DOI
https://doi.org/10.18849/ve.v6i4.384Abstract
PICO question
In dogs with an acute thoracolumbar myelopathy, is non-contrast computed tomography (CT) a reliable method for the diagnosis of intervertebral disc extrusion, compared to magnetic resonance imaging (MRI)?
Clinical bottom line
Category of research question
Diagnosis
The number and type of study designs reviewed
Four papers were critically reviewed. Two were retrospective, cross-sectional studies, and two were prospective, observational cohort studies
Strength of evidence
Moderate
Outcomes reported
The current literature suggests that CT is often sufficient for the diagnosis of thoracolumbar intervertebral disc extrusion, with MRI superior to CT for lesion characterisation. Non-contrast CT is likely sufficient for the diagnosis and surgical planning for intervertebral disc disease in Dachshunds. However, MRI is recommended for diagnosis and surgical planning of thoracolumbar intervertebral disc disease in non-Dachshund breeds
Conclusion
Computed tomography is often sufficient for the diagnosis of thoracolumbar intervertebral disc extrusion. However, MRI is superior to CT for lesion characterisation and it is therefore recommended to use MRI for cases requiring surgical planning. Computed tomography is likely sufficient for the diagnosis and surgical planning of intervertebral disc disease in Dachshunds
Regard for the reason of diagnostics performed (e.g. surgical planning) and the likelihood of other differential diagnoses (e.g. spinal neoplasms) should be taken before deciding to use one imaging modality over the other. Consideration into the risks associated with anaesthetising an animal with a spinal cord lesion, the ability of the practitioner to accurately localise the myelopathy and interpret the results, should be taken before pursuing diagnostics in these cases
How to apply this evidence in practice
The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
References
Cooper, J.J., Young, B.D., Griffin IV, J.F., Fosgate, G.T. & Levine, J.M. (2014). Comparison between noncontrast computed tomography and magnetic resonance imaging for detection and characterization of thoracolumbar myelopathy caused by intervertebral disk herniation in dogs. Veterinary Radiology & Ultrasound. 55(2), 182–189. DOI: http://dx.doi.org/ 10.1111/vru.12114
Emery, L., Hecht, S. & Sun, X. (2018). Investigation of parameters predicting the need for diagnostic imaging beyond computed tomography in the evaluation of dogs with thoracolumbar myelopathy: Retrospective evaluation of 555 dogs. Veterinary Radiology & Ultrasound. 59(2), 147–154. DOI: https://doi.org/10.1111/vru.12576
Noyes, J. A., Thomovsky, S.A., Chen, A.V., Owen, T.J., Fransson, B.A., Carbonneau, K.J. & Matthew, S.M. (2017). Magnetic resonance imaging versus computed tomography to plan hemilaminectomies in chondrodystrophic dogs with intervertebral disc extrusion. Veterinary Surgery. 46(7), 1025–1031. DOI: https://doi.org/10.1111/vsu.12700
Tamura, S., Doi, S., Tamura, Y., Takahashi, K., Enomoto, H., Ozawa, T. & Uchida, K. (2015). Thoracolumbar intradural disc herniation in eight dogs: clinical, low-field magnetic resonance imaging, and computed tomographic myelography findings. Veterinary Radiology & Ultrasound. 56(2), 160–167. DOI: https://doi.org/10.1111/vru.12213
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