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- Author or Editor: Jennifer A. Reetz x
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To describe the diagnostic utility and clinical safety of ultrasonographically guided percutaneous pyelocentesis and antegrade pyelography in cats and dogs.
Retrospective case series.
39 cats and 10 dogs with 55 affected kidneys.
Medical records were reviewed to identify cats and dogs that underwent ultrasonographically guided pyelocentesis and antegrade pyelography between June 1, 2007, and December 31, 2015. Data collected included procedure descriptions; results of diagnostic imaging, urine cytologic evaluation, and bacterial culture; and evidence of complications. Animals were assigned to the pyelocentesis group (underwent only pyelocentesis) or to the antegrade pyelography group (underwent pyelocentesis followed immediately by pyelography).
The diagnostic rate for pyelography was 94% (31/33; 95% confidence interval [CI], 80.4% to 98.9%). The total, minor, and major complication rates for both treatment groups combined were 25% (95% CI, 15.8% to 38.3%), 24% (95% CI, 14.4% to 36.3%), and 2% (95% CI, 0.09% to 9.6%), respectively. Performing bacterial culture of urine obtained by pyelocentesis did not provide an advantage over performing bacterial culture of urine obtained from the lower urinary tract.
CONCLUSIONS AND CLINICAL RELEVANCE
Findings indicated that ultrasonographically guided pyelocentesis and antegrade pyelography were well-tolerated techniques for investigating upper urinary tract disease in cats and dogs and that pyelography had a higher diagnostic rate than previously reported; therefore, pyelography should be considered for identification of mechanical and functional ureteral patency abnormalities in cats and dogs.
In collaboration with the American College of Veterinary Radiology
Objective—To describe a method for ultrasonographic and color-flow Doppler ultrasonographic imaging of the 4 direct cutaneous arteries commonly used for axial pattern skin flaps in dogs.
Animals—20 clinically normal dogs.
Procedures—Dogs were manually restrained and fundamental and harmonic ultrasonographic and colorflow Doppler ultrasonographic examinations of the superficial cervical, thoracodorsal, deep circumflex iliac (cranial and caudal branches), and caudal superficial epigastric arteries were performed by a resident in diagnostic imaging. The level of confidence in locating these vessels was subjectively graded as high, moderate, or low.
Results—High-frequency fundamental and harmonic ultrasonography was important for maximizing image resolution, and color-flow Doppler ultrasonography was important for vessel identification. The superficial cervical artery was the most difficult vessel to identify; confidence in correct vessel identification was low or moderate. The thoracodorsal and deep circumflex iliac arteries were identified with a moderate or high level of confidence. The caudal superficial epigastric artery was the easiest vessel to identify; confidence in correct vessel identification was high. Except for the superficial cervical artery, the level of confidence in correct vessel identification improved over time as operator experience increased.
Conclusion and Clinical Relevance—Results suggest that the combination of fundamental ultrasonographic and color-flow Doppler ultrasonographic imaging is an easy and noninvasive method for identifying the 4 direct cutaneous arteries commonly used for axial pattern skin flaps in dogs. This method could be useful in planning axial pattern skin flaps, particularly in dogs with regional soft tissue trauma in which the integrity of the vessel is in question.
Objective—To describe the computed tomographic features of oral squamous cell carcinoma (SCC) in cats and identify imaging characteristics associated with survival time.
Design—Retrospective case series.
Animals—18 cats with a diagnosis of oral SCC.
Procedures—Information on history; clinical, laboratory, and diagnostic imaging findings; treatment; and survival time was obtained from medical records of 18 cats with oral SCC. Computed tomography (CT) studies were examined to identify features associated with oral SCC. The association of CT features with survival time was evaluated.
Results—On CT images, SCC was centered at the following sites: sublingual or lingual region (n = 7), maxilla (5), buccal mucosa (4), mandible (4), pharyngeal mucosa (2), soft palate mucosa (1), and lip (1). These results were in agreement with the results of oral examination for all sites, except the soft palate (CT, 1 cat; oral examination, 4 cats). On CT images, extension of maxillary masses was most often observed to affect the orbit (5 cats). Heterogeneous contrast enhancement was most commonly identified (8/18). Osteolytic mass lesions were identified on CT images in 9 cats. None of the quantitative CT features that were identified, including mass size, attenuation, or lymph node width, were correlated with survival time.
Conclusions and Clinical Relevance—Common CT features of oral SCC in cats included sublingual and maxillary locations, marked heterogeneous contrast enhancement, and osteolysis. Computed tomography may be used to determine mass extension and lymph node enlargement, but results did not correlate with survival time.
OBJECTIVE To assess the utility of ultrasonography to detect the cause and location of ureteral obstruction in cats and to identify factors associated with agreement between ultrasonographic and surgical findings.
STUDY DESIGN Retrospective case series.
ANIMALS 71 cats.
PROCEDURES Medical records were searched to identify cats that had ureteral obstruction diagnosed ultrasonographically and that subsequently underwent exploratory laparotomy. Patient signalment, ultrasonographic findings, interventions performed, and surgical findings were recorded. Cause and location of ureteral obstruction as assessed by ultrasonography were compared with surgical findings. Sensitivity, specificity, and positive predictive value of ultrasonography for detection of ureteroliths and strictures were calculated. Statistical analysis was performed to identify factors associated with agreement between ultrasonographic and surgical findings.
