Table Of Content.
EQUINE SCINTIGRAPHY
Edited by S. J. Dyson, R. C. Pilsworth, A. R. Twardock and M. J. Martinelli
(cid:1005)
EQUINE VETERINARY JOURNAL LTD
Editor: P. D. RossDALE, OBE, MA, PbD, Dr(b"c.)Beme, Dr(h.c.)Edinburgh, DESM, FACVSc, FRCVS
Depury Editor: RACHEL E. GREEN
Assistant Edjtors: A. E. GooosmP, BVSc, MRCVS, PhD
T. S. MAIR, BVSc, PhD, DElM, MRCVS
W.W. Mu1R, DVM, PhD
Equine Veterinary Journal, 351 JEx.ning Road, Newmarket, Suffolk CB8 OAU, UK.
Tel: +44 (0) 1638 666160 •Fax.: +44 (0) l638 668665 • Website: www.evj.co.ruk •Email: [email protected]
Equine Veierinary Journal is the official journal of the Briiish Equine Veterinary Association. It is produce-0 and published by
Equine Veterinary Journal Ltd.
~World cvpyright by Equine Veterinary Journal Ltd 2003
• ISBN 0-9545689--0· 7
• Firsl Published 2003
The cuullors, edJwrs and pu/Jltsiters do nu/ accepJ ri!.'fJ()HSil>iliry for any IMS or damage urising /.mm aclio11s "' decJ.1ioJ1s based on
informarion conrained in this pubfica.Iic11: ulrimme respon.fibilityfor rhe rrearment of parients and imerpmation ofp ublished marerial lies
with rhe vei'€ ri11ar)' ~ur~eun. '
front Cover Image Courtesy of Dr Mark Holrrws, Sc:hool of \.i'terinwy Medicine, U11i~·ersity ofC ambridgf:!, C:ambridge:rhire, UK.
Subject Indexes Prepared by bulaing Specialists (UK) Lid., Hove, West Sussex, UK.
Typeset and Published by Equine Veterinary Joumaf Lid., Newmarket, Suffolk, UK.
Printed in Great B:ri~am by Geerings ofA shford Ltd., Ashford, Kent, UK.
0 'fl
-lk
.CO.
WWW~eVJ
2
CONTENTS,
Foreword Gottlieb Ueftschi _ ________ ___________ _____ _______?
Acknowledgements 8
Preface __________________________________ ____ 11
___ _ ____________ _______________ _ 12
Terms and Abbreviations
PART I
CHAPTER 1 Basic principles of equine scintigraphy Adam Driver 17
CHAPTER 2a Radiopharmacy Adam Drive} 25
CHAPTER 2b Practical radiopharmacy tor equine bone scintigraphy Jo Weekes -------~-----33
CHAPTER 3 Basic structure and function of the camera Bob Twardock 37
CHAPTER4 Gamma camera installations Rob Pilsworth and Mike Shepherd _ _____ ________4 7
CHAPTER 5 Image acquisition, post processing, display and storage Jo Weekes and Sue Oyson ___ ____5 3
CHAPTER 6 Patient preparation Sue Dyson 69
CHAPTER: 7 Practical scintigraphic examination of the horse Rob Pilsworth and Sue Dyson 73
CHAPTER 8 Orthopaedic imaging Sue Dyson and Jo Weekes 77
~
CHAPTER 9 Image description and interpretation in musculoskeletal scintigraphy Sue Dyson and Mark MarUnelli _ _ 87
~
CHAPTER: 10 Artefacts and nonskeletal uptal'<e encountered in skeletal scintigraphy Marcus Head ___ ___ 97
I
CHAPTER 11 Electronic transmission of images Mark Marlinelli 103
~
CHAPTER 12 Radiation safely Rob PJ/sworth and Karen Goldstone 107
figure Layout for Part II ---------------------~~------115
PART II ATLAS OF NORMAL AND ABNORMAL PATTERNS OF UPTAKE
CHAPTER 1 The European Thoroughbred Mike Shepherd <u1d Josie Meehan 117
CHAPTER 2 The American Thoroughbred Mark Martine/Ji and Rick Arthur 151-
~ CHAPTER J. The Standardbred Mike Ross 1S.3
~
CHAPTER 4 The sports horse Sue Dyson 191
~
CHAPTIER S. The head Pete Ramzan 225
CHAPTIER 6 Nonorthopaedic scintigraphy Russell Malton 239
~
CHAPTER 7 Pulmonary scintigraphy Dominique-Marie Votion and Pierre Lekeux 263
Index 283
(cid:1007)
4
EQUINE SCINTIGRAPHY
FOREWORD
M odern veterinary medicine is confronted in a persistent way by basic sciences and new
techniques. Various developments in chemistry, biochemistry and physics allow new
diagnostic and therapeutic procedures and force the veterinarian to engage in
interdisciplinary problems.
