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Computed Tomography in the Diagnosis and Treatment of Canine Tarsocrural Osteochondrosis

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Computed Tomography in the Diagnosis and Treatment of Canine Tarsocrural Osteochondrosis Computed Tomography in the Diagnosis and Treatment of Canine Tarsocrural Osteochondrosis Ingrid Gielen Proefschrift ter verkrijging van de graad van Doctor in de Diergeneeskundige Wetenschappen (PhD) aan de Faculteit Diergeneeskunde, Universiteit Gent Promotor: Prof. Dr. H. van Bree Co-promotor: Prof. Dr. Y. Palmers Vakgroep Medische Beeldvorming van de Huisdieren Faculteit Diergeneeskunde Universiteit Gent Dit proefschrift draag ik op aan mijn papa, Dr. Jan Gielen Moed is niet het ontbreken van angst of wanhoop, maar de kracht om die te overwinnen. D. Steel LIST OF ABBREVIATIONS CL: clinical CT: computed tomography DFOV: display field-of-view DJD: degenerative joint disease dorsal plane (veterinary medicine) = coronal plane (human medicine) 3-D: three-dimensional HU: Hounsfield units kVp: peak kilovoltage LTOC: lateral tarsocrural osteochondrosis mAs: milliampereseconds MPR: multiplanar-reformatting MTOC: medial tarsocrural osteochondrosis NCL: non-clinical OA: osteoarthrosis OC: osteochondrosis OCD: osteochondritis dissecans ROI: region of interest (S)FOV: (scan) field-of-view TOC: tarsocrural osteochondrosis transversal plane (veterinary medicine) = axial plane (human medicine) WL: window level WW: window width LIST OF ABBREVIATIONS List of abbreviations GENERAL INTRODUCTION: Review of the literature 1 1. Computed tomography in small animals. Part 1: Technical aspects 3 Adapted from: Kompendium der Allgemeinen Veterinärchirurgie 2003; 3. Bildgebende Verfahren, c. Computertomographie, Kramer M. (ed.), Schlütersche Verlag, Hannover, Deutschland: In press. And: Vlaams Diergeneeskundig Tijdschrift 2003: In press. 2. Computed tomography in small animals. Part 2: Clinical applications 25 Adapted from: Kompendium der Allgemeinen Veterinärchirurgie 2003; 3. Bildgebende Verfahren, c. Computertomographie, Kramer M. (ed.), Schlütersche Verlag, Hannover, Deutschland: In press. And: Vlaams Diergeneeskundig Tijdschrift 2003: In press. 3. Tarsocrural osteochondrosis in the dog 57 AIMS OF THE STUDY 73 CHAPTER 1. COMPUTED TOMOGRAPHY OF THE TARSAL JOINT IN 77 CLINICALLY NORMAL DOGS Adapted from: American Journal of Veterinary Research 2001; 62: 1911-1915. CHAPTER 2. RADIOGRAPHIC, COMPUTED TOMOGRAPHIC AND 95 ARTHROSCOPIC FINDINGS IN 23 DOGS WITH OSTEOCHONDROSIS OF THE TARSOCRURAL JOINT Adapted from: Veterinary Record 2002; 150: 442-447. CHAPTER 3. COMPUTED TOMOGRAPHY COMPARED WITH 117 RADIOGRAPHY IN THE DIAGNOSIS OF TARSOCRURAL OSTEOCHONDROSIS OF THE LATERAL TROCHLEAR RIDGE IN THE DOG Adapted from: Veterinary and Comparative Orthopaedics and Traumatology 2003; Manuscript accepted for publication. And: Abstract 12th International Veterinary Radiology Association.Obihiro- Japan, August 21-25, 2000. p 29. Veterinary Radiology & Ultrasound 2001; 42: 174. Award for the best oral presentation. CHAPTER 4. COMPARISON OF MORPHOLOGICAL AND CLINICAL 131 FEATURES BETWEEN MEDIAL AND LATERAL, AND CLINICAL AND NON-CLINICAL CANINE TARSOCRURAL OSTEOCHONDROSIS LESIONS Adapted from: American Journal of Veterinary Research 2003; Manuscript submitted for publication. CHAPTER 5. MINIMALLY INVASIVE TREATMENT OF CANINE 145 TARSOCRURAL OSTEOCHONDROSIS: A LONG-TERM FOLLOW-UP STUDY OF 30 CASES Adapted from: Veterinary Surgery 2003; Manuscript submitted for publication. CHAPTER 6. THE VALUE OF COMPUTED TOMOGRAPHY IN THE 163 CLINICAL COURSE OF CANINE TARSOCRURAL OSTEOCHONDROSIS Adapted from: Abstract 9th Annual Conference EAVDI (European Association of Veterinary Diagnostic Imaging). 24-27th July 2002, Archena (Murcia), Spain. p 75. Veterinary Radiology & Ultrasound 2003; 44: p 253. GENERAL DISCUSSION 179 SUMMARY 191 SAMENVATTING 199 DANKWOORD 207 CURRICULUM VITAE 211 INTRODUCTION 1 GENERAL INTRODUCTION: Review of the literature 1. Computed tomography in small animals. Part 1: Technical aspects Adapted from: Kompendium der Allgemeinen Veterinärchirurgie 2003; 3. Bildgebende Verfahren, c. Computertomographie, Kramer M. (ed.), Schlütersche Verlag, Hannover, Deutschland and Vlaams Diergeneeskundig Tijdschrift 2003: In press 2. Computed tomography in small animals. Part 2: Clinical applications Adapted from: Kompendium der Allgemeinen Veterinärchirurgie 2003; 3. Bildgebende Verfahren, c. Computertomographie, Kramer M. (ed.), Schlütersche Verlag, Hannover, Deutschland and Vlaams Diergeneeskundig Tijdschrift 2003: In press. 