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Horses - Bulter, thrall and articles > Articles - Distal limb > Flashcards

Articles - Distal limb Flashcards

1
Q

What TE (echo time) for T2 FSE eliminates the effects of the Magic Angle in the collateral ligaments of the distal interphalangeal joint?

A

140ms

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2
Q

What TE (echo time) for T2 FSE is recommended to mitigate the Magic Angle effects of the collateral ligaments of the distal interphalangeal joint BUT still keep adequate contrast?

A

120ms

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3
Q

The advantage of a long TE (echo time) for T2 FSE is helpful due to the minimization of the magic angle… but what do you lose?

A

Reduces SNR and contrast

Thus you lose the ability to see small lesions

Also, fibrous scarring will typically be decreased in intensity and there for a high TE will lose the ability to see it. (only shows hyperintense on low TE)

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4
Q

Heterogeneous intensity in the collateral ligaments of the distal interphalangeal joint likely due to?

A

Difference in fiber orientation and density throughout the ligament structure.

Big difference between tendons which have a straight fiber orientation.

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5
Q

What layers does the less opaque layer of the hoof correlate with?

A

Stratum lamellatum - epidermis

Stratum retculare - dermis

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6
Q

Inter and intraobserver correlation for DR and MRI for assessment of the equine hoof was?

A 
DR = 0.98
MRI = 0.99
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7
Q

Avg sole thickness?

A

~13mm

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8
Q

What ligament is the largest (cross sectional area) in a new born; suspensory, DDF or SDFT? When does this change?

A

Suspensory is the biggest.
This changes at the origin at 2months
This changes at the body at 5 months

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9
Q

At what age is the most change seen in the CSA (cross sectional area) in the DDF?

A

2-5 months

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10
Q

At what age is the most change seen in the CSA (cross sectional area) in the SDF?

A

10-15 months

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11
Q

Increased in palmar compact bone of the navicular was seen correlated with what lesions on MRI?

A

DDFT lesions
Collateral sesamoidean ligament lesions
Lesions of the navicular bone (medulla and prox compact bone)

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12
Q

Long toed horses had a high incidence of lesions involving what on MRI?

A

Spongiosa and proximal border of the navicular bone

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13
Q

Elongation of the navicular bone was associated with lesions on MRI?

A

Proximal and distal injuries of the navicular bone

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14
Q

Reduction in palmar angle and increased angle of the distal interphalangeal joint was associated with what lesions on MRI?

A

Collateral lig of the distal interphalangeal joint

Navicular spongiosa

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15
Q

Classification and regression trees (CARTs) can be to correlate radiographic findings with MRI at what percentage of accuracy?

A

> 80%

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16
Q

What does prodromal means?

A

Changes or signs before something happens

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17
Q

What percentage of parasagittal P1 fractures were prodromal changes noted in TB racing horses?

A

14%

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18
Q

Are parasagittal P1 fractures in TB racing horses monotomic or stress fractures?

A

BOTH

Since 14% show prodromal changes then 14% might be stress related.

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19
Q

What are the three classifications of parasagittal fractures of P1?

A

Short incomplete
Long incomplete
Complete

They are all articular

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20
Q

What is a short incomplete parasagittal fracture?

A

<30mm

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21
Q

What is a long incomplete parasagittal fracture?

A

> 30mm

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22
Q

Where are most prodromal changes seen in P1?

A

Dorsoproximal aspect of P1

  • thickening of the proximal subchondral bone plate
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23
Q

When comparing CT to radiographs; which is better at finding the fracture? What is the intermodality agreement?

A

CT is better. Identified more fractures.

Intermodality agreement was 56%

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24
Q

When was intermodality agreement good when comparing CT and rads in distal limb fractures?

A

Which bone is involved

Localization within the bone

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25
Q

Did fractures become more complicated in P1 fractures in 120 TB racehorses?

A

Yes - their complete complexity could not be assessed on initial radiographs.

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26
Q

Is there seasonality to P1 fractures in TB racing horses?

A

Yes - only seen in 2-3 year olds

March - October

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27
Q

The seasonality of P1 fractures in TB racing horses likely correlates with what?

A

UK turf racing

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28
Q

What percentage of TB racing horses were in training when fractured their P1?

A

92%

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29
Q

Most common configuration of the P1 fractures is?

A

Long incomplete parasagittal

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30
Q

Fracture of P1 that coursed further distally past the middle third of the diaphysis usually turned which way?

A

Laterally.

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31
Q

Where did most delayed unions take place in P1 fractures?

A

proximal portion of the fracture

- suggest this is from prodromal changes

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32
Q

Articular comminution of proximal P1 fractures was?

A

20% - more common than previously thought.

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33
Q

The sensitivity for contrast enhanced CT finding DDFT lesions?

A

93%

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34
Q

What area of the DDFT had the lowest detection rate on contrast enhanced CT?

A

Immediately adjacent to the navicular bone

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35
Q

Does regional limb perfusion of gadolinium contrast cause good enhancement on MRI?

