phd thesis summary · afectiuni dermatologice afectiuni neurologice probleme stomatologice. 9 chart...

UNIVERSITY OF AGRICULTURAL SCIENCES ANDVETERINARY MEDICINE CLUJ NAPOCA

DOCTORAL SCHOOLFACULTY OF VETERINARY MEDICINE

PhD Student GLAD MORAR

PhD THESISSummary

SCIENTIFIC COORDINATOR:Prof. IONEL PAPUC, PhD

CLUJ NAPOCA

2014




PhD THESISSummary


CLUJ NAPOCA

2014




PhD THESISSummary


CLUJ NAPOCA

2014




SUMMARY

RELEVANCE AND LIMITS OF CLINICAL ANDIMAGING EXAMINATION OF CRANIAL AND

DENTAL AFFECTIONS IN DOG


CLUJ NAPOCA

2014




SUMMARY




CLUJ NAPOCA

2014




SUMMARY




CLUJ NAPOCA

2014

3

Table of Contents

INTRODUCTION ........................................................................................................4WORKING HYPOTHESIS ........................................................................................6PURPOSE OF THE THESIS ......................................................................................6BIOLOGICAL MATERIAL.......................................................................................7RESULTS AND DISCUSSION.................................................................................11

Radiographic examination of the teeth .................................................................12Radiographic examination of the skull .................................................................13

COMPUTER DIAGNOSIS AND cranial tomography in dental diseases DOG ..14DIAGNOSIS BY MAGNETIC RESONANCE IN DENTAL AND CRANIALAFFECTIONS IN DOG.............................................................................................14CONCLUSIONS.........................................................................................................15References....................................................................................................................16

4

INTRODUCTIONDiagnosis of diseases or performing therapeutic procedures in the twenty-first

century, are unthinkable without the help of medical imaging or without the results of

laboratory analyzes. Using these methods complement clinical examination and

laboratory provides safety and accuracy of medical care.

Medical imaging is a relatively new branch of medicine, and has emerged as a

necessity in order to establish a correct and accurate diagnosis.

Better management of the patients and the diagnostic process, in veterinary

medicine, was asked by customers as an increasingly demanding for pets health and

spectacular discoveries of recent years in the field of medical imaging.

In 1895 Wilhelm Rontgen discovered X-rays and performed first X-rays in

humans, and in 1896, in England, Hobday and Johnson published the first article on

the use of X-rays in veterinary medicine. Also in 1896, in Berlin, Troester made the

first X-rays, in veterinary medicine, followed by french Lemoine, issues presented in

scientific articles.

Also computed tomography was invented by Sir Godfrey Hounsfield in 1970,

and in October 1, 1971 was placed in a clinic in London, managing to establish the

diagnosis of cerebral cyst in a human patient. Images in the experimental period of the

CT system were obtained using cow brain.

Nobel Prize in Physics is awarded in 1952 to Felix Bloch and Edward Purcell,

scientists who discovered independently of one another the magnetic resonance. The

emergence of the first magnetic resonance device in 1970 is due to increased

processing speed of computers, they managed to calculate the data fast enough to

create a usable image and appearance superconductors have managed to create strong

electromagnetic fields, which led to the possibility of using in medicine. The device

has been used in human medical clinics since 1977, and in veterinary medicine in

1980. In the 80’s and 90’s the technology was not widely implemented yet due to the

large size of the devices and high purchase prices. In America, these devices were

installed in specially built trailers and moved by rotating by truck to veterinary

schools and several specialized veterinary clinics.

5

Radiological technique has made a huge leap, moving from long exposure

times up to 30 minutes at an exposure time of a few milliseconds, from the

radiological image rendered on film, to render them on your computer and digital

storage media. The quality and sharpness were improved gradually in tandem with

technological advances. Major changes have suffered also diagnostic techniques using

computerized tomography which decreased radiation than the amount needed to form

the image, the more sensitive receptors and magnetic resonance apparatus is

miniaturised and become more accessible.

In human medicine diagnostic imaging has become a routine diagnostic, which

is intended to achieve also in the Romanian veterinary medicine, and in this paper we

try to reveal the importance and limits of diagnostic imaging in cranial and dental

diseases in dogs by a standardization anatomical orientation elements and the better

identify the working parameters of the device.

***

Medical imaging has undergone remarkable progress in the last decade. The

need to improve the certainty of diagnosis using laboratory methods have spurred

research towards achieving optimal and rapid methods in terms of imaging. Rapid

changes in digital technology have created opportunities for the development of high-

class equipment in the field of medical imaging practice. Thus, radiography, computed

tomography, magnetic resonance methods of investigation are key in making a

diagnosis on the image, and by a judicious use of their techniques can increase the

limits of the range associated with other techniques.

