FREE SHIPPING over $40
OVER 10000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Animals : an open access journal from MDPI2023; 13(24); 3772; doi: 10.3390/ani13243772

Does Direct MRI Tenography Improve the Diagnostic Performance of Low-Field MRI to Identify Artificially Created Soft-Tissue Lesions within the Equine Cadaveric Digital Flexor Tendon Sheath?

Abstract: Tenosynovitis of the digital flexor tendon sheath (DFTS) is diagnosed using ultrasonography and contrast tenography. Nevertheless, making a precise preoperative diagnosis is challenging. This study aimed to determine and compare the sensitivity and specificity of low-field MRI and MRI tenography (MRIt) to detect artificially created soft-tissue lesions in the DFTS. In 21 DFTSs, 118 lesions were made tenoscopically in the superficial digital flexor tendon (SDFT), deep digital flexor tendon (DDFT), manica flexoria (MF) and proximal scutum. MRI and MRI, following intrathecal gadolinium administration (MRIt), were performed. The sensitivity and specificity of MRI and MRIt were calculated and compared. Proximal scutum lesions were less frequently identified by MRI (Sensitivity 38%, specificity 96%) compared to MRIt (Sensitivity: 50%, = 0.80; specificity: 96%, = 1). This was similar for SDFT lesions (Sensitivity: 39% versus 54%, = 0.72; specificity: 93% versus 96%, = 1). MRI detected DDFT lesions (sensitivity 34%; specificity 100%) better than MRIt (sensitivity 32%, = 0.77; specificity 98%, = 1). This was similar for MF lesions (MRI sensitivity 61%; specificity 100% vs. MRIt sensitivity 50%, = 0.68; specificity 96%, = 1). Lesion size was significantly associated with MRI or MRIt diagnosis ( = 0.001). The intrathecal administration of gadolinium did not significantly improve the ability of low-field MRI to diagnose artificial DFTS tendon lesions. Small lesion length was a significant discriminating factor for lesion detection. MRI and MRIt specificity were high, thus being helpful in diagnosing an intact structure.
Get Full Text
Publication Date: 2023-12-07 PubMed ID: 38136809PubMed Central: PMC10740514DOI: 10.3390/ani13243772Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research assesses if combining MRI tenography with a standard MRI can enhance diagnosis capacity for artificially created lesions in the digital flexor tendon sheath of horses. The findings suggest that MRI enhanced with gadolinium does not significantly improve the diagnosis of such tendon lesions, though both techniques show high specificity in diagnosing healthy tendon structure.

Research Context and Aim

  • The study is based on the challenge encountered in diagnosing tenosynovitis of the digital flexor tendon sheath (DFTS) in horses. The conventional method used for diagnosis is a combination of ultrasonography and contrast tenography.
  • The researchers’ objective was to evaluate the sensitivity and specificity of standard low-field MRI and MRI enhanced with intrathecal gadolinium (known as MRI tenography) in detecting artificially created soft-tissue lesions in a horse’s DFTS.

Methods

  • The researchers artificially created 118 lesions within the DFTS of 21 equine cadavers using a method called tenoscopy. The created lesions were spread over various components: the superficial digital flexor tendon (SDFT), deep digital flexor tendon (DDFT), manica flexoria (MF), and proximal scutum.
  • After creating the lesions, both standard MRI and MRI tenography were performed on each DFTS. MRI tenography was done following the administration of gadolinium into the sheath.
  • The accuracy of both MRI methods in identifying these artificially created lesions was then compared.

Findings

  • The results showed that the use of gadolinium in MRI tenography did not significantly enhance the ability to diagnose the artificially created DFTS tendon lesions compared to the standard MRI.
  • However, both techniques demonstrated high specificity in diagnosing an unblemished structure. This means that they are highly accurate in identifying a tendon sheath that is not damaged.
  • The size of the lesion was a significant determinant in its detection. Small lesions were harder to detect regardless of the MRI method used.

Implications

  • Although the gadolinium-enhanced MRI tenography did not improve the detection of tendon lesions, it proved useful in confirming the integrity of the horse’s tendon sheath.
  • The results indicated that both diagnosis techniques have limitations in detecting small lesions. Medical practitioners, therefore, need to be aware of these limitations when diagnosing tenosynovitis in horses, as small lesions could be overlooked.

