Contrast-enhanced computed tomographic evaluation of the deep digital flexor tendon in the equine foot compared to macroscopic and histological findings in 23 limbs.
Abstract: Distal deep digital flexor tendinopathy is an important cause of foot lameness in horses that is difficult to diagnose with radiography and ultrasonography. Magnetic resonance imaging is a well-accepted and validated technique for the identification of deep digital flexor tendon (DDFT) lesions, but has some practical and financial drawbacks. Contrast-enhanced computed tomography (CECT) has been proposed as a suitable alternative, but validation studies are currently lacking. Objective: To assess the accuracy of CECT for the identification and characterisation of deep digital flexor tendinopathy. Methods: Descriptive study of CT, macroscopic and histological findings of the DDFT. Methods: Plain and CECT scans were acquired of 23 limbs of 16 horses with clinical lameness localised to the foot. All horses had lesions of the DDFT that were identified and characterised with CT and CECT with respect to their anatomic location and extent. All horses underwent post mortem examination and gross abnormalities were described. Samples of the DDFT were taken at specific sites (lesion and nonlesion) for histological evaluation. Macroscopic and histological outcomes were compared with CECT findings. Results: Of 67 sites in 23 DDFTs that were evaluated, 42 sites in 18 tendons had lesions on CECT images. These 42 sites also had lesions on macroscopic evaluation. There were 3 false negative and 3 false positive results identified on CECT. The sensitivity of CECT for diagnosing lesions of the DDFT in the equine foot was 93%. Conclusions: CECT is an effective adjunct to the more commonly used diagnostic techniques in equine foot pain.
© 2013 EVJ Ltd.
Publication Date: 2013-09-11 PubMed ID: 23808755DOI: 10.1111/evj.12129Google Scholar: Lookup
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- Journal Article
- Research Support
- Non-U.S. Gov't
- Anatomy
- Clinical Findings
- Clinical Pathology
- Clinical Study
- Computed Tomography
- Deep Digital Flexor Tendon
- Diagnosis
- Diagnostic Imaging
- Diagnostic Technique
- Disease Diagnosis
- Disease Treatment
- Equine Diseases
- Equine Health
- Histology
- Horses
- Lameness
- Magnetic Resonance Imaging
- Post Mortem
- Radiology
- Veterinary Medicine
- Veterinary Research
Summary
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The study reveals the effectiveness of Contrast-enhanced computed tomography (CECT) in identifying and diagnosing distal deep digital flexor tendinopathy, a common cause of foot lameness in horses. The research highlights that CECT, despite a few inaccuracies, has a high sensitivity and could be a worthy alternative to the more common, yet costly and less practical, MRI scan.
About the Study
- The research was a descriptive analysis of computed tomography (CT), macroscopic, and histological findings of the deep digital flexor tendon (DDFT) in horses.
- Both plain and contrast-enhanced CT scans were obtained from 23 limbs of 16 horses diagnosed with clinical lameness localized to the foot.
- All these horses had detectable DDFT lesions that were classified according to their anatomical location and extent using both CT and CECT.
- Postmortem examinations were conducted on all horses, and any gross abnormalities were noted. Tissue samples from the DDFT (both lesion and non-lesion sites) were collected for histological evaluation.
- The outcomes of macroscopic and histological evaluations were later matched with the findings of the CECT scans.
Findings of the Study
- The study identified 67 sites across 23 DDFTs for evaluation. Using CECT imaging, the researchers discovered lesions in 42 sites across 18 tendons.
- The same 42 sites also revealed lesions under macroscopic evaluation, confirming the diagnostic effectiveness of CECT imaging.
- However, there were a few inconsistencies, with 3 false negative and 3 false positive results identified on CECT. This implies that CECT scans mistakenly identified some healthy sites as having lesions and vice versa.
- Despite these few errors, the overall sensitivity of CECT for diagnosing DDFT lesions was found to be as high as 93%, indicating that it was able to correctly identify the vast majority of actual lesions.
Implications of the Study
- The study concluded that CECT, despite its occasional inaccuracies, can be a highly effective supplementary method for diagnosing causes of equine foot pain.
- While magnetic resonance imaging (MRI) remains the gold standard for identifying DDFT lesions, its practical disadvantages and high cost make CECT a promising alternative, especially in cases where MRI is not an option.
Cite This Article
APA
van Hamel SE, Bergman HJ, Puchalski SM, de Groot MW, van Weeren PR.
(2013).
Contrast-enhanced computed tomographic evaluation of the deep digital flexor tendon in the equine foot compared to macroscopic and histological findings in 23 limbs.
Equine Vet J, 46(3), 300-305.
https://doi.org/10.1111/evj.12129 Publication
Researcher Affiliations
- Department of Equine Sciences, Utrecht University, The Netherlands.
MeSH Terms
- Animals
- Cadaver
- Contrast Media
- Foot / anatomy & histology
- Forelimb / anatomy & histology
- Horses / anatomy & histology
- Tendons / anatomy & histology
- Tomography, X-Ray Computed / veterinary
Citations
This article has been cited 8 times.- Scharf A, Acutt E, Bills K, Werpy N. Magnetic resonance imaging for diagnosing and managing deep digital flexor tendinopathy in equine athletes: Insights, advances and future directions. Equine Vet J 2025 Sep;57(5):1183-1203.
- Blaettler C, Kaessmeyer S, Grabherr S, Koch C, Schweizer D, Van der Vekens E. Post-mortem Computed Tomographic Angiography in Equine Distal Forelimbs: A Feasibility Study. Front Vet Sci 2022;9:868390.
- Trolinger-Meadows KD, Biedrzycki AH, He H, Werpy N. Three-Dimensional Segmentation and in silico Comparison of Equine Deep Digital Flexor Tendon Pathology in Horses Undergoing Repeated MRI Examination. Front Vet Sci 2021;8:706046.
- Arencibia A, Corbera JA, Ramírez G, Díaz-Bertrana ML, Pitti L, Morales M, Jaber JR. Anatomical Assessment of the Thorax in the Neonatal Foal Using Computed Tomography Angiography, Sectional Anatomy, and Gross Dissections. Animals (Basel) 2020 Jun 17;10(6).
- Zani D, Rabbogliatti V, Ravasio G, Pettinato C, Giancamillo MD, Zani DD. Contrast enhanced magnetic resonance imaging of the foot in horses using intravenous versus regional intraarterial injection of gadolinium. Open Vet J 2018;8(4):471-478.
- Froydenlund TJ, Meehan LJ, Morrison LR, Labens R. A Rare Case of Deep Digital Flexor Tendinopathy following Centesis of the Navicular Bursa. Front Vet Sci 2017;4:169.
- Vandenberghe A, Broeckx SY, Beerts C, Seys B, Zimmerman M, Verweire I, Suls M, Spaas JH. Tenogenically Induced Allogeneic Mesenchymal Stem Cells for the Treatment of Proximal Suspensory Ligament Desmitis in a Horse. Front Vet Sci 2015;2:49.
- Jacobson E, Dart AJ, Mondori T, Horadogoda N, Jeffcott LB, Little CB, Smith MM. Focal experimental injury leads to widespread gene expression and histologic changes in equine flexor tendons. PLoS One 2015;10(4):e0122220.
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