Modern medicine requires an early and efficient diagnosis. No condition where

basically, imaging evaluation not bring an extra element of diagnosis. The use of these

modern methods of investigation does not decrease the role and importance of clinical

examination but completes it. Clinician, based on physical examination will guide the

imaging examination. The clinician must be familiar with the indications and

diagnostic value of each imaging and which laboratory methods to choose, depending

on the particularities of each case, the most suitable method that will confirm or refute

the clinical diagnosis.

6

WORKING HYPOTHESISEstablishing a definite diagnosis by corroborating information obtained from

clinical examination, medical imaging examination and laboratory examination, will

give security and accuracy of care and clinician the opportunity to implement a

working protocol clear and concise to prove that the work is done properly and with

maximum effectiveness in the patient's interest.

Traditional and digital radiography, computed tomography and magnetic

resonance imaging as modern imaging methods will be customized to each case, thus

revealing the importance and limitations of the method and the information obtained

will be combined with laboratory data or cytological examination geared vital signs

for correctly diagnosticate clinical disease.

PURPOSE OF THE THESIS

The purpose of this doctoral thesis is to highlight the importance and

limitations of clinical examination and medical imaging in the diagnosis of dental and

cranial disorders in dogs by standardizing the working parameters of the machine and

by targeting anatomical elements.

In dental conditions in dog the examiner will identify the proper dental

radiography techniques, how to interpret the images obtained, working parameters of

the device, the patient's position and the position of the exposure and the disease will

identify cranial imaging method that provides the most accurate information about the

outbreak pathogen.

Based on the results will establish a working protocol in the management of

dental and cranial disorders in dogs, taking as its starting point the diagnosis.

The research objectives.

Identification and application of relevant dental radiography techniques and

adapting those techniques toward establishing a clinical diagnosis.

Setting the proper parameters in dental radiographs to ensure the

best image quality.

Establishing patient position and radiographs exposure in dental affection.

7

Identification, selection and use of medical imaging methods: radiography,

CT and magnetic resonance in cranium affection diagnosis based on clinical diagnosis.

Creation of an algorithm to use various methods of diagnostic

imaging according to cranium pathology.

Identification and use of relevant laboratory methods that will complete

clinical examination and imaging data according to pathology.

Implementation a management system and management of cranium and

dental affection dogs.

By correlating the current data in the literature with those obtained by us from

own research, we hope to make significant contributions to complement data from

veterinary dentistry and in the field of medical imaging and laboratory in the head

diseases in dogs.

BIOLOGICAL MATERIALStudy was conducted during 2010 - 2014 on a total of 510 dogs with diverse

pathology, of different sex and ages 4 months to 14 years (Chart 1).

Of the 510 cases, 120 of dogs (23% of all cases examined) have been

diagnosed with different fracture type 60 dogs (12% of all cases examined) have been

diagnosed with respiratory affection, 35 dogs (7% of all cases examined) were

diagnosed with heart disorders, 40 dogs (8% of all cases examined) were diagnosed

with viral diseases, 65 dogs (12% of all cases examined) were diagnosed with

metabolic disorders, 35 dogs (7 % of all cases examined) were diagnosed with skin

problems, 45 dogs (9% of all cases examined) were diagnosed with neurological

diseases, 25 dogs (5% of all cases examined) were diagnosed with dental problems, 45

dogs (9% of all cases examined) have been diagnosed with various disorders localized

to the neurocranium and 40 dogs (8% of all cases examined) have been diagnosed

with various disorders localized to the splahnocranium (Chart 2, Chart 3).

8

Chart 1 Distribution of cases by sex

Chart 2 Distribution of number of examined cases

Rott

wei

ler

Brac

ger

man

Pins

cher

piti

cPe

chin

ezSe

tter

irla

ndez

0102030

40

50

60

24

129

27 3133

114 7

1521

138

212 10

Numar pacienti

406535

4525

4540

8



Sett

er ir

land

ezCo

cker

span

iel

Amer

ican

staf

ford

shire

…

Pitb

ull

Gold

en re

trie

ver

Pug

Husk

y

Cio

băne

sc g

erm

an

Labr

ador

Bulld

og e

ngle

z

Tosa

inu

Boxe

r

Met

is

31 33

21

6

43

22

37

5653

22

11

44

59

21

117

4

27

9

2419

29

17

6

35 37

10

2214

2

1613 13

37

24

5 5 9

22

Numar pacienti Masculi Femele

120

60

3540

Fracturi

Afectiuni respiratorii

Afectiuni cardiace

Afectiuni virale

Tulburari metabolice

Afectiuni dermatologice

Afectiuni neurologice

Probleme stomatologice

8



Met

is

59

37

22


Afectiuni cardiace





9

Chart 3 Percentage distribution of examined cases

Of the 510 cases consulted a number of 110 cases were subject to imaging

diagnostic, 25 patients were diagnosed with dental problems, 45 patients with diseases

of the neurocranium and 40 patients with disorders splanchnocranium. Of the 110

patients undergoing imaging examination, 60 patients (55%) were subjected to

radiographic examination, on 30 patients (27%) was performed CT examination and

in 20 patients (18%) was performed RM examination (Graph 4).

