Köpeklerde kalça topallıklarında klinik, radyografik ve sintigrafik bulguların karşılaştırılması
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Date
2005
Authors
Tan, Hakan
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Publisher
Uludağ Üniversitesi
Abstract
Bu çalışma, Mayıs 2002-Nisan 2004 tarihleri arasında Uludağ Üniversitesi Veteriner Fakültesi Cerrahi Anabilim Dalı Küçük Hayvan Kliniği’ne getirilen ve kalça topallığı anamnezi verilen hastalar arasından seçilen değişik ırk, yaş ve cinsiyetteki orta ve büyük boy köpeklerden oluşan toplam 21 olgu üzerinde gerçekleştirildi. Bu çalışmada köpeklerde sırasıyla klinik, radyografik ve sintigrafik muayene yapılarak elde edilen bulgular karşılaştırılmış ve sintigrafik muayenenin diagnostik açıdan sağladığı olası faydalarının irdelenmesi amaçlandı. Klinik muayeneleri tamamlanan olguların radyografik muayeneleri için kliniklerimizde mevcut Trophy marka Omnix N 60 A (110 kV, 500 mA) röntgen cihazı kullanıldı. Sintigrafik muayene için ise U. Ü. Tıp Fakültesi Nükleer Tıp Anabilim Dalı’nda mevcut olan General Electric (GE) Starcam 3200 (Milwaukee) marka gamma kamerası kullanıldı. Köpekler genel anesteziye alınıp 5-20 mCi (miliCurie) Tc-99m MDP (Teknesyum- 99m- metilen difosfonat) intravenöz verildikten 3-5 dk sonra planar kan havuzu imajları alındı. İki saat sonra lezyon bölgesinin planar statik imajları ve tüm vücut kemiklerinin statik görüntülenmesi yapıldı. Değerlendirmede olguların klinik bulguları incelenmiş ve klasifiye edilmiştir. Radyolojik değerlendirmelerde kemik dokuya ilişkin patolojiler dikkate alındı ve kalça displazisi yönünden ‘İngiliz Veterinerler Birliği Köpek Kulüpleri Kalça Displazisi Değerlendirme Kriterleri’ esas alınarak olguların Norberg Açı ölçümleri tespit edildi. Daha sonra sintigrafik muayene bulguları değerlendirilip kaydedildi. Klinik, radyografik ve sintigrafik bulgular arasındaki istatistiki ilişki regresyon modeli kullanılarak araştırıldı. Klinik olarak kalça topallığı olan 6 olgunun (4, 9, 11, 14, 15, 20 no’lu olgular) (%28.6) radyografik muayenesinde bir patoloji saptanmadı. 9 olguda (1, 2, 5, 6, 10, 16, 17, 19 ve 21 no’lu olgular) kalça displazisi saptandı. Olgu 18’de bilateral caput femoris’in epifizer ayrılmasına rastlanırken olgu 19’da bilateral kalça eklemi displazisi ve sol femurda panosteitis tanısı kondu. Çalışma olgularımızın yapılan sintigrafik muayenelerinde 12 olgunun (3, 4, 6, 7, 8, 9, 11, 12, 13, 14, 15 ve19 no’lu olgular) aktivite tutulumlarında bir artış izlenmedi ve normal olarak değerlendirildi. Olgularımızın 9’unda (1, 2, 5, 10, 16, 17, 18, 20 ve 21 no’lu olgular) aktivite tutulumlarında artış saptandı. Radyografik ve sintigrafik bulgular karşılaştırılıp kalça displazisi ile radyonüklid aktivite tutulumu arasındaki ilişki araştırıldığında olgu 2 ve 10’da bilateral kalça eklemi displazisi saptandı ve bu olguların sintigrafik muayenelerinde de bilateral kalça eklemi ve çevresinde aktivite tutulumunda artış olduğu belirlendi. Olgu 1’de bilateral kalça eklemi displazisi saptanırken sintigrafik muayenede solda aktivite tutulumu, olgu 5’te bilateral kalça eklemi displazisi saptanırken sintigrafik muayenede sağda aktivite tutulumu belirlendi. Olgu 17’de sol kalça ekleminde I. derece kalça eklemi displazisi ve sağda kalça displazisine geçiş döneminde olduğu saptandı. Ancak olgunun sintigrafik muayenesinde bilateral olarak femur gövdelerinde aktivite tutulumunda artış belirlendi. Yine 20 no’lu olguda radyografik olarak patoloji saptanmazken sintigrafik muayenenin hem yumuşak doku hem de kemik doku fazlarında sol femur gövdesinde artmış aktivite tutulumu saptandı. 20 no’lu olgudaki yumuşak doku fazındaki izlenen aktivite tutulumundaki artış bölgedeki perfüzyonda bir artışın olduğunu dolayısıyla yumuşak dokuda enflamasyonu göstermektedir. Bu imajlar, kemik dokulardaki tutulum olan bölgelerde osteoblastik aktivitede artış olduğunu göstermektedir. Çalışmamızda olgulara ilişkin tespit edilen klinik, radyografik ve sintigrafik bulgular arasındaki istatistiksel ilişki araştırıldığında ne radyografik ve ne de sintigrafik bulgular klinik bulgularla istatistiksel olarak anlamlı bir şekilde uyumlu değildir. Buna rağmen McFadden R2’lerden (Tablo 23) sintigrafik tanının klinik bulgularla uyumunun daha yüksek olduğu çıkmaktadır. İlaveten ağrı klinik bulgusunun sintigrafik bulgu ile istatistiksel olarak anlamlı bir şekilde uyumlu olduğu gözlenmektedir. Ağrı, radyografik değişikliklerin ortaya çıkmasından önce saptanabilen önemli bir bulgudur ve ağrı duyan bir köpek radyografik bulgu göstermeden önce topallık sergiler. Dolayısıyla nedeni bilinmeyen kalça topallıklı köpeklerde kalça displazisi radyografik olarak doğrulanmış olsun veya olmasın sintigrafik muayene endikasyon bulur. Sintigrafi ile ilgili çalışma yapacak araştırmacılara osteoblastik aktivitedeki olası artışları veya azalmaları yakalamada ve ilave bilgiler sağlamada önemli olabileceği düşüncesiyle periyodik ve seri sintigrafik muayenelerin yapılacağı çalışmaları önerebiliriz.
