Comparison of cone-beam and fan-beam computed tomography and low-field magnetic resonance imaging for detection of palmar/plantar osteochondral disease in Thoroughbred horses

BACKGROUND

Palmar/plantar osteochondral disease (POD) of the metacarpal/tarsal condyles is a common pathological finding in racehorses.

OBJECTIVE

To compare diagnoses, imaging details, and measurements of POD lesions between cone-beam computed tomography CT (CBCT), fan-beam CT (FBCT), and low-field magnetic resonance imaging (MRI) using macroscopic pathology as a gold standard.

STUDY DESIGN

Cross-sectional study.

METHODS

Thirty-five cadaver limbs from 10 horses underwent CBCT, FBCT, MRI, and macroscopic examination. CT and MR images were examined for presence of POD, imaging details of POD, and measurements of POD dimensions and areas. Imaging diagnoses, details, and measurements were compared with macroscopic examination and between modalities.

RESULTS

Forty-eight POD lesions were seen over 70 condyles. Compared with macroscopic examination the sensitivity and specificity of diagnosis were 95.8% (CI95 = 88%-99%) and 63.6% (CI95 = 43%-81%) for FBCT, 85.4% (CI95 = 74%-94%) and 81.8% (CI95 = 63%-94%) for CBCT, and 69.0% (CI95 = 54%-82%) and 71.4% (CI95 = 46%-90%) for MRI. Inter-modality agreement on diagnosis was moderate between CBCT and FBCT (κ = 0.56, p < 0.001). POD was identified on CT as hypoattenuating lesions with surrounding hyperattenuation and on MRI as either T1W, T2*W, T2W, and STIR hyperintense lesions or T1W and T2*W heterogeneous hypointense lesions with surrounding hypointensity. Agreement on imaging details between CBCT and FBCT was substantial for subchondral irregularity (κ = 0.61, p < 0.001). Macroscopic POD width strongly correlated with MRI (r = 0.81, p < 0.001) and CBCT (r = 0.79, p < 0.001) and moderately correlated with FBCT (r = 0.69, p < 0.001). Macroscopic POD width was greater than all imaging modality (p < 0.001).

MAIN LIMITATIONS

Effect of motion artefact in live horse imaging could not be assessed.

CONCLUSIONS

All imaging modalities were able to detect POD lesions, but underestimated lesion size. The CT systems were more sensitive, but the differing patterns of signal intensity may suggest that MRI can detect changes associated with POD pathological status or severity. The image features observed by CBCT and FBCT were similar.

Relationship between CT-Derived Bone Mineral Density and UTE-MR-Derived Porosity Index in Equine Third Metacarpal and Metatarsal Bones

Fatigue-related subchondral bone injuries of the third metacarpal/metatarsal (McIII/MtIII) bones are common causes of wastage, and they are welfare concerns in racehorses. A better understanding of bone health and strength would improve animal welfare and be of benefit for the racing industry. The porosity index (PI) is an indirect measure of osseous pore size and number in bones, and it is therefore an interesting indicator of bone strength. MRI of compact bone using traditional methods, even with short echo times, fail to generate enough signal to assess bone architecture as water protons are tightly bound. Ultra-short echo time (UTE) sequences aim to increase the amount of signal detected in equine McIII/MtIII condyles. Cadaver specimens were imaged using a novel dual-echo UTE MRI technique, and PI was calculated and validated against quantitative CT-derived bone mineral density (BMD) measures. BMD and PI are inversely correlated in equine distal Mc/MtIII bone, with a weak mean r value of -0.29. There is a statistically significant difference in r values between the forelimbs and hindlimbs. Further work is needed to assess how correlation patterns behave in different areas of bone and to evaluate PI in horses with and without clinically relevant stress injuries.

Comparison of skeletal scintigraphy and standing 18 F-NaF positron emission tomography for imaging of the fetlock in 33 Thoroughbred racehorses

