ACVR and ECVDI Consensus Statement for the Standardization of the Abdominal Ultrasound Examination

Cytologic Evaluation of the Liver

Liver fine needle aspiration (FNA) and bile cytology are valuable diagnostic tools for evaluating various hepatobiliary diseases in veterinary medicine. Although FNA of the liver is less invasive and faster than histopathology, it may not always provide a definitive diagnosis, but will often provide information regarding pathologic processes occurring in the liver. Cytologic evaluation is most effective when integrated with clinical information including bloodwork, imaging, and results of other diagnostic tests.

Transient Third-Degree Atrioventricular Block in a Dog with Addisonian Crisis

A 3-year-old spayed male mixed-breed Labrador presented to the Emergency and Critical Care Unit with lethargy, loss of appetite, vomiting, a recent history of presyncopal episodes, and severe exercise intolerance. On admission, the patient had bradycardia, low blood pressure, and mild abdominal pain. Serum biochemistry information revealed severe hyperkalemia, hyponatremia, hypoglycemia, and mildly increased liver and kidney parameters. Upon taking these findings into consideration, hypoadrenocorticism was suspected, and a basal cortisol level was determined; it was below 1.0 µg/dL. Upon examination with ultrasound, we observed that the size of the adrenal glands was considerably reduced. Due to the bradycardia, a complete cardiologic examination consisting of 5 min of six-lead electrocardiography and echocardiography (ECG) was performed. Six-lead ECG revealed a complete atrio-ventricular block with an atrial rate of 140 bpm and a ventricular rate of 60 bpm. The PQ interval was variable, without any evidence of atrio-ventricular conduction. Treatment for hyperkalemia was initiated immediately after admission, followed by dexamethasone sodium phosphate administration, which led to an improvement in the patient's general condition, and the normalization of the ECG readings, after 24 h of therapy. Afterward, prednisolone (0.5 mg/kg/24 h p.o.) and desoxycorticosterone pivalate (2.2 mg/kg s.c.) were administered. This case shows that a third-degree atrioventricular block might be a reversible problem in dogs with hypoadrecorticism that can be managed with specific treatment for this disorder, without requiring pacemaker implantation.

The Usefulness of the Kidney-to-Aorta Ratio in Dogs with Chronic Kidney Disease †

The kidney length (KL) to aortic diameter (AoD) ratio (KL/AoD) has been proposed as an ultrasonographic objective method to assess renal dimensions. However, its wide range of normal values limits sensitivity. Of note, its clinical utility in detecting renal disease has not been investigated. The main aim of this study was to assess the sensitivity and specificity of KL/AoD in dogs with chronic kidney disease. Of the 227 dogs in the final sample, 185 were healthy and 42 were diseased. The obtained cut-off values for healthy dogs were similar to those previously reported. No differences were found between the KL of healthy and diseased dogs; however, using the KL/AoD ratio, diseased dogs showed a significantly smaller ratio (p = 0.0003), although a partial overlap between the two groups' values was present. Considering the Youden index at KL/AoD = 6.3, the ROC curve displayed a specificity of 83.24% and a sensitivity of 41.67%, while for KL/AoD = 5.6, the specificity was 97.57% and the sensitivity was 13.10%. The results of this study provide clinical usefulness for the KL/AoD ratio method, revealing excellent specificity but poor sensitivity.

