Contrast enhancement ultrasonography (CEUS) for the evaluation of gastrointestinal desease

La ricerca è incentrata sulla valutazione dell’applicabilità dell’esame ecocontrastografico (CEUS) nello studio delle patologie dell’apparato gastroenterico (GE) dei piccoli animali ed in particolare dell’Inflammatory Bowel Disease (IBD) e dell’ischemia gastrointestinale. Per l’IBD sono stati condotti due studi: uno per determinare l’applicabilità della metodica CEUS nella valutazione della perfusione parietale del duodeno in cani con IBD e l’altro per valutare l’applicabilità della CEUS nel monitoraggio della risposta terapeutica. E’ stato arruolato un gruppo di cani con IBD e uno di cani sani sui quali sono stati formulati e confrontati score clinici, ecografici, ecocontrastografici, endoscopici e istologici del duodeno. Inoltre in un gruppo di soggetti con IBD tali score sono stati confrontati sia al momento della diagnosi che dopo un tempo standardizzato dall’inizio della terapia. Sono state osservate differenze nella modalità di distribuzione del mezzo di contrasto nella parete duodenale tra soggetti sani e quelli con IBD, e tra soggetti con IBD per e post terapia. La quantificazione delle variabili perfusive CEUS ha invece evidenziato differenze statisticamente significative tra soggetti sani e malati per quanto riguarda il Peak Intensity (PI) e Mean Transit Time (MTT). Nessuna differenza è stata evidenziata nelle variabili CEUS dei soggetti con IBD pre- e post-terapia. Su questi risultati è possibile affermare che la CEUS è utile nel distinguere i cani malati dai sani ma non è utili per il monitoraggio terapeutico. Nello studio delle patologie ischemiche GE è stato incluso un piccolo gruppo di cani e gatti (5 pazienti) con lesioni ischemiche di diversa natura. La CEUS ha mostrato una severa riduzione o una completa assenza della perfusione parietale del tratto gastroenterico colpito in confronto alla normale perfusione dei tratti intestinali circostanti dimostrando l’applicabilità e l’utilità di questa metodica nel determinare un danno perfusivo parietale in analogia con quanto già dimostrato in Medicina Umana.May research project was focused on contrast-enhanced ultrasonography (CEUS) for the evaluation of two different small animal gastrointestinal (GI) diseases: Inflammatory Bowel Disease (IBD) and GI ischemia. Concerning the first disease, 42 dogs with IBD and 20 healthy dogs were included in the study. CEUS of the duodenum was performed to characterize the perfusion of the wall both in healthy and affected dogs. For 12 patients with IBD we performed comparisons of the CEUS parameters before and after two months of a standardized treatment. The duodenal wall exhibited a typical perfusion pattern characterized by a radial and simultaneous enhancement of wall. No differences were observed on the contrast medium distribution between healthy and affected dogs, and between dogs with IBD before and after treatment. Statistically significant differences occurred in the peak intensity and mean transit time between healthy and affected dogs. No significant differences were found for the perfusion parameters before and after treatment. In conclusion, this preliminary study demonstrated that CEUS is useful in distinguishing sick dogs from healthy ones, but it was not able to provide useful information to monitor therapeutic response. Concerning the second disease, the aim of this study was to describe the use of CEUS in a case series of small animal with confirmed GI ischemia. On conventional US all GI lesions were characterized by a focal hypoechoic thickening of the gastric/intestinal wall with loss of normal layering associated with hyperechoic mesentery surrounding the affected GI tract. CEUS showed a severe reduced or absent enhancement of the GI lesions compared to the normally perfused surrounding gastric/intestinal wall. The CEUS features observed in our patients with GI ischemia are similar to those reported in humans. These preliminary findings demonstrated the feasibility and usefulness of CEUS for the detection of canine and feline GI wall impaired perfusio

Diagnosis and Treatment of Foetal Anasarca in Two English bulldog Puppies

This case report provides the first description of foetal anasarca, from prenatal diagnosis to neonatal treatment, in two English Bulldog puppies. Anasarca affected 2 out of 3 puppies of the same litter. The dam was a 3 year-old primipara and was ultrasonographically monitored during pregnancy. The diagnosis of foetal anasarca was performed on d53. The most severely affected puppy was a female, which showed subcutaneous oedema and fluid in the thoracic and abdominal cavities. The other affected puppy was a male, which showed subcutaneous oedema but no fluid in thoracic and abdominal cavities. At birth, the female puppy did not respond to resuscitation, whereas the male puppy was successfully treated with furosemide after resuscitation and completely recovered within 36 hours. The third puppy was a healthy female. Two weeks after birth, the male puppy was healthy, although it was lighter compared to its sister puppy. In conclusion, ultrasound examination during routine pregnancy monitoring permits an early diagnosis of foetal anasarca, at least in the most severe cases. Prenatal diagnosis can be useful for the planned c-section, in order to apply an adequate treatment as soon as possible at delivery

