Analyze Diet
Animals : an open access journal from MDPI2025; 15(15); 2250; doi: 10.3390/ani15152250

Does Low-Field MRI Tenography Improve the Detection of Naturally Occurring Manica Flexoria Tears in Horses?

Abstract: Diagnosing digital flexor tendon sheath (DFTS) pathologies, particularly manica flexoria (MF) tears, can be challenging with standard imaging modalities. Standing low-field MRI tenography (MRIt) may improve the detection rate of MF tears. This study aimed to compare ultrasonography, contrast radiography, pre-contrast MRI, and MRIt to detect naturally occurring MF lesions in horses undergoing tenoscopy. Ten horses with a positive DFTS block, which underwent contrast radiography, ultrasonography, MRI, MRIt, and tenoscopy were included. Two radiologists evaluated the images and recorded whether an MF lesion was present and determined the lesion side. Sensitivity and specificity were calculated for each modality using tenoscopy as a reference. MRIt and contrast radiography detected MF lesions with the same frequency, both showing 71% sensitivity and 100% specificity. Pre-contrast MRI and ultrasonography detected MF lesions with a lower sensitivity (57%); however, the MRI (100%) demonstrated a higher specificity than ultrasonography (33%). Adding contrast in MRI changed the sensitivity from (4/7 lesions) 57% to (5/7 lesions) 71%, with a constant high specificity (100%). MRIt diagnoses MF tears with a similar sensitivity to contrast radiography, with the same specificity, but with the added benefit of lesion laterality detection. The combined advantages of the anatomical detail of the T1 sequence and the post-contrast hyperintense appearance of the fluid may help diagnose MF tears and identify intact MFs. However, this needs to be substantiated in a larger number of cases.
Publication Date: 2025-07-31 PubMed ID: 40805040PubMed Central: PMC12345494DOI: 10.3390/ani15152250Google 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.
  • 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 study investigates the effectiveness of standing low-field MRI tenography (MRIt) in detecting manica flexoria (MF) tears, a type of tendinitis, in horses. The findings suggest that it could be a feasible tool for this purpose, offering similar sensitivity and specificity to contrast radiography, but with additional advantages, such as the detection of tear location.

Research Purpose and Methodology

  • The study aims to evaluate the effectiveness of different imaging modalities – ultrasonography, contrast radiography, pre-contrast MRI, and MRI tenography (MRIt) – in detecting naturally occurring MF lesions in horses.
  • Ten horses with a positive digital flexor tendon sheath (DFTS) block, which had undergone contrast radiography, ultrasonography, MRI and MRIt, were included in the study. These techniques were compared with tenoscopy, a type of surgery, which was used as the reference.
  • Images were evaluated by two radiologists who assessed the presence and location of MF lesions.

Key Findings

  • The research indicates that MRIt and contrast radiography detected MF lesions with equivalent frequency, each with 71% sensitivity and 100% specificity.
  • Pre-contrast MRI and ultrasonography showed a lower sensitivity, identifying MF lesions only 57% of the time.
  • However, the specificity of MRI (100%) was higher than that of ultrasonography (33%), indicating a low rate of false positive results for MRI.
  • When contrast was added in MRI, the sensitivity increased from 57% to 71%, without affecting the high specificity observed.

Implications and Conclusion

  • MRIt was found to diagnose MF tears with similar sensitivity to contrast radiography, with equivalent specificity, but with the added advantage of being able to detect lesion laterality (side location).
  • The combination of the anatomical detail provided by the T1 sequence and the contrast-enhanced appearance of the fluid in MRIt images could improve the diagnosis of MF tears and identification of intact MFs.
  • Despite these promising results, the authors acknowledge the need for further validation in a larger set of cases.

