Ultrasonography of Brain Diseases in Dogs and Cats
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This document discusses ultrasonography of the canine brain. It begins by describing ultrasonography as a low-cost, non-invasive alternative to other imaging techniques. It then covers the technique, including use of linear and microconvex probes on various acoustic windows to obtain sagittal, transverse, and dorsal plane images. The document details normal brain anatomy visible on ultrasound and vascular anatomy. It also discusses several congenital and acquired diseases that can be evaluated with transcranial ultrasonography, including hydrocephalus, lissencephaly, cysts, Chiari-like malformations, neoplasms, encephalitis, trauma, neurodegeneration, and strokes. Throughout, it provides examples of ultrasound images depicting various anatomical structures and
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Ultrasonography of Brain Diseases in Dogs and Cats
- 1. Ultrasonography of brain Cibele Figueira Carvalho DMV, MSc, PhD Imaging Diagnostic Department - PROVET Researcher INRAD - HCFMUSP
- 2. Introduction • Alternative method • Low cost, non-invasive and safe • No anesthesia or contrasts • Allows repeated measurements and monitoring • Small breed dogs (<10kg): good image resolution
- 3. Technique Technique •Patient •Equipment •Acoustic windows •Planes of images
- 4. Equipment Technique •Patient •Equipment •Acoustic windows •Planes of images Real time equipment with: •linear probes (5 - 10MHz) -neonates and/ or opened rostral fontanelle •high resolution microconvex probes (2 - 6MHz) - adults (small breed dogs) with closed fontanelle
- 5. Acoustic windows Technique •Patient •Equipment •Acoustic windows •Planes of images • opened fontanelle (neonates, toy breeds until 3months of age or abnormal) • closed rostral fontanelle (small dogs, thin frontal bone) • Temporal (above zygomatic arch) • Suboccipital CARVALHO, 2004
- 6. • Saggital • Transversal • Dorsal Planes of images Technique •Patient •Equipment •Acoustic windows •Planes of images
- 7. ROSTRAL WINDOW Transversal Planes CARVALHO, 2014 Saggital Planes Technique •Patient •Equipment •Acoustic windows •Planes of images
- 8. Dorsal Planes CARVALHO, 2014 TEMPORAL WINDOW Technique •Patient •Equipment •Acoustic windows •Planes of images
- 9. SUBOCCIPITAL WINDOW Technique •Patient •Equipment •Acoustic windows •Planes of images Transversal and Saggital
- 10. Anatomy
- 11. Anatomy What can we see? • Sulci • Interhemispheric fissure • ventricular system (LV, III, IV, mesencephalic aqueduct) • Cerebellum • Brainstem • Medulla
- 12. • Sulci • fissure • Ventricular system • Cerebellum • Brainstem • Medulla Carvalho, 2014 Anatomy
- 13. • Sulci • Fissure • Ventricular System • Cerebellum • Brainstem • Medulla 2 4 1 3 2 Cr Ca 4 3 LE 1 D Carvalho et al. 2014 Anatomy
- 14. • Sulci • Fissure • Ventricular System • Cerebellum • Brainstem Anatomy • Medulla Cintra, Carvalho et al. 2014
- 15. 5 7 1 4 3 6 8 2 Cr Ca 7 5 1 4 6 3 2 8 LD V 1- temporal bone 2- temporal lobe 3- presilvian sulci 4- Tentoriun of cerebellum 5- Cerebellum 6- longitudinal fissure 7- Mesencephalon 8- etmoid bone • Sulci • Fissure • Ventricular System • Cerebellum • Brainstem Anatomy • Medulla
- 16. • Sulci • Fissure • Ventricular System • Cerebellum • Brainstem Anatomy • Medulla 2 4 1 3 5 2 1 1 6 3 4 Cintra, Carvalho et al. 2014
- 17. 1 5 6 3 4 Ca LE LD Cr 1 2 3 4 1- subaracnoid space 2- Medulla 3- Canal 4- Atlas 5- dorsal horn 6- ventral horn • Sulci • Fissure • Ventricular System • Cerebellum • Brainstem Anatomy • Medulla
- 18. Vascular anatomy • RI brain arteries = 0,55±0,04 (SEO et al.,2005) • RI basilar artery = 0,5 - 0,78 (SAITO et al.,2003) Arterious circle Vertebrobasilar system
- 19. Arterious circle Vertebrobasilar system Vascular anatomy
- 20. Arterious circle Vertebrobasilar system Vascular anatomy
- 21. Vertebrobasilar system Arterious circle Vertebrobasilar system
- 22. Arterious circle Vertebrobasilar system
- 23. Arterious circle Vertebrobasilar system
- 24. Transcranial Ultrasonography of congenital and adquired diseases
- 25. Transcranial Ultrasonography of congenital and adquired diseases • Hydrocephaly • Lissencephaly • Cyst (s) • Chiari-like lesions • Dandy walker • Trauma • Neoplasia • Encephalitis Carvalho et al. 2007
- 26. Hydrocephalus • Hydrocephaly • Lissencephaly • Cyst • Chiari-like • Dandy walker Carvalho et al. 2007; Carvalho et al. 2010
