Identification of surgically-induced longitudinal lesions of the equine deep digital flexor tendon in the digital flexor tendon sheath using contrast-enhanced ultrasonography: an ex-vivo pilot study

Acta Veterinaria Scandinavica

Andrea Bertuglia²  Giulia Mollo²  Michela Bullone¹  Barbara Riccio³ 

[1] Department of Clinical Sciences, Université de Montréal 3200 rue Sicotte, Saint-Hyacinthe, J2S2M2, QC, Canada

[2] Dipartimento di Science Veterinarie, Università degli Studi di Torino, via Leonardo da Vinci 44, Grugliasco, 10095, TO, Italy

[3] Studio Veterinario Associato Cascina Gufa, strada provinciale 201 km 3, Merlino, 26833, LO, Italy

关键词: Horses;    Cadaver limb;    Intrathecal injection;    Synovial sheath;    Angle contrast ultrasonography;    Contrast ultrasonography;    Sulfur-hexafluoride;    Microbubbles;   

Others  :  1082507
DOI  :  10.1186/s13028-014-0078-7

 received in 2014-07-24, accepted in 2014-11-11,  发布年份 2014

【 摘 要 】

Background

Longitudinal tears in the lateral aspect of the deep digital flexor tendon are the most common causes of pain localised to the equine digital flexor tendon sheath. However conventional ultrasonographic techniques provide limited information about acute lesions. Ultrasonographic contrast agents are newly developed materials that have contributed to advancement in human diagnostic imaging. They are currently approved for intravenous use in human and animal models. In this study we described intrathecal use in the horse. This study was undertaken to evaluate the reliability of standard and angle contrast-enhanced ultrasonography to detect and characterize surgically-induced longitudinal lesions in the deep digital flexor tendons.

In this pilot study surgically-induced lesions were created in the lateral aspect of the deep digital flexor tendon within the digital flexor tendon sheath in 10 isolated equine limbs to generate a replicable model for naturally occurring lesions. Another 10 specimens were sham operated. All the limbs were examined ultrasonographically before and shortly after the intrasynovial injection of an ultrasound contrast agent containing stabilised microbubbles. The images were blindly evaluated to detect the ability to identify surgically-created lesions. The deep digital flexor tendons were dissected and a series of slices were obtained. The depth of longitudinal defects identified with contrast-enhanced ultrasound scans was compared to the real extent of the lesions measured in the corresponding gross tendon sections.

Results

Contrast-enhanced ultrasonography with both angle and standard approach provided a significant higher proportion of correct diagnoses compared to standard and angle contrast ultrasonography (p < 0.01). Contrast-enhanced ultrasonography reliably estimated the depth of surgically-induced longitudinal lesions in the deep digital flexor tendons.

Conclusion

Contrast-enhanced ultrasound of the digital flexor tendon sheath could be an effective tool to detect intrasynovial longitudinal tears of the deep digital flexor tendon, although an in vivo study is required to confirm these results for naturally occurring lesions.

