of the articular surface
  • oblique views of the sesamoid bones
  • eg Latero40Dorso70Proximal-mediopalmarodistal
  • Skyline of the saggital ridge
  • dorsoproximo-dorsodistal oblique
30
Q

Forelimb

  • The Fetlock, osteochondrosis dissecans
A
  • mostly but not only young horses
  • some only show clinical signs once developed OA
  • more common in the dorsal than palmar aspect
  • separation of small fragments
  • flattering or concacity of the sagittal ridge of McII
31
Q

Forelimb

  • The Fetlock, fractures
A
  • traumatic/stress related
  • short incomplete fractures of the proximal phalanx
  • sagittal fractures of the proximal phalanx - can be complete
32
Q

Forelimb

  • The Fetlock, Condylar fractures
A
  • racehorses and endurance horses
  • medial more likely to prpagate proximally
33
Q

Forelimb

  • the proximal metacarpal region, indications
A
  • lameness localised to the region
  • focal pain on palpation
  • enlargement/swelling over MvII/IV
34
Q

Forelimb

  • the proximal metacarpal region, standard views
A
  • lateromedial and dorsopalmar for McIII
  • oblique views for the splint bones
35
Q

Forelimb

  • the proximal metacarpal region, splint bones
A
  • fracture
  • exostosis
  • periosteal reaction from trauma
  • can be associated with previous fracture
  • often asymptomatic
36
Q

Forelimb

  • the Carpus, indications
A
  • lameness localised to the region
  • swelling, distension of the joint capsule or carpal sheat
37
Q

Forelimb

  • the Carpus, standard views
A
  • should include flexed LM to separate the carpal bones and their articular surfaces
  • lateromedial, flexed lateromedial, dorsopalmar, D45M-PaIO, Pa45L-DMO
  • skyline views to highlight the dorsal aspects of the carpal bones and the radius
38
Q

Forelimb

  • the Carpus, common traumas
A
  • sclerosis and fractures/fragments of the carpal bones
  • third carpal bone most commonly affected
  • osteoarthritis
  • osteochondroma/distal radial physeal exostosis
39
Q

Forelimb

  • radius, common fractures
A
  • complete fracture
  • incomplete fracture
  • often from a kick
  • there may be a puncture wound
40
Q

Forelimb

  • elbow, indications
A
  • fracture of olecranon
  • lamness localised to the region
41
Q

Forelimb

  • elbow, standard views
A
  • mediolateran and craniocaudal views
42
Q

Forelimb

  • Shoulder, indications
A
  • lameness localised to the area
  • lameness that cant be localised to a more distal region
43
Q

The neck

  • indications
A
  • ataxia, neck pain, abnormalities in the neck on clinical examination - often secondary
  • poor performance - rarely related to the neck
  • forelimb lameness that could not be localised with diagnosti analgesia
44
Q

The neck

  • preparations
A
  • from the occiput to T1 (T2)
  • standing, sedated horse
  • head on a stool, rope headcollar (no metal buckles)
  • horse has to stand square with the neck 100% straigh
  • Lateral-lateral radiographs
  • side closer to the plate is highlighted
  • oblique views of the articular process joints (lateroventral - laterodorsal)
45
Q

The neck

  • common findings
A
  • enlargement of the articular process joint of the caudal cervical vertebra
  • pain - articular pain and pain due to nerve root compression
  • ataxia - if compression on the spinal cord
  • (lameness)
  • enlargement of the C5-C6 and C6-C7 vertebrae very common, often no clinical consequences
46
Q

The Neck

  • sagittal diameter measurements, ratios
A
  • if abnormal, can indicate spinal cord compression
  • normal values are published
  • Minimum saggital diameter:
  • height of the narrowest part of the intervertebral foramen
  • intravertebral saggital ratio:
  • minimum saggital diameter / dorsoventral height of the body of the same vertebra
  • Intervertebral saggital ratio:
  • heigh of the foramen between adjacent vertebra / height of vertebral body
47
Q

The Neck

  • myelography
A
  • contrast medium into vertebral canal (atlantooccipital puncture)
  • under general anaesthesia
  • latero-lateral and dorsoventral radiographs
  • neck in neutral and flexed and extended positions (static and dynamic lesions)
  • recent evidence:
  • myelography can be unreliable
  • semiquantitative evaluation of plain radiographs may be more accurate
  • Computed tomography may be superior:
  • standing horse - more cranial lesions
  • more caudal lesions and myelography - under general anaesthesia
48
Q

Types of MRI

A
  • Closed magnet
  • Since 1990´s
  • under general anaesthesia
  • 1,5-3 Tesla
  • Open magnet for the standing horse
  • Since 2002
  • under sedation
  • 0.27 Tesla
49
Q

MRI

  • what types of structures can you see
A
  • bony and soft tissue
  • thin slices in 3 dimensions
  • different sequences highlight different tissues and types of lesions
  • increased/decreased signal intensity or hyperintense/hypointense signa
50
Q

