Cornell Ruffian Diagnostic Imaging
CRES offers a wide variety of state of the art imaging modalities all under one roof. The specialists at CRES routinely utilize cutting edge imaging to help reach a diagnosis, create optimal treatment plans, guide surgical planning and treatment, monitor healing of injuries, determine condition progression over time and response to therapy. For some cases, multiple imaging modalities are required to best diagnose the problem, all of which can be performed on site.
Imaging modalities available at CRES:
Digital radiography (including high powered gantry mounted unit for spine, abdomen, thorax)
CRES has multiple digital radiograph machines that are used routinely to further investigate the skeleton for causes of lameness, poor performance, neurologic disease and others. Radiographs are an integral part of most lameness work ups and prepurchase exams, providing fine skeletal detail. Digital radiographs are most commonly used to evaluate bone but are integral for some soft tissue conditions as well. They are routinely used to help further characterize pneumonia and to further investigate some causes of colic. CRES has a high powered gantry mounted unit that provides superior imaging of the spine, abdomen and thorax, locations that are difficult to get quality images of in the field.
At CRES, we have multiple high performance ultrasound machines capable of imaging various areas of the horse. Ultrasound gives high soft tissue detail and superficial detail of many bones and joints depending on location. Our clinicians have expertise in high detail musculoskeletal imaging, abdominal ultrasound, thoracic ultrasound, echocardiography (heart), and a variety of other locations such as the larynx, sacroiliac joint and pelvis. Ultrasound is used routinely at CRES to help diagnose conditions like colic, pneumonia, heart disease, tendon/ligament injury and many more. Rectal ultrasound is used to further investigate intra-abdominal conditions (including reproductive disorders), pelvic fractures, sacroiliac joint discomfort and others. Ultrasound is used routinely to guide sample collection such as cerebrospinal fluid as well as to accurately deliver local regenerative therapies (platelet rich plasma or stem cells) into tendon/ligament injuries. It is used to deliver medication into difficult to access joints such as the facet joints of the neck, the sacroiliac joints of the pelvis and the hip joints. Our imaging system is linked to electronic medical records and each study is available as a digital file making review on subsequent examinations easy to compare.
Nuclear scintigraphy (bone scan)
Nuclear scintigraphy or bone scan is a diagnostic tool that allows us to scan larger areas of the equine skeleton in search of potential causes of lameness. It uses a safe radiopharmaceutical agent (Technetium 99m), that is injected into the horses’ blood stream. After injection, it will distribute to areas of the skeleton. Areas of bone inflammation, bone turnover or rapid bone growth attract a greater amount of the radiopharmaceutical. With standing sedation, the horse is then imaged using a special camera that is able to detect emitting radiation to produce an image of the bone. Areas of increased radiopharmaceutical uptake (IRU) also called a ‘hot spot’ are investigated as potential sites of injury. Bone scan is a useful tool in the workup of a challenging lameness case where either flexion tests or diagnostic nerve blocks have failed to localize the cause, when there are several areas or limbs contributing to the lameness, or if specific bone information is needed after a lameness is localized. Horses are considered radioactive for approximately 24 hours and must remain in hospital until their radiation level is below a safe threshold. In most cases, horses arrive in the morning, are injected and scanned on day 1, stay overnight, and either go home the following day or remain in hospital for further diagnostics. Bone scan findings always need to be clinically correlated with a lameness exam, sometimes with additional nerve/joint blocks, and frequently with other imaging modalities (radiographs, ultrasound, or MRI) to provide more detail of the abnormal areas.
Standing MRI (MRI)
At CRES, we have a standing, low field MRI unit from Hallmarq that generates superior imaging of both soft tissue and bone. It is a routine procedure here and is performed standing with sedation. MRI (magnetic resonance imaging) involves putting the body part of interest in a magnetic field while using radio waves to help generate images of the region. Various sequences are obtained which highlight specific tissue characteristics (example STIR sequence highlights fluid both in bone and soft tissue). It is imperative to have a detailed lameness exam (most often with joint and nerve blocks) prior to an MRI. An MRI is most beneficial when the location of the lameness has been localized as much as possible. A typical MRI scan is 1-3 sites, but is dependent on the lameness examination. MRI cases typically spend one night in the hospital to ensure the highest quality images are obtained. A single site MRI scan (example 1 front foot) can generate 300-500 images that need to be interpreted. All MRI examinations are read by one of the lameness specialists at CRES (Dr. Pigott or Dr. Claffey) and a board certified radiologist (Dr. Natasha Werpy) to provide the most amount of information for each case. The lameness specialists at CRES work with the client and the local veterinarian to come up with treatment and rehabilitation protocols that optimize healing and return to function.
MRI images left to right: coffin joint collateral ligament injury, deep digital flexor tendon injury in foot, navicular bone flexor cortex erosion with adjacent deep digital flexor tendon damage, bone trauma in fetlock joint
Fluoroscopy is a technique that uses x-rays to generate real time moving images inside the body. At CRES, fluoroscopy is used routinely intraoperatively during fracture repair, joint fusion (arthrodesis or ankylosis) and certain orthopedic conditions to allow for the most anatomic repair possible. It is used to help guide screw or plate placement based on the exact fracture configuration or condition. It speeds up the procedure by providing intraoperative imaging in the surgeon’s hand, all under one sterile field.
Intraoperative images during condylar fracture repair