A new CT scanner that has been available for less than a year was a virtual game-changer for Nathaniel A. White II, DVM, MS, Dipl. ACVS, and the hospital faculty and staff at Virginia Tech’s Marion duPont Scott Equine Medical Center. The scanner is the Pegaso, which is a CT made by Epica Medical Innovations. Dr. White, a professor emeritus of equine surgery at the Virginia Tech, believes there are only two such units in operation in the U.S.—one at his school and one at Colorado State University. “It allows us to see things we can’t see any other way,” White said. “It’s extremely helpful.” CT on horses isn’t new, but the units until now had been designed for human medicine—not too accommodating for capturing images of a horse, he said. The bore on the CT unit is big enough to accommodate a horse’s legs, neck or head, White said, adding, “this allows a lot more of the horse to get scanned.” The unit enables a horse’s head and neck to be scanned with the horse sedated and standing. “It doesn’t take long—just a few minutes to get the scan, which is the other advantage,” White said. “There are horses we can put through the machine, take a scan, and then roll it into surgery to fix whatever gets diagnosed.” The EMC faculty, which has become quite familiar with the machine, have scanned some 70 horses since November 2016, White estimated. The imaging is taken in slices, enabling a more detailed view of a horse’s head, sinuses, teeth or whatever anatomy is being examined. Does it improve diagnoses? “Basically it gives us a three-dimensional view so we can know what to do, where to go,” White said. “It helps make an exact diagnosis to know what surgery to do.” Also new for the large animal industry is Biovision’s Veterinary Endoscopy’s NeedleView 18-gauge micro-arthroscope, which is standard of care for diagnosing lameness of the stifle as well as other joints, said John Small, company president. “Where digital radiography fails, it 100 percent conclusively diagnoses the lameness,” Small said. “It compliments and competes with MRI, CT scan and ultrasounds.” The stifle lameness diagnosis was limited prior to the introduction of the NeedleView micro arthroscope, according to Small. “With the introduction of this technology, the practice can use the scope system to determine the root cause of the lameness and whether or not it can be fixed,” he said. Beside stifle lameness diagnoses, veterinarians also are using the product on other joints, such as carpus, fetlock, hock, coffin joint and navicular bursa, Small said. Josh Zacharias, DVM, MS, Dipl. American College of Veterinary Surgeons – LA, Dipl. American College of Veterinary Sports Medicine and Rehabilitation – EQ, is an avid user of the scope. “What I like about the needlescope is the ability it gives me to evaluate a synovial structure in a less invasive way than even standard arthroscopy,” said Dr. Zacharias, who practices at Countryside Large Animal Veterinary Services in Greeley, Colo. “In many cases the procedure can be done in a standing, sedated horse.” The most common application in Zacharias’ practice is stifle diagnostics. Horses with a lameness that blocks to a stifle are examined usually via radiographs and ultrasound, and certain lesions can be seen on radiographs but not ultrasound or ultrasound and not radiographs, he said. “Some lesions can only be picked up during arthroscopic examination,” he said. “As with many regions, there is not an imaging modality that is 100 percent sensitive. Even more often, a lesion on radiographs may not be the primary issue that would dictate the outcome. There may be an articular cartilage lesion that could possibly have a more direct influence on the prognosis. The sensitivity of the needlescope to articular cartilage, meniscal and intra-articular ligament injuries in the stifle has significantly increased our outcomes of stifle injuries.” He credits the improved outcomes to an earlier and more accurate diagnosis, which typically leads to a more appropriate treatment, and a more realistic prognosis and case selection. “A number of times radiographs and ultrasound were not sensitive enough to give me the confidence to make retirement type of recommendations, however it is really hard to argue with the visual presence of a lesion that the owner can be looking over your shoulder and say ‘Wow, that looks bad,’” Zacharias said.