A

Yes

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36
Q

How much gadopentetate dimeglumine was administered in the regional limb perfusion for MRI evaluation? Was anything else mixed with it?

A

5ml

Yes - 5 ml of saline

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37
Q

What vein was used to MRI enhanced regional limb perfusion for injection of gadopentetate?

A

palmar/plantar digital vein

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38
Q

Where was the tourniquet placed in the MRI enhanced regional limb perfusion study?

A

Mid aspect of 3MC or 3MT

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39
Q

Where there lesion exclusively seen following contrast enhanced regional limb perfusion?

A

Yes - 12/144 lesions

Total of 92/144 lesions (64%) contrast enhanced

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40
Q

Short frontal plane fractures involving the dorsoproximal articular surface of P1 are likely on what side?

A

Medial - like 95%

41
Q

Short frontal plane fractures involving the dorsoproximal articular surface of P1 are most common in what type of horse?

A

TB racing

42
Q

Can short frontal plane fractures involving the dorsoproximal articular surface of P1 be bilateral?

A

Yes

43
Q

What is the best views to use to see frontal plane fractures ivolving the dorsoproximal articular surface of P1?

A

Laterals

DLPMO - 70-80 degrees

44
Q

The obliquity of the frontal plane fractures involving the dorsoproximal articular surface of P1 were described as?

A

Extending from proximal palmar/plantar to distal dorsal

45
Q

Majority of short frontal plane fractures involving the dorsoproximal articular surface of P1 at seen in which feet?

A

Hind limbs

46
Q

What is the half-life of 18F- sodium fluoride used in PET scan of the equine distal limb?

A

2 hours

Compare that with 6 hours of 99m Tc MDP

47
Q

How long after 18F - Sodium fluoride was injected was the distal limb images obtained?

A

45min

Compare this to 2-3 hours in a bone scan

48
Q

The effective dose for 18F-NaF (sodium fluoride) is increased or decreased when comparing to 99mTc MDP

A

50% reduction

49
Q

Whats the primary advantage of PET vs scintigraphy?

A

Cross-sectional imaging

Higher spatial resolution

50
Q

Adding additional palmarprox-palmarodistal obliques increases or decreases your specificity or sensitivity in finding cortical lesions in the navicular bone on radiographs?

A

Improves sensitivity
Decreases specificity

Also improves:

  • Interobserver agreement
  • Confidence
  • Accuracy finding a lesion
  • Accuracy in grading a lesions severity
51
Q

Alternate angle that is suggested for additional palmarprox-palmarodistal obliques of the navicular bone are what?

A

Flatter angles = ~35-45 degrees

Regular angle is 55-65 degrees

52
Q

What are the four layers of the hoof?

A 
Stratum externum (tectorium)
Stratum medium
Stratum internum (lamellatum) 
Dermis parietis  (corium)
53
Q

Superficial layer of the hoof (more radiopaque layer) is made up of what layers?

A 
Stratum externum (tectorium)
Stratum medium
54
Q

Deep layer of the hoof (more radiolucent layer) is made up of what layers?

A

Stratum internum

Dermis parietis

55
Q

What percentage of the hoof is normal the superficial layer of the hoof (more radiopaque layer)?

A

65% - Mean

55-71% - range

56
Q

Where do most of the laminitic changes occur in the hoof aka what layers?

A 
Stratum internum (lamellatum)
Dermis parietis (corium)
57
Q

What is the threshold value for the absolute thickness of the dorsal hoof wall?

A

20mm

58
Q

What type of needle is used in MRI guided injections?

A

Titanium - 16g

59
Q

Injection success with MRI guidance into the DDFT was evaluated using gross pathology and MRI. What was the success rate in both?

A

70% proximal and 100% distal for the Gross

60% proximal and 70% distal in the MRI

60
Q

What sequence was used in MRI guided DDFT injections?

A

T1

61
Q

Was there a difference in accuracy in MRI guidance when injecting the medial or lateral lobes of the DDFT?

A

NO

62
Q

What was the avg time it took for MRI guided injections of the DDFT?

A

6-17min

63
Q

In MRI of navicular bursa adhesions they divided adhesions into three types… what were they?

A

Type 1: Discontinuity of the bursa fluid signal
Type 2: Bursa fluid was disrupted and an ill-defined tissue was present.
Type 3: Bursa fluid was disrupted and an well-defined tissue was present.

64
Q

MRI for navicular bursa adhesions had a positive predictive value for each type of adhesion classification…what were they?

A

Type 1: 50%
Type 2: 67%
Type 3: 100%

65
Q

Are other podotrochlear lesions common with navicular bursa adhesions? If so, what are they?

A 
Yes
Lesions were seen most commonly in the:
#2 - DDFT
#1 - Navicular bone
Collateral sesamoidean ligaments 
distal sesamoidean impar lig.
66
Q

How are adhesions made?

A

Erosions in the fibrocartilage of the navicular bone and fibrillation of the dorsal surface of the DDFT

67
Q

What are the best sequences to evaluate the navicular bursa for adhesions?

