Diagnostic Imaging Services

Computed Tomography (CT)
 
The Mid-Atlantic Equine Medical Center is pleased to announce the arrival of computed tomography (CT, or "cat scan") to our advanced diagnostic imaging arsenal. Mid-Atlantic is proud to be on the forefront of this technology, having acquired the most updated version of the EQUIMAGINE robotics-controlled imaging system. In doing so, Mid-Atlantic becomes the first privately owned equine hospital in the world to be offering this service to its clientele. The system will allow for detailed imaging of the skull, neck and distal limbs without the need to anesthetize the horse. In addition to CT, the system is also capable of performing other modalities such as fluoroscopy, tomosynthesis, and digital radiography.
 
CT technology utilizes very small x-ray beams from many different angles around the region of interest (called a slice) that are transmitted to a computer program, which then produces a compilation image of the highest quality. Images can be manipulated to render 3-dimensional reconstructions from 2-dimensional slices, producing not only exceptional images, but opening up whole new areas of diagnosis and treatment. The CT unit in use at the Mid-Atlantic Equine Medical Center is able to accommodate very large body parts relative to the majority of CT units available for medical or veterinary use.
 
Implementation of this technology will allow the doctors at Mid-Atlantic the unique opportunity to image anatomical regions in the standing horse such as the entire cervical region (neck). Such studies have previously been limited to radiographic interpretation. Few hospitals in the world currently have the ability to perform equine CT myelography, and Mid-Atlantic is proud to join this elite group.
 
With the more recent focus on equine safety and injury prevention, owners, riders and trainers want to know if they can safely compete the horses under their care. The imaging team at Mid-Atlantic has spent the past 2 months working on perfecting the image acquisition and quality, with the results being exceptional images obtained in a matter of minutes.
 
In spite of its diagnostic utility, CT imaging has not yet gained mainstream acceptance in equine racing and sporting arenas primarily due to the need for general anesthesia. This system eliminates the risk, time and cost of anesthesia. Images of exquisite detail can be acquired with the horse under light sedation, and more importantly in a weight bearing position, allowing us to diagnose injuries not visible on plain radiographs. In addition to its diagnostic capabilities, CT is tremendously useful in guiding complex fracture repair. More accurate reconstruction, especially at the articular surface, translates to higher success rates and better outcomes for horses.
 
To see more videos of our new robotic CT in action, visit our YouTube channel.
 
MRI
MRI is the gold standard imaging modality for orthopedic conditions in horses. Injuries involving soft tissue, bone and cartilage can be detected with MRI when inconclusive information is gathered with traditional imaging methods, such as radiography and ultrasonography.
 
MRI evaluations are typically performed after the lameness has been localized to a specific area but nuclear scintigraphy, radiographs, and ultrasonography do not adequately depict the cause of lameness.
 
The Mid-Atlantic Equine Medical Center uses the Ellegro magnetic resonance imaging (MRI) unit to determine the cause of lameness in areas ranging from the foot through the carpus and the hock. MRI has greatly improved the diagnosis and treatment of equine foot pain in the last decade. The use of general anesthesia to acquire these images allows for superior image quality versus the low field standing units and hence a more accurate diagnosis of conditions being evaluated. It also allows for imaging of regions such as the hock that cannot be performed with a standing MRI. Due to the magnetic field, shoes must be pulled and feet radiographed to ensure no small pieces of nail are left that can distort the image quality. A physical examination and blood work will be performed prior to the anesthesia.
 
During your horse's MRI, the area of interest is evaluated in three different planes from front to back, top to bottom, and side to side to obtain a thorough evaluation. Using the tissue's response to radiofrequency pulses in the magnetic field, this technique can detect bony and soft tissue lesions such as fractures, bone cysts, erosions, edema, hemorrhage, bony avulsions, ligament and tendon inflammation or core lesions and adhesions.

