EFFECT OF CONTRAST MEDIUM INJECTION DURATION ON PEAK ENHANCEMENT AND TIME TO PEAK ENHANCEMENT OF CANINE PULMONARY ARTERIES

Use of a cavitron ultrasonic surgical aspirator for parenchyma-sparing and complex liver resections in dogs

OBJECTIVE

To report the clinical use of a cavitron ultrasonic surgical aspirator (CUSA) for the resection of hepatic lesions in dogs.

STUDY DESIGN

Clinical prospective study.

ANIMALS

Eleven client-owned dogs.

METHODS

Dogs requiring a hepatic nodulectomy, segmentectomy, and/or a lobectomy (including complex lobectomies) were enrolled. The number and location of procedures, blood loss, duration of surgery, and short-term complications were recorded.

RESULTS

Dogs underwent a mean of 2.3 ± 1.1 procedures. All masses were amenable to surgical excision regardless of their location and their relationship with major hepatic vessels. Dogs lost a median of 77 mL of blood (9.9-161), which corresponded to 4.3% of blood volume (0.8%-23.2%). The dog with the highest blood loss survived without requiring transfusion. The median duration of all CUSA procedures was 33.5 minutes (15-82). Short-term outcomes were assessed for the first 15 days, during which two complications were diagnosed. Cholangiohepatitis was diagnosed in one dog and resolved after medical management, and another dog developed necrotic pancreatitis and died.

CONCLUSION

Liver parenchyma-sparing nodulectomies and segmentectomies and liver lobectomies including complex lobectomies were achieved with a CUSA in all dogs.

CLINICAL SIGNIFICANCE

Use of a CUSA can be considered as an alternative for the removal of hepatic lesions in dogs.

Effects of airway pressure on contrast enhancement and diameter of the pulmonary artery in healthy dogs as determined by use of computed tomography angiography

OBJECTIVE

To evaluate effects of airway pressure on contrast enhancement and diameter of the pulmonary artery and determine the optimal airway pressure for pulmonary CT angiography in dogs.

ANIMALS

8 healthy Beagles.

PROCEDURES

Thoracic CT was performed at end-expiration (0 cm H₂O) and 2 positive-pressure end-inspirations (10 and 20 cm H₂O). Attenuation curves of enhancement for the sinus of the pulmonary trunk artery were obtained by use of a bolus technique. Contrast medium (300 mg of I/kg) was administered IV, and CT imaging began at the time of peak enhancement. At each pressure, time to peak enhancement, ratio of blood flow from the caudal vena cava to the right side of the heart (K_CdVC), and enhancement characteristics and diameter changes of the pulmonary artery were evaluated.

RESULTS

All dogs had a significant delay for time to peak enhancement in the sinus of the pulmonary trunk artery as airway pressure increased. The K_CdVC progressively increased as airway pressure increased, and there was low contrast enhancement and increased pulmonary artery filling defects at 20 cm H₂O. All pulmonary arteries had marked increases in diameter as pressure increased. Arterial distensibility in the gravity-dependent cranial lung region was greater than that in the gravity-independent caudal lung region at the 2 positive-pressure end-inspirations.

CONCLUSIONS AND CLINICAL RELEVANCE

Airway pressure affected time to peak enhancement, K_CdVC, contrast enhancement, and pulmonary artery diameter. Results suggested that 10 cm H₂O could be an optimal pressure for evaluation of the pulmonary artery of dogs by use of CT angiography. (Am J Vet Res 2019;80;756-763).

Thoracic computed tomographic interpretation for clinicians to aid in the diagnosis of dogs and cats with respiratory disease

In humans, high-resolution computed tomography (CT) is a key diagnostic modality for pulmonary disorders. Its success likely lies in excellent correlation of lung diseases with associated subgross anatomic changes, as assessed by histopathology, and because of a multidisciplinary approach between clinicians, radiologists and pathologists. Although thoracic CT studies have been performed in dogs and cats for nearly three decades, there is a lack of uniformity in both protocols for acquisition and in terminology used to describe lesions. Importantly, terms such as a bronchial, interstitial, and alveolar patterns are inappropriate descriptors for canine and feline thoracic CT imaging changes; instead, lung patterns should be classified as increased or decreased attenuation, nodular patterns, and linear patterns, with specific vocabulary to describe subtypes of lesions. In this manuscript, the authors provide an overview of basic CT principles, strategies to optimize and acquire high-quality diagnostic studies (inclusive of paired inspiratory and expiratory series, contrast and triphasic angiography) and provide a roadmap for systematic interpretation of thoracic CT images.