This study is performed on 21 cases, consisted of dogs, having hip lameness, from different breeds, ages and gender which brought to Clinic of Small Animal Surgery, Uludag University Faculty of Veterinary Medicine between May 2002 and April 2004. The aims of this study were to research the clinical, radiographical and scintigraphic findings of hip lameness in dogs and find out whether scintigraphy could provide any advantages and additive information. After the clinical examination of the cases, radiographs were taken in the Radiology Department of the clinic with the Trophy ,Omnix N 60 A (110 kV, 500 mA) x-ray machine. Then the cases were taken to Nuclear Medicine department of the Medicine Faculty, University Uludag for the scintigraphic examination. Under general anesthesia the dogs were given 5-20 mCi (miliCurie) Tc-99m MDP by intravenous route. After 3-5 minutes blood pool images were recorded and after 2 hours the planar static images taken and the whole skeleton statically screened. The clinical findings were classified and the radiographs were evaluated. Radiographical readings were done for the bony pathologies and ccording to The British Veterinary Association (BVA) and the Kennel Club in the UK Hip Scoring and Norberg angle, measurements were performed. Statistical relationship between clinical, radiographical and scintigrafic findings was evaluated by regression model. No radiographical findings of 6 cases (4,9,11,14,15,20 were found altough used to be clinically lame. Canine hip dysplasia were diagnosed in 9 cases(1,2,5,6,10,16,17,19 and 21). Case 18 had bilateral ephyphysiolysis and case 19 had bilateral hip dysplasia and panosteitis on the left thighbone. Scintigraphical examination of our material revealed no bone tracer uptake in 12 cases (case no. 3,4, 6,7,8,9,11,12,13,14,15 and 19) and were evaluated as normal. Bone tracer uptake were dedected in 9 cases ( case no. 1,2,5,10,16,17,18,20 and 21). Comparison of radiographical and scintigraphical findings concerning the relation between tracer uptake and CHD showed an icreased bilateral uptake in the hip joint region only in two cases with hip dysplasia. Cases 1 and 5 both with bilateral CHD showed an increased bone tracer uptake only in the left and right hip joint, respectively. In case 17 the left hip joint was classified as mildly dysplastic, while the right hip joint had grade borderline, radiograhically. However, an increased bone tracer uptake was detected in both femur diaphyses scintigraphically. Again, case 20 showed an increased radiopharmaceutical uptake at the left femur diaphysis both during soft tissue and bone phases. Soft tissue uptake shows the perfusion of the region as a result of tissue enflamation. When the statistical relationship among the clinical, radiographical and scintigraphical findings was analized it was seen that neither radiographical nor scintigraphic findings were coherent with clinical findings. However according to McFadden R2 (Table 23) it’s came out that the coherency of the scintigraphical diagnosis with clinical findings were more dominant. In addition to this; the pain, one of the clinical findings, was more coherent with scintigraphic findings according to statistical analysis. Pain is an important finding that can be determined before radiographical alterations exist and a dog with pain is lame before radiographical findings exist. Therefore, scintigraphic examination should be perforemed for the dog that has unkown hip lameness. We offer the researchers to make serial scintigraphy of the patients that are lame but have no radiographical findings. By that way some more information can be gained parallel with the level of osteoblastic activity.
