Vet Comp Orthop Traumatol 2020; 33(05): 356-362
DOI: 10.1055/s-0040-1714299
Original Research

Computed Tomography Enhances Diagnostic Accuracy in Challenging Medial Coronoid Disease Cases: An Imaging Study in Dog Breeding Appeal Cases

Jan Wennemuth
1   Department of Radiology, Justus-Liebig-Universität Gießen, Giessen, Germany
,
Bernd Tellhelm
1   Department of Radiology, Justus-Liebig-Universität Gießen, Giessen, Germany
,
Nele Eley
1   Department of Radiology, Justus-Liebig-Universität Gießen, Giessen, Germany
,
Kerstin von Pückler
1   Department of Radiology, Justus-Liebig-Universität Gießen, Giessen, Germany
› Author Affiliations
Funding This project was funded by the Justus-Liebig-Universität Gießen.

Abstract

Objectives The aim of this study was to determine the radiographic sensitivity in detecting medial coronoid disease (MCD), using computed tomography (CT) as reference in dogs presented for an official second opinion, and to compare the medial coronoid process (MCP) in fragmented and fissured MCP as well as those unaffected by MCD.

Materials and Methods The data of dogs, presented for official second opinion radiographs and CT, were reviewed by three board-certified observers and in accordance with the International Elbow Working Group guidelines regarding MCD. Radiographic delineation, radiopacity and Hounsfield Units (HU) of the MCP were recorded additionally and the correlation between radiography and CT was investigated.

Results Sensitivity and specificity of radiography compared with CT yielded values of 83.6% for the former and 83.5% for the latter. False-negative grading in radiography correlated significantly (p = 0.0001) with a present fissure line in CT. The mean delineation (p = 0.03) and mean HU of fragmented MCP (p = 0.0045) were significantly reduced compared with fissured MCP and no significant differences in measured HU for fissured MCP were detected in comparison to elbows unaffected by MCD.

Conclusion The results of the present study show substantial agreement between radiography and CT in second opinion cases. However, sensitivity is reduced compared with not preselected cases. A present fissure line in CT was significantly associated with a false-negative grading in radiography. Therefore, CT imaging of the elbows is strongly recommended in cases of appeal.

Authors' Contributions

All authors contributed to the study concept, design, data acquisition, analysis and interpretation. All authors drafted, revised and approved the submitted manuscript.




Publication History

Received: 08 September 2019

Accepted: 31 May 2020

Article published online:
26 July 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 
  • References

