MAGNETIC RESONANCE IMAGING OF THE INITIAL ACTIVE STAGE OF EQUINE LAMINITIS AT 4.7 T

Anaesthesia-related morbidity associated with recumbent, low-field magnetic resonance imaging of horses

CASE HISTORY

Medical records from 2009 to 2021 from a private equine referral hospital in Rochester, NH, USA were analysed for cases that underwent general anaesthesia for low-field MRI of the distal limb. These were used to determine peri-anaesthetic morbidity and mortality.

CLINICAL FINDINGS AND OUTCOME

Two hundred and forty-three anaesthetic episodes were recorded in horses undergoing low-field MRI. The peri-anaesthetic complication rate prior to discharge was 6.2% (15/243). No patients experienced a fatal complication. Ninety two of the 243 patients had multiple sites imaged, 90/243 received pre-anaesthetic dantrolene, 134/243 received intra-anaesthetic dobutamine, and 15/243 were positioned in dorsal recumbency. Complications included: abdominal discomfort ("colic"; 9/243), myopathy (4/243), hyphaema (1/243) and carpal fracture (1/243). At the time of discharge, 14/15 complications had resolved. Of 135 horses for which data were available 55 became hypotensive during the procedure (lowest mean arterial pressure < 65 mmHg). Median body weight was 553 (min 363, max 771) kg. Horses were anaesthetised for a median of 150 (min 45, max 210) minutes. There was no evidence of an association between higher body weight (p = 0.051) or longer duration of anaesthesia (p = 0.421) and development of an anaesthetic complication. For categorical variables (dantrolene administration pre-anaesthesia, dobutamine administration during anaesthesia, hypotension (mean < 65 mmHg) during anaesthesia, dorsal vs. lateral recumbency, and imaging of single vs. multiple sites), the 95% CI for the OR included 1, indicating a lack of effect of the variable on the odds of complication.

CLINICAL RELEVANCE

The cases included in this series suggest that low-field MRI under general anaesthesia is a viable option for diagnostic imaging in otherwise healthy horses. Complications occur, but most resolve before discharge.

The influence of equine hoof conformation on the initiation and progression of laminitis

BACKGROUND

The health and performance of horses are significantly affected by diseases associated with the hoof. Laminitis is a critical hoof disease that causes pain and, potentially, severe hoof and bone pathology.

OBJECTIVE

To generate an equine hoof finite element (FE) model to investigate the impact of normal and toe-in hoof conformations on the degeneration (decrease in elastic modulus) of the laminar junction (LJ), as occurs in chronic laminitis.

STUDY DESIGN

Computer software modelling.

METHODS

A hoof FE model was generated to investigate the biomechanics of hoof laminitis. A 3D model, consisting of nine components, was constructed from computed tomography scans of an equine left forelimb hoof. The model was loaded with 100 cycles of trotting. Two different centres of pressure (COP) paths representing normal and toe-in conformations were assigned to the model. LJ injury was modelled by degenerating the tissue's elastic modulus in the presence of excessive maximum principal stresses.

RESULTS

FE models successfully showed findings similar to clinical observations, confirming third phalanx (P3) dorsal rotation, a symmetric distal displacement of the P3 (2 mm at the lateral and medial sides) in the normal model, and an asymmetric distal displacement of the P3 (4 mm at the lateral and 1.5 mm at the medial side) in the toe-in model. The proximal distance between P3 and the ground after LJ degeneration in the current model was significantly different from experimental measurements from healthy hooves (P < 0.01).

MAIN LIMITATIONS

The inability to account for variations in population geometry and approximation of boundary conditions and system relations were the limitations of the current study.

CONCLUSIONS

The distribution of LJ tissue degeneration was symmetric at the quarters in the normal hoof and in comparison, there was a lateral concentration of degeneration in the toe-in model.

