Scintigraphic evaluation of the proximal metacarpal and metatarsal regions in clinically sound horses.

Abstract: In recent years, pain arising from the proximal metacarpal and metatarsal regions has become well recognized as a cause of lameness and various disease entities have been identified. However, our knowledge of normal patterns of radiopharmaceutical uptake is limited, making interpretation of images problematic. It is therefore important to characterize normal patterns of radiopharmaceutical uptake at specific sites to ensure valid interpretation of images in clinical cases with subtle lesions. The purpose of this study was to describe the pattern of radiopharmaceutical uptake in the proximal metacarpal and proximal metatarsal regions in clinically sound horses. Scintigraphic images from 64 clinically normal horses were evaluated. All the images were assessed subjectively. The lateral, dorsal, and plantar scintigraphic images were assessed qualitatively using horizontal line profiles through the proximal metacarpal and proximal metatarsal regions. Mean ratios of radiopharmaceutical uptake were calculated from three regions of interest sited over the proximal metacarpal and proximal metatarsal regions and a reference site. In 78% of forelimbs the peak of radiopharmaceutical activity was at the dorsal to central portion of the proximal metacarpal region. Seventy-five per cent of the dorsal plane profiles of activity were symmetrical, with the highest peak over the medial to central portion of the proximal metacarpal region. In 80% of hindlimb lateral images the peak radiopharmaceutical activity was at the central to plantar aspect of the proximal metatarsal region. All (100%) plantar image profiles of activity were symmetrical, with the highest peak being over the lateral portion of the proximal metatarsal region. There was no significant left and right variation between sites for mean ratios on the lateral and dorsal images of the proximal metacarpal region. However, using lateral images the mean ratios from all regions of the right proximal metatarsal were greater than left (dorsal P = 0.003, plantar P < 0.0001 and whole proximal metatarsal, P = 0.0006). There was no significant variation in mean ratios between left and right on plantar images. However, the mean ratio for the lateral proximal metatarsal region was significantly greater than for the medial proximal metatarsal regions (P < 0.0001). There was no significant effect of age. Left/right symmetry of radiopharmaceutical uptake was shown in the proximal metacarpal region. However, there was a significant difference between left and right proximal metatarsal regions. There was higher radiopharmaceutical uptake in the right proximal metatarsal region than the left, which agrees with previous studies of the tarsal and metatarsophalangeal joints. There were differences in the pattern of radiopharmaceutical uptake between the forelimbs and hindlimbs. In the forelimbs maximum radiopharmaceutical uptake was located at the dorsal to central portion of the proximal metacarpal region in the lateral image, with peak activity over the medial to central portion of the proximal metacarpal region on dorsal images. In the hindlimbs the maximum radiopharmaceutical uptake was at the central to plantar aspect of the proximal metatarsal region in the lateral image, with peak activity over the lateral portion of proximal metatarsal region on plantar images. The results of this study support the hypothesis that there would be a standard pattern of radiopharmaceutical uptake across the proximal metacarpal and l metatarsal regions, but the pattern of uptake observed would be different in the proximal metacarpal region compared with the proximal metatarsal region. There was left/right symmetry of radiopharmaceutical uptake in the proximal metacarpal region. However, there was a significant difference between left and right proximal metatarsal regions, with higher radiopharmaceutical uptake in the right. There was no variation of radiopharmaceutical uptake pattern with age.