High- and Low-field MRI

A

High field MRI

  • more details
  • better resolution
  • thinner slices (1.5mm)
  • movement less of an issue
  • risk of general anaesthesia

Low field MRI

  • could potentially miss small lesions
  • lower resolution
  • thicker slices (5mm)
  • movement can ven prohibit image acquisition
51
Q

MRI - indications

A
  • if lameness can´t be explanied by findings of conventional diagnostic imaging
  • most commonly imaged region is the foot
  • possible up to carpus and hock (stifle)
  • time consuming
  • 2 feet: 2-4 hr
  • only a small area can be examined
  • multiple sequences
  • hundreds of images
  • interpretation requires specialist knowledge
52
Q

MRI - preparations

A
  • remocal of shoes and clenches
  • double check on radiographs
53
Q

MRI advantages and limitations

A

Advantages:

  • excellent details of bones and soft tissues
  • can be done in a standing horse

Limitations

  • time consuming, only small area can be examined
  • susceptible to artefacts
  • movement
  • metal
  • magic angle artefact
  • cant do guided injections
54
Q

What are CT (Computed tomography)

A
  • ´3 dimensional x-ray´
  • uses x-rays to build cross sectional images “slices”
  • emitter of x-rays rotates around the patient: detector on the opposite side
  • image based on difference in absorption in the imaged plane
55
Q

CT

  • slicing vs continuous
A
  • Slicing CT: 5-15 min
  • Continous
  • spiral 30-60 sec
  • multiclice, multidetector spiral CT: 5-15 sec
56
Q

CT

  • Hounsfield unit (HU) scale
A
  • measures radiodensity
  • calculated from attenuation coefficient
  • calibrated to water (0 value)
  • tissues have stablished HU´s
57
Q

CT - windowing

A
  • a range of the grayscale is selected in order to improve resolution within one tissue type
  • upper and lower levels of HU set
  • everything above the upper level is white
  • everything below the lower level is black
58
Q

Usage of CT

A
  • traditionally for osseous lesions
  • with changing the window and the contrast, soft tissue lesions can also be diagnosed
59
Q

CT - description of images

A
  • Low density / hypoatteniating
  • air, water
  • oedema, necrosis
  • High density / hyperattenuating
  • bone
  • hyperaemia, recent bleeding, contrast
  • contrast-enhanced CT
  • iodine based contrast
  • improves sensitivity to detect soft tissue lesions
  • assessment of angiogenesis
60
Q

CT - indications

A
  • fracture, preoperative planning
  • localised lameness not explained by radiography and ultrasonography
  • ataxia, clinical signs suggesting neck pain, no abnormalities on radiographs or not sufficient explanation
61
Q

CT

  • advantages and limitations
A

Advantages:

  • very wuick
  • excellent information on bones
  • allows guided injections
  • pre-operative planning

Limitations:

  • for limbs: general anaesthesia - few exceptions
  • less information about soft tissues than MRI
62
Q

CT or MRI for orthopaedic reasons?

A

MRI

  • in standing sedation
  • bone and soft tissue injury
  • neck - only cranial aspect
  • time consuming

CT

  • general anaesthesia for limbs
  • fractures, planning
  • neck: standing, depends on the CT even C7
  • very quick
63
Q

Scintigraphy

A
  • principle: detection of gamma rays
  • radiopharmaceutical - Tc99m - methylene diphosphonate
  • binds to hydroxyapatite of the bone
  • uptake influenced by osteoblastic activity and perfusion
  • information about function of organs
  • mostly for osseous injuries
  • the entire horse can be imaged
  • ionising radiation - shouldnt be used as screening method
  • sensitivity for bone injuries > specificity
  • poor spatial resolution
  • can localise abnormal activity but further imaging is often needed to specify the type and extent of the lesion
64
Q

Scintigraphy

  • indications
A

Most important indication:

  • suspicion of stress fractures in racehorses

Other indications:

  • stress-related injuries in racehorses and sports horses
  • poor performance in racehorses
  • multilimb lameness
  • lameness that cant be localised
65
Q

Scintigraphy

  • patient preparation
A
  • exercise - lunging
  • bandaging, taping feet
  • IV catheter
  • injection of the radiopharmaceutical
  • 1 GBq/100 kg bwt
  • furosemide
66
Q

Scintigraphy

  • equipment
A
  • overhead gantry system
  • hydraulic carco crane system
67
Q

Scintigraphy

  • image acquisition
A
  • distance from the camera
  • inverse square low
  • motion
  • static
  • dynamic
68
Q

Scintigraphy

  • image interpretation
A
  • in light of clinical and other findings
  • increased radiopharmaceutical uptake (IRU)
  • IRU normal/abnormal
  • IRU is not the same as source of pain
  • subjective and objective evaluation
  • Objective: Region Of Interest (ROI) analysis
69
Q

Scintigraphy

  • advantages and limitations
A

Advantages:

  • early detection of stress fractures
  • entire horse can be examined

Limitations

  • not useful for soft tissue injuries
  • false negative results
  • limited use in sports horses
  • radiation
70
Q
A

Equine MS (1 decks)

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