Transmural Ultrasonography in the Evaluation of Horse Hoof Internal Structures: Comparative Quantitative Findings-Part 2

The transmural ultrasound allows for the definition of the normal appearance of the hoof tissues and internal structures. Determining such measurements and proportions could contribute to evaluations of the normal spatial distal phalanx-hoof relationship. The objective was to describe the hoof's dermis and epidermis measurements using the transmural technique, in comparison with DR and anatomical sections. Sixty-two healthy hooves without digital radiographic abnormalities, made up of 30 anatomical pieces (phase 1) and 32 alive horse hooves (phase 2), and 16 sagittal sections of the first ones were used. The proximal and distal planes were compared, defining the following measurements: coronary band-extensor process, distal phalanx apex-hoof wall, sole dermis, middle stratum, parietal dermis, lamellar layer, the sublamellar dermis, and ratios between them. Most of the measurements were consistent among methods. Some showed measurement differences and a minority was impossible to determine. The transmural technique allowed for the observation and replication of measurements of the hoof structures, described with other diagnostic aids. It also allowed for the implementation of new measurements that would help to determine the spatial location of the distal phalanx. Additionally, it contributes to the visualization of normal findings, which will be useful to compare variations in the different phases of laminitis.

Transmural Ultrasonography in the Evaluation of Horse Hoof Internal Structures: Comparative Qualitative Findings-Part 1

Ultrasonography is commonly used to evaluate equine lameness-related structures, but traditional hoof approaches cannot adequately visualize internal structures such as the lamellar layer. To address this limitation, we used 62 healthy hooves without digital radiographic abnormalities, made up of thirty anatomical pieces (phase 1) and thirty-two hooves from living horses (phase 2). In both phases, half of the digits were submerged in water (group 1) and the other half in water and ice (group 2) for 24 h. Ultrasonographic views and temperature and humidity measurements were taken every two hours, and sagittal sections were obtained in phase 1. Good quality images were obtained in both phases. The transmural technique allowed the evaluation of several structures of the DEJ (tubular and lamellar strata of the hoof wall, sublamellar dermis, and solar and coronary papillae) and of the distal phalanx (extensor process, parietal surface, and apex). Our findings suggest that the transmural technique following hoof submersion can be useful for internal evaluation of hoof conditions, such as laminitis. However, further validation of the technique in natural or experimental cases is required.

Measurement accuracy of foot conformation parameters on low-field magnetic resonance images in horses

BACKGROUND

Foot imbalance and malalignment of the digits are common in horses. Angle and distance measurements performed on bones, joints and hoof wall on radiographs provide essential guidance for precise corrective trimming and shoeing. This study aimed to investigate, if selected standing low-field magnetic resonance (MR) images can be used to accurately measure dorsopalmar and lateromedial foot conformation parameters in comparison to the radiographic gold standard.

METHODS

Images of 100 horses referred for standing low-field MR examination were selected. Foot conformation angles and distances were measured and compared between radiographs and MR images.

RESULTS

Measurements from most imaging sources were significantly different from each other. Moderate to high correlation of foot conformation angles between radiographs and MR images in the lateromedial and dorsopalmar planes was found, with exception of the proximal interphalangeal joint angle, where there was only moderate agreement between radiographs and the 5-plane MR pilot (0.47, p<0.001) and between radiographs and the 3-plane MR pilot (0.4, p<0.001), respectively.

CONCLUSION

Measurement of foot conformation parameters from low-field MR images should be used with caution in clinical practice and acquisition of current foot radiographs immediately before or after MR examination should be considered to facilitate precise trimming and shoeing.

Quantitative magnetic resonance imaging and histological hoof wall assessment of 3-year-old Quarter Horses

BACKGROUND

Few noninvasive methods are available for equine hoof wall evaluation. The highly organised wall structures and composition of proteoglycans and collagens may make this region amenable to quantitative MRI (qMRI) techniques of T1ρ and T2 mapping to identify pathology related to proteoglycan content and collagen organisation respectively.

OBJECTIVE

To establish normative T1ρ and T2 values of the equine hoof wall of 3-year-old Quarter Horses with histological comparison.

STUDY DESIGN

Cadaveric anatomical study.

METHODS

Six cadaveric left thoracic feet from 3-year-old racing Quarter Horses with no reported lameness were evaluated using T1ρ and T2 mapping. Mapping was performed at six regions of interest at the toe of each hoof including proximal and distal regions of the inner epidermis, stratum lamellatum and corium. Histology was evaluated for standard hoof morphology and proteoglycan staining.

RESULTS

T2 values of the stratum lamellatum and corium were similar (42.9 [95% CI: 41.6-44.2] ms and 44 [95% CI: 42.7-45.3] ms respectively), but both were significantly different to the inner epidermis (35.8 [95% CI: 34.5-37.1] ms, P<0.001). T1ρ values for the inner epidermis, stratum lamellatum and corium were significantly different (25.1 [95% CI: 23.1-27.1] ms, 44.4 [95% CI: 42.4-46.4] ms and 50.1 [95% CI: 48.1-52.1] ms, respectively, P<0.001). Histology demonstrated normal organised morphology. Proteoglycan staining was only visible in the stratum lamellatum and corium.

