Abstract
To determine whether assessment of morphological MRI sequences or delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) would have strong correlations with arthroscopic assessment of cartilage pathology in dogs with naturally occurring medial compartment pathology of the elbow. Dogs tentatively diagnosed with medial coronoid disease had evaluation of their affected elbows using radiography, morphological MRI sequences, and dGEMRIC MRI evaluation prior to arthroscopy. Elbow radiographs were graded 0-6 for severity of changes. Cartilage of the medial coronoid process (MCP) and humeral trochlea (HT) were scored on a 0-3 scale using anatomical MRI sequences. The T1 relaxation times for the MCP and trochlea were quantified using dGEMRIC. Cartilage pathology was graded arthroscopically using a modified Outerbridge score (MOS) by a surgeon blinded to MRI assessment. Correlations between radiography and MOS, and between MRI and MOS, were quantified. Twenty-six elbows in 14 dogs were evaluated. There were statistically significant (p < 0.05) moderate correlations between radiographic scores and MOS for the MCP (r = 0.71) and HT (0.57). There was a statistically significant moderate correlation between morphological MRI scoring and MOS for the HT (r = 0.54; p < 0.05), but not for the MCP (p > 0.05). There was a weak, but significant correlation, between the dGEMRIC value and MOS of the MCP (r = 0.41; p < 0.05), but no correlation between the dGEMRIC values and MOS for the HT (p > 0.05). Statistically significant correlations to MOS were identified for both radiography and MRI but neither diagnostic modality provided sufficiently strong correlations to serve as a substitute for arthroscopic evaluation of the articular cartilage.
Highlights
There is great variability in the character and severity of pathology affecting dogs with medial compartment disease of the elbow
The inclusion of dogs with notable variability in severity of cartilage pathology was desired to maximize the likelihood of detecting positive correlations between non-invasive diagnostic imaging modalities and the arthroscopic assessed cartilage pathology
These data do demonstrate statistically significant but only moderate correlations between radiographic assessment and arthroscopic assessments of cartilage pathology in the medial compartment of the canine elbow. These results warrant accepting our first hypothesis and are not surprising given results from a previous study demonstrating a relationship between the arthroscopic global cartilage pathology score and radiographic assessment of disease severity in a large group of Labrador Retrievers [1]
Summary
There is great variability in the character and severity of pathology affecting dogs with medial compartment disease of the elbow. There is a need to accurately characterize pathology in the canine elbow noninvasively so that treatment planning can be performed prior to performing any surgery, including arthroscopic assessment. This is clinically relevant because approximately 50% of dogs with medial coronoid disease have some pathology of cartilage on the HT and there are a growing number of surgical options available for treating dogs when pathology is not limited solely to the MCP [3,4,5,6,7]. Their response to non-surgical treatment could be compared to dogs managed surgically while being confident that the pathology affecting both groups were similar or equivalent
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