Scope of Diagnostic Imaging in Veterinary Practice

A number of imaging procedures have been developed to help diagnose diseases in humans, and
many of these have been adapted for use in animals. Most imaging methods provide a large amount
of information by noninvasive and economical means and, at the same time, do not change the
disease process or cause unacceptable discomfort to the pet. However, because of the complexity
and expense of the equipment and instruments, some of these procedures are carried out in
facilities designed especially for their use.

X-ray Imaging
X-rays have been in use for many decades. Also known as radiography, this is the most commonly
used imaging procedure in veterinary practices. The x-ray images are produced using the same
processes used in human medicine except that the equipment is sized for use with dogs, cats, and
other small animals. Portable equipment may be used in a large animal clinic that treats horses and
other large animals. Although the procedure is painless, in some cases pets are sedated to reduce
the anxiety and stress associated with the procedure and to position the animal and to help the
animal stay still while the images are taken.

X-rays work well for imaging bones,

foreign objects, and large body
cavities. They are often used to help
detect fractures, tumors, injuries,
infections, and deformities.
Although x-rays may not give
enough information to determine
the exact cause of your pet’s
problem, they can help your
veterinarian determine which other
tests may be needed to make a
diagnosis.

The body’s soft tissues do not absorb x‑rays well and can be difficult to see using this technology
alone. Specialized x‑ray techniques, called contrast procedures, are used to help provide more
detailed images of body organs. In these procedures the animal is given a dye that will block x‑rays.
This can be given intravenously to examine organs like the kidneys or heart, or by mouth to examine
the digestive tract. A series of x-rays is taken after the dye is given, which will outline the organs
where the dye collects. This makes it easier to spot any abnormalities.

There are many advantages to storing x‑ray images on computer. One of the most important is the
ability to rapidly and economically transmit copies of the images to specialists or other clinics.
Specialists or individuals at other clinics can study the images of your pet and help your veterinarian
accurately diagnose and treat your pet’s condition.
Ultrasonography
Ultrasonography (commonly called ultrasound) is the second most commonly used imaging
procedure in veterinary practice. It uses ultrasonic sound waves to create images of body structures
based on the pattern of echoes reflected from the tissues and organs. Ultrasound is much better
than x-rays at showing the soft tissues within the body.

The technician usually performs an ultrasound scan by pressing a small probe against the animal’s
body, most frequently the abdominal wall. The sound waves are directed to various parts of the
abdomen by moving the probe. Echoes occur as the sound beam changes velocity while passing
through tissues of varying density. The echoes are converted into electrical impulses that are then
converted into an image that represents the appearance of the tissues. In modern scanning systems,
the sound beam is swept through the body many times per second, producing a dynamic, real-time
image that changes as the probe moves across the body.

An ultrasound scan can show the size and

shape of many organs and can also show
abnormalities within them. An ultrasound
scan is both painless and noninvasive, and
poses no risk of complications. This is the
same diagnostic tool used in many medical
facilities to check the condition of a human
fetus in the womb.

Although ultrasound can be used to

evaluate most soft tissues, the heart and
abdominal organs are the most frequently
scanned in veterinary clinics. Ultrasonic
imaging of the heart is termed
echocardiography. The structure and function of the heart and its valves can be evaluated by this
procedure. There are limitations to ultrasonography. It cannot be used to scan gas-filled or bony
tissues.

Computed Tomography
Computed tomography (CT) is a computer-enhanced x-ray procedure used to detect abnormalities in
various body organs. Because of the expense and size of the equipment, and the need for specially
trained technicians, this procedure is not often used for pets. However, it may be available in some
locations (such as hospitals associated with veterinary schools or large specialty practices) and may
occasionally be recommended.

In this procedure, the animal is placed on a motorized bed inside a CT scanner, which takes a series
of x-rays from different angles. When one series, or scan, is completed, the bed is moved forward,
and another scan is taken. CT scans differ from ordinary x-rays because they show different levels of
tissue density and produce more detailed images. From these scans, a computer creates cross-
sectional images of the body part under investigation and displays the images on a monitor. A dye
that can be seen on x-rays may be injected intravenously to make it easier to see abnormalities in
the images. By sequentially scanning a body area, an entire organ or other structure can be imaged
without interference from neighboring or overlying structures. These scans can be used by the
veterinarian to detect structural changes deep within the body, including tumors, abscesses,
changes in blood vessels, and fractures.