Nuclear medicine sets a typical example for these tendencies. The use of radioactive substances
in medical diagnosis has gained a high standing because of large clinical experiences, numerous
experimental results, advances in physics, radiochemistry and marked improvements of the
technical equipment. The development of human nuclear medicine in the last two decades has
been amazing.
In the 1980s and 1990s, turf battles started between nuclear medicine and new imaging
modalities such as computer assisted tomography and magnetic resonance imaging. Nuclear·
medicine seemed to be on the losing end. However, new techniques like positron emission
tomography and imaging with radioactive labelled antibodies kindled new interest.
The development of nuclear medicine in the veterinary field was much less spectacular. The first
publications of the applications of radioisotope imaging techniques appeared in the late 1960s
and early 1970s. Usually these were very limited investigations in selected cases with exotic
nuclides such as sssr and 87msr. Routine application of the radioactive labelled tracers became
possible after the introduction of 99mTc and the availability of suited labels for the different target
organs. In small animal medicine, nearly all procedures known to the human nuclear medicine
were tested and became routine examinations in specialised centres. However, large scale
availability never became reality.
In equine radiology, only the application of 99mTc-labelled substances for the demonstration of
bone metabolism and the airways became accepted examination methods. All other possibilities
for the demonstration of organ .metabolism never gained acceptance on a larger scale.
The duties of the veterinarian using radioactive imaging are varied. Indications for the use of the
radioactive label, the assessment of radioactive risk, differenil:iation and interpretation of results
are some of the points to be considered.
The aim of this book is to substantiate the application of the radioisotope imaging method in the
horse by physical, chemical, biochemical, physiological and pharmacological means and to
outline its advantages against other imaging methods. It is not a book containing all the
information to interpret bone scans in the different regions. Instead, it tries to give the necessary
information on how to perform the examination and which possibilities exist for the interpretation
process. Examinations can be performed in different ways. Most veterinarians like-to perform
scintigraphic examination in the standir.ig horse. This limits the total number of counts that
generate the image. Movement of the patient is the limiting factor. Examination in the
anaesthetised horse allows the acquisition of large count numbers and images with better
resolution and more anatomical detail, but at the cost of the anaesthetic risk. ·
Professor Gottlieb Ueltschi
University of Berne, Switzerland
(cid:1009)
EQUINE SCINTIGRAPHY
ACKNOWLEDGEMENTS
Peter Rossdale - who first proposed this book to the Editors, for his help and encouragement
throughout its production.
Professor Ueltschi, University of Berne, Switzerland, not only for contributing our Forword, but
also for setting standards in scintigraphy we all feel motivated to aspire to.
Ann Monteith (EV/) - who set up the initial commissioning of the chapters from authors and put
the book on a firm foundation.
Anita Boole (EVJ) - who took over the production of the book from Ann Monteith, designed the
cover, and designed such an attractive style and layout for the text.
Lindsey Abeyasekcre (EV/) -who painstakingly proof read the manuscripts as they were produced
in the EVJ office.
Rachel Green (EVJ) - for dealing with the business of making a pile of chapters into a book.
All of our authors, for giving so freely of their time and expertise.
All those who supplied illustrations for the book, and who are credited individually in the
figure legends.
We would also like to pay tribute to the pioneers of equine scintigraphy, on several continents,
who set up this science for us to explore and and document.