- 27. Lissencephaly • Hydrocephaly • Lissencephaly • Cyst • Chiari-like • Dandy walker
- 28. Cysts quadrigeminal and aracnoid • Hydrocephaly • Lissencephaly • Cyst • Chiari-like • Dandy walker Carvalho et al. 2007
- 29. Chiari-like • Hydrocephaly • Lissencephaly • Cyst • Chiari-like • Dandy walker Carvalho et al. 2007
- 30. Dandy-walker Sindrome • Hydrocephaly • Lissencephaly • Cyst • Chiari-like • Dandy walker Carvalho et al. 2007
- 31. Trauma Trauma Neoplasias NME GME Carvalho et al. 2007
- 32. Neoplasias Trauma Neoplasias NME GME Carvalho et al. 2007
- 33. Encephalitis Trauma Neoplasias NME GME Carvalho, Perez et al. 2012
- 34. Encephalitis Trauma Neoplasias NME GME Carvalho, Perez et al. 2012
- 35. Physiology – main considerations • Supply of O2 • Glucose supply • Blood flow supply
- 36. Hemodynamic changing diseases Intracranial pressure (ICP) can be increased: •Hydrocephaly •Neoplasia •Encephalitis •Traumas •Neurodegeneration •Strokes
- 37. Hydrocephaly • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes • Sonographic images may demonstrate ventriculomegaly but the parameters obtained in B-mode are not suitable for monitoring the treatment and clinical evolution of the disease (Spaulding and Sharp, 1990; Tucker and Gavin, 1996) Researches show that induced acute hydrocephaly in cats leads to a reduction of 22% in the blood flow of the brain, cerebellum, and encephalic trunk (Hochwald et al., 1975).
- 38. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes
- 39. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Carvalho et al., 2010
- 40. Neoplasias • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes • Tumoral vessels are not always detected • Hemodynamic changes may occur because “mass effect” (stenosis), neoangiogenesis or trombosis • Intracranial pressure arising leads to elevated RI
- 41. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes
- 42. Encephalitis • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes • Granulomatous meningoencephalitis (GME) - hemodynamic changes are variable and progressive with the disease Carvalho et al., 2012
- 43. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes
- 44. Color Doppler image demonstrated conspicuous vessels in the arterial circle that appeared tortuous and more obvious than usual with minimum adjustments on color gain settings • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes
- 45. - Some ventriculomegaly degrees - Focal hyperechoic lesion (granuloma) - the diffuse brain congestion and inflammation can lead to a compensatory vasodilatation • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes
- 46. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes - Doppler spectral mapping can demonstrate low or high resistive index depending on mechanical compression (e.g., stenosis or occlusion) caused by the perivascular cuffs observed in pathologic evaluation, or space-occupying mass
- 47. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Granulomatous meningoencephalitis in a dog – increased blood vessels caliber; inflammatory process with mononuclear cells around subpial surface and ocluded blood vessels (hematoxilin eosin stain; scale 100 μm). Photo: Paulo C. Maiorka.
- 48. GME after treatment – histopathologic Degenerated areas; Partial lumen desobstruction; Increased vessels caliber • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes
- 49. Trauma • Focal lesion detection varies with location, extension and collateral damages; • Vessels change can be present or not • Focal lesion can cause “mass effect” and intracranial pressure (ICP) increase • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes
- 50. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes ICP x RI •RI is correlated to intracranial pressure (ICP) in patients with severe brain damage and in hydrocephalic infants; •and detecting brain death (after head injury) Rainov, 2000; Fukushima et al., 2000
- 51. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration Neurodegeneration • Strokes Neurodegeneration process displays some common morphological characteristics: •cortical cerebral atrophy, •ventricles enlargement, •diffuse deposits of β-amyloid (A) peptides, •senile plaques formation, •lipofuscin and intraneuronal “aging pigment” accumulations changing the cytoskeleton, •vascular changes in the cerebrum.
