Page 6 - Clinical Connections - Summer 2023
P. 6

RVC RESEARCH    STUDY    VETERINARY SERVICES       RVC.AC.UK
         Advanced imaging
        SPOTLIGHT ON IMAGING-GUIDED
        PROCEDURES


        Francisco Llabres-Diaz, Head of the Small Animal Diagnostic Imaging Service and Senior Lecturer in
        Veterinary Diagnostic Imaging
              iagnostic imaging has developed at   sample, not only because of their small size,   they cannot be removed under ultrasound
              an amazing pace in the last 20 years.   but also sometimes due to their location in   guidance.
        DWe can now obtain hugely detailed   the body or the fact that they are very close   Although  the  colleagues  in  the
        images of the body that continuously help the   to vital structures like large blood vessels.   anaesthesia team perform locoregional
        Queen Mother Hospital for Animals (QMHA)   Samples  from orbital  abscesses  causing   anaesthesia, rather than the imaging team,
        offer better patient care. The main areas of   exophthalmos are another area where   it is worth mentioning that ultrasound is
        change in this period include quick in-house   imaging can help not only diagnose but also   used in many of those cases to guide the
        access to advanced imaging modalities (CT   treat.                      procedure, demonstrating the wide uses of
        and MRI) and the quality of the images that                             imaging throughout the hospital.
        are obtained (this applies to all modalities,   Specialist training      Ultrasound is, however, not the only
        with the arrival of digital radiography and the   We  can  teach  residents  how  to  safely   guiding imaging modality at the QMHA.
        software and hardware improvements seen   perform these procedures after a relatively   Fluoroscopy is routinely used by our
        in ultrasound).                     short period of time. From July, the imaging   colleagues  in  the  anaesthesia  team  to
          In addition, the Diagnostic Imaging Service   team will be training five residents to become   perform epidural injections in the pain clinic
        at the QMHA has extensive experience in   specialists in imaging. We are a large (and   and the radiology team has been using
        helping patients through imaging-guided   successful) training centre where many   CT  to  guide  the  sampling  of  deeper  or
        procedures. Within those, ultrasound is   veterinary surgeons interested in imaging   more challenging lesions that may not be
        by  far  the  modality  most  frequently  used   apply for further training.  immediately visible with ultrasound.
        and, within ultrasound-guided procedures,   We can also use ultrasound to guide   A sad case where CT-guided sampling
        ultrasound-guided fine needle aspirates are   the placement of needles that help the soft   helped the owners receive confirmation that
        the  most  commonly  performed.  Examples   tissue surgeons find smaller structures that   their  beloved  dog  suffered  from  a  tumour
        would include obtaining cells from the liver   need to be removed surgically. Special   affecting the base of the skull demonstrated
        and the spleen or masses.           localisation needles originally designed,   this well. We would not have been able to
          The team is also experienced in targeting   for instance, for locating breast lesions in   sample the lesion with ultrasound.
        far smaller and challenging structures. It   human medicine, are used. Once deployed,   Imaging-guided sampling and therapy
        is not uncommon for colleagues in other   they leave a guiding wire within the patient.   is  a  growing  field.  Interventional  radiology
        departments  to  ask  us  to  perform  fine-  The surgeon can then follow that wire to the   is  becoming  more  widespread  in  multiple
        needle aspirates of small lymph nodes in the   target lesion, with a significant decrease in   veterinary centres. The imaging team is not
        region of 2 to 3 mm in width.       surgical  time.  Foreign  bodies  can  also  be   directly involved in this field at the QMHA, but
          These  lymph  nodes  can  be  difficult  to   marked for removal in a similar fashion, if   fluoroscopy is heavily used in interventional
                                                                                procedures.
                                                                                 Examples  of  areas  where  the  imaging
                                                                                team could expand its role include the use
                                                                                of MRI. Here, the use of MRI-safe needles,
                                                                                together with the superb contrast resolution
                                                                                of MRI, can help in cases where MRI has
                                                                                been the modality of choice to investigate
                                                                                the clinical signs. Furthermore, imaging
                                                                                could become involved in the use of ablation
                                                                                techniques to treat lesions.
         CT images of a cytologically confirmed carcinoma of the base of the skull in a dog. The arrows point   Imaging-guided  sampling  and
         to the aggressive changes in the skull base with a mass, which was then sampled.
                                                                                interventions are going to make the future
                                                                                even more interesting, as veterinary
                                                                                medicine becomes more patient and
                                                                                disease-specific. The future is expected to
                                                                                introduce real changes, not only in terms of
                                                                                diagnosing a disease either earlier or with
                                                                                more certainty, but also in terms of tailoring
                                                                                the treatment to the specific patient.



                                                                                       For small animal referrals, please call:
         CT images of a cytologically confirmed lymphoma affecting the vertebrae in a dog. The arrows point   01707 666399
         to the aggressive changes in the vertebra and the presence of a mass, which was successfully
         sampled                                                                       Email:
                                                                                     qmhreception@rvc.ac.uk

        6   Summer 2023
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