MAIN LIMITATIONS

Cadaveric study with frozen samples used.

CONCLUSIONS

Variation of qMRI metrics through the depth of the equine hoof wall was found. Although the highly ordered environment of collagen may contribute to T2 values, there was lack of evidence to support proteoglycan content as a major contributor of T1ρ values. It is possible T1ρ values had a greater dependence on total water content as the lowest values were seen in the epidermis. Additional research using qMRI is needed to determine mapping values in different disease states.

Characteristic findings of magnetic resonance imaging (MRI) and computed tomography (CT) for severe chronic laminitis in a Thoroughbred horse

A Thoroughbred horse with severe chronic laminitis of both forelimbs was evaluated on the same day with magnetic resonance imaging (MRI) and computed tomography (CT). Both MRI and CT revealed loss of the dorsal aspect of the cortical bone of the 3rd phalanx and sclerosis. CT reflected the status of the horny layer and bone of the affected feet, while MRI depicted inflammation of the laminar corium, together with tendon edema. On the 3-dimensional CT venogram, vessels were visualized in both the right and left forelimbs, although there was a difference in the vasculature of the coronary plexus and circumflex vessels between the right and left forelimbs. A combination of both MRI and CT provides detailed information regarding pathological conditions.

RADIOGRAPHIC AND ANATOMIC CHARACTERISTICS OF DORSAL HOOF WALL LAYERS IN NONLAMINITIC HORSES

Early radiographic diagnosis of acute laminitis is important for treatment planning and prognosis in horses. While four histopathologic layers make up the hoof wall, only two layers are distinguished on digital radiographs of horses' hooves. Objectives of this descriptive study were to determine which macroscopic layers correspond to the two radiographically visible layers, and to describe radiographic layer measurements in a group of clinically sound Warmblood horses. Twelve ex vivo equine hooves were examined at three different levels of the dorsal hoof wall. The four macroscopic layers were variably grouped and compared with radiographic layers. Stratum externum and stratum medium represented the superficial radiographic layer while stratum internum and dermis parietis represented the deep layer. In 27 clinically sound horses (54 thoracic feet), the superficial radiographic layer represented 64.3% ± 3.6% of the total dorsal hoof wall. Findings from this study provided baseline information for future studies of horses with acute laminitis.

Osteopathology in the Equine Distal Phalanx Associated With the Development and Progression of Laminitis

Although the equine distal phalanx and hoof lamellae are biomechanically and physiologically integrated, bony changes in the distal phalanx are poorly described in laminitis. The aims of this study were (1) to establish a laminitis grading scheme that can be applied to the wide spectrum of lesions seen in naturally occurring cases and (2) to measure and describe changes in the distal phalanx associated with laminitis using micro-computed tomography (micro-CT) and histology. Thirty-six laminitic and normal feet from 15 performance and nonperformance horses were evaluated. A laminitis grading scheme based on radiographic, gross, histopathologic, and temporal parameters was developed. Laminitis severity grades generated by this scheme correlated well with clinical severity and coincided with decreased distal phalanx bone volume and density as measured by micro-CT. Laminitic hoof wall changes included progressive ventral rotation and distal displacement of the distal phalanx with increased thickness of the stratum internum-corium tissues with lamellar wedge formation. Histologically, there was epidermal lamellar necrosis with basement membrane separation and dysplastic regeneration, including acanthosis and hyperkeratosis, corresponding to the lamellar wedge. The changes detected by micro-CT corresponded to microscopic findings in the bone, including osteoclastic osteolysis of trabecular and osteonal bone with medullary inflammation and fibrosis. Bone changes were identified in horses with mild/early stages of laminitis as well as severe/chronic stages. The authors conclude that distal phalangeal pathology is a quantifiable and significant component of laminitis pathology and may have important implications for early detection or therapeutic intervention of equine laminitis.

Quantitative assessment of the equine hoof using digital radiography and magnetic resonance imaging

REASONS FOR PERFORMING STUDY

Evaluation of laminitis cases relies on radiographic measurements of the equine foot. Reference values have not been established for all layers of the foot.