- 52. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration Neurodegeneration • Strokes Carvalho, 2009; Carvalho, 2012
- 53. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Brain strokes or cerebrovascular accidents • Stroke is the most common clinical manifestation of cerebrovascular disease, and can be broadly divided into ischemic and hemorrhagic stroke (Braund, 1994).
- 54. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes
- 55. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Carvalho et al., 2012
- 56. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Carvalho et al., 2012
- 57. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Carvalho et al., 2012
- 58. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Carvalho et al., 2012
- 59. Risk factors: Hyperlipemia Diabetes mellitus hypothyroidism hyperadrenocorticism Arterial Hypertension (might) Cardiac insufficiency Severe hypotension Hemorragic conditions Chronic lung diseases (hypoxia) Congenital condition Ex: Beagle’s vasculitis, cat’s idiopatic ischemic disease, Schnauzer’s hyperlipemia • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes
- 60. Brain stroke • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Carvalho, 2012
- 61. In conclusion... - Useful tool that can trial small breed dogs with neurologic signs
- 62. References CARVALHO CF, ANDRADE NETO JP. Encéfalo In: Ultrassonografia em pequenos animais. 2ed. Editora Roca, São Paulo. 2014. CARVALHO CF, ANDRADE NETO JP, JIMENEZ CD, DINIZ SA, CHAMMAS MC. Ultrassonografia transcraniana em cães com distúrbios de origem central. Arq. Bras. Med. Vet. Zootec., v.59, n.6, p.1412-1416, 2007. CARVALHO CF, CINTRA TCF, ANDRADE NETO JP. Ultrassonografia Doppler transcraniana. In: Carvalho, CF Ultrassonografia Doppler em pequenos animais. Editora Roca, 2009. CARVALHO CF, PEREZ RB, CHAMMAS MC, MAIORKA PC. Transcranial Doppler sonographic findings in granulomatous meningoencephalitis in small breed dogs. Canadian Veterinary Journal v.53, p.855–859, 2012. CARVALHO CF, ANDRADE NETO JP, DINIZ SA. Small breed dogs with confirmed stroke: concurrent diseases and sonographic findings. Arq. Bras. Med. Vet. Zootec., v.64, n.5, p.1177-1183, 2012. CINTRA TCF, CARVALHO CF, CANOLA JC, NEPOMUCENO AC. Ultrassonografia transcraniana em cães hígidos: padronização da técnica e descrição anatômica. Arq. Bras. Med. Vet. Zootec., v.66, n.1, p.61-68, 2014.
- 63. BERG, D.; GODAU, J.; WALTER, U. Transcranial sonography in movement disorders. Lancet Neurology. v.7, p.1044-1055, 2008. HUDSON, J. A. et al. Ultrasonographic anatomy of the canine brain. Veterinary Radiology, v. 30, n. 1, p. 13-21, 1989. HUDSON, J. A.; SIMPSON, S. T.; COX, N. R. Ultrasonographic examination of the normal canine neonatal brain. Veterinary Radiology, v. 32, p. 50-59, 1991. SAITO, M.; OLBY, J. N.; SPAULDING, K. Identification of arachnoid cysts in the quadrigeminal cistern using ultrasonography. Veterinary Radiology & Ultrasound, v. 42, n.5, p.435-439, 2001. GAROSI, L. S. Cerebrovascular disease in dogs and cats. Veterinary Clinics of North America: Small Animal Practice, v. 40, p. 65-79, 2010. HILLOCK, S. M. et al. Vascular encephalopathies in dogs: incidence, risk factors, pathophysiology, and clinical signs. Compendium on Continuing Education for the Practicing Veterinarian, v. 2, n. 3, p. 196-207, 2006. LILLEHEI, K. O.; CHANDLER, W. F.; KNAKE, J. E. Real time ultrasound characteristics of the acute intracerebral hemorrhage as studied in the canine model. Neurosurgery, v.14, n.1, p. 48-51, 1984.