All Editors
It hank Tim Donovan, John Palmer and Jo Weekes, the imaging technicians past and present at
the Animal I-lea/th Trust, for technical support and being sources of knowledge and experience.
A succession of interns has also provided technical assistance during image acquisition and, by
testing the hypothesis that by teaching you learn, has encouraged both the development of
knowledge and distilling clarity of thought. Steve Bloomer from Nuclear Diagnostics has been a
constant inspiration to learn more and to try to achieve the best standards of imaging. Many
colleagues from around the world have over the years provided thought-provoking questions,
shared their experiences and presented a challenge to improve our levels of diagnosis. I am
indebted to our co-authors, without whom this project could not have been achieved. The
completion of this book would not have been possible without Anita Boole and her colleagues at
the Equine Veterinary Journal, to whom we are inqebted. My husband, John Wilkinson, has again
showed extreme patience and tolerance during the many hours spent on this project, but also
encouragement, support, friendship and humour.
Sue Dyson
Iw ould like to thank: my co-editors, for agreeing without hesitation to devote endless unpaid
hours to this project when I first approached them; my colleagues and technicians at Beaufort
Cottage Diagnostic Centre for their encouragement in first setting up the scin.tigraphy facility
and their hard work in running it; my wife Lynn, and children Anna and Ellen, for tolerating my
absence both physically and mentally on numerous evenings and weekends whilst this book was
in preparation, and for their constant love and support.
Rob Pilsworth
EQUINE SCINTIGRAPHY
It hank Mike Molnar (Diagnostic Services, Inc.) for his review and suggestions regarding Part I,
Chapter 3, The Gamma Camera; Deryl Markgraf (Enhanced Technologies Corp.) for
information and photographs of gamma camera installations; Greg Daniel for returning (on
loan) Sorenson and Phelps' 'Physics in Nuclear Medicine', which I didn't think I needed after
retirement (an oxymoronic word, I've discovered); my co-editors for including me in this project,
allowing me to stay in Louch with developments and veterinarians involved in this intriguing
discipline of nuclear scintigraphy; all of my colleagues and friends who encouraged and
participated in the development of nuclear medicine at the University of Illinois College of
Veterinary Medicine; lastly, my wife Mary, for her blessing, encouragement and wisdom
knowing I should do this.
Bob Twardock
Ih ave numerous people to thank for my academic and clinical development over the 11 years
that I have been involved with nuclear scintigraphy. This includes all the referring veterinarians
in Scotland, Lhc Mid-western United States and southern California, who rP.rngnisP.r! what this
advance in diagnostic imaging could do for their cases. I would also like to thank my co-editors
for their stimulating dialogues on scintigraphy over the years and for including me in this project.
I would like to thank Rachel Green and Peter Rossdale in the EV/ office for their support and
friendship over the last 8 years. Finally, I need to thank my other co-editor, Bob Twardock, for
his mentorship, patience and friendship over the last 11 years. Or Twardock was truly a pioneer
and champion of nuclear scintigraphy long before the industry really understood the diagnostic
implications it would have on the equine performance industry. Bob, thanks for your foresight
and tutelage.
Mark Martinelli
8
EQUINE SCINTIGRAPHY
PREFACE
N
uclear scintigraphy has been widely used in equine veterinary medicine in institutions and
referral practices for approximately 15 years, and in recent years more private practices
have been establishing nuclear medicine facilities. It has become very apparent to us that
although a number of excellent general review papers and chapters in books discuss the potential
usefulness of equine nuclear scintigraphy, and some much more specific articles have been
published, there has been a lack of a general text covering all aspects of equine nuclear medicine.
We are also aware that, as with many imaging modalities, practitioners sometimes attempt to
diagnose abnormalities without a comprehensive knowledge of normal, and the full range of
normal variations, and sometimes without adequately criticising their own basic image quality.
We therefore set out to harness the collective expertise of a number of people experienced with
nuclear scintigraphy from a variety of geographical locations, and involved with different
populations of sports and pleasure horses.
The book is divided into two sections. In Part I, we aimed to provide a comprehensive but
essentially practical guide to how to perform equine nuclear scintigraphy to achieve the best
possible results, whilst complying with safety legislation, and how to interpret the resultant images.
