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Home / Equine Research Bank / Equine Vet J / Diagnostic performance of ultrasonography, bursography and s...
Equine veterinary journal2025; doi: 10.1111/evj.14530

Diagnostic performance of ultrasonography, bursography and standing magnetic resonance to detect navicular intrabursal pathology in horses with foot pain.

Abstract: Navicular intrabursal pathology (NIP) is a common cause of forelimb lameness in horses. An accurate diagnosis of which structure is involved is essential for therapy and prognosis. Objective: The study aimed to compare the diagnostic performance of ultrasonography, bursography and standing magnetic resonance (MRI) imaging as diagnostic tools of the proximal NIP using bursoscopy as the gold standard. Methods: Prospective blinded study. Methods: A total of 21 feet from 17 horses were included. The feet underwent ultrasonography, followed by MRI, and thereafter bursography and bursoscopy. The images were interpreted blindly to document the presence or absence of the podotrochlear lesions. The lesions of interest were dorsal fibrillations (DF) and splits of deep digital flexor tendon (DDFT), adhesions and fibrocartilage defect (FD) of the navicular bone. The accuracy, specificity, sensitivity, positive predictive values and negative predictive values were calculated. Furthermore, the kappa test was used to calculate the inter-observer agreement. Results: Bursoscopy revealed lesions in 95% (20/21) of the feet. Eighteen DF and 11 split lesions in the DDFT, 19 FD and 8 adhesions were identified. MRI showed accuracy of 94% (17/18, 95% CI 76.2%-99.9%) for DF and 81% (9/11, 95% CI 63.6%-97%) for split lesions in the DDFT, whereas the accuracy for FD was 58% (11/19; 95% CI 36.1%-80.8%). Adhesions with MRI were predicted correctly in only 37.5% (3/8; 95% CI 43%-85.4%) of the feet. Bursography showed with MRI similar accuracy regarding the adhesions. Bursography had accuracy for FD of 68% (13/19; 95% CI 52.8%-91.8%) and DDFT lesions were detected in 85% (17/20, 95% CI 34%-78.2%) of the feet. Ultrasonography predicted DDFT lesions in 65% (13/20, 95% CI 63.6%-96.9%) of the feet, whereas its adhesions' accuracy was 25% (2/8, 95% CI 14.5%-56.9%). The inter-observer agreement was the lowest for ultrasonography compared to MRI and bursography. Conclusions: A combination of ultrasonography and bursography can be an alternative to standing MRI when the latter is not an option or is used as complementary tests.
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Publication Date: 2025-05-13 PubMed ID: 40357924DOI: 10.1111/evj.14530Google Scholar: Lookup
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Summary

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The research article examines the effectiveness of different diagnostic tools for navicular intrabursal pathology (NIP) in horses, a common cause of forelimb lameness. The study compares ultrasonography, bursography and standing magnetic resonance (MRI) imaging, using bursoscopy as a benchmark.

Research Methodology

  • The study incorporated a blind, prospective approach, which helps to reduce potential bias.
  • 21 feet from 17 horses were examined using ultrasonography, followed by MRI, and then bursography and bursoscopy.
  • The primary goal was to identify the presence or absence of specific podotrochlear lesions, namely dorsal fibrillations and splits of the deep digital flexor tendon, adhesions, and fibrocartilage defects in the navicular bone.
  • The images from these tests were interpreted blindly (meaning the interpreters didn’t know the history or symptoms of the horses).
  • Several performance metrics – accuracy, specificity, sensitivity, positive predictive values and negative predictive values – were calculated, along with calculations of inter-observer agreement via the kappa test.

Key Findings

  • Bursoscopy found lesions in 95% of the horses’ feet. The majority of these were dorsal fibrillations and fibrocartilage defects, with fewer splits in the deep digital flexor tendon and adhesions.
  • MRI was found to be highly accurate – 94% for dorsal fibrillations and 81% for splits. However, it was notably less accurate for fibrocartilage defects (58%) and adhesions (37.5%).
  • Bursography had a similar accuracy with MRI for adhesions and a slightly higher accuracy for fibrocartilage defects.
  • Unfortunately, ultrasonography was less reliable, with a predictive accuracy of 65% for identifying splits in the deep digital flexor tendon and 25% for adhesions.
  • The study found that ultrasonography had the lowest inter-observer agreement, making it less reliable than MRI and bursography.

Conclusions

  • The concluding statement of the research suggests that a combination of ultrasonography and bursography is a viable alternative to standing MRI, especially when MRI is not feasible or as complementary tests.
  • However, using these methods in combination would require additional time and resources as compared to using only one imaging technique.

Cite This Article

APA
Maleas G, Werpy N, Joostens Z, Bladon B, Gerlach K, Mageed M. (2025). Diagnostic performance of ultrasonography, bursography and standing magnetic resonance to detect navicular intrabursal pathology in horses with foot pain. Equine Vet J. https://doi.org/10.1111/evj.14530

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English

Researcher Affiliations

Maleas, Grigorios
  • Equuria GbR Grages & Maleas, Emstek, Germany.
  • Tierklinik in Luesche, Bakum, Germany.
Werpy, Natasha
  • Equine Diagnostic Imaging, Archer, Florida, USA.
Joostens, Zoë
  • Medical Imaging Department, Equitom Equine Clinic, Lummen, Belgium.
Bladon, Bruce
  • Donnington Grove Veterinary Surgery, Newbury, UK.
Gerlach, Kerstin
  • Department for Horses, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany.
Mageed, Mahmoud
  • Equipixel Veterinary Teleradiology, Bakum, Germany.

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