Cite This Article

APA
Aßmann A, Ohlerth S, Hartmann S, Torgerson P, Bischofberger A. (2023). Does Direct MRI Tenography Improve the Diagnostic Performance of Low-Field MRI to Identify Artificially Created Soft-Tissue Lesions within the Equine Cadaveric Digital Flexor Tendon Sheath? Animals (Basel), 13(24), 3772. https://doi.org/10.3390/ani13243772

Publication

Animals : an open access journal from MDPI
ISSN: 2076-2615
NlmUniqueID: 101635614
Country: Switzerland
Language: English
Volume: 13
Issue: 24
PII: 3772

Researcher Affiliations

Aßmann, Anton
  • Equine Hospital, Vetsuisse-Faculty, University of Zürich, 8057 Zürich, Switzerland.
Ohlerth, Stefanie
  • Clinic of Diagnostic Imaging, Vetsuisse-Faculty, University of Zürich, 8057 Zürich, Switzerland.
Hartmann, Silvana
  • Equine Hospital, Vetsuisse-Faculty, University of Zürich, 8057 Zürich, Switzerland.
Torgerson, Paul
  • Section of Veterinary Epidemiology, Vetsuisse-Faculty, University of Zürich, 8057 Zürich, Switzerland.
Bischofberger, Andrea
  • Clinic of Diagnostic Imaging, Vetsuisse-Faculty, University of Zürich, 8057 Zürich, Switzerland.

Grant Funding

  • Loriot Research Fund

Conflict of Interest Statement

The authors declare no conflict of interest.

