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Diagnostic Imaging of the Head: Benefits and Limitations of Radiographs vs CT
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Diagnostic imaging of horse’s heads has proved challenging historically for equine clinicians as a consequence of the complex regional anatomy, the difficulty in obtaining a still patient when conscious, the vagaries of wet-film systems in the field and the lack of familiarity with the techniques. As a result, diagnostic sensitivity and specificity remained poor, not exceeding 50-6% sensitivity and specificity until the end of the last century1,2,3. The advent of digital radiographic systems greatly enhanced post-processing and led to increased sensitivity and specificity. Furthermore, improved radiological skills of clinicians and imagers have been acquired through undergraduate and post-graduate education, the better use of sedatives and more wide spread use of head supports.
The widespread access that the veterinarian or radiographer now has to digital and portable systems enables diagnostic quality radiographs to be obtained consistently in the field, and sensitivity and specificity for selected parameters increased significantly.
Imaging Modalities such as gamma scintigraphy offer little benefit for investigation of head pathology due to their limited sensitivity and radiation safety requirements. Ultrasonography can be very useful to detect changes to ocular structures and bony cortices, but is of limited use for imaging deeper tissue.
However, despite these advances the challenge remains of interpreting three-dimensional structures from a two-dimensional image. Therefore, the advent of three-dimensional imaging offers great advances. The first computed tomography machines were limited slice number, ex human machines, that necessitated horses to be anaesthetised in order to undertake the study. In the 1990’s the late Alistair Nelson conceived a movable plinth mounted on air cushions that could be used to deliver conscious sedated horses into the ring of a stationary CT scanner. This system remains in widespread use in Europe and is widely used for diagnostic imaging of the head. Alternative “in-theatre” human systems wherein the tube is on a moveable rail, and cone-beam CT systems are appearing in some equine hospitals. […]
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Affiliation of the authors at the time of publication
B&W Equine Clinic, Breadstone, Berkeley, Glos, UK.
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