- 64. PLATT, S. R.; GAROSI, L. Canine cerebrovascular disease: Do dogs have strokes? Journal of the American Animal Hospital Association, v. 39, n. 4, p. 337-342, 2003. DE LAHUNTA, A.; GLASS, E. Veterinary neuroanatomy and clinical neurology. 3rd ed. Philadelphia: Saunders, 2009. HOSKINS, J. D.; SHELTON, G. D. The nervous and neuromuscular systems. In: HOSKINS, J. D. Veterinary pediatrics. 3rd. ed. Philadelphia: W.B. Saunders Co., 2001. Cap. 19, p. 425. FUKUSHIMA, U. et al. Evaluation of intracranial pressure by transcranial Doppler ultrasonography in dogs with intracranial hypertension. Journal Veterinary Medical Science, v. 62, n. 3, p. 353-355, 2000. SPAULDING, K. A.; NICHOLAS, J. H.; SHARP, B. Ultrasonographic imaging of the lateral cerebral ventricles in the dog. Veterinary Radiology, v. 31, n. 2, p. 59-64, 1990. BRAUND, K. G. Neurological syndromes. In: __ Clinical neurology in small animals: localization, diagnosis and treatment. New York: International Veterinary Information Service, 2003. SAITO, M. et al. Magnetic resonance imaging features of lissencephaly in 2 lhasa apsos. Veterinary Radiology & Ultrasound, v. 43, n. 4, p. 331-337, 2002.
- 65. Doubts???? Thank you for your attention! cibelefcarvalho@gmail.com
Notas del editor
- Good morning dear colleagues! Thank you very much for coming along here today. I hope my presentation isn’t gonna take too long and that you’ll find it interesting. The purpose of today presentation is to discuss about brain’s sonography. In the next hour I gonna talk about: how to do, what we can see and finally the main application in veterinary medicine. I’d be very happy to invite you to ask questions at the end of the session and I’m sure there’ll be plenty of time for us to discuss some of the points that have been raised.
- Now, let me begin by explaining that brain’s ultrasonography is an alternative method because it is a low cóst, non-invasive and safe technique. Other advantages are that no anesthesia or contrasts are needed, and this method allows repeated measurements and monitoring. But in our experience, we can obtain good image only in small breed dogs.
- If you have a look at this clip, you can see that is a small breed dog. It’s beeing restrained by its owner with no stress. Patient can be sitting, or placed into lateral or sternal recumbency without sedation. In this case we’re using acoustic gel over the dog’s head and scanning the brain with a microconvex probe.
- Talking about the technique, we use ...
- Three acoustic windows are used to scan all the brain: rostral, temporal and suboccipital windows...
- Each window has to be scanned on all planes of images. Let’s see what I mean...
- At rostral window, driving the probe rostral to caudal direction, we obtain transversal planes. And driving the probe in lateral direction we obtain saggital planes.
- At temporal window, above the zygomatic arch and driving the probe from dorsal to ventral direction we obtain dorsal planes.
- And finally, at suboccipital window we obtain transversal and saggital planes
- There are several publications about transcranial ultrasonography. My science degree student wrote this article. This work correlates transcranial images with healty dog’s encephalic anatomy.
- So let’s check... what can we see? We can see some anatomic landmarks as...
- As we can see here, in a saggital plane, obtained through rostral window, these thin hyperechoic lines that are brain’s sulci.
- Also here, in a dorsal plane obtained through temporal window, we see interhemispheric fissure.
- Moreover, in a transversal plane obtained through rostral window, we can see part of ventricular system: lateral ventricles and third ventricle
- Through temporal window we can obtain some oblique dorsal planes in order to scan:
- Here at suboccipital window we can see in transversal and saggital planes of cerebellum and medulla
- And finally, still at suboccipital window driving caudally the probe, we can see medulla and subaracnoid space.
- Vascular anatomy can be assessed by transcranial Doppler ultrasound. A few reports have described vascular anatomy and reference values.
- To conclude, we have to remember that main arterial brain’ supply is made of vertebrobasilar system and cerebral arterial circle.
- Temporal window is the best acoustic window to assess arterious circle. Besides other arteries’ flow are assessed by Doppler from rostral window.
- And suboccipital window is the best to assess vertebrobasilar system, here in transversal and saggital planes.
- This movie is a good illustration of that. Initially, B-mode are made. In a temporal approach, driving caudally the probe, we obtain dorsal planes. Color Doppler image is performed to identify the cerebral arterial circle. Once the vessels are identified, pulsed Doppler is initiated.
- Take a look at this movie: color Doppler is used as a guide to identify vessel. Then, pulsed Doppler is initiated. We have to pay attention to the correct insonation angle to maximize signal. You can freeze when you get 3 similar sequencial waveforms. Then, measurements are made on a representative spectral waveform to determine peak systolic velocity, end diastolic velocity and resistive index.
