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Standing Equine PET Now In Use At UC Davis

UC Davis has welcomed the latest standing equine PET scanner, the MILEPET, into clinical use, less than six years after performing the world's first PET scan on a horse.

Thanks to funding support from the UC Davis Center for Equine Health and the Stronach Group, the UC Davis veterinary hospital recently installed the most recent MILEPET. After the installation of the first scanner at Santa Anita Park racetrack, a second scanner was set up on the East Coast at the University of Pennsylvania. This newest instrument at UC Davis will provide the most innovative equine imaging technique using only standing sedation to the Northern California horse population.

Since the first equine PET scan was performed at UC Davis in 2015, there have been many other “firsts” as the team, led by Dr. Mathieu Spriet, worked to develop the use of the technique to improve detection of injuries in equine limbs. The s were performed two years ago, removing the need for horses to undergo general anesthesia during imaging. Subsequently, our group validated the first scanner designed specifically to image horses prior to its installation at Santa Anita in Southern California. This scanner has now been used for over 200 studies at the racetrack, contributing to reducing the number of catastrophic injuries in racehorses.

For the past five years, the UC Davis veterinary hospital's robust equine clinical program has imaged over 100 horses, but until recently, all of these scans were performed with the piPET, a scanner originally developed to image the human brain. This program accomplished several milestones in the development of equine PET, establishing applications not only for racehorse safety, but also for diagnosis of bone and soft tissue injuries in sport horses and improved understanding of laminitis. The clinical use of the technique was limited due to the requirement to anesthetize horses, which increases costs and risks associated with the procedure.

The initial clinical case utilizing the new scanner at the UC Davis veterinary hospital was another first, a mule named Jool. She was the first patient included in a clinical trial aimed at combining standing PET with standing MRI to provide the most advanced imaging for foot lameness in horses (or mules).

In addition, a second standing PET study is underway, aimed at assessing the progression of laminitis. Laminitis is an extremely debilitating disease that can unfortunately be fatal. Laminitic patients require long-term, careful hoof care performed by an experienced farrier. UC Davis veterinary hospital farrier Shane Westman has a long list of these challenging patients. In order to manage the trimming and shoeing optimally, Westman relies on imaging techniques. In a pilot study performed on laminitic cases at UC Davis, PET demonstrated its value in precisely assessing the involvement of the soft tissues of the foot with laminitis. As PET now becomes available using simple sedation, it simplifies the use of the technique and allows for repeated scans every time a patient comes for shoeing and trimming.

In addition to these two specific clinical research studies, standing PET is now available to any equine patient in Northern California. Standing PET can image any area of the limb from the foot to the carpus (knee) or tarsus (hock).

The racehorse population of Golden Gate Fields racetrack will also benefit from the new PET scanner. As the technique has quickly gained in popularity at Santa Anita Park, a few Northern California racehorses have traveled south to be imaged with PET. Now these horses won't need to travel so far. In addition to being in operation at UC Davis, the MILEPET scanner will soon be transported on a weekly basis to image horses at the equine hospital at Golden Gate Fields.

Dr. Spriet was very enthusiastic about these latest developments in the UC Davis equine PET program, “The standing PET scanner will allow us to offer this cutting-edge modality to more cases than we could before. Repeating scans on the same patient will help us optimize treatment and rehabilitation for better outcomes.”

“Through support from our donors and endowments, we have been able to support the equine PET program at UC Davis since 2016 by providing both research and equipment support,” said Dr. Carrie Finno, director of the UC Davis Center for Equine Health. “It is incredibly rewarding to see this technology now being used to prevent catastrophic injuries in racehorses across California.”

More horses, and mules, will be scanned in the near future!

Op/Ed: ‘Even More Transparency’ Needed At California Tracks

The Los Angeles Times Editorial Board acknowledged improved equine safety measures at Santa Anita Park over the past two years, reducing equine fatalities from 37 over the 2019 season to 16 over the same period in 2020. Still, the editorial board insists there are more steps to be taken to prevent further on-track fatalities across the entire state of California.

First, there should be public postings of all necropsy and fatality reviews on horses that die on California tracks.

“The horse racing board already posts annual overall reports on fatalities and types of injuries, but even more transparency is called for,” wrote the editorial board.

Another suggestion was a centralized pharmacy at the racetrack, which is the only source for medications.

Finally, while Santa Anita's PET scan has been a good investment, the editorial board believes the machine should be used on asymptomatic horses prior to a race. Additionally, a 3D walk-in CAT scanner could be added to track veterinarians' tool kit.

