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When is a CT indicated ?

Computed tomography (CT) is a non-invasive imaging technique that is becoming standard of care for several procedures in veterinary medicine.

How a CT can help us get closer to a diagnosis and treatment plan or guide difficult decisions?

Here we are sharing just a few examples from our Hospital, where a CT proved to be an excellent imaging modality to help us plan any further diagnostic procedures, treatments, and predict outcomes.

Intervertebral disc disease

This 4-year-old dog was presented with a chronic neck pain and left hemiparesis.

A CT revealed a collapsed intervertebral space C5-C6 and presence of hyperdense mineralized material in the vertebral canal. The exact location of the material can also be determined from several CT images (dorsal to C5-C6 intervertebral space, slightly lateralised on the left side and extending to corresponding left intervertebral foramen) as well as its’ extent (hyperdense material has an extension of approximately 1.4 cm, distributed for 2/3 on the cranial part of C6 and 1/3 on the caudal part of C5). In addition, presence of a small mineralised hyperdensity protruding into the left foramen C6-C7 was seen.

The final diagnoses were reported as mineral dense disk extrusion C5-C6 with mild left lateralisation and left foraminal obliteration and severe spinal cord compression (compatible with the clinical presentation), and very mild C6-C7 left foraminal disk protrusion and in situ degenerated disk (not likely significant at the moment).

These data, together with the clinical signs, can greatly help a surgeon predict the prognosis and plan the surgery.

Advanced neoplastic disease

A 12-year-old dog was suffering from a severe cough and possible lung metastasis were seen on the thoracic radiographs.

A full-body CT was performed and revealed widespread pulmonary nodular lesions with size ranging from military to 1 cm and partially coalescing. Left caudal lung lobe showed diffuse homogeneous groundglass opacity in particular in apical region. A round mass of approximately 2.5 cm of diameter was visible on the base of the heart, at the level of right atrium. All thoracic lymph nodes were found to be enlarged. A hypodense, moderately enhancing mass of 4.2 cm, with irregular margins was seen affecting the right kidney and the renal lymph nodes were found to be enlarged.

The findings were most likely consistent with a malignant mass of the left kidney and right atrium of the heart, widespread pulmonary metastases and neoplastic enlargement of the renal lymph nodes. Based on the aspect of the metastases and location of the other neoplastic lesions, this dog most likely suffered from a hemangiosarcoma, originating in the left kidney with metastases to the right atrium of the heart and to the lungs. However, further diagnostic procedures (biopsy) can then be suggested to the client to reach a final diagnosis, while at the same time the severity of the findings can be discussed in view of the (poor) prognosis.

Brain tumor

A 6-year-old dog was showing signs of cerebellar ataxia, had depressed mental status, and was disoriented.

A pre- and post-contrast CT study of the head revealed a strongly enhancing broad based mass in the posterior fossa. The mass had a globoid aspect, was strongly and uniformly uptaking contrast and had a central hypodense non-enhancing area. It measured 2.1 cm CrC x 2.0 cm LL x 1.3 cm DV. There was a severe mass effect on the cerebellum and medulla oblongata, the first being compressed and displaced dorso-cranially and the second dorsally. At the level of the foramen magnum a severe stenosis caused by the mass was observed, with a reduction in the total diameter of approximately 80%.

Given the appearance, this intracranial, extra axial mass in the posterior fossa was considered to be most likely a meningioma and further possible treatments (e.g., radiation) can be discussed with the client.

Trauma

This young (6 months old) patient was referred to us after being hit by a car and already stabile. A CT was performed to best evaluate the suspected fractures and plan the treatments.

Double fracture of the left pubis at the level of pecten and cranial to the pubic symphysis was noted, in addition to the fracture -of the left ischiadic table, and articular comminuted fracture at the level of right acetabulum, with dorso-medial displacement, while pelvic soft tissues and organs appear to be intact.

Intervertebral disc disease

A 7-year-old dog was referred for a CT due to chronic neck pain.

A pre- and post-IV-contrast CT was performed; due to inconclusive results a subarachnoid injection of contrast media was used (i.e. CT myelography). This procedure revealed a chronic C4-C5 left foraminal disk protrusion with no evidence of significant spinal cord compressions.

CT myelography is many times needed to precisely locate the location of the disk herniation and plan accordingly for the most appropriate surgical approach.

Portosystemic shunt

A 1-year-old dog was referred to our hospital due to a suspected portosystemic shunt (i.e. a bypass of the liver by the body's vascular system) based on the history, clinical examination findings and elevated bile acids.

CT revealed smaller liver compared to normal dogs. Left gastric vein was found to be enlarged and an abnormal connection with the caudal vena cava was noted at the level of the diaphragm; with this vessel abnormality blood from the intestines was only partly going through the liver, thereby causing the observed clinical signs. No other abnormalities were noted in the abdomen apart this single extra-hepatic left gastric v. to cava v. portosystemic shunt (PSS).

These details are needed for the planning of surgical repair of the defect.

Brachycephalic obstructive airway syndrome

This 6-year-old dog was presented due to aggravated stertor and difficulties breathing.

A CT of the head, neck and thorax revealed a thickened soft palate, caudal aberrant turbinates partially obstructing the nasopharyngeal meatus, mild nonspecific rhinitis and a hypoplastic trachea.

Based on the findings and ruling out other possible causes of aggravated stertor (i.e. tumor, polyp, abscess) and difficulties breathing (i.e. pneumonia), a surgical procedure was recommended to improve the condition.

Oral neoplasia

This 8-year-old dog was presented to us for a gingival mass at the upper left canine tooth that has been present for 1 year and has started to grow faster recently. Biopsy was performed previously and reported a benign, but locally aggressive peripheral odontogenic fibroma.

A pre- and post-contrast CT of the head revealed a soft tissue proliferation appearing hypodense on unenhanced images and strongly enhancing on post-contrast images at the level of the left maxillary canine tooth with a mixed pattern of osteolysis and osteoproduction of the surrounding alveolar bone. The mass was found extending between the mesial aspect of the left maxillary canine tooth and the distal aspect of the left maxillary 2nd premolar tooth.

Based on the clinical, histopathological and CT findings a surgical removal - unilateral rostral maxillectomy with 1 cm of healthy margins (from the left maxillary third incisor tooth to the left maxillary fourth premolar tooth) was recommended to the client as a curative procedure.

If you have noted any problems with your animal, please consult your veterinarian.

Article by Tommaso Pilla & Marko Pipan.