Evaluation of experimentally induced injury to the superficial digital flexor tendon in horses by use of low-field magnetic resonance imaging and ultrasonography

Karlin, W. Michael; Stewart, Alban; Durgam, Sushmitha; Naughton, James F.; O'Dell-Anderson, Kristen; Stewart, Margaret M.

doi:10.2460/ajvr.72.6.791

Cited by 14 publications

(30 citation statements)

References 22 publications

(30 reference statements)

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“…This supports the hypothesis that a lesion present on T1‐GRE only is probably more representative of a chronic injury, namely fibroplasia . However, it remains unknown whether naturally developing tendon lesions begin with T2 hyperintensities, as proven experimentally, or whether they may initially be visible only in T1‐weighted sequences. There was indeed a nonsignificant trend for lesion size in the T1‐GRE sequence to remain stable in the excellent outcome group and to increase with time in the poor and moderate outcome groups (Table ).…”

Section: Discussionsupporting

confidence: 67%

“…The prognosis of DDF tendinopathy is often guarded to poor and presence of concomitant lesions worsens the prognosis . Recheck MR examinations allow assessment of tendon healing, with possible modification of rehabilitation but, again, the significance of the changes is not understood completely …”

Section: Introductionmentioning

confidence: 99%

“…Lesion signal intensity, maximum cross‐sectional area, length or volume may be a more comprehensive way to assess tendinopathy, as in people . Some equine studies have concentrated on these characteristics on MR images over time in natural or artificially created lesions, but only a few have focused on the relationship between DDF tendinopathy evolution and lameness grade or long‐term outcome . Recently, resolution of tendon or ligament hyperintensities on STIR sequences was associated with improved lameness at recheck examination but was not associated with long‐term outcome …”

Section: Introductionmentioning

confidence: 99%

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CLINICAL SIGNIFICANCE AND PROGNOSIS OF DEEP DIGITAL FLEXOR TENDINOPATHY ASSESSED OVER TIME USING MRI

Vanel

Olive

Gold³

et al. 2012

Vet Radiology Ultrasound

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Deep digital flexor (DDF) tendinopathy is one of the most frequent causes of foot lameness and the prognosis is guarded. The progress of lesion healing may be followed by magnetic resonance (MR) imaging to formulate a prognosis and to adapt the rehabilitation program. We assessed the correlation of outcome with total tendon damage and temporal resolution of MR abnormalities. Images from 34 horses with DDF tendinopathy that had undergone at least two low-field standing MR examinations of the foot (mean 2.5 ± 1.3 times) were reviewed. No horse having a T1-GRE hyperintense lesion over 30 mm in length or over 10% tendon cross-sectional area returned to its previous activity level. Horses with concomitant lesions had worse outcome than horses with DDF tendinopathy only (P = 0.005). In all horses including those with excellent outcome, the lesion persisted, even mildly, in T1-GRE and PD images. Horses with tendon lesion resolution on STIR-FSE and T2-FSE images on recheck examination had a better outcome (P = 0.0004 and P = 0.002, respectively), and all horses that returned to their previous level of performance had complete resolution of signal hyperintensity on the STIR-FSE sequence. Although rehabilitation remains multifactorial, characteristics of DDF tendinopathy and concomitant lesions on first and recheck MR examinations allow refining the prognosis.

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Section: Discussionsupporting

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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CLINICAL SIGNIFICANCE AND PROGNOSIS OF DEEP DIGITAL FLEXOR TENDINOPATHY ASSESSED OVER TIME USING MRI

Vanel

Olive

Gold³

et al. 2012

Vet Radiology Ultrasound

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“…Another difficulty of tendon US imaging is the artefact of anisotropy that occurs when the incident ultrasound wave is not perpendicular to the axis of the tendon or parallel to him in the longitudinal plane, so an aspect hypoechoic of the tendons is observed [12, 18]. To prevent anisotropic artefact, we performed measurement of CSA on the image where it appeared the smallest and with the highest signal intensity (i.e., US probe perpendicular to the tendon long axis).…”

Section: Discussionmentioning

confidence: 99%

“…US is also used to adjust exercises programmes during rehabilitation, with adaptation of the treatment for specific injuries [14] and to determine the readiness return to exercise and competition [12]. According to Reef 1998 [22], a CSA increase of more than 10% is suggestive of reinjury during the rehabilitation period.…”