Santa Anita PET Scans Allowing Horsemen To ‘Assess The Response Of An Injury’ Over Time

The equine Positron Emission Tomography (PET) scanner pioneered by the UC Davis School of Veterinary Medicine, in collaboration with LONGMILE Veterinary Imaging, is now in heavy use at Santa Anita Park in Southern California. In just over six months since the installation in December 2019, with the financial support from the Stronach Group, more than 100 scans have been performed with the “MILEPET” (Molecular Imaging of Limbs in Equids), the PET scanner specifically designed to acquire images on horses without the need to lay them down.

Overall, 65 different horses were imaged with the scanner, with several horses imaged multiple times, several weeks apart. In total, images of 186 front ankles, 28 hind ankles, 16 knees, and 11 feet were acquired. As shown by these numbers, the front ankles are the main area of interest, as these are the joints most commonly involved in severe injuries in racehorses.

The first objective after installation of the scanner at the racetrack was to complete a study, funded by the Grayson Jockey Club Research Foundation, aiming at assessing the value of PET for identification and follow-up of ankle injuries. The study called for 24 horses with signs of fetlock injuries to be imaged three times with the PET scanner, with follow-up scans six and 12 weeks after the initial scans. All 24 horses have now been enrolled, and over half of these horses have completed all three scans.

All scans were successful, providing very interesting preliminary results.

“The PET scans provide very precise information about the injury,” said Dr. Mathieu Spriet, associate professor of diagnostic imaging at UC Davis and lead veterinarian on the study. “With a classic 'bone scan,' we usually can associate the injury with one of the bones of the ankle, but with the PET, we can really localize the abnormality to a specific area in a bone.”

This is of particular importance, as injuries to specific areas of the ankle bones are known to predispose horses to catastrophic breakdown.

Another benefit of the PET scan is the ability to see changes over time.

“As we have repeated scans six weeks apart, we have seen marked improvement on many of the injuries following treatment and rest, whereas other injuries remained active,” continued Dr. Spriet. “Being able to assess the response of an injury is very helpful to decide the course of action: deciding whether a horse needs more time off, a different treatment, can go back to the track or should be retired from racing – these are very challenging decisions to make for the veterinarians at the track. The PET images have provided objective data to support these decisions.”

In addition to the 24 horses in the Grayson Jockey Club study, more than 40 horses have been scanned at the request of their veterinarians. Horses were sent in by 14 different veterinarians coming from 26 different trainers, demonstrating how broadly the technique has already been embraced by the Santa Anita racing community.

As a Magnetic Resonance Imaging (MRI) scanner was also installed at Santa Anita Park earlier this year, another on-going study, supported by the Oak Tree Foundation, aims at comparing PET and MRI findings in the ankles of racehorses. Twenty horses have been enrolled in this study with preliminary results demonstrating the complementarity of both techniques to provide the best assessment of various injuries.

Another study, supported by the Dolly Green Research Foundation, has recently started. This study aims at monitoring horses who are resuming training after being laid-up due to ankle injury. The goal is to assess the ankle on a regular basis to be able to adapt the training, if early signs of injury were to recur.

“It is very impressive how much has been accomplished and how much we have learned in the last six months, thanks to the support of key partners and the hard work of the technical staff and the veterinarians at Santa Anita Park,” said Dr. Spriet. “We have been able to establish this new technology as a reliable, high-precision diagnostic tool for racehorses.”

It is likely that the knowledge about PET will keep growing quickly. In addition to the different on-going studies at Santa Anita Park, this technology is now available outside of California, as a MILEPET scanner has just been installed at New Bolton Center, the equine veterinary hospital of the University of Pennsylvania. There are also on-going efforts to secure the funding to install another MILEPET at the UC Davis Veterinary Medical Center, where it would be available for racehorses from Golden Gate Fields and for sport horses across Northern California.

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Not One Size Fits All: Paper Outlines Findings From Newmarket Fetlock Injury Symposium

While the racing industry has made important strides forward in detecting horses at risk of suffering catastrophic injuries before they occur, that system is far from perfect. But better use and understanding of the various diagnostic tools at our disposal could help to plug those existing gaps–that’s the main takeaway from a recent article published in the Equine Veterinary Journal.

The seven-page paper provides a summary of the findings that came from a symposium held this past March at Newmarket, during which various veterinarians and experts shared their research into fracture risk assessment of the fetlock–the most common catastrophic injury site in racehorses.