Cite This Article

APA
Aßmann AD, Sànchez-Andrade JS, Argüelles D, Bischofberger AS. (2025). Does Low-Field MRI Tenography Improve the Detection of Naturally Occurring Manica Flexoria Tears in Horses? Animals (Basel), 15(15), 2250. https://doi.org/10.3390/ani15152250

Publication

ISSN: 2076-2615
NlmUniqueID: 101635614
Country: Switzerland
Language: English
Volume: 15
Issue: 15
PII: 2250

Researcher Affiliations

Aßmann, Anton D
  • Equine Hospital, Vetsuisse-Faculty, University of Zürich, 8057 Zürich, Switzerland.
Sànchez-Andrade, José Suàrez
  • Clinic for Diagnostic Imaging, Vetsuisse-Faculty, University of Zürich, 8057 Zürich, Switzerland.
Argüelles, David
  • Equine Veterinary Teaching Hospital, University of Cordoba, 14001 Cordoba, Spain.
Bischofberger, Andrea S
  • Clinic for Diagnostic Imaging, Vetsuisse-Faculty, University of Zürich, 8057 Zürich, Switzerland.

Conflict of Interest Statement

The authors have no personal interests to declare.

References

This article includes 55 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.
  2. Wilderjans H, Boussau 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.
  5. Cender A.N, Mählmann K, Ehrle A, Merle R, Pieper L, Lischer C.J. Diagnosis and outcome following tenoscopic surgery of the digital flexor tendon sheath in German sports and pleasure horses.. Equine Vet. J. 2023;55:48–58.
    doi: 10.1111/evj.13856pubmed: 35822486google scholar: lookup
  6. 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;52:205–212.
    doi: 10.1111/evj.13166pubmed: 31429480google scholar: lookup
  7. 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.
  8. 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.
  9. 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
  10. Pauwels F.E, Van der Vekens E, Christan Y, Koch C, Schweizer D. Feasibility, indications, and radiographically confirmed diagnoses of standing extremity cone beam computed tomography in the horse.. Vet. Surg. 2021;50:365–374.
    doi: 10.1111/vsu.13560pubmed: 33421172google scholar: lookup
  11. Shanklin A.J, Baldwin C.M, Ellesmere L, Stack J.D. Computed tomographic contrast tenography aids pre-operative diagnosis in clinical conditions of the digital flexor tendon sheath.. Equine Vet. Educ. 2024;36:197–205.
    doi: 10.1111/eve.13928google scholar: lookup
  12. Fletcher O, Agass R, Dixon J. Standing cone-beam computed tomographic digital flexor tendon sheath contrast tenography in 18 horses.. Equine Vet. Educ. 2025.
    doi: 10.1111/eve.14141google scholar: lookup
  13. 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
  14. Tucker R.L, Sande R.D. Computed tomography and magnetic resonance imaging in equine musculoskeletal conditions.. Vet. Clin. N. Am. Equine Pract. 2001;17:145–157.
    doi: 10.1016/S0749-0739(17)30080-9pubmed: 11488041google scholar: lookup
  15. Murray R.C. Equine MRI.. John Wiley & Sons; Hoboken, NJ, USA: 2010.
  16. Murray R, Mair T, Sherlock C, Blunden A. 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
  17. Dyson S, Murray R, Schramme M. Lameness associated with foot pain: Results of magnetic resonance imaging in 199 horses (January 2001–December 2003) and response to treatment.. Equine Vet. J. 2005;37:113–121.
    doi: 10.2746/0425164054223804pubmed: 15779622google scholar: lookup
  18. Crass J.R, Genovese R.L, Render J.A, Bellon E.M. Magnetic resonance, ultrasound and histopathologic correlation of acute and healing equine tendon injuries.. Vet. Radiol. Ultrasound. 1992;33:206–216.
  19. Blunden A, Murray R, Dyson S. Lesions of the deep digital flexor tendon in the digit: A correlative MRI and post mortem study in control and lame horses.. Equine Vet. J. 2009;41:25–33.
    doi: 10.2746/042516408X343028pubmed: 19301578google scholar: lookup
  20. Dyson S, Murray R. Magnetic resonance imaging of the equine fetlock.. Clin. Tech. Equine Pract. 2007;6:62–77.
  21. 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.
  22. 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.
