Diagnóstico de rutura de ligamento cruzado cranial no cão por ressonância magnética.
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2020-10-02
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A articulação do joelho é a maior e mais complexa no cão, sendo sujeita a diferentes e elevadas forças mecânicas. Para manter a movimentação anatómica correta da articulação esta possui vários ligamentos, nomeadamente o ligamento cruzado cranial. A rutura de ligamento cruzado cranial no cão é o problema ortopédico mais frequentemente recebido na prática clínica para diagnóstico e tratamento. A rutura pode ser de origem traumática ou degenerativa, sendo esta última a mais comum. Em casos não traumáticos trata-se de uma patologia multifatorial. O diagnóstico desta patologia apresenta alguma dificuldade mesmo para clínicos experientes em casos de rutura parcial, ou de ruturas com alguma cronicidade. Métodos convencionais de diagnóstico, como é o caso da radiologia, podem ser não específicos para a doença ligamentar e meniscal, evidenciando apenas sinais secundários como a efusão e osteoartrite. A ressonância magnética destaca-se como exame de diagnóstico por imagem não invasivo, pois permite o estudo das estruturas da articulação do joelho de forma detalhada e minuciosa, principalmente dos ligamentos e meniscos, os quais são de visualização limitada noutros exames complementares, tendo por isso uma presença crescente na prática clínica moderna. Uma avaliação detalhada do estado da articulação do joelho permite-nos programar o tratamento cirúrgico adequado a cada animal de forma personalizada ao indivíduo, e não apenas pela presença ou ausência de rutura no ligamento. Assim sendo, o objetivo deste estudo foi: realizar o diagnóstico de rutura de ligamento cruzado cranial e a avaliação das lesões do joelho na doença ligamentar, evidenciando o poder diagnóstico do exame imagiológico de ressonância magnética para esta patologia. Foram avaliadas ressonâncias de 41 articulações de 35 animais com suspeita de rutura de ligamento cruzado cranial. Os exames foram realizados com um equipamento de ressonância de VET-MR GRANDE 0.2 T (ESAOTE ®) e com uma antena DPA que variava consoante o tamanho e fisionomia do animal. Todas as imagens foram obtidas com o animal sob anestesia geral. Os cães foram posicionados em decúbito lateral para o lado afetado, com o joelho adjacente à mesa do equipamento. Em todos os exames foram obtidos planos sagitais, dorsais e transversais. Após a revisão dos exames foi realizada uma análise estatística descritiva dos casos recolhidos e posterior interpretação dos resultados. Dos meniscos lesionados, o lateral foi o mais afetado (38%). A fibrose concentrouse principalmente a nível articular difuso (41%) e a efusão sinovial na região retropatelar (72%). Dos 9 animais com lesão osteocondral, 11% tinham rutura parcial de ligamento. Dos 5 animais com exame bilateral e lesões num dos membros 20% não apresentou qualquer lesão relativa a doença ligamentar no membro contralateral. Comprovou-se que a ressonância magnética (neste caso de baixo campo) permite o diagnóstico de rutura de ligamento cruzado cranial e uma avaliação detalhada das lesões do joelho. Por último, a doença ligamentar, a qual pode iniciar-se, ou culminar na rutura de ligamento cruzado cranial, é de facto uma doença multifatorial e com diversas apresentações, não seguindo um desenvolvimento igual e padronizado em todos os casos.