Effect of contrast medium injection rate on computed tomography-derived renal perfusion estimates obtained with the maximum slope method in healthy

OBJECTIVE To evaluate the effect of contrast medium injection rate on CT-derived renal perfusion estimates obtained with the maximum slope method in healthy small dogs. ANIMALS 6 healthy sexually intact male purpose-bred Beagles. PROCEDURES All dogs underwent CT perfusion analysis 3 times in a crossover design, receiving a different contrast medium injection rate (1.5, 3.0, and 4.5 mL/s) each time, with a 1-week interval between imaging sessions. All CT images were obtained at the level of the left renal hilus. The time to peak aortic enhancement (TPAE) and time to initial renal venous enhancement (TIRVE) were measured from time-attenuation curves. The renal CT perfusion estimates (blood flow and blood volume) were estimated by use of the maximum slope method, which assumes no venous outflow of contrast medium during CT perfusion analysis. RESULTS The TPAE occurred at or before the TIRVE at all injection rates. Median values of estimated blood flow and blood volume did not differ significantly among injection rates. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that the assumption of no venous outflow of contrast medium during renal CT perfusion analysis with the maximum slope method was satisfied for all 3 contrast medium injection rates in the evaluated dogs. A low injection rate may be more practical than higher injection rates that require large catheters for CT perfusion analysis in small dogs such as Beagles.

Influence of injection protocol and measurement technique on computed tomographic assessment of glomerular filtration rate in healthy Beagles

OBJECTIVE To compare values of CT-derived glomerular filtration rate (GFR) determined by 3 contrast-medium injection protocols and 4 measurement techniques in healthy Beagles. ANIMALS 9 healthy Beagles (mean ± SD weight, 13.2 ± 1.6 kg). PROCEDURES Each dog underwent 3 iohexol-injection protocols (700 mg of iodine/kg administered at a constant rate over 20 seconds, 700 mg of iodine/kg administered following an exponentially decelerated injection over 20 seconds, and 350 mg of iodine/kg at a constant rate over 10 seconds) during dynamic, whole renal-volume CT in randomized order with an interval of ≥ 7 days between experiments. Values of GFR determined from Patlak plots derived by use of 4 measurement techniques (standard transverse section, optimized transverse section, dorsal reconstruction, and volume calculation techniques) were compared. RESULTS The measurement technique influenced the mean ± SD GFR results (standard transverse section technique, 2.49 ± 0.54 mL/kg/min; optimized transverse section technique, 2.72 ± 0.52 mL/kg/min; dorsal reconstruction technique, 3.00 ± 0.60 mL/kg/min, and volume calculation technique, 2.48 ± 0.51 mL/kg/min). The lower iodine dose resulted in a significantly higher GFR value (3.00 ± 0.65 mL/kg/min), compared with that achieved with either higher dose administration (constant rate injection, 2.54 ± 0.45 mL/kg/min and exponentially decelerated injection, 2.47 ± 0.48 mL/kg/min). CONCLUSIONS AND CLINICAL RELEVANCE In healthy Beagles, the CT-derived GFR measurements obtained after injection of a full dose of contrast medium were reduced, compared with measurements obtained after injection of a half dose. This finding is important with regard to potential nephrotoxicosis in dogs with impaired renal function and for GFR measurement with CT-contrast medium protocols.