Because of the need to remain still for a relatively long time while scanning is completed, animals
undergoing a CT scan are anesthetized.

Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) is another form of imaging in use today. It is an alternative to
computed tomography. MRI is a highly sensitive and noninvasive technique providing accurate and
detailed anatomic images with good contrast and spatial resolution. However, in veterinary
medicine MRI is still in its infancy and its use is infrequent. To date, MRI has been used in developed
countries in clinical cases as well as a research tool especially for CNS diseases in small animals. MRI
has a wide spectrum of application. It can be used for imaging all body regions in small animals, but
only the extremities and the head can be imagined in large animals. It is useful in answering many
questions related to the musculoskeletal diseases in animals such as understanding the pathogenesis
of navicular disease, traumatic arthritis and osteochondrosis in equines and wobbler syndrome in
dogs. The newer applications of MRI are Magnetic resonance angiography and MR spectroscopy. It is
especially used to differentiate an inflammatory process from a neoplastic mass, tumors from
peritumoral oedema. It is more specific and sensitive in detecting localizing and differentiating
osteomyelitis, cellulites and abscess. However, its use is contraindicated in pregnancy.

Nuclear Medicine Imaging

Nuclear medicine imaging, also known as radionuclide imaging or nuclear scintigraphy, involves
dosing the animal with an element that emits a type of radiation known as gamma rays. Nuclear
scintigraphy is a highly sensitive advanced procedure in which radioisotopes are used to detect the
functional abnormalities of the body system. The interpretation is based on the appearance of the
increased (hot spots) or decreased (cold spots) radioactivity regions.
For eg. an active process is indicated by a hot spot while a dull process like lack of perfusion is
indicated by cold spot. Nuclear scintigraphy has been used to detect functional disorders of the
kidney, liver, lungs, GI tract, thyroid gland and many other organs. It is very useful in the diagnosis of
occult lameness, lung perfusion and ventilation and patency of the ureter
in both large and small animals. Also used for vertebral column imaging and monitoring the
progress of fracture healing and in tumor detection.

Veterinarians most frequently use nuclear medicine imaging to analyze the lungs, kidneys, liver,
thyroid, and heart, although other portions of a pet’s body may also be studied with this technique.

DSA
DSA is a radiographic modality which allows dynamic imaging of the vascular system
following intravascular injection of iodinated X-ray contrast media through the use of image
intensification, enhancement of the iodine signal and digital processing of the image data. Temporal
subtraction of the images obtained during the first arterial phase of injection of the contrast medium
from the images obtained before and after contrast medium administration yield images which are
devoid of bone and soft tissue. This imaging modality plays an important role in highlighting the
vascular pathologies like stenosis etc.
Laparoscopy
Laparoscopy has been a valuable diagnostic and therapeutic tool in human clinical medicine. Only in
the last 15 years, its use has been extensive in various animal species for
research and clinical diagnostic and therapeutic purposes. Laparoscopic surgey offers significant
advantages over open surgeries in fields of cholecystotomy, appendicectomy, vagotomy, hernia
repair and adhesion release etc. For gynaecological problems like ovarian cyst or in the case of
oophorectomies and hysterectomies, laparoscopic surgery (scarless surgery) is now considered a
better alternative in addition to laparoscopic sterilization. The most advantageous characteristic of
laparoscopy is that it allows direct examination of abdominal cavity with only minimal and superficial
surgical intervention. Thoracoscopy has been employed in man for the diagnosis and treatment of
diseases of the pleura, lung, mediastinum, great vessels, pericardium and esophagus. Visceral
inspection of the thoracic cavity by thoracoscopy has been used to provide a more accurate
diagnosis and prognosis in horses affected with pleuropneumonia and other thoracic and
esophageal disorders. Thoracoscopy allows visualization and biopsy of a large surface of the lung and
provides adequate specimen for histopathological diagnosis.

