Additional palmaroproximal-palmarodistal oblique radiographic projections improve accuracy of detection and characterization of equine flexor cortical lysis.
Abstract: Radiographic flexor cortical lysis indicates advanced degenerative change and its earlier recognition may improve case outcome. Aims of this prospective, diagnostic accuracy study were to determine effects of radiographic beam angle and observer on accuracy of lesion detection. The sample included 36 limbs from 31 horses. Palmaroproximal-palmarodistal oblique (skyline) radiographs were acquired at standard (n = 38) and more shallow (alternate) angles (n = 58). Images were independently reviewed by four experience levels of five observers each (n = 20) for the presence and severity of flexor cortical lysis. Observers also reported their confidence in these answers. Responses were compared based on seeing a standard skyline or multiple projections. The definitive presence (or absence) and severity of lysis was based upon radiologist consensus agreement. When assessed by observer, the identification of lysis and the assessment of its severity was most similar to that of radiologists when observers of all levels of experience were able to view multiple skyline projections (P = 0.399, P = 0.174). Using multiple views to detect lysis resulted in improved sensitivity (85.3% vs. 97.2%, P < 0.001), decreased specificity (82.8% vs. 74.5%, P = 0.03), and improved interobserver agreement (86.0% vs. 90.2%, P = 0.21). On average, observers of all levels of experience became more confident viewing multiple projections (P < 0.001). Skyline radiographs using a flatter angle of incidence improve radiographic detection and characterization of flexor cortical lysis severity, may allow the beam to be tangential to the more distal portion of the navicular bone, and are recommended when flexor cortical lysis is suspected.
© 2018 American College of Veterinary Radiology.
Publication Date: 2018-04-29 PubMed ID: 29707844DOI: 10.1111/vru.12620Google Scholar: Lookup
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- Journal Article
Summary
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The research study uncovers that additional palmaroproximal-palmarodistal oblique radiographic projections can improve the accuracy of detecting advanced degenerative changes in horses, like flexor cortical lysis.
Methodology
- The research study employed a prospective, diagnostic accuracy design to examine the influence of the radiographic beam angle and observer on the accuracy of lesion detection.
- The study included 36 limbs from 31 horses. Palmaroproximal-palmarodistal oblique radiographic images, or skyline view, were captured at both standard and alternate, or more shallow angles.
- A total of 20 observers, divided into four different skill levels, independently examined the images to identify the presence and measure the severity of flexor cortical lysis. They were also asked to express their level of confidence in their evaluations.
- The definitive identification and severity of lysis were established based on radiologist consensus agreement.
Findings
- Findings revealed that the detection and assessment of lysis severity closely matched the radiologists’ consensus when observers of varying expertise were allowed multiple skyline projections to examine.
- Utilizing multiple views to detect lysis resulted in an increase in sensitivity (85.3% vs. 97.2%). However, it led to a decrease in specificity (82.8% vs. 74.5%).
- Using multiple views also led to better interobserver agreement (86.0% vs. 90.2%).
- Observers, irrespective of their level of experience, felt more confident when they could use multiple projections for evaluation.
Conclusion
- Skyline radiographs employing a flatter angle of incidence enhance the radiographic detection and characterization of flexor cortical lysis severity.
- Such projections also potentially offer a more focused beam to the distal part of the navicular bone.
- Therefore, employing multiple skyline radiographs is recommended for suspected cases of flexor cortical lysis.
Cite This Article
APA
Johnson SA, Barrett MF, Frisbie DD.
(2018).
Additional palmaroproximal-palmarodistal oblique radiographic projections improve accuracy of detection and characterization of equine flexor cortical lysis.
Vet Radiol Ultrasound, 59(4), 387-395.
https://doi.org/10.1111/vru.12620 Publication
Researcher Affiliations
- Orthopaedic Research Center, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, 80523.
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, 80523.
- Orthopaedic Research Center, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, 80523.
MeSH Terms
- Animals
- Cartilage Diseases / diagnostic imaging
- Cartilage Diseases / veterinary
- Forelimb / pathology
- Hindlimb / pathology
- Horse Diseases / diagnostic imaging
- Horses
- Lameness, Animal / pathology
- Prospective Studies
- Radiography / veterinary
Citations
This article has been cited 3 times.- Peeters MWJ, Thursby JJ, Watson HE, Berner D. Caudal foot placement superior to toe elevation for navicular palmaroproximal-palmarodistal-oblique image quality. Equine Vet J 2023 Jan;55(1):122-128.
- Esselman AM, Johnson SA, Frisbie DD, Barrett MF, Zhou T, Contino EK. Substantial variability exists in the interpretation of survey radiographs among equine veterinarians. Equine Vet J 2025 Jan;57(1):169-182.
- Dancot M, Joostens Z, Audigié F, Busoni V. The plantar proximal cortex of the third metatarsal bone shows raised longitudinal ridges at the suspensory ligament enthesis in normal equine isolated limbs - a radiographic, computed tomography, and MRI study. Front Vet Sci 2023;10:1265116.
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