  • 1 Kirberger RM, Fourie SL. Elbow dysplasia in the dog: pathophysiology, diagnosis and control. J S Afr Vet Assoc 1998; 69 (02) 43-54
  • 2 Morgan JP, Wind A, Davidson AP. Bone dysplasias in the Labrador retriever: a radiographic study. J Am Anim Hosp Assoc 1999; 35 (04) 332-340
  • 3 Grøndalen J, Grøndalen T. Arthrosis in the elbow joint of young rapidly growing dogs. V. A pathoanatomical investigation. Nord Vet Med 1981; 33 (01) 1-16
  • 4 Danielson KC, Fitzpatrick N, Muir P, Manley PA. Histomorphometry of fragmented medial coronoid process in dogs: a comparison of affected and normal coronoid processes. Vet Surg 2006; 35 (06) 501-509
  • 5 Lau SF, Wolschrijn CF, Hazewinkel HA, Siebelt M, Voorhout G. The early development of medial coronoid disease in growing Labrador retrievers: radiographic, computed tomographic, necropsy and micro-computed tomographic findings. Vet J 2013; 197 (03) 724-730
  • 6 Temwichitr J, Leegwater PA, Hazewinkel HA. Fragmented coronoid process in the dog: a heritable disease. Vet J 2010; 185 (02) 123-129
  • 7 Lau SF, Hazewinkel HA, Grinwis GC. , et al. Delayed endochondral ossification in early medial coronoid disease (MCD): a morphological and immunohistochemical evaluation in growing Labrador retrievers. Vet J 2013; 197 (03) 731-738
  • 8 Cook CR, Cook JL. Diagnostic imaging of canine elbow dysplasia: a review. Vet Surg 2009; 38 (02) 144-153
  • 9 Hornof WJ, Wind AP, Wallack ST, Schulz KS. Canine elbow dysplasia. The early radiographic detection of fragmentation of the coronoid process. Vet Clin North Am Small Anim Pract 2000; 30 (02) 257-266 , v
  • 10 Villamonte-Chevalier A, van Bree H, Broeckx B. , et al. Assessment of medial coronoid disease in 180 canine lame elbow joints: a sensitivity and specificity comparison of radiographic, computed tomographic and arthroscopic findings. BMC Vet Res 2015; 11 (01) 243
  • 11 Villamonte-Chevalier A, Dingemanse W, Broeckx BJ. , et al. Bone density of elbow joints in Labrador retrievers and Golden retrievers: comparison of healthy joints and joints with medial coronoid disease. Vet J 2016; 216: 1-7
  • 12 Klumpp S, Karpenstein H, Tellhelm B. Die computertomographische Morphologie und Anatomie des Ellbogengelenkes mit Schwerpunkt des Processus coronoideus medialis ulnae bei mit ED = 0 beurteilten Hunden spezieller Rassen. Kleintierpraxis 2013; 2: 57-64
  • 13 Ondreka N. Explanation of grading according to IEWG and discussion of cases. Proceedings 29th annual meeting IEWG. Bangkok Thailand, May 17, 2015:38–39
  • 14 Fitzpatrick N, Smith TJ, Evans RB, Yeadon R. Radiographic and arthroscopic findings in the elbow joints of 263 dogs with medial coronoid disease. Vet Surg 2009; 38 (02) 213-223
  • 15 Haudiquet PR, Marcellin-Little DJ, Stebbins ME. Use of the distomedial-proximolateral oblique radiographic view of the elbow joint for examination of the medial coronoid process in dogs. Am J Vet Res 2002; 63 (07) 1000-1005
  • 16 Rau FC, Wigger A, Tellhelm B. , et al. Observer variability and sensitivity of radiographic diagnosis of canine medial coronoid disease. Tierarztl Prax Ausg K Klientiere Heimtiere 2011; 39 (05) 313-322
  • 17 Carpenter LG, Schwarz PD, Lowry JE, Park RD, Steyn PF. Comparison of radiologic imaging techniques for diagnosis of fragmented medial coronoid process of the cubital joint in dogs. J Am Vet Med Assoc 1993; 203 (01) 78-83
  • 18 Lau SF, Theyse LF, Voorhout G, Hazewinkel HA. Radiographic, computed tomographic, and arthroscopic findings in Labrador retrievers with medial coronoid disease. Vet Surg 2015; 44 (04) 511-520
  • 19 Wosar MA, Lewis DD, Neuwirth L. , et al. Radiographic evaluation of elbow joints before and after surgery in dogs with possible fragmented medial coronoid process. J Am Vet Med Assoc 1999; 214 (01) 52-58
  • 20 Lappalainen AK, Mölsä S, Liman A, Snellman M, Laitinen-Vapaavuori O. Evaluation of accuracy of the Finnish elbow dysplasia screening protocol in Labrador retrievers. J Small Anim Pract 2013; 54 (04) 195-200
  • 21 Janutta V, Hamann H, Klein S, Tellhelm B, Distl O. Genetic analysis of three different classification protocols for the evaluation of elbow dysplasia in German shepherd dogs. J Small Anim Pract 2006; 47 (02) 75-82
  • 22 Schaffler MB, Radin EL, Burr DB. Mechanical and morphological effects of strain rate on fatigue of compact bone. Bone 1989; 10 (03) 207-214
  • 23 Danova NA, Colopy SA, Radtke CL. , et al. Degradation of bone structural properties by accumulation and coalescence of microcracks. Bone 2003; 33 (02) 197-205
  • 24 Tami AE, Nasser P, Schaffler MB, Knothe Tate ML. Noninvasive fatigue fracture model of the rat ulna. J Orthop Res 2003; 21 (06) 1018-1024
  • 25 Bentolila V, Boyce TM, Fyhrie DP, Drumb R, Skerry TM, Schaffler MB. Intracortical remodeling in adult rat long bones after fatigue loading. Bone 1998; 23 (03) 275-281
  • 26 Burr DB. Targeted and nontargeted remodeling. Bone 2002; 30 (01) 2-4
  • 27 Colopy SA, Benz-Dean J, Barrett JG. , et al. Response of the osteocyte syncytium adjacent to and distant from linear microcracks during adaptation to cyclic fatigue loading. Bone 2004; 35 (04) 881-891
  • 28 Cardoso L, Herman BC, Verborgt O, Laudier D, Majeska RJ, Schaffler MB. Osteocyte apoptosis controls activation of intracortical resorption in response to bone fatigue. J Bone Miner Res 2009; 24 (04) 597-605
  • 29 Verborgt O, Gibson GJ, Schaffler MB. Loss of osteocyte integrity in association with microdamage and bone remodeling after fatigue in vivo. J Bone Miner Res 2000; 15 (01) 60-67
  • 30 Mariee IC, Gröne A, Theyse LF. The role of osteonecrosis in canine coronoid dysplasia: arthroscopic and histopathological findings. Vet J 2014; 200 (03) 382-386
  • 31 Moores AP, Benigni L, Lamb CR. Computed tomography versus arthroscopy for detection of canine elbow dysplasia lesions. Vet Surg 2008; 37 (04) 390-398
  • 32 Oakley SP, Portek I, Szomor Z. , et al. Arthroscopy -- a potential “gold standard” for the diagnosis of the chondropathy of early osteoarthritis. Osteoarthritis Cartilage 2005; 13 (05) 368-378