Ultrasonographic assessment of the normal ileocecocolic junction in dogs

The ultrasonographic appearance of the ileocecocolic junction (ICCJ), comprising the ileocolic junction (ICJ) and the cecocolic junction (CCJ), has not been established in dogs. The purpose of this prospective study was (1) to evaluate the feasibility and technique of systematic ultrasonographic evaluation of the ICJ and CCJ and (2) to describe its ultrasonographic features. Abdominal ultrasound was performed in 102 fasted dogs, free of digestive signs. The time required to identify the ICJ using a standardized method was recorded for each operator and compared among four experienced ultrasonographers (ECVDI certified and associated member ECVDI) and two previously trained ECVDI residents to evaluate the feasibility of the technique. Measurements were obtained for the ICJ wall thickness. Evaluation of the contents and peristalsis of the ICJ was recorded for descriptive purposes. The easiest way to identify the ICJ was to follow the colon proximally from the urinary bladder to the ICJ. The probe was then rotated anticlockwise and shifted slightly laterally while increasing the pressure to obtain a longitudinal section of the ICJ. The ICJ was identified in less than 2 min in 98% of cases by experienced ultrasonographers and in 86% of cases by ECVDI residents. The canine ICJ appears as a short invagination of the ileum into the colon, whereas the CCJ appears as a small opening of the colon within the cecum. This study suggests that it is possible to nearly systematically identify the ICCJ with ultrasound in dogs using the described method and provides reference values for its ultrasonographic measurements.

B-mode, Doppler, and Elastography abdominal ultrasound in Tamandua tetradactyla

The aim of this study was to describe the normal B-mode, Doppler, and 2D Shear Wave Elastography ultrasonographic findings of some abdominal structures in a six-month-old male Southern Tamandua (Tamandua tetradactyla). The animal was found and rescued by the environmental police after being discovered in the wild near its mother, who had died in a car accident. For the ultrasonographic exams, the animal's abdominal region was shaved, and only physical restraint was used. In the B-mode exam, the urinary bladder, small intestine, kidneys, left adrenal gland, stomach, liver, and gallbladder were located and evaluated. Doppler examination obtained spectral tracings of the arcuate and renal arteries of both kidneys. Elastography assessed the stiffness of the renal cortex, liver, and spleen. The ultrasound examination provided an adequate evaluation and novel findings of the Southern Tamandua abdominal structures without invasiveness.

Diagnostic yield of percutaneous, ultrasound-guided, fine needle aspirates of the gastrointestinal wall: a retrospective analysis of 152 samples

OBJECTIVES

The aim was to assess the technical success of percutaneous ultrasound-guided fine needle aspirates of gastrointestinal wall lesions and evaluate predictors of success. Secondary aims included comparing the cytological diagnosis with histopathology, evaluating the utility of concurrent locoregional lymph node cytology and assessing the procedure's complication rate.

MATERIAL AND METHODS

Gastrointestinal wall cytology from 75 dogs and 70 cats obtained between 2018 and 2023 were reviewed and categorised as successful (resulting in a diagnostic cytology report) and accurate (resulting in the correct diagnosis when compared to histopathology). Unsuccessful fine needle aspirates, not submitted for cytology, were not recorded. Variables recorded included animal signalment, lesion and lymph node's appearance on ultrasound, size, location, number of smears submitted and experience of the ultrasonographer.

RESULTS

One hundred and fifty-two reports were analysed. Eighty-eight (58%) were successful: three normal epithelium, 21 inflammatory processes and 64 neoplasms. Variables associated with increased technical success included description of a mass, higher number of slides submitted and thickness of gastrointestinal lesion on ultrasound. Comparison with histopathology, performed for 17 lesions, showed discrepancies in eight, complete agreement in seven and partial in two. Eighty-four loco-regional lymph nodes were sampled, of which, 67 were successful (80%) and 52 brought additional clinical information (supporting GI wall cytology or diagnosing neoplasia not identified on GI wall cytology). No complication strictly attributable to gastrointestinal wall sampling was reported but when possibly related, death of the patient occurred in 2.5% of cases.

CLINICAL SIGNIFICANCE

Ultrasound-guided fine needle aspirate of gastrointestinal wall had moderate accuracy and was unsuccessful in 42% of cases, but technical success increased when sampling mass lesions, thicker intestinal layers and submitting more slides.