 

Your horse’s veterinarian is the best person to coordinate the referral of your horse for an MRI, as a thorough history will be needed prior to admission. It is important to make sure that the surgeon in charge has complete details of the history of your horse’s condition (degree/duration of lameness, response to nerve/joint blocks, previous radiographic/ultrasonographic exam findings, and previous treatment/response) prior to the MRI. Horses may be dropped off the night before or early the day of the MRI, and must be held off feed for 8 hours prior to the procedure. After the MRI, they are monitored overnight and allowed to go home the next day. The exam typically requires 90 minutes to complete. Once completed, preliminary results from a boarded radiologist are typically available that afternoon with a final report within 24-48 hours. We work closely with your veterinarian to provide optimal care and communication throughout the process.

 

Digital Radiology

 

The Mid-Atlantic Equine Medical Center is proud to announce the acquisition of the most upgraded version of the Optomed dynamic endoscope. Use of this technology will allow us to more accurately diagnose disorders of the upper respiratory tract of the horse. In contrast to standard endoscopy, this system is used while the horse is being ridden or driven, giving us a direct look (live telemetric feed and video recording) at airway function when disease is most likely to manifest itself clinically. It is an invaluable tool in planning upper respiratory laser and surgical procedures. Conditions such as dynamic collapse of arytenoids, collapse of the aryepiglottic (AE) folds, pharyngeal collapse, and vocal cord collapse can only be observed during a dynamic respiratory endoscopic study. Dynamic respiratory endoscopy is also indicated for use in horses with exercise intolerance and poor performance.
 
These studies can be performed at the clinic or on the farm, on sport and pleasure horses where they can be ridden and/or longed. They may also be performed on horses at the racetrack or training center, where the patient can be ridden or driven, and the airway assessed under realistic training conditions.
 
The dynamic endoscopy study may be used as a stand alone diagnostic, or can be part of a poor performance (cardiopulmonary) evaluation package which may include lower respiratory tract examination (endoscopy and bronchoalveolar lavage) or full cardiac examination (echocardiogram and ECG at rest and during exercise to evaluate heart rhythm under performance conditions).
 

 

We are excited to add this service to our diagnostic arsenal and look forward to collaborating with you and any horses that may benefit from the use of this technology. Please call the clinic for estimates and to schedule an appointment. Studies will be performed by Dr. Mary Durando (internal medicine specialist), Dr. Janik Gasiorowski (staff surgeon) or Dr. Rodney Belgrave (staff internal medicine specialist).
 
Video Endoscopy
 
Endoscopy is a minimally invasive diagnostic procedure commonly used to evaluate the interior of certain organs in your horse's body.
 
The use of video endoscopy has enhanced our diagnostic capabilities for various body systems, including the respiratory tract, the gastrointestinal tract, and the urinary and reproductive tracts. Video endoscopy not only makes small structures more visible, it also allows for real time observation of the examination findings as we diagnose a problem in your horse.

 

At the Mid-Atlantic Equine Medical Center we routinely perform endoscopic examinations of the upper and lower respiratory tracts. Upper respiratory tract endoscopy allows for evaluation of the nasal passages, sinuses, ethmoid turbinate region, guttural pouches, and functional evaluation of the pharynx and larynx. Laser therapy of tissues of the upper respiratory tract is also facilitated by use of the video endoscope. Endoscopy of the lower respiratory tract is used to assess mucus accumulation and hyper responsiveness of the lower airways in disease processes such as inflammatory and allergic airway disease and pneumonia (bacterial, viral and fungal).
 
Gastroscopic examinations are performed to assess for the presence of Equine Gastric Ulcer Syndrome, delayed emptying of the stomach and obstructions of the proximal small intestine. Gastroscopic examinations are routinely performed in horses with performance or behavioral changes, decreased appetite or chronic intermittent abdominal discomfort.
 
Determining an accurate diagnosis from your horse's symptoms begins with compiling as complete and accurate a picture of what is going on inside his or her body as possible. For that reason, endoscopy is recommended when routine blood and urine tests and radiographs are unable to tell us everything we need to know. Although sedation may be required to keep your horse still during the endoscopic procedure, the recovery time is minimal.
 
Ultrasound
 
Ultrasound is a painless, safe, non-invasive procedure we use to evaluate your horse's internal organs. Using high-frequency sound waves, ultrasound produces a real-time moving picture of your horse's organs that allows us to visualize objects that cannot be detected by X-rays alone.
 
