Evaluating the reliability of computed tomography for the diagnosis of intervertebral disc extrusion in dogs

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.

Breast Lesion Characterisation with Diffusion Weighted Imaging Versus Dynamic Contrast Enhanced-MRI: A Prospective Observational Study in a Tertiary Care Hospital

Purpose: Dynamic contrast-enhanced (DCE)-MRI has a promising role in breast cancer detection and lesion characterisation. Diffusion-weighted imaging (DWI) acts as an adjunct in the differentiation between benign and malignant lesions. The purpose of the study was to evaluate the efficacy of DCE-MRI and DWI in differentiating benign and malignant lesions. Methods: In a prospective study conducted between March 2019 and February 2020, 60 patients with breast lesions underwent DWI combined with DCE-MRI of the breast. The time–intensity curves were plotted. Lesions were classified according to the latest American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS; 5th edition). The results were compared with the histopathological diagnosis. The sensitivity and specificity of DWI, DCE-MRI, and combined DWI and DCE-MRI were calculated for detection of benign and malignant breast lesions. Results: Sixty patients underwent breast MRI in which 78 lesions were detected, out of which 28 were benign and 50 were malignant. Quantitative apparent diffusion coefficient measurement revealed 96% sensitivity and 82% specificity, with a positive predictive value of 92% and negative predictive value of 96%, for differentiating benign from malignant lesions. DCE-MRI findings showed 96% sensitivity and 78.5% specificity. The sensitivity of combined DWI and DCE-MRI was 98% and specificity was 86%, which was higher than DWI and DCE-MRI alone. Conclusion: Multiparametric MRI of the breast has very high sensitivity for detecting and characterising breast lesions as benign or malignant lesions. DWI had higher specificity than DCE-MRI, and the combined use of DWI and DCE-MRI had greater efficacy than DWI and DCE-MRI alone.