A survey of the use of ultrasound by small animal veterinary clinicians

This study aimed to determine the current use of ultrasound amongst small animal veterinarians. A total of 1216 small animal veterinary practitioners responded to an electronic survey that was administered through the Veterinary Information Network to all its members. Descriptive statistics were generated; limited inferential statistics were performed to examine specific relationships. Eighty-four percent of respondents had access to an ultrasound unit, and 86% of respondents reported using their unit multiple times per week. The most common uses were assistance with cystocentesis (93%) and abdominocentesis (71%), pregnancy diagnosis (69%), limited abdominal evaluation (63%), to aid in thoracocentesis (59%), and limited thoracic evaluation (52%). Eighty-nine percent of respondents received some formal training in ultrasound, most commonly from continuing education courses. Most respondents (52%) reported receiving ≤25 h of training. Additionally, 88% of respondents believed it was either extremely or very important for there to be ultrasound training for veterinary students prior to graduation. Based on this survey, most small animal practitioners commonly use ultrasound for limited examinations, being most confident in the sonographic evaluation and centesis of the bladder and for the detection and centesis of effusion in a body cavity. With most respondents having ≤25 h of training in ultrasound, typically obtained in postgraduate courses, an expansion in standardized basic ultrasound training within the veterinary curriculum may be warranted.

Ultrasonography of Testicular Maturation and Correlation with Body Growth and Semen Evaluation in Beagle Dog Model

This prospective study investigated the ultrasonographic appearance of the canine testis from birth to adulthood. Eight purpose-bred laboratory Beagle-breed dogs were monitored from 4 to 40 weeks of life. The following parameters were evaluated every two weeks: bodyweight and height, scrotal and testicular volume, ultrasonographically measured testicular volume, echogenicity, heterogeneity, blood-flow score, ratio of the grayscale intensity value of the testis to the capsule, ejaculate volume, motility, viability, and number of spermatozoa. A correlation analysis was carried out between the various measurements obtained. Fertility was achieved in the 36th week of life. The echogenicity of the testicular parenchyma increased with age, and subsequently to the 30th week of life remained constant. The heterogeneity of the testicular parenchyma, as was evaluated by the standard deviation of the values of grayscale intensity of the parenchyma, also increased with age and was >19 at the onset of fertility. The ratio of grayscale intensity of testicular parenchyma had values < 200 at maturity. A colour Doppler evaluation first detected blood flow in the testis in the 22nd week. After the 32nd week, distinct signals were visible. In the 36th week, >80% of the testes imaged had visible vessels. A significant correlation was found between all the evaluation methods. The findings of the study may help clinicians detect the onset of fertility in dogs, especially when semen evaluation is not feasible; however, their applicability in all breeds or individuals might possibly vary due to genetic, physiological, and developmental differences. In summary, the study ultrasonographically explores the testicular maturity in dogs, with the aim to improve clinical assessments and health management in these animals.

Serial monitoring of pancreatic lipase immunoreactivity, C-reactive protein, abdominal ultrasonography, and clinical severity in dogs with suspected pancreatitis

BACKGROUND

Diagnosis of pancreatitis is based on clinical signs, pancreatic lipase immunoreactivity (cPLI), and abdominal ultrasonography (AUS). Diagnostic discrepancies exist between test results which might be related to differences in the timeline for resolution of these abnormalities after pancreatic injury.

HYPOTHESIS/OBJECTIVES

To evaluate disease severity, ultrasonographic findings, and serum biomarkers of pancreatitis in dogs over a period of 28-days.

ANIMALS

Sixteen client-owned dogs with a clinical suspicion for acute pancreatitis based on history/physical examination, an abnormal SNAP cPLI, and ultrasonographic evidence of pancreatitis.

METHODS

Prospective observational study. Clinical severity (modified clinical activity index [MCAI]), cPLI, C-reactive protein (CRP), and AUS were evaluated at days 0, 2, 7, and 28. Owner assessed overall health (OH) was noted. Dogs were stratified into baseline cPLI ≥400 μg/L vs <400 μg/L groups for reporting.