Section: Introductionmentioning

confidence: 99%

Ultrasonograph and Clinical Quantitative Characterization of Tendinopathy by Modified Splitting in a Goat Model

Grandis

Boulocher

Viguier

et al. 2012

The Scientific World Journal

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A tendinopathy is a clinical condition characterized by activity-related pain, focal tendons tenderness, and intratendinous imaging changes. This study characterizes a surgically induced tendinopathy in a goat model with a noninvasive in vivo longitudinal followup based on physical examination and US. Cross-sectional area (CSA) is the most objective feature for the evaluation of tendinopathy in correlation with clinical findings. The deep digital flexor tendon (DDFT) of the left hind limb of six goats was isolated and scarified by a modified splitting. Pain and lameness at walk and trot were evaluated. External width and thickness of tendon region were measured by calipers. CSA and the ratio lesion/tendon CSA were obtained at days 0, 7, 21, 42, and 84 by US. The highest value of global functional score was obtained at day 7, then decreased until day 40 and was not significantly different from day 0 at the end of the study. The external width recovered a normal value at the end of the study, but the external thickness was still significantly increased (P < 0.05). Peritendinous oedema was observed at day 7, but intratendinous lesions were visible only at day 21 as a focal hypo to anechoic area. At day 84, two tendons still presented visible lesions. US examination was reproducible, specific, and provided complementary information to the global functional score. A standardized focal tendinopathy was induced in goats. This experimental model of focal tendinopathy could be used to study the effect of different treatments.

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Approaches to standardising the magnetic resonance image analysis of equine tendon lesions

Doll

Bohner

Berner

et al. 2023

Veterinary Record Open

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Background Low‐field magnetic resonance imaging (MRI) has gained increasing importance to monitor equine tendon lesions. Comparing results between studies and cases is hampered, because image analysis approaches vary strongly. This study aimed to improve reliability, comparability and time efficiency of quantitative MRI image analysis. Methods Induced tendon lesions were studied over a 24‐week period with 10 follow‐up MRI examinations. Signal intensities (SIs) of tendons, tendon lesions, cortical bone and background, as well as lesion cross‐sectional areas (CSAs) were measured. Lesion SI standardisation with different formulas was evaluated, using histological findings as reference. Different types of region of interest (ROI) for lesion SI measurement were compared. Lesion CSA measurement at different levels was evaluated, using the calculated total lesion volume as reference. Subjective lesion identification and manual CSA and SI measurements were compared to an automated, algorithm‐based approach. Results Lesion SI standardised using a quotient of lesion and background or cortical bone SI, correlated best with histologically determined lesion severity. Lesion SI in circular ROIs correlated strongly with lesion SI in free‐hand whole‐lesion ROIs. The level of the maximum lesion CSA shifted over time; the CSA maximum correlated strongly with lesion volume. In sequences with short acquisition time, algorithm‐based automated lesion detection showed almost perfect agreement with subjective lesion identification. Automated measurement of CSA and SI was also feasible, with stronger correlation and better agreement with the manually obtained data for the SI than for the CSA. Conclusion Our study may provide guidance for MRI image analysis of tendon healing. Reliable image analysis can be performed time‐efficiently, particularly regarding lesion SI quantification.

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Evaluation of experimentally induced injury to the superficial digital flexor tendon in horses by use of low-field magnetic resonance imaging and ultrasonography

Abstract: Ultrasonography may underestimate the extent of tendon damage in tendons with long-term injury. Low-field MRI provided a more sensitive technique for evaluation of tendon injury and should be considered in horses with tendinitis of > 4 weeks' duration.

Cited by 14 publications

References 22 publications

CLINICAL SIGNIFICANCE AND PROGNOSIS OF DEEP DIGITAL FLEXOR TENDINOPATHY ASSESSED OVER TIME USING MRI

CLINICAL SIGNIFICANCE AND PROGNOSIS OF DEEP DIGITAL FLEXOR TENDINOPATHY ASSESSED OVER TIME USING MRI

Ultrasonograph and Clinical Quantitative Characterization of Tendinopathy by Modified Splitting in a Goat Model

Approaches to standardising the magnetic resonance image analysis of equine tendon lesions

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