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Veterinary surgery : VS2026; doi: 10.1111/vsu.70110

Standing computed tomographic tenography is reliable in identifying soft tissue lesions within the digital flexor tendon sheath in horses.

Abstract: To determine the diagnostic performance of standing computed tomographic tenography (CTT) in detecting naturally occurring intrathecal lesions of the superficial digital flexor tendon (SDFT), deep digital flexor tendon (DDFT), manica flexoria (MF), and in identifying palmar/plantar annular ligament (PAL) desmitis and constriction in horses undergoing tenoscopy. Methods: Retrospective observational study. Methods: Client-owned horses of various breeds and use, median age of 12.5 years (range: 6-20 years). Methods: A total of 24 horses with inconclusive ultrasonographic and contrast tenographic examinations were included. All underwent DFTS anesthesia, CTT, and tenoscopy. CTT images were retrospectively evaluated by one ECVDI radiologist and a third-year ECVDI resident, both blinded to tenoscopy findings, reaching a consensus. For each structure within the DFTS (SDFT; DDFT; MF and PAL), lesions were recorded as present or absent. Diagnostic performance of CTT for lesion detection was calculated using tenoscopy as the reference. Results: CTT demonstrated high overall diagnostic performance, with a sensitivity and specificity of 93% for detecting intrathecal lesions. Identification was improved for lesions of the DDFT (sensitivity: 100%; 12/12; 95% confidence interval [CI]: 51%-97%; specificity 83%; 95% CI: 51%-97%) and MF (sensitivity: 90%; 9/10; 95% CI: 66%-99%; specificity: 93%; 95% CI: 66-99%), compared to the SDFT (sensitivity: 71%; 5/7; 95% CI: 29%-99%; specificity: 94%; 95% CI: 71%-99%) and PAL (sensitivity: 64%; 14/22; 95% CI: 15%-100%; specificity: 100%; 95% CI: 15%-100%). Conclusions: CTT demonstrated a high diagnostic performance in detecting intrathecal lesions, particularly those involving the DDFT and MF. Conclusions: CTT is a valuable advanced imaging modality for evaluating DFTS pathology, particularly when standard imaging techniques do not provide definitive diagnosis.
© 2026 American College of Veterinary Surgeons.
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Publication Date: 2026-04-17 PubMed ID: 41999073DOI: 10.1111/vsu.70110Google Scholar: Lookup
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  • 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.

Overview

  • This research evaluated the effectiveness of standing computed tomographic tenography (CTT) in diagnosing soft tissue lesions within the digital flexor tendon sheath of horses.
  • The study compared CTT results to tenoscopy findings to determine CTT’s diagnostic accuracy for tendon sheath abnormalities.

Background and Purpose

  • Equine digital flexor tendon sheath (DFTS) lesions can be challenging to diagnose using standard imaging like ultrasound or contrast tenography, especially when results are inconclusive.
  • The digital flexor tendon sheath comprises several key structures, including:
    • Superficial digital flexor tendon (SDFT)
    • Deep digital flexor tendon (DDFT)
    • Manica flexoria (MF) – a tendinous sleeve junction
    • Palmar/plantar annular ligament (PAL) – providing ligamentous support
  • Tenoscopy—a type of arthroscopy—is an invasive reference standard for detecting intrathecal tendon sheath lesions.
  • The study’s main goal was to assess standing CTT’s diagnostic performance (sensitivity and specificity) in detecting lesions of these structures compared to tenoscopy in horses.

Methods

  • This was a retrospective observational study including 24 client-owned horses of various breeds and uses, aged 6 to 20 years (median 12.5 years).
  • All horses had inconclusive ultrasonographic and contrast tenographic exams prior to inclusion.
  • Procedures conducted on each horse included:
    • Digital flexor tendon sheath anesthesia
    • Standing computed tomographic tenography (CTT)
    • Subsequent tenoscopy for definitive diagnosis
  • CTT images were independently reviewed by two blinded veterinary radiologists (one board-certified, one resident) who reached consensus on lesion presence or absence per structure.
  • Lesions detected included soft tissue abnormalities within SDFT, DDFT, MF, and evidence of annular ligament desmitis or constriction.
  • Diagnostic sensitivity (true positive rate) and specificity (true negative rate) of CTT were calculated using tenoscopy findings as the gold standard.

Results

  • Overall, CTT showed high diagnostic accuracy for detecting intrathecal lesions within the DFTS:
    • Sensitivity: 93% (ability to correctly identify horses with lesions)
    • Specificity: 93% (ability to correctly identify horses without lesions)
  • Performance varied by specific structure examined:
    • Deep digital flexor tendon (DDFT):
      • Sensitivity: 100% (12 out of 12 lesions correctly identified)
      • Specificity: 83%
    • Manica flexoria (MF):
      • Sensitivity: 90%
      • Specificity: 93%
    • Superficial digital flexor tendon (SDFT):
      • Sensitivity: 71%
      • Specificity: 94%
    • Palmar/plantar annular ligament (PAL):
      • Sensitivity: 64%
      • Specificity: 100%
  • These results indicate outstanding detection ability for DDFT and MF lesions, whereas sensitivity for SDFT and PAL lesions was moderately lower.

Conclusions and Clinical Implications

  • Standing computed tomographic tenography is a reliable, non-invasive diagnostic tool with high accuracy in identifying soft tissue lesions within the equine digital flexor tendon sheath.
  • It is especially valuable for diagnosing lesions of the DDFT and MF, which are critical structures for tendon function.
  • CTT is advantageous when ultrasonography and conventional contrast tenography provide inconclusive results, enhancing diagnostic confidence.
  • Use of CTT can aid veterinarians in selecting appropriate treatment plans and may improve clinical outcomes by enabling earlier and more accurate diagnosis of tendon sheath pathologies.

Cite This Article

APA
Aßmann AD, Suàrez Sànchez-Andrade J, Bischofberger AS. (2026). Standing computed tomographic tenography is reliable in identifying soft tissue lesions within the digital flexor tendon sheath in horses. Vet Surg. https://doi.org/10.1111/vsu.70110

Publication

Veterinary surgery : VS
ISSN: 1532-950X
NlmUniqueID: 8113214
Country: United States
Language: English

Researcher Affiliations

Aßmann, Anton D
  • Equine Hospital, Vetsuisse-Faculty, University of Zürich, Zürich, Switzerland.
Suàrez Sànchez-Andrade, José
  • Clinic of Diagnostic Imaging, Vetsuisse-Faculty, University of Zürich, Zürich, Switzerland.
Bischofberger, Andrea S
  • Clinic of Diagnostic Imaging, Vetsuisse-Faculty, University of Zürich, Zürich, Switzerland.

Grant Funding

  • Loriot Research Fund

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