We are aware that the legislation concerning the use of radiopharmaceuticals varies worldwide,
but the basic guidelines provided should encompass the requirements of most countries.
The majority of equine nuclear scintigraphic examinations are used to evaluate the musculoskeletal
system and a large proportion of the book is devoted to this. We have therefore provided guidelines
for image interpretation and also, in Part II, a comprehensive, but not exhaustive, atlas of normal
images from horses involved in different athletic disciplines and examples of some of the more
common conditions causing lameness or poor performance. However, there are also extensive
chapters in Part II devoted to other aspects of nonorthopaedic nuclear medicine. We hope that, by
providing many high quality illustrations, we will encourage practitioners to strive to match the
image standard reproduced here.
In order to keep the figure legends as concise as possible, we introduced a number of standard
abbreviations which are listed on the following pages. We recognise that some readers may find
this more difficult, but space constraints made this essential.
We feel strongly that nuclear scintigraphy is not a tool to be used in isolation. It should be used
selectively and the results must always be reJated to those of clinical examination and other
diagnostic techniques. It is not going to provide an answer in every horse and we have
attempted to highlight both the limitations of nuclear scintigraphy and some artefacts that may
confound interpretation.
We, the Editors, learnt a lot by sharing our collective experiences and sincerely hope that anyone
reading this text or browsing through the figures will be both stimulated and challenged to
improve their level of diagnosis.
The Editors
(cid:1013)
EQUINE SCINTIGRAPHY
TERMS & ABBREVIATIONS
ANATOMICAL ABBREVIATIONS USE
ABC Antebrachiocarpal (joint) Am. Competition Amateur Competition
ACB Accessory carpal bone Am. Dressage Amateur Dressage
ALDDFT Accessory ligament of the DDFr Dressage
CD Centrodistal (joint) Dressage (Nov.) Novice
CF Coxofemoral (joint) Dressage (Med.) Medium
CMC Carpometacarpal (joint) Dressage (Adv.Med.) Advanced Medium
Cl First carpal bone Dressage (Prix St George)
C2 Second carpal bone Potential Dressage
C3 Third carpal bone Driving
C4 Fourth carpal bone Endurance Riding
DDFT Deep digital flexor tendon Eventing (Int.) Intermediate
DJD Degenerative joint disease Eventing (Adv.) Advanced
DIP Distal interphalangeal joint 3-Day Eventing
DSP Dorsal spinous process Flat Racing
ELL Enostosis-like lesion General Purpose
FP Femoropatellar (joint) Hunting
FT Femorotibial (joint) National Hunt Racing
HR Humeroradial/elbow (joint) Native Showing
IC Intermediate carpal (bone) Pacer
LFT Lateral femorotibial (joint) Pony Club Activities
MC Middle carpal (joint) Showing
MCP Metacarpophalangeal (joint) Showj umping
Mell Second metacarpal bone Am. Showjumping Amateur Showjumping
Mclll Third metacarpal bone Showjumping (Grand Prix)
MclV Fourth metacarpal bone Showjumping (International)
MFT Medial femorotibial joint Trotter
MTP Metatarsophalangeal (joint)
Mtll Second metatarsal bone
FIGURE ORIENTATION
Mtlll Third metatarsal bone
MtlV Fourth metatarsal bone L Left
OA Osteoarthritis R Right
OCD Osteochondritis dissecans LF Left Fore
OCLL Osseous cyst-like lesion RF Right Fore
PIP Proximal interphalangeal (joint) LH Left Hind
PSB Proximal sesamoid bone RH Right Hind
PSD Proximal suspensory desmitis DORS Dorsal
RC Radial carpal (bone) PALM Palmar
SBC Subchondral bone cyst CRAN Cranial
SOFT Superficial digital flexor tendon CAUD Caudal
SH Scapulohumeral (joint) MED Medial
SL Suspensory ligament LAT Lateral
TC Tarsocrural (joint) PROX Proximal
TMT Tarsometatarsal (joint) DIST Distal
T3 Third tarsal bone VENT Ventral
UC Ulnar carpal (bone) ROST Rostral
•
(cid:1005)0