References

This article includes 47 references
  1. Arensburg L, Wilderjans H, Simon O, Dewulf J, Boussauw B. Nonseptic tenosynovitis of the digital flexor tendon sheath caused by longitudinal tears in the digital flexor tendons: A retrospective study of 135 tenoscopic procedures.. Equine Vet. J. 2011;43:660–668.
    doi: 10.1111/j.2042-3306.2010.00341.xpubmed: 21649711google scholar: lookup
  2. Wilderjans H, Boussauw B, Madder K, Simon O. Tenosynovitis of the digital flexor tendon sheath and annular ligament constriction syndrome caused by longitudinal tears in the deep digital flexor tendon: A clinical and surgical report of 17 cases in Warmblood horses.. Equine Vet. J. 2003;35:270–275.
    doi: 10.2746/042516403776148183pubmed: 12755430google scholar: lookup
  3. Smith M.R, Wright I.M. Noninfected tenosynovitis of the digital flexor tendon sheath: A retrospective analysis of 76 cases.. Equine Vet. J. 2006;38:134–141.
    doi: 10.2746/042516406776563350pubmed: 16536382google scholar: lookup
  4. Findley J.A, De Oliveira F, Bladon B. Tenoscopic surgical treatment of tears of the manica flexoria in 53 horses.. Vet. Surg. 2012;41:924–930.
    doi: 10.1111/j.1532-950X.2012.01044.xpubmed: 23198921google scholar: lookup
  5. Edinger J, Möbius G, Ferguson J. Comparison of tenoscopic and ultrasonographic methods of examination of the digital flexor tendon sheath in horses.. Vet. Comp. Orthop. Traumatol. 2005;18:209–214.
    pubmed: 16594388
  6. Garcia da Fonseca R.M, Evrard L, Rabba S, Salciccia A, Busoni V. Dynamic flexion/extension and non-weight bearing ultrasonography is helpful for identifying manica flexoria tears in horses.. Vet. Radiol. Ultrasound. 2019;60:65–74.
    doi: 10.1111/vru.12675pubmed: 30121953google scholar: lookup
  7. Hibner-Szaltys M, Cavallier F, Cantatore F, Withers J.M, Marcatili M. Ultrasonography can be used to predict the location of manica flexoria tears in horses.. Equine Vet. Educ. 2022;35:e200–e207.
    doi: 10.1111/eve.13687google scholar: lookup
  8. Kent A.V, Chesworth M.J, Wells G, Gerdes C, Bladon B.M, Smith R.K.W, Fiske-Jackson A.R. Improved diagnostic criteria for digital flexor tendon sheath pathology using contrast tenography.. Equine Vet. J. 2019;52:205–221.
    doi: 10.1111/evj.13166pubmed: 31429480google scholar: lookup
  9. Fiske-Jackson A.R, Barker W.H, Eliashar E, Foy K, Smith R.K. The use of intrathecal analgesia and contrast radiography as preoperative diagnostic methods for digital flexor tendon sheath pathology.. Equine Vet. J. 2013;45:36–40.
    doi: 10.1111/j.2042-3306.2012.00573.xpubmed: 22563706google scholar: lookup
  10. Nixon A.J, McIlwraith C.W, Wright I.M. Arthroscopic Surgery of the Carpal and Digital Tendon Sheaths.. 4th ed. Mosby; Maryland Heights, MI, USA: 2015.
  11. Gonzalez L.M, Schramme M.C, Robertson I.D, Thrall D.E, Redding R.W. MRI features of metacarpo (tarso) phalangeal region lameness in 40 horses.. Vet. Radiol. Ultrasound. 2010;51:404–414.
    doi: 10.1111/j.1740-8261.2010.01676.xpubmed: 20806872google scholar: lookup
  12. King J.N, Zubrod C.J, Schneider R.K, Sampson S.N, Roberts G. MRI findings in 232 horses with lameness localized to the metacarpo (tarso) phalangeal region and without a radiographic diagnosis.. Vet. Radiol. Ultrasound. 2013;54:36–47.
    doi: 10.1111/j.1740-8261.2012.01983.xpubmed: 23020207google scholar: lookup
  13. Dyson S, Murray R. Magnetic resonance imaging of the equine fetlock.. Clin. Tech. Equine Pract. 2007;6:62–77.
    doi: 10.1053/j.ctep.2006.11.006google scholar: lookup
  14. Daniel A, Leise B, Selberg K, Barrett M. Enhanced ultrasonographic imaging of the equine distal limb using saline injection of the digital flexor tendon sheath: A cadaver study.. Vet. J. 2019;247:26–31.
    doi: 10.1016/j.tvjl.2019.02.007pubmed: 30971347google scholar: lookup
  15. Steinbach L.S, Palmer W.E, Schweitzer M.E. Special focus session: MR arthrography.. Radiographics. 2002;22:1223–1246.
    doi: 10.1148/radiographics.22.5.g02se301223pubmed: 12235350google scholar: lookup
  16. Bergin D, Schweitzer M. Indirect magnetic resonance arthrography.. Skelet. Radiol. 2003;32:551–558.
    doi: 10.1007/s00256-003-0669-2pubmed: 12942203google scholar: lookup
  17. Bittersohl B, Hosalkar H.S, Werlen S, Trattnig S, Siebenrock K.A, Mamisch T.C. Intravenous versus intra-articular delayed gadolinium-enhanced magnetic resonance imaging in the hip joint: A comparative analysis.. Investig. Radiol. 2010;45:538–542.
    doi: 10.1097/RLI.0b013e3181ea5bb5pubmed: 20697224google scholar: lookup
  18. Şahin G, Demirtaş M. An overview of MR arthrography with emphasis on the current technique and applicational hints and tips.. Rev. Clin. Imaging. 2007;31:73.
