Abstract
ABSTRACT This study set out to determine normal values for acoustic radiation force impulse (ARFI) elastography of the superficial digital flexor tendon, deep digital flexor tendon, accessory ligament of the deep digital flexor tendon and suspensory ligament in horses. Twenty-four horses were submitted to conventional sonographic assessment and elastography imaging (quantitative ARFI method) of distal forelimb tendons and ligaments at nine anatomical regions. Elastograms depicted tendons and ligaments in orange to red tones consistent with greater stiffness. Shear wave velocity was higher in the longitudinal compared to the cross-sectional plane but did not differ significantly between the left and right forelimbs. The suspensory ligament was stiffer compared to remaining structures in the cross-sectional plane. Ligaments were stiffer than tendons and the deep digital flexor tendon was stiffer than the superficial digital flexor tendon in the longitudinal plane. Target structures were stiffer in male compared to female horses and stiffness tended to increase with age. ARFI elastography proved to be a feasible and reproducible imaging modality for assessment of distal forelimb tendons and ligaments in horses. Qualitative features derived from stiffness quantification in these structures can be applied to horses with musculoskeletal disorders, as well as to other animal species.
Highlights
Ultrasonography (US) is routinely used for visual assessment of tendons and ligaments in horses and is a valuable tool in clinical lameness evaluation
Shear wave velocity recorded in crosssectional images differed significantly (P≤0.01) between structures, the suspensory ligament (SL) being the stiffest structure and the superficial digital flexor tendon (SDFT) stiffer than the AL
Shear wave velocity recorded in longitudinal images differed significantly (P≤0.01) between structures, ligaments being stiffer than tendons and the deep digital flexor tendon (DDFT) stiffer than the SDFT (Tab. 1)
Summary
Ultrasonography (US) is routinely used for visual assessment of tendons and ligaments in horses and is a valuable tool in clinical lameness evaluation. Critical appraisal of image quality and proper image acquisition and interpretation are required for accurate diagnosis (Whitcomb, 2014). This imaging modality is prone to artifacts such as acoustic shadowing at tendon margins. Elastography is a novel US technique aimed at early detection of tendon and ligament injuries (Dudea et al, 2011; Whitcomb, 2014). Soft tissue stiffness may be determined using different methods, such as compression elastography, acoustic radiation force impulse (ARFI) and real-time shear wave elastography (Dudea et al, 2011). The value of ARFI for diagnosis of mammary neoplasms (Feliciano et al, 2014b) and testicular disorders (Feliciano et al, 2016) in dogs has been reported
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