Abstract
Computed tomography (CT) is the imaging modality of choice to evaluate patients with acute head trauma. However, magnetic resonance imaging (MRI) may be chosen in select cases. The objectives of this study were to evaluate the agreement of MRI with CT in the assessment for presence or absence of acute skull fractures in a canine and feline cadaver model, compare seven different MRI sequences (T1-W, T2-W, T2-FLAIR, PD-W, T2*-W, “SPACE” and “VIBE”), and determine agreement of four different MRI readers with CT data. Pre- and post-trauma CT and MRI studies were performed on 10 canine and 10 feline cadaver heads. Agreement of MRI with CT as to presence or absence of a fracture was determined for 26 individual osseous structures and four anatomic regions (cranium, face, skull base, temporomandibular joint). Overall, there was 93.5% agreement in assessing a fracture as present or absent between MRI and CT, with a significant difference between the pre and post trauma studies (99.4 vs. 87.6%; p < 0.0001; OR 0.042; 95% CI 0.034–0.052). There was no significant difference between dogs and cats. The agreement for the different MRI sequences with CT ranged from 92.6% (T2*-W) to 94.4% (PD-W). There was higher agreement of MRI with CT in the evaluation for fractures of the face than other anatomic regions. Agreement with CT for individual MRI readers ranged from 92.6 to 94.7%. A PD-W sequence should be added to the MR protocol when evaluating the small animal head trauma patient.
Highlights
Head trauma in dogs and cats is associated with a high morbidity and mortality
Half each of the canine and feline heads were dropped from a height of about 15 feet to mimic a fall, and the other half were hit with an object in a way to mimic the impact from a kick or bite wound
One feline skull was traumatized with no fractures found on Computed tomography (CT); this case remained assigned to the post trauma group
Summary
Head trauma in dogs and cats is associated with a high morbidity and mortality. Possible causes include road traffic accidents, falls, injuries caused by other animals (e.g., kicks or bites), and human inflicted trauma including ballistic injuries and abuse [1–8].Advanced imaging of the head may be performed for assessment of the type and extent of intracranial injuries, therapeutic planning, and prognostication [1, 4, 7, 8]. MRI in Skull Fractures (CT) is generally considered the modality of choice to evaluate patients with acute head trauma [9]. It is quick, does not require general anesthesia, and is highly accurate in the diagnosis of conditions which may impact clinical management such as fractures, intracranial hemorrhage, brain swelling and brain herniation [2, 10–17]. MRI is limited in its ability to evaluate cortical bone which is characterized by low proton density and very short T2 relaxation time [23]. Another disadvantage of MRI compared to CT is the need for general anesthesia
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