Penile Foreign Bodies in Dogs: A Retrospective Study

Abstract Hematuria, or preputial hemorrhagic discharge, is an extremely common clinical sign; it can be associated with a wide range of diseases, including, even if only rarely, penile foreign bodies. The aim of this retrospective study was to describe the diagnosis and therapy involving migration from the preputial ostium or penile urethra of a foreign body (awn grass) embedded in the connective tissue surrounding the penis, or in deeper inguinal tissues, in dogs with hematuria or preputial hemorrhagic discharge. In the selected cases, signaling, history, clinical signs, results of laboratory exams, endoscopic and ultrasonographic evaluation, and the technique used for foreign body removal were evaluated. Dogs with hemorrhagic discharge consequent to a penile foreign body represented 2% of the entire population considered. At physical examination, the most common features were the presence of swelling of the glans and hyperemia associated with a penile fistula (4/6 dogs), and pain during penile exteriorization (3/6 dogs). Laboratory results showed mild neutrophilic leukocytosis in 2/3 dogs and reticulocytosis in 1/3 dogs. Endoscopy, performed in 2/6 dogs, did not reveal any alterations associated with passage of the foreign body. Ultrasonography was useful in reaching a definitive diagnosis, identifying the position of the grass awn in 6/6 cases and permitting its removal in all dogs using an ultrasound-guided technique. This case report suggested that penile foreign bodies are a rare, but possible, cause of hematuria or hemorrhagic discharge in male dogs, and that ultrasonography is a useful technique in the making of a differential diagnosis and removal of foreign bodies

Use of contrast-enhanced ultrasonography for the characterization of tumor thrombi in seven dogs

Some neoplasia-such as adrenal and thyroid glands tumors-have been associated with "tumor thrombi" both in humans and dogs. The detection and characterization of these venous tumor thrombi is important for both surgical planning and prognosis. In human medicine, contrast-enhanced ultrasonography (CEUS) is considered an accurate diagnostic technique for differentiating malignant from benign portal vein thrombosis in hepatocellular carcinomas. Data regarding the characteristics of tumor thrombi in dogs are currently lacking. Therefore, the aim of this study was to assess the feasibility of CEUS for the characterization of malignant venous thrombosis in dogs. On the basis of our results, CEUS appeared to be useful in the detection of malignant intravascular invasion; contrast uptake of the thrombus was present in all cases. In addition, CEUS may clearly detect newly formed vessels within the thrombus, and arterial-phase enhancement and washout in the venous phase were the main features in malignant thrombosis in our dogs. As CEUS is an easy to perform, noninvasive technique, its application in the detection of malignant thrombosis in dogs may be used to improve the diagnosis in oncological canine patients. Tumors of adrenal and thyroid glands have been associated with vascular invasions-so-called tumor thrombi, both in humans and dogs. The detection and characterization of venous thrombi is an important diagnostic step in patients with primary tumors for both surgical planning and prognosis. The aim of this study was to describe the use of contrast-enhanced ultrasonography (CEUS) for the characterization of tumor thrombi. Dogs with tumor thrombus who underwent bi-dimensional ultrasound (B-mode US) and CEUS were included. Seven dogs were enrolled in this retrospective case series. On B-mode US, all thrombi were visualized, and vascular distension and thrombus-tumor continuity were seen in three and two cases, respectively. On color Doppler examination, all thrombi were identified, seemed non-occlusive and only two presented vascularity. On CEUS, arterial-phase enhancement and washout in the venous phase were observed in all cases. Non-enhancing areas were identified in the tumor thrombi most likely representing non-vascularized tissue that could potentially be embolized in the lungs after fragmentation of the tumor thrombi. On the basis of these preliminary study, CEUS appeared to be useful for the characterization of malignant intravascular invasion

Ultrasonographic assessment of early leakage in intestinal sutures in dogs

Intestinal suture dehiscence is one of the most feared complications following gastrointestinal surgery in both human and veterinary medicine, increasing the morbidity and mortality of these patients. Clinical and laboratory early signs of septic peritonitis are not always easily identifiable while prompt treatment should help decrease postoperative morbidity and mortality. The aim of this study is to describe the ultrasonographic (US) features of confirmed leakage of intestinal sutures (LIS) and to evaluate if this imaging technique can be useful as noninvasive tool for the early diagnosis of LIS. Seven dogs developed LIS in a range of three-four days after gastrointestinal surgery and four of these developed a second dehiscence. On B-mode ultrasonography, all intestinal surgical sites were identified and characterized by a bowel focal thickening with reduced or absent wall layering and the presence of hyperechoic, double-walled foci at regular intervals (suture material). Furthermore, hyperechoic linear interfaces associated with dirty acoustic shadowing and comet-tail artifacts crossing the intestinal wall to free-float in peritoneal cavity or in a saccate collection have been documented. On the basis of these preliminary results, canine abdominal ultrasound seems to be a useful diagnostic technique for post-operative monitoring of patients undergoing intestinal surgery, allowing early detection of signs of a LIS, before the patient develops clinical signs of septic peritonitis

