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    Use of Multidetector Computed Tomography in The Assessment of Dogs With Pericardial Effusion - Enhanced Reader

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    dpcamposh

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    © All Rights Reserved
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    Journal of Veterinary Internal Medicine J Ves Intern Med 201529:79 87 Use of Multidetector Computed Tomography in the Assessment of Dogs with Pericardial Effusion KF, Scollan, B. Bottorff, S. Stieger-Vanegas, 8. Nemanic, and D. Sisson Backgromd: Conirastenhanced maltidetector computed tomography (MDCT) allows high spatial and temporal resolution imaging of cardiac, thoracic, and abdominal structures. Accurate determination of the cause of percarialef Sion (PE) is esental to prosiding appropriate treatment and prognosis. Echocardiography and pericardial Mid analysis ‘may aot difeentate betscen eases of PE and eannot iemtly extracardive metastasis ypathesis/Objetives: Describe the thoracic and abdominal MDCT findings and evaluate the wiity of MDCT to dit Foreniate between neoplastic and nonneoplastic causes of PE in dogs. ‘Animals: Eleven cllent-owned dogs with PE diagnosed by echocardiography Methods: Prospective observational study. Transthoracic echocardiography (TTE), $-siew thoracic radiography, and conirastenhanced thorasie and abdominal MDCT images were evaluated for the presence of cardiac masses, pulmonary metastases, and abdominal masses Histopathology in 5 dogs and survival analysis in all dogs were evaluated Results neoplastic eause was identified in 6/11 dogs and a nonneoplastic cause was idemtited in 5/11. Cardiae MDCT findings were consistent with TTE findings in all dogs with right atrial (S/S) and heart base masses (1/1). Pulmo- rary metastases were identified in 1/11 dogs by thoracic radiography and in 2/11 dogs by MDCT. MDCT identified spe nie 0 hepatie ksions eonsstent with neoplasia in 6/11 and 5/11 dogs, respectively. Focal MDCT pericutal changes at the pericardiocentsis site were noted in 3/11 dogs. ‘Conclusions and Clinical Importance: Mulidetcior computed tomography did not improve the detection of cardiae masse in dogs with PE over echocardiography. The bene of MDCT was primarily in the deteton of pulmonary metas: tases and extracardive lesions using a single imaging modality Key words: Cardiac tumors; Cardiology; Echocardiography. effusion (PE) is a common cardiac n dogs resulting in the accumulation of fluid within the pericardial space.' The most common causes of PE in dogs are cardiac neoplasia and idio- pathic pericarditis and less commonly congenital peri cardial disorders, trauma, or infectious processes.” Regardless of the etiology, consequent increases in in- trapericardial pressure result in impaired diastolic fill- ing and decreased venous return, Increased venous pressures, decreased preload, and decreased stroke vol- lume cause the common clinical signs of jugular disten- tion, weak arterial pulses, and collapse, The most common neoplasms in dogs with PE are hhemangiosarcoma (HSA), chemodectoma, and meso- thelioma, with HSAs and chemodectomas most fre quently located in the right auricle and heart base, respectively.” Additional neoplasms have been repor- ‘od in a small number of cases including ectopic thyr- oid carcinoma, lymphosarcoma, and myxosatcoma.” From the Department of Clinical Sciences, College of Veterinary “Medicine. Oregon State University, Corvallis, OR (Scollan, StiegerVanegas.Nomanic, Siswn); and. the Seale Veterinary Speciatiss, Kirkland, WA (Bottor}).. This work was completed at the Lois Bates Acheson Veterinary Teaching Hosp tal, Oregon Stare Unversity, Corvallis, OR. Part of ths study war presomed as an absnact at 2012 ACVIM Forum, ‘New Orleans, LA Corresponding author: K.P, Scollan, Oregon State University 281 Magrader Hal, Corals, OR 97531; email katescollan aon. ‘egonsate ed Sumitted May 5, 2014; Revised July 16, 2014; Accepted September 8, 2014 Copyright ©2014 by he American College of Veterinary Internal Medline DOF: 1.1111|pin. 12479 ‘compat tomography hemangiosarcoma ounsteld units rmultidetetor computed tomography magnetic resonance imaging Oregon Sate Universiy pesicardaleTosion transthoracic echocardiography Long-term prognosis varies with etiology and dogs with nonneoplastic causes have the longest survival, followed by those with chemodectomas, and dogs with HSA have the poorest prognosis." The most likely cause of the shorter survival with HSA is the tumor's high metastatic rule and possibility of concurrent primary lesions in cextracardiac locations. Chemodectomas have lower reported rates of metastasis, and treatment by pericar dectomy to prevent occurrence of cardiac tamponade ccan result in prolonged survival." Thus, an accurate determination of the underlying cause of PE and extent ‘of disease is essential to recommending appropriate ‘treatment and estimation of prognosis. Obtaining a definitive antemortem diagnosis for the cause of PE can be problematic. Echocardiogra- phy is an excellent initial imaging tool for the diag nosis of PE and also may provide information on the underlying cause by identification of a cardiac mass. The reported sensitivity of echocardiography for detecting cardiac mass lesions however varies from 17 to 82%." Its application may be limited by the small field of view, occasional poor acoustic windows, and high operator dependency. Moreover, 80 Scollan eta cchocardiography is not useful for evaluating asso. ated abnormalities. inthe lungs, mediastinum, or adjacent structures, which is important in the assess- ment of concurrent metastatic disease Contrastenhanced multidetector computed tomog- raphy (MDCT) is a technique that acquires cross- sectional images of the thorax in <30 seconds, can be performed under sedation or brief general anesthesia, and permits 3-dimensional reconstruction of cardiac structures. Rapid image acquisition allows the scan to be extended through the abdomen with minimal ad tional scan time. Magnetic resonance imaging (MRI) js another cross-sectional technique, und currently is the imaging modality of choice in human medicine to evaluate cardiac tumors."* The disadvantage of MRI in veterinary medicine is the requirement of general anesthesia because of the long image acquisition times for cach body region imaged, ranging from 20 to 60 minutes. Thus, including both the abdomen and thorax using MRI could double image acquisition time, In cases of suspected neoplastic cause of PE, sereen- ing for thoracic metastases is most_ commonly pe formed by using thoracic radiography, but MDCT is, more sensitive, mostly due the detection of pulmonary nodules too small to be seen on radiographs." Sereen- ing for abdominal metastases or primary neoplasms most commonly is performed by abdominal ultraso- nography, but abdominal MDCT is superior to ultra- sonography in dogs >25 kg." Other diagnostic tests have been investigated in dogs with PE including cytology.” pH" and troponin I concentsations,? but none have allowed unequivocal differentiation between neoplastic and nonneoplastic causes. ‘The pur- pose of this study was to assess the uility of contrast- enhanced MDCT in differentiating neoplastic and non- neoplastic causes of PE in dogs. We aimed to describe thoracic and abdominal MDCT finding in dogs with PE in comparison to echocardiography and 3-view thoracic radiographs. Materials and Methods ‘Study Population and Protocol In this prospective, observational study, clentowned dogs presented to the Oregon State University (OSU) Veterinary Teaching Hospital between January 2010 and July 2011 were included. Inclusion erteria were a recent (

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