3. Tarsocrural osteochondrosis in the dog 2 INTRODUCTION INTRODUCTION 3 1. COMPUTED TOMOGRAPHY IN SMALL ANIMALS Part 1: TECHNICAL ASPECTS I. Gielen, A. Van Caelenberg, H. van Bree Department of Medical Imaging, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, Belgium Adapted from: I. Gielen, H. van Bree. Kompendium der Allgemeinen Veterinärchirurgie 2003; 3. Bildgebende Verfahren, c. Computertomographie, Kramer M. (ed.), Schlütersche Verlag, Hannover, Deutschland: In press. And I. Gielen, A.Van Caelenberg, H. van Bree. Computed tomography in small animals. Part 1: Technical aspects. Vlaams Diergeneeskundig Tijdschrift 2003: In press. 4 INTRODUCTION INTRODUCTION 5 SUMMARY Computed tomography (CT) is a cross-sectional imaging technique using x-rays and computers that is becoming increasingly available to veterinarians. During CT scanning, an x-ray tube rotates around the patient. Multiple radiographic projections of a particular slice of tissue are made, and information from all projections is combined to create a single tomographic (slice) image. CT images provide accurate anatomic evaluation of tissue planes and regions that often cannot be visualised with conventional radiography. Compared to radiography, CT uses a wide range of grey shades which enables a high contrast resolution, very important for soft tissue discrimination. Many imaging artefacts can occur in the process of generating CT images. A good understanding of these artefacts is necessary to enable an accurate interpretation of the CT images. After the scan examination, images in other planes can be produced using computerised reformatting, which is of help in evaluating the extent of a lesion. To increase the amount of soft tissue information, contrast agents can be used. Positive contrast techniques are of greatest importance e.g. for demonstrating brain tumours. Biopsies can also be obtained under CT guidance, a procedure that can be accurately performed. 6 INTRODUCTION INTRODUCTION 7 INTRODUCTION Computed tomography (CT) is a cross-sectional imaging technique using x-rays and computers (Huygens and Baert, 1983; Hathcock and Stickle, 1993). With the discovery of x-rays in 1895, a new era of visualisation of internal body structures had begun. The discovery was almost immediately recognised and accepted for its potential as a great medical diagnostic tool. The technique has been characterised by many evolutional improvements during the intervening 85 years. In the early 1970s a new technique of x- ray imaging had a revolutionary impact on medicine. In 1971 an x-ray scanner has been developed which produced cross-sectional images of the brain by using several different scientific concepts, some known for over 50 years (Robb, 1982). The tomographic nature of CT images provides accurate anatomic evaluation of tissue planes and regions which are often impossible to visualise with conventional radiography. The most valuable property of this new technique is its high contrast resolution. The ability to image in cross-section makes it possible to build up a three-dimensional picture which is invaluable for understanding normal anatomy and for planning surgical or radiotherapy treatment. The greatly increased tissue resolution allows differentiation between fluid and solid tissues and assessment of the internal structure of soft tissues (Dennis, 1995). HISTORY Already in 1963, Cormak was able to determine the absorption coefficient of x-rays through a flat object and to measure the variations in intensity of the x-ray beam in different planes. In 1967, Hounsfield had the idea that it must to be possible to measure the intensity of the x-ray beam as it is sent through the body. He understood that a computer was needed to make the calculations. In 1972, Hounsfield introduced the EMI Mark I brain scanner for computerised axial transverse scanning of the head. Initially, the procedure was known as CAT scanning (Computerised Axial Tomography or Computer- Assisted Tomography), but the preferred term now is CT or Computed Tomography. This 8 INTRODUCTION original scanner was capable of producing a pair of cross-sectional images following a four to five minute scan time (Wortman, 1986). The first-generation scanners used a single, narrow x-ray beam and one single detector. Hooked together, they moved in straight and parallel lines across the patient, radiation and recordings being made at the same time. At the end of the linear motion, the tube and the detector were rotated 1° and the linear motion was repeated again, in all, 180 times. With these so-called translation rotation scanners, a scan lasted 5 to 6 minutes per slice to acquire the data (Hathcock and Stickle, 1993; Wegener et al., 1993). A wide, fan-shaped x-ray beam and multiple detectors were used in the second- generation units, the so-called rotation-only scanners, allowing a larger rotation between linear motions. Scan times were reduced to less than 1 minute (Wegener et al., 1993). Third and fourth-generation units employ a rotating x-ray tube with movable or stationary detectors (Figure 1). Scan time with these units is only a few seconds. B A Figure 1: Rotation scanner of the third generation with movable
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