This study is performed on 21 cases, consisted of dogs, having hip lameness, from different breeds, ages and gender which brought to Clinic of Small Animal Surgery, Uludag University Faculty of Veterinary Medicine between May 2002 and April 2004. The aims of this study were to research the clinical, radiographical and scintigraphic findings of hip lameness in dogs and find out whether scintigraphy could provide any advantages and additive information. After the clinical examination of the cases, radiographs were taken in the Radiology Department of the clinic with the Trophy ,Omnix N 60 A (110 kV, 500 mA) x-ray machine. Then the cases were taken to Nuclear Medicine department of the Medicine Faculty, University Uludag for the scintigraphic examination. Under general anesthesia the dogs were given 5-20 mCi (miliCurie) Tc-99m MDP by intravenous route. After 3-5 minutes blood pool images were recorded and after 2 hours the planar static images taken and the whole skeleton statically screened. The clinical findings were classified and the radiographs were evaluated. Radiographical readings were done for the bony pathologies and ccording to The British Veterinary Association (BVA) and the Kennel Club in the UK Hip Scoring and Norberg angle, measurements were performed. Statistical relationship between clinical, radiographical and scintigrafic findings was evaluated by regression model. No radiographical findings of 6 cases (4,9,11,14,15,20 were found altough used to be clinically lame. Canine hip dysplasia were diagnosed in 9 cases(1,2,5,6,10,16,17,19 and 21). Case 18 had bilateral ephyphysiolysis and case 19 had bilateral hip dysplasia and panosteitis on the left thighbone. Scintigraphical examination of our material revealed no bone tracer uptake in 12 cases (case no. 3,4, 6,7,8,9,11,12,13,14,15 and 19) and were evaluated as normal. Bone tracer uptake were dedected in 9 cases ( case no. 1,2,5,10,16,17,18,20 and 21). Comparison of radiographical and scintigraphical findings concerning the relation between tracer uptake and CHD showed an icreased bilateral uptake in the hip joint region only in two cases with hip dysplasia. Cases 1 and 5 both with bilateral CHD showed an increased bone tracer uptake only in the left and right hip joint, respectively. In case 17 the left hip joint was classified as mildly dysplastic, while the right hip joint had grade borderline, radiograhically. However, an increased bone tracer uptake was detected in both femur diaphyses scintigraphically. Again, case 20 showed an increased radiopharmaceutical uptake at the left femur diaphysis both during soft tissue and bone phases. Soft tissue uptake shows the perfusion of the region as a result of tissue enflamation. When the statistical relationship among the clinical, radiographical and scintigraphical findings was analized it was seen that neither radiographical nor scintigraphic findings were coherent with clinical findings. However according to McFadden R2 (Table 23) it’s came out that the coherency of the scintigraphical diagnosis with clinical findings were more dominant. In addition to this; the pain, one of the clinical findings, was more coherent with scintigraphic findings according to statistical analysis. Pain is an important finding that can be determined before radiographical alterations exist and a dog with pain is lame before radiographical findings exist. Therefore, scintigraphic examination should be perforemed for the dog that has unkown hip lameness. We offer the researchers to make serial scintigraphy of the patients that are lame but have no radiographical findings. By that way some more information can be gained parallel with the level of osteoblastic activity.
Description
Keywords
Kalça topallığı, Köpek, Radyografi, Sintigrafi, Radyonüklid, Hip lameness, Dog, Radiography, Scintigraphy, Radionuclide
Citation
Tan, H. (2005). Köpeklerde kalça topallıklarında klinik, radyografik ve sintigrafik bulguların karşılaştırılması. Yayınlanmamış doktora tezi. Uludağ Üniversitesi Sağlık Bilimleri Enstitüsü.