Figure 4 Graphical representations of cases subject to different imaging methods

From 110 cases studied, 60 dogs were subjected to radiological examination of

which 20 dogs were diagnosed with dental problems (33.33%), 20 dogs showed

problems in the neurocranium (33.33%) and 20 dogs showed the splanchnocranium

disorders (33.33%) (Chart 5).

12%7%

9%

5% 9%8%

6030

20

9













23%

12%

7%8%

8%

Fracturi


Afectiuni cardiace

Afectiuni virale




Examen Rx

Examen CT

Examen RM

55%

27%

18%Examen Rx

Examen CT

Examen RM

9

















Examen Rx

Examen CT

Examen RM

10

Chart 5 Graphical representation of radiologic pathology30 patients were subjected to CT examination, 5 of them suffering from dental

problems, 15 dogs with problems in the neurocranium and 10 dogs with problems in

the splanchnocranium (Chart 6).

Chart 6 Graphical representation of pathology diagnosed by CT

RM examination was performed in 20 patients, 10 of them suffering from

diseases related to the neurocranium and 10 of them suffering from diseases related to


Chart 7 Graphical representation of pathology diagnosed by examination RMRadiological examinations were performed within the discipline of semiology

and Imaging, Faculty of Veterinary Medicine of Cluj Napoca, and veterinary clinic

5

15

10

5

15

10

Problemestomatologice

Afectiunilocalizate lanivelulneurocraniului

1010


Afectiunilocalizate lanivelulsplahnocraniului

10












33,3%

33,3%

33,3%





17%

50%

33%


Afectiuni localizatela nivelulneurocraniului

Afectiuni localizatela nivelulsplahnocraniului



50%50%



10













Afectiuni localizatela nivelulneurocraniului

Afectiuni localizatela nivelulsplahnocraniului



11

Biovet Cluj Napoca. CT examinations were performed in various imaging clinics in

Cluj Napoca and Bucharest and RM examination was performed in the laboratory of

Veterinary magnetic resonance Bucharest.

All patients in the study were subjected to the principles of research ethics and

animal protection standards and safety principle of the work in laboratories using X-

rays required by the National Commission for Nuclear Activities Control (CNCAN),

both for patients and qualified staff.

RESULTS AND DISCUSSIONOf the 110 cases subject to imaging diagnostics, represented numerically

(Chart 8) and in terms of percentage (Chart 9) will be presented the most relevant

cases, both in terms of dental diseases and the skull pathology.

Chart 8 Distribution of number of cases examined by imaging methods

40

11












25

45


Afectiuni localizate lanivelul neurocraniului

Afectiuni localizate lanivelul splahnocraniului

11















12

Chart 9 Percentage distribution of cases examined by imaging methodsRadiographic examination of the teeth

Using radiological technique of the whole skull in latero-lateral incidence,

provides information about the status of the mandibular arch, the maxillary sinus,

temporomandibular joint, dental alveoli and the presence of pathological formations.

Dental radiographic technique in dogs presents a set of features: enamel is the

most radio-opaque tissue and dentin it is less radio-opaque and is easy to see because

it is part of the root and hard tissue beneath the enamel. Radiographic examination of

the entire skull was done using three exposures position: latero-lateral, dorsal-ventral,

ventral-dorsal, is easier to perform and provides an overview of the structures in this

area. Parallel technique provides the best dental radiographic image projection that is

performed on a scale of 1: 1 without lengthening or shortening of the tooth

image. Mandibular symphysis and palate stretch in a cranial direction, which limits the

use of this technique for viewing these formations.

Bisect angle X-ray technique is not as useful as parallel technique, but is only

accessible to expose upper and lower incisors.

Intra-oral radiography technique is greatly influenced by the shape of the skull:

Dolichocephalics (long nose) or brachiocephalic (short nosed). Brachyephalic breeds

are more difficult to examine due to crowding of teeth as if Dolichocephalics breeds

are more spaced teeth making accessible intra-oral technique.

36%

12




















23%

41%




12






















13

Using radiological examination techniques is essential in veterinary dentistry

because offer information on different data structures, about the volume, number,

positioning and integrity of teeth and other ordonto-periodontal elements.

Relevant radiographic images were obtained from the oral cavity following

roentgen machine working parameters:

dog under 15 kg - 100 mA / 60kVA, 0.1 seconds at 40cm distance;

dog between 15 kg and 30 kg - 100 mA / 60-70kV, 0.1 seconds at 40cm

distance;

dogs over 30 kg - 100 mA / 70-85kV, 0.1 seconds from 40cm distance.