OBJECTIVES

To establish normal hoof wall and sole measurements using digital radiography (DR) and magnetic resonance imaging (MRI) and to document tissue components present in the dorsal hoof wall and solar layers seen on DR.

STUDY DESIGN

Prospective observational case-control study.

METHODS

Digital radiography and MRI were performed on 50 cadaver front feet from 25 horses subjected to euthanasia for nonlameness-related reasons. Four observers measured hoof wall (dorsal, lateral and medial) and sole thickness (sagittal, lateral and medial) using DR and magnetic resonance images. One observer repeated the measurements 3 times. Inter- and intraobserver correlation was assessed.

RESULTS

Digital radiography and MRI measurements for the normal hoof wall and sole were established. Inter- and intraobserver pairwise Pearson's correlation for DR (r>0.98) and MRI measurements (r>0.99) was excellent. Based on MRI, the less radiopaque layer on DR is comprised of the stratum lamellatum and stratum reticulare.

CONCLUSIONS

Normal DR and MRI measurements for the hoof wall and sole were established. On DR images, the less radiopaque layer of the foot observed corresponds to the critical tissues injured in laminitis, the strata lamellatum and reticulare. These reference measurements may be used by the clinician to detect soft-tissue changes in the laminitic equine foot and provide a foundation for future research determining changes in these measurements in horses with laminitis.

Impact of successive freezing-thawing cycles on 3-T magnetic resonance images of the digits of isolated equine limbs

OBJECTIVE

To assess the impact of cycles of freezing and thawing on magnetic resonance (MR) images (obtained by use of a 3-T magnet) of equine feet examined ex vivo.

SAMPLE

9 forelimbs from 9 horse cadavers.

PROCEDURES

9 forefeet underwent MR imaging first at ambient temperature within 12 hours after the horses' death and then after each freezing-thawing cycle. Three digits underwent freezing and thawing (at 4°C for 36 hours) 2 times, 3 digits underwent freezing and thawing (at 4°C for 36 hours) once and rescanning after 24 hours at ambient temperature, and 3 digits underwent freezing and thawing at ambient temperature for 24 hours once. Images of the digits obtained prior to freezing were subjectively compared with images obtained after freezing and thawing. Changes in the signal-to-noise ratio between examinations were assessed.

RESULTS

Overall image quality was considered unchanged except for the hoof capsule. Quantitative analysis revealed signal-to-noise ratio changes in bone marrow, soft tissues, and hoof capsule induced with both thawing processes. The signal-to-noise ratio in the synovial recess of the distal interphalangeal joint significantly increased as a result of thawing at 4°C.

CONCLUSIONS AND CLINICAL RELEVANCE

Although overall image quality was considered unchanged except for the hoof capsule, results suggested that changes induced in cadaver limbs following freezing and thawing, which are probably attributable both to modified and inhomogeneous temperature distribution and direct tissue damage, may alter the reliability of signal intensity in ex vivo MR examinations.

Magnetic resonance signal changes during time in equine limbs refrigerated at 4 degrees C

When ex vivo magnetic resonance (MR) imaging studies are undertaken, specimen conservation should be taken into account when interpreting MR imaging results. The purpose of this study was to assess MR changes during time in the anatomic structures of the equine digit on eight cadaver limbs stored at 4 degrees C. The digits were imaged within 12 h after death and then after 1, 2, 7, and 14 days of refrigeration. After the last examination, four feet were warmed at room temperature for 24 h and reimaged. Sequences used were turbo spin echo (TSE) T1, TSE T2, short tau inversion recovery (STIR), and double-echo steady state (DESS). Images obtained were compared subjectively side by side for image quality and signal changes. Signal-to-noise ratio (SNR) was measured and compared between examinations. There were no subjective changes in image quality. A mild size reduction of the synovial recesses was detected subjectively. No signal change was seen subjectively except for bone marrow that appeared slightly hyperintense in STIR and slightly hypointense in TSE T2 sequence after refrigeration compared with day 0. Using quantitative analysis, significant SNR changes in bone marrow of refrigerated limbs compared with day 0 were detected in STIR and TSE T2 sequences. Warming at room temperature for 24 h produced a reverse effect on SNR compared with refrigeration with a significant increase in SNR in TSE T2 images. After 14 days of refrigeration a statistically significant decrease of SNR was found in bone marrow in TSE T2 and DESS sequences. The SNR in the deep digital flexor tendon was not characterized by significant change in SNR.