The knee joint is the largest and most complex joint in the dog, being subject to different and high mechanical forces. To maintain the correct anatomical movement of the joint there are several ligaments, namely the cranial cruciate ligament. The commonest cause of canine stifle disease is cranial cruciate ligament injury, which is often associated with subsequent damage to the meniscus. The rupture can be of traumatic or degenerative origin, the latter being the most common. In non-traumatic cases it is a multifactorial disease. While acute, complete cranial cruciate ligament rupture can be accurately diagnosed by experienced clinicians on physical examination, chronic tears and partial ruptures are less easy to detect. Radiography is often non-specific in the diagnosis of cranial cruciate ligament and meniscal disease, showing only the secondary changes of joint effusion and osteoarthritis. Magnetic resonance imaging is becoming increasingly available as a diagnostic tool in small animal practice and offers a non-invasive method in the evaluation of canine cranial cruciate ligament and meniscal disease. The aim of this study was to evaluate the lesions and findings in the MR images and show the diagnostic value of magnetic resonance as an imaging modality in the stifle cruciate disease. Magnetic resonance (MR) images of 41 stifles from 35 dogs which had undergone MRI for the investigation of stifle disease were reviewed. Imaging was performed with a 0,2 T whole-body scanner VET-MR GRANDE 0.2 T (ESAOTE ®), using a DPA coil varying according to the patient’s size. All images were obtained with the patients under general anaesthesia. The dogs were positioned in lateral recumbency, with the stifle being imaged positioned adjacent to the couch. In each case, images were obtained in sagittal, dorsal, and transverse planes. After reviewing the exams, a descriptive statistical analysis of the cases collected, and subsequent interpretation of the results was performed. Of the injured menisci, the lateral was the most affected (38%). Fibrosis was mainly diffuse in the joint (41%) and effusion in the retropatelar region (72%). Of the 9 animals with osteochondral injury, 11% had partial ligament rupture. Of 5 the animals with bilateral examination and lesions in one limb, 20% did not present any lesion related to ligament disease in the contralateral limb. It has been proven that magnetic resonance imaging (in this case, low field) allows a thorough evaluation of the knee in ligament disease and the diagnosis of cranial cruciate ligament rupture. Finally, the ligamentous disease, which can start or culminate in the rupture of the cranial cruciate ligament, is in fact a multifactorial disease and with several presentations, not following an equal and standardized development in all cases.
The knee joint is the largest and most complex joint in the dog, being subject to different and high mechanical forces. To maintain the correct anatomical movement of the joint there are several ligaments, namely the cranial cruciate ligament. The commonest cause of canine stifle disease is cranial cruciate ligament injury, which is often associated with subsequent damage to the meniscus. The rupture can be of traumatic or degenerative origin, the latter being the most common. In non-traumatic cases it is a multifactorial disease. While acute, complete cranial cruciate ligament rupture can be accurately diagnosed by experienced clinicians on physical examination, chronic tears and partial ruptures are less easy to detect. Radiography is often non-specific in the diagnosis of cranial cruciate ligament and meniscal disease, showing only the secondary changes of joint effusion and osteoarthritis. Magnetic resonance imaging is becoming increasingly available as a diagnostic tool in small animal practice and offers a non-invasive method in the evaluation of canine cranial cruciate ligament and meniscal disease. The aim of this study was to evaluate the lesions and findings in the MR images and show the diagnostic value of magnetic resonance as an imaging modality in the stifle cruciate disease. Magnetic resonance (MR) images of 41 stifles from 35 dogs which had undergone MRI for the investigation of stifle disease were reviewed. Imaging was performed with a 0,2 T whole-body scanner VET-MR GRANDE 0.2 T (ESAOTE ®), using a DPA coil varying according to the patient’s size. All images were obtained with the patients under general anaesthesia. The dogs were positioned in lateral recumbency, with the stifle being imaged positioned adjacent to the couch. In each case, images were obtained in sagittal, dorsal, and transverse planes. After reviewing the exams, a descriptive statistical analysis of the cases collected, and subsequent interpretation of the results was performed. Of the injured menisci, the lateral was the most affected (38%). Fibrosis was mainly diffuse in the joint (41%) and effusion in the retropatelar region (72%). Of the 9 animals with osteochondral injury, 11% had partial ligament rupture. Of 5 the animals with bilateral examination and lesions in one limb, 20% did not present any lesion related to ligament disease in the contralateral limb. It has been proven that magnetic resonance imaging (in this case, low field) allows a thorough evaluation of the knee in ligament disease and the diagnosis of cranial cruciate ligament rupture. Finally, the ligamentous disease, which can start or culminate in the rupture of the cranial cruciate ligament, is in fact a multifactorial disease and with several presentations, not following an equal and standardized development in all cases.
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Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
rutura de ligamento cruzado cranial , cão