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Original Article a Technique for Computed Tomography (CT) of the Foot in the Standing Horse F

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Original Article a Technique for Computed Tomography (CT) of the Foot in the Standing Horse F EQUINE VETERINARY EDUCATION / AE / FEBRUAry 2008 93 Original Article A technique for computed tomography (CT) of the foot in the standing horse F. G. D ESBROSSE, J.-M. E. F. VANDEWEERD*, R. A. R. PERRIN, P. D. CLEGG†, M. T. LAUNOIS, L. BROGNIEZ AND S. P. GEHIN Clinique Equine Desbrosse, 18, rue des Champs, La Brosse, 78470, St Lambert des Bois, France; and †Department of Veterinary Clinical Science and Animal Husbandry, The University of Liverpool, Leahurst, Neston, Cheshire CH64 7TE, UK. Keywords: horse; computed tomography; standing; foot Summary fracture lines within the bone (Rose et al. 1997; Martens et al. 1999). Computed tomography has proved to be valuable in Computed tomography (CT) in equine orthopaedics is the diagnosis of lameness associated with distal limb currently limited because of the price, availability, pathology in the horse (Whitton et al. 1998; Tucker and Sande impossibility to transport the scanner into surgical 2001; Nowak 2002; Puchalski et al. 2007). Though CT has theatre, and the contraindications of general anaesthesia traditionally been perceived as an inferior soft tissue imaging in some patients. A pQCT (peripheral quantitative modality compared to MRI, a recent abstract indicated that it computerised tomography) scanner was designed by the may be a useful modality for soft tissue injury of the equine authors to image the limbs of the horse, both in standing foot (Eliashar et al. 2006). or recumbent position. Standing computed tomography However, the use of CT in equine orthopaedics is currently of the foot with a pQCT scanner is feasible and well limited because of the expense, availability and logistic tolerated by the horse. It enables good visualisation of problems associated with performing the procedure with large bony structures but is not suitable to evaluate soft animals. The contraindications of general anaesthesia in some tissues. The technique can also assist surgery by patients have to be considered when using CT in clinical cases. assessing the 3D configuration of bone lesions. CT imaging of the distal extremities of the standing, sedated horse would be desirable if diagnostic quality images could be Introduction obtained. There is a growing interest in the use of computed tomography (CT) and magnetic resonance (MR) imaging in equine orthopaedic patients. The highly detailed cross- sectional images obtained with these 2 modalities can often demonstrate pathological changes undetected with other common imaging techniques (Barbee 1996; Tucker and Sande 2001). The use of CT imaging has been reported to adequately detect and characterise bone injury (Lischer et al. 2005; Morgan et al. 2006; Waselau et al. 2006), and to evaluate subchondral osseous lesions (Hanson et al. 1996) and occult osteochondral defects (Barbee et al. 1987). Where the complex nature of comminuted fractures makes radiographic interpretation difficult, computed tomography allows the production of cross-sectional images with spatial separation of structures that are superimposed on survey radiographs. This allows accurate assessment of the number and direction of Fig 1: Preparation of scanning. Five persons are required: one at the head, 2 at the forelimbs, one at the scanner and one at the *Author to whom correspondence should be addressed. computer. 94 EQUINE VETERINARY EDUCATION / AE / FEBRUAry 2008 In 2002, a pQCT (peripheral quantitative computerised tomography) scanner (Equine XCT 3000, Norland-Stratec Medical Sys.)1 was designed by the authors to specifically image the distal limbs of the horse both in standing or recumbent position. It is a translate-rotate multidetector system used for peripheral quantitative computerised tomography in man. pQCT is a method of assessing bone mineral density that uses multiple cross-sectional x-rays to reconstruct a volumetric model of the bone density distribution. The x-ray tube is operated at 60 kV maximum at an anode current of 0.3 mA. The mean energy is 45 keV. The fan beam detector consists of 6 CdTe detectors with amplifiers, rotating in a gantry with an opening of 300 mm. In the longitudinal direction, the minimal step width for scans is 0.01 mm over a full length of 350 mm (Braun et al. 1998). The system was modified by the authors to allow horizontal and vertical use. It was mounted on a frame that is moved with Fig 2: Positioning the limbs for standing CT of the left fore foot. electric motors. Wheels and brake have been added to the structure. This resulted in a scanner of 200 kg that was Patient selection mobile, could be moved within the hospital and transported in a small car (Fig 1). The system uses software to control the The criterion for inclusion for standing CT was that horses had scan, display the images and measure