Contrast-enhanced ultrasonography of the pancreas in healthy cats

Background: This study describes the pattern of ultrasonographic contrast enhancement of the pancreatic body and left lobe using a second-generation commercial contrast medium (Sonovue) in 10 clinically healthy cats. Results: Following contrast medium administration, microbubbles were observed within the splenic artery. This was followed by an inflow of contrast medium into the pancreatic capillary beds, providing a uniformly contrast-enhanced pancreas at peak intensity (PI). At the time of PI, a replenishment of the splenic and portal veins started and increased progressively during the wash-out phase. During the wash-out phase, the echogenicity of the pancreatic parenchyma decreased progressively. Perfusion parameters included arrival time (4.69 \ub1 1.26 s), time to peak from injection (7.52 \ub1 1.88 s), time to peak from initial rise (2.84 \ub1 0.88 s), peak intensity (6.58 \ub1 2.66 a.u.), and wash-in rate (2.11 \ub1 1.79 a.u./s). Conclusions: This perfusion pattern of normal pancreatic parenchyma may be useful for characterising cats with exocrine pancreatic disorders

Use of contrast-enhanced ultrasonography for the characterization of tumor thrombi in seven dogs

Tumors of adrenal and thyroid glands have been associated with vascular invasions—so-called tumor thrombi, both in humans and dogs. The detection and characterization of venous thrombi is an important diagnostic step in patients with primary tumors for both surgical planning and prognosis. The aim of this study was to describe the use of contrast-enhanced ultrasonography (CEUS) for the characterization of tumor thrombi. Dogs with tumor thrombus who underwent bi-dimensional ultrasound (B-mode US) and CEUS were included. Seven dogs were enrolled in this retrospective case series. On B-mode US, all thrombi were visualized, and vascular distension and thrombus-tumor continuity were seen in three and two cases, respectively. On color Doppler examination, all thrombi were identified, seemed non-occlusive and only two presented vascularity. On CEUS, arterial-phase enhancement and washout in the venous phase were observed in all cases. Non-enhancing areas were identified in the tumor thrombi most likely representing non-vascularized tissue that could potentially be embolized in the lungs after fragmentation of the tumor thrombi. On the basis of these preliminary study, CEUS appeared to be useful for the characterization of malignant intravascular invasion

Contrast‐enhanced ultrasonography in dogs with inflammatory bowel disease

Background: Contrast-enhanced ultrasonography (CEUS) is used to evaluate vascularity of the gastrointestinal wall in neoplastic and inflammatory diseases. Objective: To assess the feasibility of CEUS for the evaluation of duodenal perfusion in dogs with inflammatory bowel disease (IBD). Animals: Forty-two dogs with IBD and 20 clinically healthy dogs. Methods: All CEUS studies of the duodenum were analyzed to obtain time-intensity curves and perfusion parameters. The procedure was repeated in 12 IBD dogs 2 months after a standardized treatment. Results: On CEUS, the duodenal wall showed a typical perfusion pattern characterized by a radial and simultaneous enhancement of the wall in all dogs. On qualitative assessment, no differences were observed in contrast medium distribution between healthy and affected dogs, or between dogs with IBD before and after treatment. Peak intensity (PI) and area under the curve (AUC) significantly differed between healthy (PI = 3.58 arbitrary units [au; 1.86-4.93 au] and AUC = 47.63 au seconds [aus, 22.68-62.15]) and affected dogs (PI = 5.10 au [0.63-15.16 au] and AUC = 63.62 aus [5.31-212.20 aus]; P = .03 and .03, respectively). No significant differences were found for the perfusion parameters before and after treatment. Conclusions and clinical importance: We showed that CEUS allows discrimination between IBD affected dogs and healthy dogs by evaluation of time-intensity curves, but did not provide useful information for monitoring therapeutic response. The qualitative assessment identified no significant differences between healthy and affected dogs, or between dogs before and after treatment

IMAGING DIAGNOSIS-CHOLANGIOCELLULAR ADENOMA: CONTRAST-ENHANCED ULTRASONOGRAPHIC FINDINGS OF A BENIGN TUMOR MIMICKING MALIGNANT NEOPLASIA IN A DOG

A 9-year-old Giant Schnauzer was referred for polyuria and polydipsia. On abdominal ultrasound, a hyperechoic mass with low color Doppler signal was detected in the medial right hepatic lobe. Contrast-enhanced ultrasound (CEUS) demonstrated increased enhancement of the mass during the arterial phase, and contrast washout during portal and late phases with decreased enhancement relative to the liver. These findings were consistent with primary liver malignancy or liver metastasis. A final diagnosis of cholangiocellular adenoma was made based on histopathology. To our knowledge, this is the first description of a benign hepatic neoplasm exhibiting malignant CEUS characteristics in a dog