MRI Study Hopes To Turn Skeptics Into Believers

Efforts to stop racehorse breakdowns have increased exponentially in the past decade, with many high-tech tools being brought into play. The learning curve on these advanced diagnostics can be steep and additional complexities surface when veterinarians are expected to draw conclusions from current images without access to previous medical records: Something that may appear “significant” on an image may be an old, non-issue to the horse, reports Thoroughbred Daily News.

A study funded by the Oak Tree Charitable Foundation will be launched in Southern California to help racetrack veterinarians who use MRIs decipher what the images are telling them. The study will use 23 Thoroughbreds Dr. Tim Grande, the chief official veterinarian of the California Horse Racing Board, has deemed lame in their fetlock. The lame horses will be chosen from a pool of horses that are a morning-of or race-day scratch; those that are lame in the test barn or after a scheduled work or race; or those that have a voided claim.

A group of 23 control horses that show no signs of lameness will also be used; these horses will be similar in age, sex, and class to the lame horses. Researchers will be looking for changes in density within the proximal sesamoid bones and distal cannon bone, swelling in the cannon bone, and bone bruising. Each of these relates to fetlock failure and condylar fracture.

Though the MRI is not new, there is still skepticism about what it can “tell” veterinarians. Researchers hope the study will increase belief in the machine's ability to assist horses and their owners.

Read more at TDN.

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New SoCal MRI Study Aims to Bring Clarity to its Diagnostic Role

Seeking a full stop to the spate of high-profile fatalities in the race that stops Australia, Racing Victoria this year tightened the veterinary screws. The practical rollout of these efforts can hardly be described as an unadulterated success, however.

One of these new measures was a precautionary CT scan of all runners in the days leading up to the G1 Melbourne Cup–a target that hit the skids when Racing Victoria's new $1.27-million CT unit suffered a malfunction with the Cup field only half scanned, leaving the rest to be X-rayed (with a machine that was also temporarily incapacitated).

But other, less-mechanical incidents highlight some of the more nuanced problems that come with using sophisticated–and still yet relatively new–imaging technologies to diagnose lameness in equine athletes.

Despite the results of a mandatory CT scan that gave French import Gold Trip (Fr) (Outstrip {GB}) the all-clear to train up toward the G1 Cox Plate, Racing Victoria's veterinary team scratched him on the eve of the race–a diagnosis that jarred with the horse's connections, who declared him sound.

In a further twist, Gold Trip was given the all-clear to run in Sydney in the Rosehill Gold Cup just a week later–only to be scratched once more due to the prevailing firm going.

In short, as more and more regulatory veterinarians turn to imaging modalities like MRI, PET, and CT to help diagnose lameness, they're left to wrestle with slippery conundrums.

What clear connection exists between the image before them and an increased chance of injury in the horse, for example? And without an extensive historic medical record at their fingertips, how can they be sure that any possible abnormality that appears on the image is significant?

A new standing MRI-focused study set to launch in Southern California seeks to provide some much-needed answers.

“Lameness is a precursor to fetlock failure, and maybe we find bone changes that help us identify lameness. But we should never get to the point where the fetlock fails–we want to do better than that. And that's the goal of the study,” said Florida-based John Peloso, the lead researcher on the study.

“We need to figure out when they're helping us,” Peloso added, of imaging modalities like the standing MRI. “We need to learn more.”

Standing MRI | UC Davis photo

Participants in the study–which is funded by the Dolly Green Research Foundation and the Southern California Equine Foundation–will be split into two.

There will be 23 case horses whose lameness has been narrowed to the fetlock region, and 23 control horses who exhibit no visible sign of lameness.

The 23 case horses will be selected by Dr. Tim Grande, the California Horse Racing Board (CHRB)'s chief official veterinarian, from a variety of scenarios where regulatory veterinarians commonly have to intercede in a horse's training or racing program.

These include a morning or race-day scratch, a voided claim, and lameness in the test barn or following a scheduled work or race.