    doi: 10.1016/j.clinimag.2006.09.007pubmed: 16464555google scholar: lookup
  19. Kopka L, Funke M, Fischer U, Keating D, Oestmann J, Grabbe E. MR arthrography of the shoulder with gadopentetate dimeglumine: Influence of concentration, iodinated contrast material, and time on signal intensity.. AJR. Am. J. Roentgenol. 1994;163:621–623.
    doi: 10.2214/ajr.163.3.8079856pubmed: 8079856google scholar: lookup
  20. McCauley T.R, Elfar A, Moore A, Haims A.H, Jokl P, Lynch J.K, Ruwe P.A, Katz L.D. MR arthrography of anterior cruciate ligament reconstruction grafts.. Am. J. Roentgenol. 2003;181:1217–1223.
    doi: 10.2214/ajr.181.5.1811217pubmed: 14573407google scholar: lookup
  21. Robinson P, White L, Salonen D, Ogilvie-Harris D. Anteromedial impingement of the ankle: Using MR arthrography to assess the anteromedial recess.. Am. J. Roentgenol. 2002;178:601–604.
    doi: 10.2214/ajr.178.3.1780601pubmed: 11856682google scholar: lookup
  22. Sciulli R.L, Boutin R.D, Brown R, Nguyen K.D, Muhle C, Lektrakul N, Pathria M.N, Pedowitz R, Resnick D. Evaluation of the postoperative meniscus of the knee: A study comparing conventional arthrography, conventional MR imaging, MR arthrography with iodinated contrast material, and MR arthrography with gadolinium-based contrast material.. Skelet. Radiol. 1999;28:508–514.
    doi: 10.1007/s002560050554pubmed: 10525794google scholar: lookup
  23. Saveraid T.C, Judy C.E. Use of intravenous gadolinium contrast in equine magnetic resonance imaging.. The Veterinary clinics of North America. Equine Pract. 2012;28:617–636.
    doi: 10.1016/j.cveq.2012.08.008pubmed: 23177135google scholar: lookup
  24. De Zani D, Rabbogliatti V, Ravasio G, Pettinato C, Di Giancamillo M, Zani D.D. Contrast enhanced magnetic resonance imaging of the foot in horses using intravenous versus regional intraarterial injection of gadolinium.. Open Vet. J. 2018;8:471–478.
    doi: 10.4314/ovj.v8i4.19pmc: PMC6356101pubmed: 30775287google scholar: lookup
  25. Aarsvold S, Solano M, Garcia-Lopez J. Magnetic resonance imaging following regional limb perfusion of gadolinium contrast medium in 26 horses.. Equine Vet. J. 2018;50:649–657.
    doi: 10.1111/evj.12818pubmed: 29417635google scholar: lookup
  26. Nelson B, Goodrich L, Barrett M, Grinstaff M, Kawcak C. Use of contrast media in computed tomography and magnetic resonance imaging in horses: Techniques, adverse events and opportunities.. Equine Vet. J. 2017;49:410–424.
    doi: 10.1111/evj.12689pubmed: 28407291google scholar: lookup
  27. Zhalniarovich Y, Przyborowska-Zhalniarovich P, Mieszkowska M, Adamiak Z. Direct magnetic resonance arthrography of the canine elbow.. Acta Vet. Brno. 2017;86:85–89.
    doi: 10.2754/avb201786010085google scholar: lookup
  28. Banfield C.M, Morrison W.B. Magnetic resonance arthrography of the canine stifle joint technique and applications in eleven military dogs.. Vet. Radiol. Ultrasound. 2000;41:200–213.
    doi: 10.1111/j.1740-8261.2000.tb01479.xpubmed: 10850868google scholar: lookup
  29. Van Zadelhoff C, Schwarz T, Smith S, Engerand A, Taylor S. Identification of naturally occurring cartilage damage in the equine distal interphalangeal joint using low-field magnetic resonance imaging and magnetic resonance arthrography.. Front. Vet. Sci. 2020;6:508.
    doi: 10.3389/fvets.2019.00508pmc: PMC6999043pubmed: 32064268google scholar: lookup
  30. Bischofberger A.S, Fürst A.E, Torgerson P.R, Carstens A, Hilbe M, Kircher P. Use of a 3-telsa magnet to perform delayed gadolinium-enhanced magnetic resonance imaging of the distal interphalangeal joint of horses with and without naturally occurring osteoarthritis.. Am. J. Vet. Res. 2018;79:287–298.
    doi: 10.2460/ajvr.79.3.287pubmed: 29466042google scholar: lookup
  31. Carstens A, Kirberger R.M, Velleman M, Dahlberg L.E, Fletcher L, Lammentausta E. Feasibility for mapping cartilage T1 relaxation times in the distal metacarpus3/metatarsus3 of thoroughbred racehorses using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC): Normal cadaver study.. Vet. Radiol. Ultrasound. 2013;54:365–372.
    doi: 10.1111/vru.12030pubmed: 23551282google scholar: lookup
  32. McIlwraith C.W, Nixon A.J, Wright I.M. Diagnostic and Surgical Arthroscopy in the Horse.. 4th ed. Elsevier; Amsterdam, The Netherlands: 2014.
  33. Aßmann A.D, Ohlerth S, Torgerson P.R, Bischofberger A.S. Sensitivity and specificity of 3 Tesla magnetic resonance imaging and multidetector computed tomographic tenography to identify artificially induced soft tissue lesions in the equine cadaveric digital flexor tendon sheath.. Equine Vet. Educ. 2023;35:e507–e516.
    doi: 10.1111/eve.13751google scholar: lookup