RESULTS

The median CRP, MCAI, and OH were 111.9 mg/L, 10, and 4/10 respectively in the cPLI ≥400 μg/L group. The median CRP, MCAI, and OH were 58.0 mg/L, 6, and 6/10 respectively in the cPLI <400 μg/L group. None of these variables were significantly different between groups. Most dogs (4/5) in the cPLI <400 μg/L group had a history of suspected pancreatitis (ie, suspect acute on chronic disease). cPLI and MCAI rapidly decreased in dogs with a baseline cPLI ≥400 μg/L, whereas sonographic evidence of pancreatitis persisted for a longer time period.

CONCLUSIONS AND CLINICAL IMPORTANCE

Ultrasonographic evidence of pancreatitis in the absence of overt clinical or biochemical abnormalities might represent a resolving injury rather than active disease.

Characterization of clinical presentation, histological features, ultrasonographic findings, and survival in 29 dogs with granulomatous hepatitis

BACKGROUND

Granulomatous hepatitis (GH) is a form of chronic hepatitis (CH) in dogs for which limited information is published.

HYPOTHESIS

Describe the clinical presentation, clinical pathology, ultrasound, and hepatic histopathology findings and to report survival times in dogs with GH.

ANIMALS

Twenty-nine client-owned dogs with GH.

METHODS

Retrospective observational study. Pathology records were searched. Inclusion criteria included a histopathologic diagnosis of GH, absence of an identified etiology or evidence of extrahepatic granulomatous disease, and a medical record available for review. Clinical presentation, clinical pathologic findings, treatment protocols, and survival times were recorded. Available hepatic biopsy material was graded and scored, and ultrasound evaluations reviewed.

RESULTS

The median age was 7 years (range, 0.66-12 years). Nineteen breeds were represented. Decreased appetite (19/29), lethargy (16/29), and fever (13/29) were seen most commonly. All dogs had increased serum transaminase activities, whereas 21/29 and 12/24 had hyperbilirubinemia and neutrophilia, respectively. Ultrasonographic findings included hepatomegaly (12/22), nodular parenchymal lesions (9/22), and hyperechoic parenchymal bands (8/22). Histopathologic necroinflammatory scores were moderate to severe in 16/19 dogs, and fibrosis scores were mild in 14/19 dogs. Treatments varied and included antibiotics, immunosuppressive drugs, and hepatoprotectants. Overall median survival was 635 days (range, 1-2482 days).

CONCLUSION AND CLINICAL IMPORTANCE

Granulomatous hepatitis in dogs is associated with high histopathologic grade, fever, neutrophilia, and a high incidence of hepatomegaly and focal parenchymal lesions on ultrasound examination. Despite disease severity on presentation, dogs with GH can have a good outcome with prolonged survival.

A survey of testicular texture in canine ultrasound images

Introduction

Computer-based texture analysis provides objective data that can be extracted from medical images, including ultrasound images. One popular methodology involves the generation of a gray-level co-occurrence matrix (GLCM) from the image, and from that matrix, texture fractures can be extracted.

Methods

We performed texture analysis on 280 ultrasound testicular images obtained from 70 dogs and explored the resulting texture data, by means of principal component analysis (PCA).

Results

Various abnormal lesions were identified subjectively in 35 of the 280 cropped images. In 16 images, pinpoint-to-small, well-defined, hyperechoic foci were identified without acoustic shadowing. These latter images were classified as having "microliths." The remaining 19 images with other lesions and areas of non-homogeneous testicular parenchyma were classified as "other." In the PCA scores plot, most of the images with lesions were clustered. These clustered images represented by those scores had higher values for the texture features entropy, dissimilarity, and contrast, and lower values for the angular second moment and energy in the first principal component. Other data relating to the dogs, including age and history of treatment for prostatomegaly or chemical castration, did not show clustering on the PCA.

Discussion

This study illustrates that objective texture analysis in testicular ultrasound correlates to some of the visual features used in subjective interpretation and provides quantitative data for parameters that are highly subjective by human observer analysis. The study demonstrated a potential for texture analysis in prediction models in dogs with testicular abnormalities.