RESULTS There was significant, moderate agreement between ultrasonographic and surgical findings for the cause and location of ureteral obstruction. Signalment variables, ureter affected (left vs right), and presence of retroperitoneal effusion were not associated with this agreement. Sensitivity was 98% and 44%, specificity was 96% and 98%, and positive predictive value was 98% and 88% for detection of ureteroliths and strictures, respectively, by ultrasonography.
CONCLUSIONS AND CLINICAL RELEVANCE Ultrasonography was highly sensitive for detection of ureteroliths that caused ureteral obstruction but was considerably less sensitive for detection of ureteral strictures in the study population. Future prospective studies are needed to determine the role of advanced imaging in assessing cats with ureteral abnormalities. (J Am Vet Med Assoc 2019;254:710–715)
Objective—To determine the sensitivity, positive predictive value, and interobserver variability of CT in the detection of bullae associated with spontaneous pneumothorax in dogs.
Design—Retrospective case series.
Animals—19 dogs with spontaneous pneumothorax caused by rupture of bullae.
Procedures—Dogs that had CT for spontaneous pneumothorax caused by rupture of bullae confirmed at surgery (median sternotomy) or necropsy were included. Patient signalment, CT protocols, and bulla location, size, and number were obtained from the medical records. Computed tomographic images were reviewed by 3 board-certified radiologists who reported on the location, size, and number of bullae as well as the subjective severity of pneumothorax.
Results—Sensitivities of the 3 readers for bulla detection were 42.3%, 57.7%, and 57.7%, with positive predictive values of 52.4%, 14.2%, and 8.4%, respectively, with the latter 2 readers having a high rate of false-positive diagnoses. There was good interobserver agreement (κ = 0.640) for correct identification of bullae. Increasing size of the bulla was significantly associated with a correct CT diagnosis in 1 reader but not in the other 2 readers. Correct diagnosis was not associated with slice thickness, ventilation protocol, or degree of pneumothorax.
Conclusions and Clinical Relevance—Sensitivity and positive predictive value of CT for bulla detection were low. Results suggested that CT is potentially an ineffective preoperative diagnostic technique in dogs with spontaneous pneumothorax caused by bulla rupture because lesions can be missed or incorrectly diagnosed. Bulla size may affect visibility on CT.
To evaluate radiation exposure of dogs and cats undergoing procedures requiring intraoperative fluoroscopy and for operators performing those procedures.
360 fluoroscopic procedures performed at 2 academic institutions between 2012 and 2015.
Fluoroscopic procedures were classified as vascular, urinary, respiratory, cardiac, gastrointestinal, and orthopedic. Fluoroscopy operators were classified as interventional radiology-trained clinicians, orthopedic surgeons, soft tissue surgeons, internists, and cardiologists. Total radiation exposure in milligrays and total fluoroscopy time in minutes were obtained from dose reports for 4 C-arm units. Kruskal-Wallis equality of populations rank tests and Dunn pairwise comparisons were used to compare differences in time and exposure among procedures and operators.
Fluoroscopy time (median, 35.80 minutes; range, 0.60 to 84.70 minutes) was significantly greater and radiation exposure (median, 137.00 mGy; range, 3.00 to 617.51 mGy) was significantly higher for vascular procedures than for other procedures. Median total radiation exposure was significantly higher for procedures performed by interventional radiology-trained clinicians (16.10 mGy; range, 0.44 to 617.50 mGy), cardiologists (25.82 mGy; range, 0.33 to 287.45 mGy), and internists (25.24 mGy; range, 3.58 to 185.79 mGy).
CONCLUSIONS AND CLINICAL RELEVANCE
Vascular fluoroscopic procedures were associated with significantly longer fluoroscopy time and higher radiation exposure than were other evaluated fluoroscopic procedures. Future studies should focus on quantitative radiation monitoring for patients and operators, importance of operator training, intraoperative safety measures, and protocols for postoperative monitoring of patients.
Objective—To determine the incidence of adverse events within 24 hours after contrast-enhanced ultrasonography (CEUS) in dogs and cats and compare the risk of death within 24 hours after imaging for animals that underwent ultrasonography with and without injection of a contrast agent.
Design—Retrospective case-control study.
Animals—750 animals (411 case dogs, 238 control dogs, 77 case cats, and 24 control cats).
Procedures—At 11 institutions, medical records were reviewed of dogs and cats that had CEUS performed (cases) as were medical records of dogs and cats with clinical signs similar to those of case animals that had ultrasonography performed without injection of a contrast agent (controls). Information regarding signalment; preexisting disease; type, dose, and administration route of contrast agent used; immediate (within 1 hour after CEUS) and delayed (> 1 and ≤ 24 hours after CEUS) adverse events; and occurrence and cause of death (when available) was extracted from each medical record. Risk of death within 24 hours after ultrasonography was compared between case and control animals.
Results—Of the 411 case dogs, 3 had immediate adverse events (vomiting or syncope) and 1 had a delayed adverse event (vomiting). No adverse events were recorded for case cats. Twenty-three of 357 (6.4%) clinically ill case animals and 14 of 262 (5.3%) clinically ill control animals died within 24 hours after ultrasonography; risk of death did not differ between cases and controls.
Conclusions and Clinical Relevance—Results indicated that CEUS was safe in dogs and cats.