The use of planar bone scintigraphy and HiSPECT for diagnosis of primary and concomitant flexor enthesopathy in the canine elbow

E. de Bakker; K. Peremans; S. Vermeire; E. Vandermeulen; A. Dobbeleir; K. J. Dik; I. Gielen; J. H. Saunders; B. Van Ryssen

doi:10.3415/VCOT-12-08-0103

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2013; 26(05): 348-355
DOI: 10.3415/VCOT-12-08-0103

Original Research

Schattauer GmbH

The use of planar bone scintigraphy and HiSPECT for diagnosis of primary and concomitant flexor enthesopathy in the canine elbow

E. de Bakker

¹Ghent University, Faculty of Medical Imaging and Small Animal Orthopaedics, Salisburylaan, Merelbeke, Belgium

,

K. Peremans

¹Ghent University, Faculty of Medical Imaging and Small Animal Orthopaedics, Salisburylaan, Merelbeke, Belgium

,

S. Vermeire

¹Ghent University, Faculty of Medical Imaging and Small Animal Orthopaedics, Salisburylaan, Merelbeke, Belgium

,

E. Vandermeulen

¹Ghent University, Faculty of Medical Imaging and Small Animal Orthopaedics, Salisburylaan, Merelbeke, Belgium

,

A. Dobbeleir

¹Ghent University, Faculty of Medical Imaging and Small Animal Orthopaedics, Salisburylaan, Merelbeke, Belgium

,

K. J. Dik

¹Ghent University, Faculty of Medical Imaging and Small Animal Orthopaedics, Salisburylaan, Merelbeke, Belgium

,

I. Gielen

¹Ghent University, Faculty of Medical Imaging and Small Animal Orthopaedics, Salisburylaan, Merelbeke, Belgium

,

J. H. Saunders

¹Ghent University, Faculty of Medical Imaging and Small Animal Orthopaedics, Salisburylaan, Merelbeke, Belgium

,

B. Van Ryssen

¹Ghent University, Faculty of Medical Imaging and Small Animal Orthopaedics, Salisburylaan, Merelbeke, Belgium

› Author Affiliations

Abstract

Summary

Objective: To investigate the possibilities and limitations of planar bone scintigraphy and high resolution single photon emission computed tomography (HiSPECT) to diagnose flexor enthesopathy and to distinguish primary flexor enthesopathy from the concomitant form.

Materials and methods: A prospective study of 46 dogs with primary flexor enthesopathy, concomitant flexor enthesopathy, medial coronoid disease, and normal elbows was performed. All dogs underwent planar bone scintigraphy and HiSPECT imaging. The obtained images were visually scored for increased radiopharmaceutical uptake in the medial humeral epicondylar and medial coronoid process region using a score from 1-3.

Results: Planar bone scintigraphy demonstrated increased radiopharmaceutical uptake in all diseased elbow joints, except for one. HiSPECT demonstrated increased radiopharmaceutical uptake of the medial humeral epicondyle in nearly all clinically affected joints with primary and concomitant flexor enthesopathy. Additional uptake of the medial coronoid process was recorded in all clinically affected joints with concomitant flexor enthesopathy and in six out of 18 with primary flexor enthesopathy. No difference in intensity of the uptake was noticed.

Clinical significance: Planar bone scintigraphy allows the attribution of lameness to the elbow joint in cases of primary flexor enthesopathy with minimal or even absent radiographic changes. The more detailed HiSPECT enables the localization of pathology within the elbow joint and is a sensitive technique to detect flexor enthesopathy. However HiSPECT is insufficient to distinguish primary from concomitant flexor enthesopathy.

Keywords

Planar bone scintigraphy - HiSPECT - flexor enthesopathy - diagnosis - canine elbow

Full Text

References

References
1 Morgan JP, Wind A, Davidson AP. Elbow Dysplasia. In: Hereditary Bone and Joint Diseases in the Dog. Hannover: Schlütersche GmbH & Co KG; 2000. p. 2000-41.
2 Fox SM, Bloomberg MS, Bright RM. Developmental anomalies of the canine elbow. J Am Anim Hosp Assoc 1983; 19: 605-615.
3 Ljunggren G, Cawley AJ, Archibald J. The elbow dysplasias in the dog. J Am Vet Med Assoc 1966; 148: 887-891.
4 Wind AP. Elbow inconguity and developmental elbow diseases in the dog: Part I. J Am Anim Hosp Assoc 1986; 22: 712-724.
5 Van Ryssen B, de Bakker E, Beaumlin Y. et al. Primary flexor enthesopathy of the canine elbow: imaging and arthroscopic findings in eight dogs with discrete radiographic changes. Vet Comp Orthop Traumatol 2012; 25: 239-243.
6 de Bakker E, Saunders J, Gielen I. et al. Radiographic findings of the medial humeral epicondyle in 200 canine elbow joints. Vet Comp Orthop Traumatol 2012; 25: 359-365.
7 de Bakker E, Gielen I, Saunders JH. et al. Primary and concomitant flexor enthesopathy of the canine elbow. Vet Comp Orthop Traumatol 2013. 2013 Jun 26 [Epub ahead of print]
8 de Bakker E, Samoy Y, Gielen I. et al. Medial humeral epicondylar lesions in the canine elbow. A review of the literature. Vet Comp Orthop Traumatol 2011; 24: 9-17.
9 May C, Bennett D. Medial epicondylar spur associated with lameness in dogs. J Small Anim Pract 1988; 29: 797-803.
10 Meyer-Lindberg A, Heinen V, Hewicker-Trautwein M. et al. Vorkommen und Behandlung von knochern Metaplasien in den am medialen Epikondylus des Humerus entspringenden Beugesehnen beim Hund [Occurence and treatment of bone metaplasia in the medial epicondyle of the humerus arising from the flexor tendon in dogs]. Tierarztl Prax 2004; 32: 276-285.
11 Zontine WJ, Weitkamp RA, Lippincott CL. Redefined type of elbow dysplasia involving calcified flexor tendons attached to the medial humeral epicondyle in three dogs. J Am Vet Med Assoc 1989; 194: 1082-1085.
12 Walker TM. A redefined type of elbow dysplasia in the dog--2 cases. Can Vet J 1998; 39: 573-575.
13 de Bakker E, Saunders JH, van Bree H. et al. Radiographic features of primary and concomitant flexor enthesopathy in the canine elbow. Vet Radiol Ultrasound 2013; 54: 107-113.
14 Samoy Y, Van Ryssen B, Van Caelenberg A. et al. Single-phase bone scintigraphy in dogs with obscure lameness. J Small Anim Pract 2008; 49: 444-450.
15 Schwarz T, Johnson VS, Voute L. et al. Bone scintigraphy in the investigation of occult lameness in the dog. J Small Anim Pract 2004; 45: 232-237.
16 Peremans K, Vermeire S, Dobbeleir A. et al. Recognition of anatomical predilection sites in canine elbow pathology on bone scans using micro-single photon emission tomography. Vet J 2011; 188: 64-72.
17 van Bree H, Gielen I, Van Ryssen B. et al. Comparative joint imaging in small animals. European Journal of Companion Animal Practice 2002; 12: 25-36.
18 Punke JP, Hulse DA, Kerwin SC. et al. Arthroscopic documentation of elbow cartilage pathology in dogs with clinical lameness without changes on standard radiographic projections. Vet Surg 2009; 38: 209-212.
19 Collier D, Fogelman I, Rosenthall L. Skeletal Nuclear Medicine. Missourri: Mosby; 1996