A

PD
STIR

T2 was alright too

68
Q

What sequence is terrible for looking at the navicular bursa for adhesions?

A

T1 (27% were seen)

69
Q

Why might there be less adhesion noted at surgery than on MRI?

A

When you go in the bursa you are probably tearing some of the adhesion.

MRI also makes up shit due to volume avg

70
Q

What views (dorsal, sagittal or transverse) should you use to evaluate the navicular bursa?

A

Sagittal and transverse

Dorsal is trach and only 21% of adhesions could be found.

71
Q

What is the T ligament?

A

A piece of tissue in the proximal pouch of the navicular bursa connecting the DDFT and the collateral sesamoidean ligaments

Hypertrophy of this ligament can be seen

72
Q

Do horses need to have joint swelling or be lame to have sagittal groove injuries of P1?

A

No

73
Q

Most common P1 injuries noted in warmbloods on low field MRI?

A

Incomplete short mid-sagittal fractures
Osseous cyst-like lesions
Subchondral bone loss
Contusions

74
Q

Injuries noted in the P1 sagittal grove consistent with acute or chronic injuries?

A

Chronic, from repetitive motion

80% had osteoarthritis

75
Q

What does hyperintense signal on STIR mean?

A 
Edema
Hemorrhage
Necrosis
Fibrosis
Degeneration
Microdamage 
Bone remodeling
76
Q

What percentage of warmbloods with sagittal groove injuries were still lame at time of follow-up MRI?

A

69%

77
Q

What is the most common cause of septic arthritis in an adult horse?

A

Trauma - Penetrating wounds = most common source
Synovial injections
Post operative

78
Q

Do all septic arthritis cases look similar?

A

No

79
Q

What is the biggest factor that determines how septic arthritis will look on US?

A

Time from start of clinical signs to time of ultrasound

80
Q

The majority of horse in the “Ultrasound of septic synovitis in horses” had what changes on radiographs?

A

None

81
Q

Majority of horses have what changes on US when looking at septic arthritis?

A

Marked degree of effusion
Severe synovial thickening
Synovial fluid could be echogenic or anechoic

82
Q

What radiopharmecutical is used in PET of the distal limb?

A

18F-Fluorodeoxyglucose (1.5-2.9 Mbq/kg)

83
Q

Where was the highest uptake of 18F-FDG in the distal limb of the horse?

A

Coronary band

84
Q

Where was the lowest uptake of 18F-FDG in the distal limb of the horse?

A

Bones and tendons

85
Q

When did the horses in Spriet’s study on PET scan in anesthesized horse get to a level (2mRem/h) where they could be released?

A

8 hours vs 24 hours in scinitgraphy

86
Q

What was the difference in image quality between 1.5 mBq/kg and 3.0 mBq/kg of 18F- FDG

A

Nothing… speaks to possible dose reduction

87
Q

Where do most injuries occur when a horse experiences a solar foot penetration?

A

Distal border of the navicular bone
Facies flexoria

DDF was involved in all horses in the study (schiavo 2018)

88
Q

Scintigraphic uptake at the fascies flexoria correlates well with what?

A

A lesion in the DDF, WHERE EVER its location.

89
Q

Compact bone thickening at the fascies flexoria is a sign of podotrochlear syndrome?

A

NO. Erosion of the fascies flexoria may have correlation with navicular bursitis due to the correlation between erosions and synovial proliferation of the navicular bursa.

90
Q

Can horses have a good outcome with solar penetrating wounds that involve the DDF but are not septic?

A

YES

Basically many other studied said involvement of the DDF was a death sentence.. This paper says that may not be the case if sepsis is not noted.

91
Q

What is the “street nail” procedure?

A

Making a radical excision of the penetrating tract and resection or fenestration of the DDF

92
Q

What is the best sequence for seeing solar penetrating wounds?

A

T2* - can pick up hemorrhage with good contrast

93
Q

What is the best orientation for observing solar penetrating wounds?

A

Transverse plane

94
Q

The most common limitation for finding solar penetrating wounds on MRI was what?

A

Motion artifact

95
Q

When was the penetrating solar wound most likely to be visualized?

A

In the first 7 days.. this is statistically significant

96
Q

What was the most common reactions to ultrasonographic contrast in horses was?

A

Increase in systolic pressure

Increase respiration rate

97
Q

Is the venous system or the arterial system better for injecting ultrasonographic contrast in horses for visualization of the distal limb?

A

intra arterial

LATERAL PALMAR DIGITAL Arteries

98
Q

What do horses have in their pulmonary vasculature that may make them more susceptible to ultrasonographic contrast?

A

Pulmonary intravascular macrophages

This is why a horses shock organ is the lungs

99
Q

Besides better visualization what is another advantage in using the arterial system instead of the venous system when injecting ultrasonographic contrast in a horse’s distal limb?

A

Less dose need (10x less)

Horses - Bulter, thrall and articles (3 decks)

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