【 授权许可】

   
2014 Bertuglia et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Wilderjans H, Boussauw B, Madder K, Simon O: Tenosynovitis of the digital flexor tendon sheath and annular ligament constriction syndrome caused by longitudinal tears in the deep digital flexor tendon: a clinical and surgical report of 17 cases in Warmblood horses. Equine Vet J 2003, 35:270-275.
• [2]Wright IM, McMahon PJ: Tenosynovitis associated with longitudinal tears of the digital flexor tendons in horses: a report of 20 cases. Equine Vet J 1999, 31:12-18.
• [3]Blunden A, Murray R, Dyson S: Lesions of the deep digital flexor tendon in the digit: a correlative MRI and post mortem study in control and lame horses. Equine Vet J 2009, 41:25-33.
• [4]Edinger J, Mobius G, Ferguson J: Comparison of tenoscopic and ultrasonographic methods of examination of the digital flexor tendon sheath in horses. Vet Comp Orthop Traumatol 2005, 18:209-214.
• [5]Arensburg L, Wilderjans H, Simon O, Dewulf J, Boussauw B: Nonseptic tenosynovitis of the digital flexor tendon sheath caused by longitudinal tears in the digital flexor tendons: a retrospective study of 135 tenoscopic procedures. Equine Vet J 2011, 43:660-668.
• [6]Smith MR, Wright IM: Noninfected tenosynovitis of the digital flexor tendon sheath: a retrospective analysis of 76 cases. Equine Vet J 2006, 38:134-141.
• [7]Werpy NM, Denoix JM, McIlwraith CW, Frisbie DD: Comparison between standard ultrasonography, angle contrast ultrasonography, and magnetic resonance imaging characteristics of the normal equine proximal suspensory ligament. Vet Radiol Ultrasound 2013, 54:536-547.
• [8]Fiske-Jackson AR, Barker WHJ, Eliashar E, Foy K, Smith RKW: The use of intrathecal analgesia and contrast radiography as preoperative diagnostic methods for digital flexor tendon sheath pathology. Equine Vet J 2013, 45:36-40.
• [9]Vanel M, Olive J, Gold S, Mitchell RD, Walker L: Clinical significance and prognosis of deep digital flexor tendon tendinopathy assessed over time using MRI. Vet Radiol Ultrasound 2012, 53:621-627.
• [10]Cillán-García E, Milner PI, Talbot A, Tucker R, Hendey F, Boswell J, Reardon RJM, Taylor SE: Deep digital flexor tendon injury within the hoof capsule; does lesion type or location predict prognosis? Vet Rec 2013, 173:70.
• [11]King JN, Zubrod CJ, Schneider RK, Sampson SN, Roberts G: MRI findings in 232 horses with lameness localized to the metacarpo(tarso)phalangeal region and without a radiographic diagnosis. Vet Radiol Ultrasound 2013, 54:36-47.
• [12]Chang KV, Lew HL, Wang TG, Chen WS: Use of contrast enhanced ultrasonography in musculoskeletal medicine. Am J Phys Med Rehabil 2012, 91:449-457.
• [13]Dijkmans PA, Juffermans LJ, Muster RJ, van Wamel A, ten Cate FJ, van Gilst W, Visser CA, de Joing N, Kamp O: Microbubbles and ultrasound: from diagnosis to therapy. Eur J Echocardiogr 2004, 5:245-256.
• [14]Funakoshi T, Iwasaki N, Kamishima T, Nishida M, Ito Y, Nishida K, Motomiya M, Suenaga N, Minami A: In vivo vascularity alterations in repaired rotator cuffs determined by contrast-enhanced ultrasound. Am J Sports Med 2011, 39:2640-2646.
• [15]Song IH, Althoff CE, Herman KG, Scheel AK, Knetsch T, Schoenharting M, Werner C, Burmester GR, Backhaus M: Knee osteoarthtitis. Efficacy of a new method of contrast-enhanced musculoskeletal ultrasonography in detection of synovitis in patients with knee osteoarthritis in comparison with magnetic resonance imaging. Ann Rheum Dis 2007, 67:19-25.
• [16]Klauser A, Halpern E, Frauscher F, Gvozdic D, Duftner C, Springer P, Schirmer M: Inflammatory low back pain: high negative predictive value of contrast-enhanced color Doppler ultrasound in the detection of inflamed sacroiliac joints. Arthritis Rheum 2005, 53:440-444.
• [17]Rocconi RA, Sampson SN: Comparison of basilar and axial sesamoidean approaches for digital flexor tendon sheath synoviocentesis and injection in horses. J Am Vet Med Assoc 2013, 243:869-873.
• [18]Schneider M, Arditi M, Barrau MB, Brochot J, Broillet A, Ventrone R, Yan F: BR1: a new ultrasonographic contrast agent based on sulphur hexafluoride-filled microbubbles. Invest Radiol 1995, 30:451-457.
• [19]Geleijnse ML, Nemes A, Vletter WB, Michels M, Soliman O, Caliskan K, Galema TW, Cate FJ: Adverse reaction after the use of sulphur hexafluoride (Sonovue) echocontrast. J Cardiovasc Med 2009, 10:75-77.
• [20]Furlow B: Contrast-enhanced ultrasound. Radiol Technol 2009, 80:547S-561S.
• [21]Domenech E, Bernà-Serna JD, Polo L, Reus M, Bernà-Mestre JD, Canteras M: Effect of SonoVue on the synovial membrane in rabbit knees. J Ultrasound Med 2011, 30:1241-1246.