Background: Equine palmar foot syndrome is a common cause of chronic lameness. Radiographic and ultrasound imaging are sometimes insufficient to examine the podotrochlear apparatus. MRI and CT have great diagnostic value but are expensive and are not available for all patients. Bursography might become a highly available and inexpensive diagnostic tool for this purpose.Material and Methods: To evaluate the technique, standard palmaroproximal-palmarodistal-oblique (PaPr-PaDiO ) and dorsoproximal-palmarodistal oblique (DPr-PaDiO) radiographs were acquired both before and after injecting contrast medium in the navicular bursa (NB) and were subsequently compared with gross pathology as gold standard in 48 dissected front feet. For all results a scoring system with 4 groups was introduced. Results: Compared with the gold standard, the fleiss kappa between groups were 0.349, 0.280, 0.358, and 0.455 for DPr-PaDiO, PaPr-PaDiO, DPr-PaDiO contrast enhanced (CE), and PaPr-PaDiO (CE), respectively (P < 0.001). The combined view of native images and the view of all pictures were correlated to the gold standard with a Spearman’s rank correlation coefficient of 0.373 and 0.556, respectively (P < 0.001). The Kruskal-Wallis-Test did not reveal any significant difference between standard radiographs and gross pathology group 1, 2, and 3. Contrast enhanced (CE) radiographs showed significant differences between gross pathology group 1 versus 2 and 3. Group 4 feet (gross pathology score) were remarkably well evaluated by both radiographic imaging techniques. When more than two projections were graded with findings, the respective feet were found to be moderately to severely changed in gross pathology (specificity: 100 %, sensitivity: 41.4 %). 3/13 (23.1%) group 3 and 4/19 (21.1%) group 4 specimens showed altered CE radiographs and unremarkable native radiographs. 2/13 (15.4%) group 3 and 2/19 (10.5%) group 4 feet do not have any findings in radiographs. Conclusion: In the present study, bursography with two additional CE images led to more information on the podotrochlear apparatus compared to native radiographs alone. Some cases with no changes in native radiographs will be detected in bursography, and in specimens with altered native radiographs, the diagnosis will be ensured. Therefore, bursography is a useful tool for diagnosing horses with suspected navicular disease when an MRI is not possible or the NB is injected anyway for therapeutic purposes.
Equine palmar foot syndrome or navicular disease is a common cause of chronic front limb lameness. The state-of-the-art magnetic resonance imaging is not available for all patients and ultrasonography is sometimes impossible. Intrabursal medication is an important part of treating the disease. Contrast-enhanced (CE) radiography seems to be another interesting imaging modality. There is no information about the CE dorsoproximal-palmarodistal oblique (DPr-PaDiO) radiographs in living horses. This case study shows the first results of this imaging technique with explanations of the findings. Twenty out of 23 injections were successful. The navicular bursa (NB) and the distal interphalangeal joint were filled with contrast medium (CM) in 1/23. There was CM palmar to the deep digital flexor tendon (DDFT) in addition to the filled NB in 5/20 (25 %) cases. The DPr-PaDiO CE showed alliterations in 7/9 (77.78 %) with a clinical history of lameness. There were two DDFT lesions, one full flexor cortex lesion, three suspected ruptures of the NB and five NB adhesions. The DPr-PaDiO CE X-ray is an inexpensive and highly available additional imaging tool in horses with suspected equine palmar foot syndrome.
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