RESUMEN
A 3-year-old dog with cervical myelopathy resulting from a vascular anomaly is described. Marked intradural-extramedullary spinal cord compression was observed, in association with multilevel ectatic anastomotic radicular arterial branches connecting the left and right vertebral arteries. A nonpatent proximal segment of the right subclavian artery had resulted in compensatory enlargement of the left vertebral artery. Flow within the right vertebral artery was retrograde and fed into the patent distal segment of the right subclavian artery. Multiple imaging techniques including myelography, computed tomography, magnetic resonance imaging, and selective digital angiography were used to document this anomaly. To reduce spinal cord compression the largest collateral vessel was embolized without complication. Good clinical response was observed within 6 weeks and improved clinical neurologic function was maintained at the time of a 12-month re-evaluation.
Asunto(s)
Enfermedades de los Perros/diagnóstico , Compresión de la Médula Espinal/veterinaria , Enfermedades de la Médula Espinal/veterinaria , Síndrome del Robo de la Subclavia/veterinaria , Animales , Vértebras Cervicales , Diagnóstico Diferencial , Enfermedades de los Perros/diagnóstico por imagen , Enfermedades de los Perros/patología , Enfermedades de los Perros/fisiopatología , Enfermedades de los Perros/terapia , Perros , Femenino , Imagen por Resonancia Magnética/veterinaria , Compresión de la Médula Espinal/diagnóstico , Enfermedades de la Médula Espinal/diagnóstico , Síndrome del Robo de la Subclavia/diagnóstico , Tomografía Computarizada por Rayos X/veterinaria , Arteria Vertebral/patología , Arteria Vertebral/fisiologíaRESUMEN
OBJECTIVE: To determine the sensitivity and specificity of radiographic evaluation of radio-ulnar incongruence in canine elbow joints in vitro. STUDY DESIGN: Radiographic evaluation of induced radio-ulnar incongruence in canine cadaveric forelimbs by radiologists blinded to study design. SAMPLE POPULATION: Six cadaveric canine left forelimbs. METHODS: Extended lateral, 90 degrees flexed lateral, and cranio-caudal projections were taken of the elbow joint of six cadaveric canine forelimbs. A four-pin, type I external skeletal fixator (ESF) with a linear motor side bar was attached to the medial aspect of the radius, and a 2-cm segment of bone was removed from the mid-diaphysis. A 3.5-mm cortical bone screw placed from the medial to lateral styloid processes prevented relative movement between the distal radius and ulna during radial shortening. The ESF was used to progressively shorten the radius in increments of 0.5 mm to a total of 4 mm. The three radiographic projections were repeated after each incremental change of length. After the study, each elbow joint was disarticulated to confirm the presence of a step defect. The original radiographs and three copies were randomized and then evaluated by four radiologists blinded to the study design. Radiologists were asked to evaluate whether the joint was normal or abnormal and if there was evidence of radio-ulnar incongruence. The ability of each radiologist to correctly identify congruent elbows (specificity) and incongruent elbows (sensitivity) was calculated. RESULTS: The median specificity was 86% using the lateral projection and 82% using the cranio-caudal projection. The median sensitivities using the lateral and cranio-caudal radiographic projections were 78% and 79%, respectively. The degree of radial shortening required for individual radiologists to achieve a sensitivity of 90% ranged from 1.5 mm to greater than 4 mm. CLINICAL RELEVANCE: Standard radiographic evaluation for radio-ulnar incongruence in the dog may be associated with relatively poor sensitivity and specificity. Invasive surgical procedures and screening programs that rely on radiographic diagnosis of radio-ulnar incongruence should be discouraged until a more reliable method of diagnosis of this type of elbow joint incongruence is available.