CROSSTALK: COMBINING DIAGNOSTIC APPROACHES FOR CASE SUCCESS


Fig. 5. Multiplanar reformatted CT images (top row) and fused 18F-NaF PET/CT images (bottom row) of the left hind fetlock of a 14-year-old off-the-track Thoroughbred used for eventing. There is marked focal increased 18F-NaF uptake in the medial compact subchondral bone of the proximal phalanx without associated CT abnormality (short arrow). (Note that the lucency adjacent to the uptake in the transverse plane is a slice thickness artifact.) There is a focal short linear defect in the lateral compact subchondral bone of the proximal phalanx (long arrow), without associated 18F-NaF uptake. This suggests that the lateral lesion is an inactive lesion, likely developmental, whereas there is early stress remodeling of the medial subchondral bone.


The carpus and tarsus are other imaging sites


where PET demonstrates obvious advantages over scintigraphy to better define anatomical location of abnormalities. The carpus is the second ana- tomical site most commonly imaged with PET in racehorses. PET allows uptake from the dorso- proximal aspect of the third carpal bone to be dis- tinguished from the dorsodistal aspect of the


radial carpal bone, which typically cannot be resolved with scintigraphy. PET of the tarsus is particularly interesting in sport horses with lame- ness localized to the distal tarsus or proximal metatarsal area. PET is able to distinguish active from inactive distal tarsal osteoarthritis and also easily detects proximal enthesopathy of the origin of the suspensory ligament (Fig. 3).


Fig. 6. Lateral (A) and dorsal (B) maximal intensity projections of 18F-NaF PET, multiplanar reformat standing low field 3D T1 isotropic MRI (C, E, G) and fused PET/MRI (D, H, F) of the left fore foot of a horse with lameness localized to this region. The 18F- NaF PET demonstrates focal increased uptake at the proximal lateral aspect of the distal phalanx (long arrows). The fused PET/ MRI confirms that this uptake is associated with the attachment of the collateral ligament of the distal interphalangeal joint (short arrows). Changes were not appreciated on MRI in the soft tissue part of the ligament, and the lesion was considered an enthesopathy rather than a desmitis.


AAEP PROCEEDINGS / Vol. 68 / 2022 161


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