bone densities. clinical disease isolated to the foot by physical examination, Additional software (VolView)2 was used in more recent cases local anaesthesia or radiography, but further imaging was to obtain 3D images. required to identify lesions, measure their extent, monitor the The aim of the current study was to evaluate and progress or assist surgical treatment. Only horses with a good demonstrate the feasibility of CT scan in the standing horse temperament that would tolerate front limb manipulation and and to discuss some of the applications of the technique. distal flexions were selected for the procedure. All horses that underwent the procedure (n = 51) in the standing position Material and methods tolerated the examination without incident. The medical records of all horses undergoing standing foot Patient preparation and handling CT at The Clinique Vétérinaire Équine Desbrosse between February 2002 and May 2007 were reviewed to report on: Before scanning, the shoes were removed and the feet were the selection of the patients; the CT scan procedure; the trimmed and cleaned. An indwelling catheter was placed in image acquisition and the number of valid slices that could the jugular vein. The horse was tranquilised with i.v. be performed; and the clinical usefulness. The procedure administration of 0.02 mg/kg bwt of acepromazine was considered clinically useful when it answered the clinical (Vetranquil)3 30 min before scanning. A fly repellent question by confirming or excluding a diagnosis, or (Emouchine)4 was sprayed on the horse. providing helpful information for the treatment or surgical Once in the scanning room, the horse was positioned in procedure. stocks, with the head either supported by 2 ropes or held by a handler at a height of 1.3 m (Fig 1). The gantry was moved Results up and down a few times to accustom the animal to the noise of the engine. Sedation was achieved by i.v. administration of Between February 2002 and March 2007, 56 CT scans of the 0.01 mg/kg bwt of detomidine (Domosedan)5. ‘Top up’ foot were performed. In 5 cases, standing CT was not sedation was administered in one case only. Cotton wool was considered applicable either due to the temperament of the placed in the ears of the horse. When the animal was quiet horse or because the scan was performed for presurgical and accustomed to the environment, both feet were planning and thus the images were acquired under general positioned a few times on the pads until the horse accepted anaesthesia. Fifty-one standing scans were obtained of the procedure. The scanner was then brought forward, the forelimbs. There were 26 left fore feet and 29 right fore feet. feet were placed on the pads with the foot to be examined The 51 horses in this study included 33 Selle Français, within the gantry (Fig 2). The limb was centred in the gantry 14 Standardbred Trotters, 1 Thoroughbred, 1 Belgian and maintained as immobile as possible during acquisition. Warmblood and 2 Oldenburgs. The age ranged from 3–13 years (mean 7 years). They were 19 mares, 19 stallions Images acquisition and 13 geldings. Four horses were clinically normal and used to test and develop the technique, and 47 scans were The site of interest was first determined by a pilot scan of the performed on clinically abnormal horses. foot (taking approximately 1 min). The pilot sequence was also EQUINE VETERINARY EDUCATION / AE / FEBRUAry 2008 95 used to check positioning and set the position and angle of horse, no diagnostic images could be obtained due to a subsequent scans. The number of slices performed was software problem. Images that were considered clinically determined by the clinician. Ten slices were taken when 3D useful were identified in 26 of the 47 clinical cases. The reconstruction was requested. Generally, the procedure time indication for CT and clinical details are reported in Table 1 was about 90 s per slice and the entire scan protocol took and illustrated in Figure 3. 20 min to obtain 10 slices. The number of slices performed ranged from 1–11 (mean 6). Eleven percent of slices were Discussion invalid due to movement of the limb or inadequate targeting. In 4 cases, 3D images were created. The main disadvantages of the standing CT scan are the risk to the equipment and the problem of motion that need to be Clinical usefulness addressed to achieve successful, diagnostic quality images. In the current study, the CT scan was well tolerated by the horses On the 47 scans performed on clinically abnormal horses, that were selected. No adverse incident occurred during 2 cases were seen for assessment of a keratoma, 5 for scanning due to the horses reacting adversely to the diagnosis of P3 fracture, one for investigation of chronic technique. This indicates both good case selection based on lameness subsequent to previous pedal bone fracture, 4 for assessment of the horses’ behaviour as well as tolerance of the evaluation of foot abscess and seedy toe, 7 for assessment of procedure by horses.
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