The control horses–those with no visible lameness–will be selected as a comparative match in terms of things like sex, age, and class.

If a case horse is picked from a race, then the winner–if sound–will make an obvious control match. If a case horse is selected after a workout, then a suitable match will be selected using PPs.

And what exactly will the researchers be looking for? The answer encompasses four specific areas of concern within the fetlock joint, the primary site of musculoskeletal injury in racehorses.

Researchers will be looking for density within the proximal sesamoid bones and distal cannon bone, bone marrow edema–or swelling–in the cannon bone, and palmer osteochondral disease, a type of bone bruising commonly referred to as just “POD.”

To elaborate on these points, Peloso pointed to a couple of relatively recent papers he had co-authored connecting important diagnostic dots.

Two issues associated with fetlock failure are high density–noticeable bone development that predisposes a horse to a greater risk of fracture–in the sesamoid bone and palmer osteochondral disease, while condylar fractures are linked to bone marrow edema and high density in the distal cannon bone.

“It's because of those two papers that we've dialed in on those bone changes,” said Peloso. “Maybe the study will teach us something new, and so, there'll be something that gets added to it.”

The standing MRI unit has been part of the Southern California backstretch furniture since the start of last year. Since then, the unit has been used to scan hundreds of fetlocks.

Nevertheless, as a relatively newfangled diagnostic tool, the MRI is still looked upon with a touch of skepticism by some corners of the backstretch community, including attending veterinarians, admitted Peloso.

As such, this study is seen as an opportunity to increase the volume of MRI equine traffic. “It needs to be a real relationship so we can do best by the horse and best by the owner,” Peloso explained, before looking at the broader implications from this and other such studies.

“It'll be interesting to see to what degree some of these imaging modalities–PET, CT if it makes it, MRI–what role they play to help the regulatory veterinarian identify who's safe and who's not safe.”

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CT Scan Best Modality To ID Foreign Bodies In Equine Feet

Drs. Nadine Ogden, Peter Milner, John Stack and Alison Talbot from the University of Liverpool created a study that compared diagnostic modalities to determine which was the best for identifying foreign bodies in horses' feet. Even when an injury is obvious, it isn't always clear if any foreign material remains within the wound.

The research team buried two foreign bodies into cadaver equine legs: one at the sole and one at the coronary band. The materials included dry wood, soaked wood, glass, slate and plastic. They then asked three equine veterinarians to examine the images produced by computed tomography (CT), magnetic resonance imaging (MRI) and digital X-rays.

They determined that there was minimal variation between the vet's findings on all the images. CT was found to be the most useful imaging modality. CT was able to detect all materials; it was able to pick out slate, glass and dry wood better than the other imaging modalities.

The foreign bodies were able to be seen on MRI, but these images were not clear enough for the vets to determine what type of material it was. Plastic and wood were difficult to determine on digital X-rays.

The team notes that though it is not traditionally necessary to determine what material is involved, it is important to use an appropriate imaging technique to make sure the foreign body can be detected.

Read the full investigation here.

Read more at Equine Science Update.

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Del Mar And Santa Anita Prioritize Equine Safety With Shuttling Program

Equine diagnostic equipment based at Santa Anita Park has been credited with catching minor equine soundness issues before they become major problems in racehorses at both Del Mar and Santa Anita racetracks, reports the Daily Racing Form.

A joint effort between both tracks, Del Mar subsidized the shipping of horses to Santa Anita to use the advanced services, which include positron emission tomography (PET), magnetic resonance imaging (MRI) and nuclear scintigraphy. These tools are provided by the Southern California Equine Foundation (SCEF), a nonprofit, charitable organization dedicated to protecting the interests and promoting the welfare of the equine athlete.

Dr. Joe Dowd, president of the SCEF and a local veterinarian, and Del Mar's Josh Rubinstein, president and chief operating officer, and Tom Robbins, executive vice president of racing and industry relations, were three key players in finalizing the arrangement.

Read more at DRF.

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