  34. Findley J.A, Ricci E.E, Singer E.E. An anatomical and histological study of the equine proximal manica flexoria.. Vet. Comp. Orthop. Traumatol. 2017;30:91–98.
    doi: 10.3415/VCOT-16-01-0016pubmed: 28127617google scholar: lookup
  35. Lin S.P, Brown J.J. MR contrast agents: Physical and pharmacologic basics.. J. Magn. Reson. Imaging Off. J. Int. Soc. Magn. Reson. Med. 2007;25:884–899.
    doi: 10.1002/jmri.20955pubmed: 17457803google scholar: lookup
  36. Murray R.C, Mair T.S, Sherlock C.E, Blunden A.S. Comparison of high-field and low-field magnetic resonance images of cadaver limbs of horses.. Vet. Rec. 2009;165:281–288.
    doi: 10.1136/vr.165.10.281pubmed: 19734560google scholar: lookup
  37. Vallance S, Bell R, Spriet M, Kass P.H, Puchalski S. Comparisons of computed tomography, contrast enhanced computed tomography and standing low-field magnetic resonance imaging in horses with lameness localised to the foot. Part 1: Anatomic visualisation scores.. Equine Vet. J. 2012;44:51–56.
    doi: 10.1111/j.2042-3306.2011.00372.xpubmed: 21623900google scholar: lookup
  38. Porter E.G, Werpy N.M. New concepts in standing advanced diagnostic equine imaging.. Vet. Clin. Equine Pract. 2014;30:239–268.
    doi: 10.1016/j.cveq.2013.11.001pubmed: 24680215google scholar: lookup
  39. Werpy N.M. Magnetic resonance imaging of the equine patient: A comparison of high-and low-field systems.. Clin. Tech. Equine Pract. 2007;6:37–45.
    doi: 10.1053/j.ctep.2006.11.004google scholar: lookup
  40. Carrino J.A, Morrison W.B, Zou K.H, Steffen R.T, Snearly W.N, Murray P.M. Noncontrast MR imaging and MR arthrography of the ulnar collateral ligament of the elbow: Prospective evaluation of two-dimensional pulse sequences for detection of complete tears.. Skelet. Radiol. 2001;30:625–632.
    doi: 10.1007/s002560100396pubmed: 11810154google scholar: lookup
  41. Zanetti M, Bräm J, Hodler J. Triangular fibrocartilage and intercarpal ligaments of the wrist: Does MR arthrography improve standard MRI?. J. Magn. Reson. Imaging. 1997;7:590–594.
    doi: 10.1002/jmri.1880070322pubmed: 9170047google scholar: lookup
  42. Stecco A, Brambilla M, Puppi A.M, Lovisolo M, Boldorini R, Carriero A. Shoulder MR arthrography: In vitro determination of optimal gadolinium dilution as a function of field strength.. J. Magn. Reson. Imaging Off. J. Int. Soc. Magn. Reson. Med. 2007;25:200–207.
    doi: 10.1002/jmri.20788pubmed: 17152058google scholar: lookup
  43. Andreisek G, Froehlich J.M, Hodler J, Weishaupt D, Beutler V, Pfirrmann C.W, Boesch C, Nanz D. Direct MR arthrography at 1.5 and 3.0 T: Signal dependence on gadolinium and iodine concentrations—Phantom study.. Radiology. 2008;247:706–716.
    doi: 10.1148/radiol.2473071013pubmed: 18403628google scholar: lookup
  44. Murphy S.E, Ballegeer E.A, Forrest L.J, Schaefer S.L. Magnetic resonance imaging findings in dogs with confirmed shoulder pathology.. Vet. Surg. 2008;37:631–638.
    doi: 10.1111/j.1532-950X.2008.00429.xpubmed: 19134085google scholar: lookup
  45. Schaefer S.L, Baumel C.A, Gerbig J.R, Forrest L.J. Direct magnetic resonance arthrography of the canine shoulder.. Vet. Radiol. Ultrasound. 2010;51:391–396.
    doi: 10.1111/j.1740-8261.2010.01671.xpubmed: 20806870google scholar: lookup
  46. Ugas M.A, Huynh B.H, Fox M.G, Patrie J.T, Gaskin C.M. MR arthrography: Impact of steroids, local anesthetics, and iodinated contrast material on gadolinium signal intensity in phantoms at 1.5 and 3.0 T.. Radiology. 2014;272:475–483.
    doi: 10.1148/radiol.14132352pubmed: 24661248google scholar: lookup
  47. Montgomery D.D, Morrison W.B, Schweitzer M.E, Weishaupt D, Dougherty L. Effects of iodinated contrast and field strength on gadolinium enhancement: Implications for direct MR arthrography.. J. Magn. Reson. Imaging Off. J. Int. Soc. Magn. Reson. Med. 2002;15:334–343.
    doi: 10.1002/jmri.10065pubmed: 11891980google scholar: lookup

Citations

This article has been cited 3 times.
  1. Aßmann AD, Sànchez-Andrade JS, Argüelles D, Bischofberger AS. Does Low-Field MRI Tenography Improve the Detection of Naturally Occurring Manica Flexoria Tears in Horses?. Animals (Basel) 2025 Jul 31;15(15).
    doi: 10.3390/ani15152250pubmed: 40805040google scholar: lookup
  2. Miles S, McCauley C, Carossino M, Del Piero F, Liu CC, Gaschen L. Normal MRI features of the manica flexoria in horses and evaluation of the anatomic variability between forelimbs and hindlimbs. PLoS One 2025;20(7):e0327880.
    doi: 10.1371/journal.pone.0327880pubmed: 40690480google scholar: lookup
  3. 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.
    doi: 10.1111/evj.14508pubmed: 40314097google scholar: lookup
Subscribe to our newsletter
Join 99,727 horse owners like you who receive our email updates on horse health and nutrition.