Ultrasound is frequently used for musculoskeletal and soft tissue evaluations, during advanced lameness work-ups, breeding management, early pregnancy diagnosis, cardiac imaging and evaluating the cause of colic. It can also be used to identify masses or tumors and as a guide during surgical biopsies.
 
The ultrasound procedure does not typically require sedation unless it is being used during a surgical biopsy. A diagnosis is usually available immediately - helping us to provide treatment options and solutions to your horse's problem at the time of your appointment.

 

Color Flow Doppler Ultrasonography
 
Color Flow Doppler Ultrasonography allows us to assess the flow and integrity of your horse's blood vessels and assess the speed and direction of blood flow. Our experienced, board-certified professionals use this advanced diagnostic tool to evaluate heart abnormalities, detect blood clots or narrowed blood vessels, and check the health of a fetus.
 
Nuclear Scintigraphy
 
Nuclear scintigraphy is a highly sensitive, alternative imaging technique that has been used for many years in both human and veterinary medicine. In 1998 the Mid Atlantic Equine Medical Center was one of the first private equine practices in the country to begin offering nuclear scintigraphy to horses. Nuclear medicine can detect changes in your horse's bones and soft tissues before those structural changes can be seen on a radiograph, thereby making an earlier diagnosis of disease possible.
 
During nuclear scintigraphy, the horse is injected with a radioactive substance (radioisotope). The patient begins emitting radiation in the form of gamma rays (γ-rays), which escape from the body and permit external detection and measurement. Gamma rays are electromagnetic radiation similar to x-rays.
 
A special camera, called a gamma (or scintillation) camera, is used to detect the distribution of the radioactivity within the patient's body. Hence, unlike radiology where the equipment is the radiation source, the gamma camera is only a radiation detector and the patient is the radiation source.
 
Bone scintigraphy is the most commonly performed nuclear medicine scan in horses and is indicated in a variety of skeletal disorders because of its high sensitivity and the ease at which the entire skeleton can be imaged. However, it is still recommended that scintigraphy be combined with conventional radiographs or other imaging modality such as CT or MRI to determine the cause of the bony lesion.
 
All patients that undergo a nuclear medicine procedure must be kept isolated from the general public while they are emitting radioactivity. This is a designated area that can contain and/or facilitate disposal of contaminated material. Clients are not allowed to visit during the period of confinement.
 
At Mid Atlantic Equine Medical Center, patients can be released to the owners when the radiation they emit is at a low level, which takes approximately 24 hours. During the isolation time, radiation safety measures such as gloves, lab coats, boots, and radiation badges are followed by personnel working with the patients.
 
Advantages Over Radiology:
 
  • High sensitivity for detecting early disease
  • Ease of surveying the entire skeleton
  • A negative scan virtually rules out active bone pathology and many forms of joint disease (except osteochondrosis)
  • Ability to follow-up lesions for resolution

 

Disadvantages of Scintigraphy:

 
  • Patient will be radioactive and must be isolated from the general public for 24-36 hours
 
Indications for Bone Scintigraphy:
 
  • Diagnosis of occult or intermittent lameness
  • Bone survey for multiple limb lameness
  • Early detection of skeletal injury - occult fracture
  • Determining extent and severity of skeletal lesion - activity of radiographic lesions
  • Localization of pain but inability to identify cause using radiology and ultrasonography
  • Poor performance of ill-defined cause
  • Suspected thoracolumbar or pelvic region pain
  • Evaluation of healing response
  • Evaluation of blood flow to bone
  • Diagnosis of aortoiliac thrombosis

 

Myelogram
 
A myelogram is a contrast-enhanced radiographical study of the cervical spinal cord. It is utilized in cases of suspected cervical vertebral malformation or wobblers to determine the site of your horse's spinal cord compression. Even if a diagnosis is made upon standing neck x-rays, a myelogram is still required to confirm the degree of compression and whether any other sites of compression are present prior to performing surgery.
 
The myelogram is performed under injectable or intravenous anesthesia and a contrast agent is injected into the spinal canal. The contrast outlines the spinal cord, and shows up as a bright white line surrounding the spinal. A diagnosis of compression is made by the presence of at least 50% compression of the width of the contrast dye column compared to the width of the column in a neutral position.