This retrospective, methods comparison study aimed to compare skeletal scintigraphy and ¹⁸ F-NaF positron emission tomography (PET) for the detection of abnormalities in the fetlocks of Thoroughbred racehorses. Thirty-three horses (72 limbs) imaged with both scintigraphy and ¹⁸ F-NaF PET, for investigation of lameness or poor performance related to the fetlock, were included. Seven observers, including experienced racetrack practitioners, surgery and imaging residents, and a board-certified veterinary radiologist, independently reviewed all data for evidence of increased radiopharmaceutical uptake in 10 different regions of interest. The interobserver agreement was higher for PET (Kappa-weighted (K-w) 0.73 (0.51-0.84)) (median (range)) than for scintigraphy (0.61 (0.40-0.77)) (P < 0.0001). When scintigraphy and PET were compared, the agreement was fair (K-w 0.29). More sites of increased uptake were identified using PET compared with scintigraphy. Agreement between the two modalities was higher for the palmar/plantar metacarpal/metatarsal condylar regions (K-w 0.59) than for the proximal sesamoid bones (K-w 0.25). Increased radiopharmaceutical uptake was detected in the medial proximal sesamoid bone in 6.9% and 22.2% of limbs with scintigraphy and PET, respectively. The high interobserver agreement for PET, despite the recent introduction of this technique, demonstrates the ease of clinical interpretation of PET scans. The higher number of lesions detected with PET compared with scintigraphy can be explained by the higher spatial resolution and cross-sectional nature of this modality. Study findings supported using PET in a clinical population of racehorses, in particular for the assessment of the proximal sesamoid bones.

Metabolomic analysis of synovial fluid from Thoroughbred racehorses diagnosed with palmar osteochondral disease using magnetic resonance imaging

BACKGROUND

Palmar osteochondral disease (POD) is a common cause of lameness in competition horses. Magnetic resonance imaging (MRI) is the most sensitive diagnostic modality currently available, however it may not be financially or logistically practical for routine screening of POD. There is increasing interest in the use of metabolomics for diagnosis prior to progression to irreversible damage.

OBJECTIVES

To determine metabolite levels in synovial fluid (SF) of horses with a clinical diagnosis of POD based on diagnostic analgesia and MRI, with the hypothesis that metabolomic profiles differ between diseased and healthy joints.

STUDY DESIGN

Prospective clinical study.

METHODS

Synovial fluid was collected from metacarpo/tarsophalangeal joints (MC/TPJ) of 29 horses (n = 51 joints), including 14 controls (n = 26) and 15 cases (n = 25), the latter with lameness localised to the MC/TPJ and MR changes consistent with POD (n = 23). Spectra were produced using ¹ H-nuclear magnetic resonance (NMR) spectroscopy and analysed.

RESULTS

Twenty-five metabolites were recognised associated with various biosynthetic and degradation pathways. The metabolite abundances within the controls demonstrated increased variability compared with the clinical group. The low level of variance between the spectra of the two groups was explained by five principal components. Cross-validation of the cohort demonstrated modest separation of predictive power (R²  = 0.67; Q²  = 0.34). Although statistical significance was not achieved, the most influential metabolites were glucose and lactate.

MAIN LIMITATIONS

The modest sample size and variation in signalment, background and presenting condition of the controls may have impacted the discriminative power of the constructed models. The lack of matched controls, differences in time of fluid collection and freezing times may have also reduced accuracy when representing metabolite profiles.

CONCLUSIONS

This study identified and quantified metabolites present in MC/TPJ SF of clinical cases with POD.

Solar angle of the distal phalanx is associated with scintigraphic evidence of subchondral bone injury in the palmar/plantar aspect of the third metacarpal/tarsal condyles in Thoroughbred racehorses

BACKGROUND

Subchondral bone injury at the palmar/plantar aspect of the condyles of the third metacarpal/metatarsal bone (MC/MT3) commonly causes lameness and poor performance in racehorses. Injury occurs due to repetitive loading, the magnitude of which may be influenced by the position of the distal phalanx relative to the ground surface, i.e. the solar angle. The association of solar angle and injury at the palmar/plantar condyles of distal MC/MT3 therefore warrants investigation.

OBJECTIVES

Investigate the relationship between solar angle and radiopharmaceutical uptake at the palmar/plantar aspect of distal MC/MT3 on scintigraphic images of racehorses.

STUDY DESIGN

Retrospective case-controlled study.

METHODS

Scintigraphic images of Thoroughbred racehorses presented for poor performance or lameness were graded for intensity of radiopharmaceutical uptake in the palmar/plantar aspect of distal MC/MT3. Solar angle was graded (positive, neutral or negative), referring to the angle of the solar plane of the distal phalanx relative to the ground surface. Repeatability of solar angle (n = 1226 limbs) and agreement with objective radiographic evaluation (n = 52 limbs) were evaluated. Prescintigraphy performance data were collected from race records. Associations between solar angle, performance and radiopharmaceutical uptake were investigated using multivariable logistic regression.