- Now that we saw how to do and what we can see, let’s talk about main applications in veterinary medicine. In our experience hydrocephaly is the most commom central neurological disorder.
- As I told before, ultrasonography is a valuable alternative to be used to detect all these congenital and adquired diseases in small breed dogs.
- Probably, US brain is the most commom method to determine ventricles size in suspected hydrocephalus toy breed dogs. Here hydrocephalus with and without ventricle communication.
- Lissencephaly is a formation disorder resulting in a brain folds and grooves lack of development. For example in this case, the sulci absence can be seen in the near field of the image. At necropsy we see the abnormal appearance of the surface of the brain.
- Furthermore, congenital cysts are seen as an anechoic, well defined focal lesion. It often causes liquoric system obstruction as we can see in this figure in saggital and transversal planes.
- Chiari – like is a bony malformation in the back part of the skull. Patients use to have a crowded cerebellum (pushed against the foramen magnum) resulting in a kicking medulla and obstruction of varying degrees.
- Dandy walker syndrome is a condition that affects brain development: patients have abnormal cerebellum (as hypoplasia for example) and cysts in the forth ventricle. Now, move on to see adquired diseases...
- Trauma appearance varies. This first figure (in dorsal plane obtained at temporal window), we can see a hypo to anechoic focal lesion that suggests edema. This another patient, a saggital plane obtained at subocciptal window, we can see a hyperechoic lesion surrounded by edema causing obstrution.
- Most of neoplasias are seen as focal hyperechoic lesions as we see here... These lesions often cause mass effect and liquoric system obstrution (depending on location).
- Move on to encephalitis... Some of them, as necrotizing encephalitis can cause ‘ex vaccum’ hydrocephalus as we can see here at sonogram and necropsy
- Other encephalitis as granulomatous meningomyeloencephalitis can cause focal lesions that usually occur within the white matter of the cerebrum, cerebellum, caudal brainstem and cervical spine cord.
- Additionally, some diseases can lead to hemodynamic changes. Mainly occured because decrease in oxygen supply, glucose or blood flowing
- In these cases (hydrocephaly, neoplasia, encephalitis, traumas, degeneration and strokes), transcranial Doppler ultrasonography can provide additional information. Let’s see what and why...
- We drove a research that compared Doppler parameters of main cerebral arteries in dogs with hydrocephalus before and after clinical treatment. The results presented that there’s no significant influence of the variables in the B-mode. And the resistive index was the best parameter to monitor the treatment.
- Besides, patients with hydrocephalus may alter cerebral arteries’ resistive index in each brain part, as we’re seeing in this example
- Furthermore, a good example of “mass effect”. Rostral and caudal arteries are presenting elevated resistive index.
- Move on to encephalitis... In the case of granulomatous meningoencephalitis, hemodynamic changes are variable and progressive with the disease
- This retrospective study describes transcranial Doppler ultrasonography findings in dogs with confirmed histopathology of granulomatous meningoencephalitis (GME) in several degrees
- In early stages
- Other findings are:
- As progression the disease...
- In addition, in this case we can see
- Another patient: histhology after treatment presented
- In the case of trauma,
- There are some articles showing that
- Move on to neurodegeneration, we know that this process displays some commom morphological characteristics as:
- All these features may lead to hemodynamic changes, disturbances and eventually to brain chronic hypoxia seen at Transcranial Doppler ultrasonography
- Finally, cerebrovascular accidents...
- This retrospective study in 512 examinations selected only 42 dogs with cerebrovascular disease confirmed at necropsy.
- This table shows concurrent diseases found in our study: 33% with cerebral amyloid angiopathy 31% with endocrinopathies And 24% with coagulopathy
- This table shows concurrent diseases found in our study: 33% with cerebral amyloid angiopathy 31% with endocrinopathies And 24% with coagulopathy
- This table shows concurrent diseases found in our study: 33% with cerebral amyloid angiopathy 31% with endocrinopathies And 24% with coagulopathy
- This table shows concurrent diseases found in our study: 33% with cerebral amyloid angiopathy 31% with endocrinopathies And 24% with coagulopathy
- In brief, we saw the coexisting diseases occurrence with cerebrovascular accidents like these:
- In general, Focal lesion was the most commom finding with high sensitivity at necropsy as we can see here; Decrease in echogenicity was related to edema with 62% of sensitivity in our study, Diffuse increase in echogenicity was related to aging changes and also cerebral stenosis and resistive index increasing
- In conclusion, in our experience, brain ultrasonography is an useful tool that can trial small breed dogs with neurologic signs.