Estimation of time to peak contrast enhancement of the aorta and liver for dual-phase computed tomography on the basis of contrast medium arrival time, injection duration, and injection technique in dogs

OBJECTIVE To evaluate the accuracy of estimating time to peak enhancement (TPE) of the aorta and liver parenchyma on the basis of contrast medium arrival time in the aorta, injection duration, and injection technique in dogs. ANIMALS 18 dogs of specific body weight categories (≥ 2 dogs/category) with no liver abnormalities detected via CT. PROCEDURES Dogs were randomly assigned within weight categories to receive contrast medium IV at a fixed injection rate (5 mL/s) or fixed injection duration (20 seconds). Time-contrast attenuation curves were generated from dynamic CT scans acquired at the hepatic hilus. Data collected for contrast medium arrival time and injection duration were used to estimate TPEs of the aorta and liver, and results were compared with the observed TPEs for the aorta and liver. RESULTS Contrast medium arrival time, injection duration, and injection technique were significantly associated with observed values for aortic TPE and explained 96.1% of variation in TPE. For the fixed rate technique, the regression equation for estimating aortic TPE was 0.8 × (injection duration + contrast medium arrival time) + 1.6. For the fixed duration technique, the regression equation changed by only the constant (-2.6). However, the hepatic TPE estimated from the 3 predictor variables was not significantly different from the mean of observed TPEs. CONCLUSIONS AND CLINICAL RELEVANCE Aortic TPE could be accurately estimated from contrast medium arrival time, injection duration, and injection technique in dogs with apparently healthy livers. The regression equations derived from this relationship can be used to improve the efficiency of dual-phase CT of the liver in dogs.

Effects of contrast medium injection technique on attenuation values of adrenal glands in healthy dogs during contrast-enhanced computed tomography

OBJECTIVE

To assess the effects of 3 contrast medium injection techniques on attenuation values for canine adrenal glands during contrast-enhanced CT.

ANIMALS

9 healthy Beagles.

PROCEDURES

3 protocols were evaluated in a randomized cross-over design study: 700 mg of iodine/kg at a constant injection rate over 20 seconds (full-dose constant rate), the same dose at a rate following an exponential decay curve over 20 seconds (full-dose decelerated rate), and 350 mg of iodine/kg at a constant injection rate over 10 seconds (half-dose constant rate). Multislice CT images were obtained before and at predetermined time points after the start of contrast medium injection.

RESULTS

Median peak attenuation values were 129, 133, and 87 Hounsfield units with the full-dose constant rate, full-dose decelerated rate, and half-dose constant rate injection protocols, respectively. Peak attenuation differed significantly between the full-dose constant rate and half-dose constant rate injection protocols and between the full-dose decelerated rate and half-dose constant rate injection protocols. Median time to peak attenuation did not differ significantly among injection methods and was 30, 23, and 15 seconds for the full-dose constant rate, full-dose decelerated rate, and half-dose constant rate injections, respectively.

CONCLUSIONS AND CLINICAL RELEVANCE

The dose of contrast medium and the timing of postinjection CT scanning were main determinants of peak attenuation for adrenal glands in healthy dogs; effects of the 3 injection protocols on attenuation were minor. The exponentially decelerated injection method was subjectively complex. A constant injection protocol delivering 700 mg of iodine/kg over 20 seconds, with scans obtained approximately 30 seconds after starting contrast medium injection, provided images with maximum adrenal gland attenuation values.

Dynamic computed tomographic determination of scan delay for use in performing cardiac angiography in clinically normal dogs

OBJECTIVE

To determine the scan delay for use in performing cardiac CT angiography in dogs.

ANIMALS

4 clinically normal adult Beagles.

PROCEDURES

In a crossover study, 12 formulations of iohexol solutions differing in iodine dose (300, 400, and 800 mg/kg) and concentration (undiluted and diluted 1:1, 1:2, and 1:3 with saline [0.9% NaCl] solution) were administered IV to each dog. Dynamic CT angiography was performed to evaluate enhancement characteristics of each formulation, with the region of interest set over the aorta. Time-attenuation curves (TACs) were obtained and analyzed.

RESULTS

Peak arc-type TACs were obtained after administration of all undiluted formulations. Curve shape changed from peak arc type to plateau type as the total volume of the contrast solution (ie, dilution) increased. Prolonged peaks characteristic of plateau-type TACs suggested that a sufficient period of homogeneous attenuation could be achieved for CT scanning with administration of higher iohexol dilutions (1:2 or 1:3) containing higher iodine doses (400 or 800 mg/kg). In particular, attenuation values for plateau-type TACs remained between 200 and 300 Hounsfield units for > 16 seconds after the plateau endpoint was reached for 1:2 and 1:3 dilutions containing an iodine dose of 800 mg/kg. Scan delays of 13 to 17 seconds were computed for those 2 formulations.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that for clinically normal dogs, a scan delay of 13 to 17 seconds could be used to perform cardiac CT angiography with iohexol solutions containing an iodine dose of 800 mg/kg at dilutions of 1:2 or 1:3.