RESULTS

Repeatability of scintigraphic solar angle grading (κ = 0.89, 95% CI 0.87-0.91) and agreement of scintigraphic and radiographic solar angle (κ = 0.88, 95% CI 0.75-0.97) were excellent. Horses that performed best prior to presentation were more likely to have both greater radiopharmaceutical uptake and a neutral/negative solar angle. When controlling for prior performance, horses with neutral/negative forelimb solar angle were twice as likely to have moderate/marked radiopharmaceutical uptake than horses with positive solar angle (P<0.02). Horses with negative hindlimb solar angle were six times more likely to have moderate/marked radiopharmaceutical uptake than horses with positive/neutral solar angle (P<0.001).

MAIN LIMITATIONS

Population bias due to preselected hospital population.

CONCLUSIONS

Both solar angle and race performance are independently associated with increased bone activity in the palmar/plantar aspect of the third metacarpal/tarsal condyles. The Summary is available in Portuguese - see Supporting Information.

Subchondral bone microdamage accumulation in distal metacarpus of Thoroughbred racehorses

BACKGROUND

Microdamage accumulation leads to subchondral bone injury and/or fracture in racehorses. An understanding of this process is essential for developing strategies for injury prevention.

OBJECTIVES

To quantify subchondral bone microdamage in the third metacarpal bone of Thoroughbred racehorses at different stages of the training cycle.

STUDY DESIGN

Cross-sectional.

METHODS

Bone blocks from the palmar aspect of the medial condyles of third metacarpal bones from 46 racing Thoroughbred horses undergoing post-mortem were examined with micro computed tomography (microCT) to detect calcified microcracks, and light microscopy to quantify bulk stained microcracks. Racing and training histories were obtained for comparison with microdamage data using regression modelling.

RESULTS

Subchondral bone microcracks were observed in all bones with at least one method. Microdamage grade was greater in older horses, levelling-off for horses 5 years and older (quadratic term P = 0.01), and with lower bone material density in the parasagittal groove (P = 0.02). Microcrack density was higher in older horses (P = 0.004), and with higher bone volume fraction (BV/TV) in the parasagittal groove in horses in training (interaction effect, P = 0.01) and lower in horses resting from training (P = 0.02).

MAIN LIMITATIONS

Cross-sectional data only. Incomplete detection of microdamage due to the limits of resolution of microCT and lack of three-dimensional imaging with microscopy. Multicollinearity between variables that indicated career progression (e.g. age, number of career starts, duration of training period) was detected.

CONCLUSIONS

Fatigue damage in the distal metacarpal subchondral bone is common in Thoroughbred racehorses undergoing post-mortem and appears to accumulate throughout a racing career. Reduced intensity or duration of training and racing and/or increased duration of rest periods may limit microdamage accumulation. Focal subchondral bone sclerosis indicates the presence of microdamage.

Vascular perfusion of the dorsal and palmar condyles of the equine third metacarpal bone

REASONS FOR PERFORMING STUDY

Palmar osteochondral disease (POD) is an overload arthrosis that commonly affects fetlock joints of racing Thoroughbreds (TB) but the aetiopathogenesis of the disease has not been well defined.

OBJECTIVES

The aim of this study was to compare India ink perfusion in the dorsal and palmar condyles of the third metacarpal bone (McIII) in both passively flexed and maximally extended fetlock joints from paired equine cadaver limbs.

STUDY DESIGN

Descriptive cadaver study comparing perfusion of condyles of McIII in paired cadaver limbs in flexion (control group) and maximal extension (intervention group).

METHODS

Pairs of forelimbs were acquired from 5 TB horses subjected to euthanasia for reasons unrelated to lameness. Limb pairs were perfused intra-arterially with India ink and then randomly assigned to passive flexion or maximal extension of the fetlock joint. Limbs were sectioned sagittally in 3 mm sections through the fetlock and 12 sections per limb processed using a modified tissue-clearing technique. Sections were subsequently digitally imaged and bone perfusion evaluated with image analysis software.

RESULTS

Greater perfusion of the dorsal condyle than of palmar condyle was observed in 78% of sections from limbs in passive flexion and 92% of maximally extended sections. Perfusion to the palmar aspect of the condyle was significantly decreased (P < 0.0001) when the limbs were placed in maximal extension compared to passive flexion.

CONCLUSIONS

The palmar condyle of McIII had less perfusion than the dorsal condyle when the fetlock joint was in passive flexion and this difference was exacerbated by maximal extension. Based on the anatomical location of POD lesions, perfusion differences between the dorsal and palmar condyles of McIII may be associated with development of these lesions.