  23. 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.
  24. Murray R, Mair T. Use of magnetic resonance imaging in lameness diagnosis in the horse.. In Pract. 2005;27:138–146.
    doi: 10.1136/inpract.27.3.138google scholar: lookup
  25. Lin S.P, Brown J.J. MR contrast agents: Physical and pharmacologic basics.. J. Magn. Reson. Imaging. 2007;25:884–899.
    doi: 10.1002/jmri.20955pubmed: 17457803google scholar: lookup
  26. Steinbach L.S, Palmer W.E, Schweitzer M.E. Special focus session: MR arthrography.. Radiographics. 2002;22:1223–1246.
  27. Bergin D, Schweitzer M. Indirect magnetic resonance arthrography.. Skelet. Radiol. 2003;32:551–558.
    doi: 10.1007/s00256-003-0669-2pubmed: 12942203google scholar: lookup
  28. 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
  29. Şahin G, Demirtaş M. An overview of MR arthrography with emphasis on the current technique and applicational hints and tips.. Clin. Imaging. 2007;31:73.
  30. 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.. Am. J. Roentgenol. 1994;163:621–623.
    doi: 10.2214/ajr.163.3.8079856pubmed: 8079856google scholar: lookup
  31. 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
  32. 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
  33. 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
  34. 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
  35. 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.
  36. 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
  37. 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
  38. 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
  39. Aßmann A, Ohlerth S, Hartmann S, Torgerson P, Bischofberger A. 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 2023;13:3772.
    doi: 10.3390/ani13243772pmc: PMC10740514pubmed: 38136809google scholar: lookup
  40. 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
  41. 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
  42. Martinelli M.J, Kuriashkin I.V, Carragher B.O, Clarkson R.B, Baker G.J. Magnetic resonance imaging of the equine metacarpophalangeal joint: Three-dimensional reconstruction and anatomic analysis.. Vet. Radiol. Ultrasound. 1997;38:193–199.
  43. Park R.D, Nelson T.R, Hoopes P.J. Magnetic resonance imaging of the normal equine digit and metacarpophalangeal joint.. Vet. Radiol. 1987;28:105–116.
  44. 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
  45. Tucker R.L, Sampson S.N. Magnetic resonance imaging protocols for the horse.. Clin. Tech. Equine Pract. 2007;6:2–15.
  46. Sherlock C, Mair T. Magic angle effect on low field magnetic resonance images in the superficial digital flexor tendon in the equine proximal pastern region.. Vet. J. 2016;217:126–131.
    doi: 10.1016/j.tvjl.2016.09.009pubmed: 27810203google scholar: lookup
  47. Bolen G, Audigié F, Spriet M, Vandenberghe F, Busoni V. Qualitative comparison of 0.27 T, 1.5 T, and 3T magnetic resonance images of the normal equine foot.. J. Equine Vet. Sci. 2010;30:9–20.
  48. McKnight A.L, Manduca A, Felmlee J.P, Rossman P.J, McGee K.P, Ehman R.L. Motion-correction techniques for standing equine MRI.. Vet. Radiol. Ultrasound. 2004;45:513–519.
  49. Labens R, Schramme M.C, Murray R.C, Bolas N. Standing low-field MRI of the equine proximal metacarpal/metatarsal region is considered useful for diagnosing primary bone pathology and makes a positive contribution to case management: A prospective survey study.. Vet. Radiol. Ultrasound. 2020;61:197–205.
    doi: 10.1111/vru.12824pubmed: 31800146google scholar: lookup
  50. 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
  51. 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
  52. 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. 2007;25:200–207.
    doi: 10.1002/jmri.20788pubmed: 17152058google scholar: lookup
  53. 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
  54. 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.
  55. 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.

Citations

This article has been cited 0 times.