Endoscopy
It is a minimal invasive diagnostic modality which aids in a best way to document
mucosal inflammation- hyperemia, active bleeding, irregular mucosal surface, and facilitates biopsy
in tubular organs like the GI tract, and respiratory and the urogenital organ systems

Pulse Oximetry
Pulse oximetry represents the greatest advance in the patient monitoring. It has the unique
advantage of continuously monitoring the saturation of haemoglobin with oxygen, easily and
noninvasively, providing a measure of cardiorespiratory function. The fundamental physical property
that allows the pulse oximeter to measure the oxygen saturation of haemoglobin is that blood
changes color as haemoglobin absorbs varying amounts of light dependent on its saturation with
oxygen. Hence, pulse oximetry remains the standard of care during anesthesia as well as in the
recovery room and intensive care unit.
Radiography of Gastro Intestinal Tract
Examinations with a visualisation of the anatomy and pathology of the gastrointestinal (GI) tract are
often necessary for the diagnosis of GI diseases.

Traditional radiology played a crucial role for many years. Endoscopy, despite some limitations,
remains the main technique in the differential diagnosis and treatment of GI diseases. In the last
decades, the introduction of, and advances in, non-invasive cross-sectional imaging modalities,
including ultrasound (US), computed tomography (CT), and magnetic resonance imaging, as well as
improvements in the resolution of imaging data, the acquisition of 3D images, and the introduction
of contrast-enhancement, have modified the approach to the examination of the GI tract.

Most frequently used imaging modalities in the study of the gastrointestinal tract: Overview of main
advantages and shortcomings

Modality Advantages Shortcomings

1. Ultrasound  High soft tissue resolution  Relatively high

(US) interobserver variability
 No radiation exposure
 Intestinal gas lowers
 Ideal for repeated
image quality
examination and research
 Artifacts may be difficult
 Evaluation of intestinal
to interpret
wall and surroundings
 Total visualisation of the
 Possibility for intraluminal
entire intestine is difficult
causes
2. Magnetic  Good soft tissue imaging  Motion artifacts due to
resonance capabilities intestinal motility
imaging (MRI)
 No radiation exposure  Long image acquisition

 Ideal for repeated  Image resolution less than

examinations and research CT making 3D
Total evaluation of entire reconstructions and virtual
intestine and its endoscopy cumbersome
surroundings
 Potential long term effects
 Functional and motility of gadolinium-based
information directly contrast media
available using special (nephrogenic systemic
techniques fibrosis)

3. Conventional  High temporal and spatial  Only direct visualisation of

radiography resolution luminal/mucosal
properties
 Fast image acquisition
 Radiation exposure
 Motility and function easily
studied using intraluminal  No 3D image data
contrast

4. Endoscopy  Direct visualisation of the  Invasive procedure

mucosa
 Discomfort and potential
 Possibility for intervention intestinal perforation
(biopsies, polypectomy
 No visualisation of deeper
and endoscopic surgery)
wall layers and
surroundings
Radiography of the urinary tract
Contrast Radigraphy
INTRODUCTION
Contrast radiography allows better visualisation of soft tissue structures than plain film radiographs.

o The urogenital system and the use of air and water soluble iodine contrast media.

In all cases, plain radiographs should be taken to check the positioning of the patient and exposures
before starting the contrast examination.

AIR AND WATER-SOLUBLE IODINE CONTRAST MEDIA

Air is a NEGATIVE CONTRAST agent, which means that it will appear less opaque on a radiograph
(blacker) than the surrounding tissues. Room air is most commonly used, although oxygen, carbon
dioxide or nitrous oxide are also suitable. Air is used to inflate hollow organs such as the stomach or
bladder in order provide effective visualization. Water soluble iodine preparations are POSITIVE
contrast agents and will appear opaquer than the surrounding tissues. Commonly used are Conray
and Urografin. These may be administered intravenously for examination of the kidneys and ureters
or via a urinary catheter for examination of the lower urinary tract. In addition, they may be given
orally to visualise the stomach, but are less effective than barium due to their hypertonicity, which
causes dilution by the gastrointestinal secretions. A DOUBLE CONTRAST radiograph of a hollow
organ utilises both negative and positive agents in order to provide good mucosal detail without
obscuring small details within the organ itself. Important terminology to remember:

 The prefix "pneumo" denotes a negative contrast radiograph.