For so long, the industry has been looking for “that one” diagnostic imaging technology “that solves all our problems,” Ryan Carpenter, a Santa Anita-based private veterinarian who gave a presentation at the symposium, told TDN. “The reality is, we’re not there yet,” he added.

“More importantly, we have to acknowledge that there are strengths and weaknesses to the whole modalities. It’s not a one size fits all,” Carpenter said. “But I think when you use them in conjunction with one another, and you recognize their strengths and weaknesses, I think you can make some serious headway.”

Many of the pre-existing injuries that end up proving catastrophic are extremely subtle and therefore difficult to detect. Indeed, this study found that 90% of horses fatally injured in Hong Kong displayed no noticeable clinical signs of injury during a pre-race veterinary inspection.

Experts have identified a range of race, horse and management-related factors that can be used to identify horses at serious risk of suffering catastrophic injuries on the track.

But as the paper points out, the statistical models these factors can be plugged into still aren’t especially effective at predicting catastrophic injuries, partly because of the low prevalence of these sorts of injuries anyway, and the dearth of relevant data.

Indeed, one study which encompasses some 2,000,000 starts and 4,000,000 workouts had a 65% success rate at predicting which one of only two horses was about to sustain a fracture–odds only marginally higher than that of a coin toss.

Which is where imaging can come in.

The paper finds a direct relationship between “serial testing”–what is a more systematic way of monitoring problem areas–and a higher probability of targeting pathology at the site of a potentially catastrophic injury.

Let’s zero in on radiography, what the paper says remains the most “important imaging modality in fetlock bone risk assessment,” but is nevertheless a “relatively untapped resource that through education of primary care vets could immediately have a profound impact on injury mitigation.”

What does the paper mean by “untapped”? This study on the effect of intraarticular joint injections on the risk of subsequent fracture found that prior imaging on the injected site had been done in less than 8% of cases.

Under the serial testing model, however, a clinical examination that identifies a problem area in the fetlock joint would lead to a second diagnostic test, like a radiograph, to get a better understanding of the issues at play.

If the veterinarian suspects further issues brewing in the fetlock than is visible on the radiograph, they have the option of ordering additional tests using a more sensitive imaging modality, like a positron emission tomography (PET) or an magnetic resonance imaging (MRI) scan.

And why isn’t that done more often as it is? “I think a lot of people are,” said Carpenter. “But I think some people aren’t.”

These are “multifactorial issues,” he added, stressing the need for trainers and their staff to flag sore horses in the first place, at the same time pinpointing the pressure put on trainers from owners and the racing office. “There’s a lot of these other factors that come into play that may or may not lead to good decisions.”

Nevertheless, as the paper points out, “there is no diagnostic test with 100% accuracy,” nor any one clear consensus of how the images are interpreted. To help in that regard, the paper has broken down into a table the pluses and minuses of each available imaging technology.

“Our goal was to basically condense a lot of information into a very useable reference,” said Carpenter.

Each technology–radiography, nuclear scintigraphy, computed tomography (CT), MRI and PET–is rated within the confines of these four categories: strengths, clinical information obtained, practical and technical limitations, and current knowledge gaps.

For nuclear scintigraphy, for example, large areas can be imaged but with low specificity. CT can be done quickly with high spatial resolution images, but there’s currently a knowledge gap in differentiating between active abnormalities in the bone and “static” long-term changes.

But knowledge is only useful when placed into the right hands, and the racing industry, the paper says, would be wise to take some lessons from human medicine, particularly when it comes to regulatory transparency and the sharing of relevant information. From a bird’s-eye viewpoint, the globalization of horse racing could be a more streamlined affair.

“Whilst veterinary assessment and regulatory pathways are in place in many racing jurisdictions globally, transparency about the process and standardization across countries is lacking,” the paper says.

But individual practitioners too must be more willing to share veterinary information that could have a bearing on that horse’s fate on the track, the paper similarly stresses. “Equally, owners, trainers and other stakeholders must understand their obligation to comply with the risk assessment process if they wish to enter a horse in a race.”

The paper also pinpoints several “actionable items” resulting from the symposium. These include:

A best practice guide on fetlock radiography.
The creation of trainer manuals to help them both identify the warning signs of serious fatigue injury and understand how these injuries progress.
The creation of an international, anonymized data repository, into which goes information like racehorse clinical and imaging data, and exercise and racing history.

This repository would then be used as a research tool.

“I don’t think anybody expected this symposium to solve all our problems, but what it did was lay a very nice foundation for the work that will come from this,” said Carpenter. “I think you’re going to look back in three to five years at a lot of good things that came out of this starting point and have a significant impact on this industry.”

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