The comparison of bolus tracking and test bolus techniques for computed tomography thoracic angiography in healthy beagles

Computed tomography thoracic angiography studies were performed on five adult beagles using the bolus tracking (BT) technique and the test bolus (TB) technique, which were performed at least two weeks apart. For the BT technique, 2 mL/kg of 300 mgI/mL iodinated contrast agent was injected intravenously. Scans were initiated when the contrast in the aorta reached 150 Hounsfield units (HU). For the TB technique, the dogs received a test dose of 15% of 2 mL/kg of 300 mgI/mL iodinated contrast agent, followed by a series of low dose sequential scans. The full dose of the contrast agent was then administered and the scans were conducted at optimal times as identified from time attenuation curves. Mean attenuation in HU was measured in the aorta (Ao) and right caudal pulmonary artery (rCPA). Additional observations included the study duration, milliAmpere (mA), computed tomography dose index volume (CTDI[vol]) and dose length product (DLP). The attenuation in the Ao (BT = 660 52 HU ± 138 49 HU, TB = 469 82 HU ± 199 52 HU, p = 0.13) and in the rCPA (BT = 606 34 HU ± 143 37 HU, TB = 413 72 HU ± 174.99 HU, p = 0.28) did not differ significantly between the two techniques. The BT technique was conducted in a significantly shorter time period than the TB technique (p = 0.03). The mean mA for the BT technique was significantly lower than the TB technique (p = 0.03), as was the mean CTDI(vol) (p = 0.001). The mean DLP did not differ significantly between the two techniques (p = 0.17). No preference was given to either technique when evaluating the Ao or rCPA but the BT technique was shown to be shorter in duration and resulted in less DLP than the TB technique.

Comparison between bolus tracking and timing-bolus techniques for renal computed tomographic angiography in normal cats

Renal dual-phase computed tomograpic angiography (CTA) is used to assess suitability of feline donors prior to transplantation. A prerequisite for successful CTA is optimal synchronization between the arterial passage of contrast material and CT data acquisition. This retrospective study was conducted to compare quality of renal vascular enhancement at dual-phase CTA in normal cats between two techniques of timing of data acquisition: the timing-bolus and the bolus tracking method. Nine cats were scanned using the timing-bolus technique and 14 with the bolus tracking technique using otherwise similar scanning parameters in a 16-slice multidetector row CT scanner. The quality of enhancement of the renal vessels at the scanned arterial phase and venous phase was assessed both subjectively and objectively by three board-certified radiologists. Arterial enhancement was not observed at the scanned arterial phase in three of the nine cats with the timing-bolus technique but only 1 of the 14 cats with the bolus tracking technique. Early venous enhancement at the scanned arterial phase was common with the bolus tracking technique. Data acquisition was significantly faster with the bolus tracking technique. We conclude that the bolus tracking technique is a valid technique that could be integrated into the routine protocol for 16-detector row CT renal angiography in cats.

Extraskeletal osteosarcoma of the thorax in a goat: case report

BACKGROUND

This report describes the results of clinical, ultrasonographic and computed tomographic examination of a 16-year-old goat with extraskeletal osteosarcoma of the thorax.

CASE PRESENTATION

The lead clinical signs were abnormal condition and demeanour, fever, tachycardia, tachypnoea, dyspnoea and dilated jugular veins. Ultrasonographic examination of the thorax revealed a precardial mass, measuring 16.4 by 11.4 by 14.2 cm. Computed tomographic examination showed dorsocaudal displacement of the trachea, heart and lungs to the right. A tentative diagnosis of mediastinal or pleural neoplasia was made, and the goat was euthanased and necropsied. A definitive diagnosis was based on histological examination of the mass.

CONCLUSIONS

To our knowledge, this case report is the first description of extraskeletal osteosarcoma of the thorax in goats and serves to broaden the diagnostic spectrum of thoracic diseases in this species. Extraskeletal osteosarcoma should be part of the differential diagnosis in goats with thoracic tumours.