 Gastrogram = contrast radiograph of the stomach.

 Urogram = contrast radiograph of the kidneys and ureters (2 methods: bolus or infusion).

 Cystogram = contrast radiograph of the stomach.

 Retrograde urethrogram = contrast radiograph of the male urethra.

 Retrograde vaginourethrogram = contrast radiograph of the female urethra.

Dosage guide:
Gastrogram - 15-100 mls Gastro-conray via stomach tube (followed by 20mls/kg air for double
contrast gastrogram).
Bolus Urogram - up to 850mg of iodine/kg (@ 50mls for a 25kg dog) intravenously as a rapid
injection.
Infusion Urogram - up to 1200mg of iodine/kg (@ 200mls for a 25kg dog) intravenously as a slow
infusion diluted with saline.
Cystogram - 50-300mls iodine for positive contrast, 30-300mls air for negative contrast, 2-15mls
iodine followed by air until bladder palpates taut; all given via urinary catheter.
Retrograde urethrogram - 5-15mls iodine via urinary catheter.
Retrograde vaginourethrogram - up to 1ml/kg via Foley catheter taken utmost care to avoid vaginal
rupture
Uses of Contrast Media in the urinary system
A contrast medium is a substance that is administered to the patient that is either more radiopaque
or more radiolucent than the surrounding tissue. This allows assessment of the position, size,
shape and internal architecture of the organ that was not apparent on the original radiograph.
Sequential films or the use of image-intensified fluoroscopy may also show the function of an organ,
e.g., the rate of stomach emptying or the presence of peristalsis. Properties required in an ideal
contrast medium include:

Different absorptive power from tissue, thereby producing effective radiographic contrast;

No irritant or toxic side effects;

Accurate delineation of the organ;

Persistence for sufficient time to take radiographs;

Total expulsion from body.

Although the use of contrast radiography has diminished in recent years due to the increasing
application of ultrasonography, endoscopy and CT/MRI, there are still a number of indications for
contrast studies, especially in general practice where the other techniques may not be readily
available.

Radiography of Respiratory Track

 Radiographic examination is helpful in evaluating the nasal passages, paranasal sinuses,
guttural pouches, pharynx, larynx and trachea.

 Clinical history and physical examination should help to determine the possible cause and
site of respiratory disease

 Lateral cervical and thoracic radiographs may be helpful when obstructive upper airway
disease or fixed airway obstruction is suspected ( e.g tracheal foreign body, masses, foreign
bodies, or stenosis).

 Thoracic radiographs are essential in any animal exhibiting lower respiratory signs (e.g
cough, rapid shallow breathing, dyspnea)

Uses

 Evaluation of the nasal passages, paranasal sinuses, guttural pouches, pharynx, larynx and
trachea.

 Size and location of space-occupying intraluminal lesions especially in paranasal sinuses with
cysts or neoplasia (Respiratory : neoplasia)
  Axial measurement of airway diameter and length of structures, e.g. epiglottic length in
dorsal displacement of the soft palate (Soft palate: dorsal displacement)

 Evaluation of extra luminal lesions, e.g. retropharyngeal abscessation, laryngeal

mineralization in arytenoid chondritis (Larynx: arytenoid chondritis).

 Assessment of swallowing reflex using barium sulfate contrast media, e.g. post-
laryngoplasty (Larynx: laryngoplasty)

 Detection of fluid lines in air filled cavities, e.g. paranasal sinuses and guttural pouches.

 Contrast arteriography in guttural pouch mycosis (Guttural pouch: mycosis)

 Assessment of tooth roots in cases with sinusitis.

Advantages

 Non-invasive diagnostic technique.

Disadvantages

 Poor visualization of the soft tissues structures.