Radiographic examination of the skull

Of the total number of cases diagnosticated with severe skull were selected 8

representative cases from the point of view of the imaging technique used and in terms

of diagnosed pathology. Each case had a clinical observation sheet with patient data,

medical history and clinical examination, radiological diagnostic and if where

necessary the hematological and morphological examination. It was established a

presumptive clinical diagnosis confirmed or denied by hematological,

histopathological, cytological or necropsy evaluation.

Dog skull radiographs are relevant to diseases that affect part of the skull bones

or the radiopaque foreign bodies located in the soft tissues. X-ray examination can be

used in the diagnosis of disorders localized at the level of the front of the nose and

sinuses. Accurate diagnosis of fractures requires at least two exposures in different

positions. Radiography provides few details about the structure of soft tissues and any

details about the pathology of the central nervous system. Clinical examination may

indicate the position of the patient and the relevant radiological exposure method

according to clinical diagnosis. Values of the roentgen machine working parameters

which have led to the best images of affections skull were between 56kV / 1mAs

(small animals) and 68kV / 2mAs large animals.

14

COMPUTER DIAGNOSIS AND cranial tomography in dental diseases

DOGCT examinations were performed in human medicine clinics in Bucharest and

Cluj - Napoca on a total of 30 patients with diverse pathology. Out of total 30 cases

were selected 4 representative cases with tumor, dental and sinus diseases to better

outline the advantages of the method in the pathology of the skull and to make a

comparison with radiological examination. Clinical observation sheets cases include

patient identification, medical history, clinical examination, CT scanning and

appropriate hematological, histology, pathology, cytology and necropsy.

CT scanning provides clear and precise results on the bone structure of the

skull. CT scanning may be used in the diagnosis of tumor formation or other localized

in the head. CT scanning provides more accurate information on dental pathology

compared with radiographs. CT scanning is limited in terms of the soft tissues of

normal anatomical structure of the patient, but is relevant in diagnostic their tumor

pathology. Compared to radiographs, computed tomography has the main advantage

of better rendering pathology and provides the ability to perform three-dimensional

reconstructions that help clinicians identify anatomy without overlapping plans

allowing them to establish a definite diagnosis. Administration of contrast in CT

scanning allows visualization of the tumor mass and differentiation between tumor

mass and a vascular malformation. Correct diagnosis in tumors and tumor cell type is

determined only by histopathology.

DIAGNOSIS BY MAGNETIC RESONANCE IN DENTAL AND

CRANIAL AFFECTIONS IN DOGRM examinations were performed in the laboratory of veterinary magnetic

resonance NMR Vets in Bucharest on a total of 20 patients diagnosed with various

pathologies.

Each patient was prepared clinical observation sheet with its identification data,

clinical examination and where appropriate RM haematological, histological,

cytological and necropsy.

15

Of the 20 cases studied were selected 9 cases with diverse pathology in order to

highlight the relevance and limitations of magnetic resonance examination and be able

to make a comparison with other medical imaging methods used.

Magnetic resonance examination provides important data related to central

nervous system pathology and soft tissue in the head, the examination of choice in

these conditions. Magnetic resonance examination provides important information for

differential diagnosis and refute or confirm the clinical diagnosis based on the

neurological examination. Magnetic resonance examination can establish a diagnosis

of intracranial tumors and certainty in identifying neurological damage that can give

epileptiform events. To perform magnetic resonance examination in the head position

of the patient should not be changed. Magnetic resonance imaging examination offers

several plans, so clinicians can form an overview of the central nervous system, the

intranevraxial cavities and the cerebrospinal fluid. Magnetic resonance examination

allow a better contrast than that obtained by CT or radiologic examination, which

provides more precise information on the differences in tissue structure because it uses

partial properties of spins of the nuclei that make up tissues. Magnetic resonance

examination use magnetic fields and radio frequencies instead of ionizing radiation,

harmful effects on the body are significantly lower compared with CT and radiologic

examination.

And in the case of magnetic resonance examination as in the case of the CT

examination, the diagnosis of certain tumor cell type is determined based only on

histopathological examination.

CONCLUSIONSJudicious use of radiological examination, a CT scan, magnetic resonance

examination and laboratory tests in the diagnosis of cranial and dental disease in dogs

is an obligation of the clinician to be contained in a routine protocol, and limits of an

examination can increase the range associated to another exam.

The examiner should identify relevant imaging method to get the best

information to establish a diagnosis of certainty. Corroborating data from the data

16

obtained by imaging exams, hematological or histopathological helps to establish an

etiologic diagnosis.

References1. Bârsasteanu, F., Mogoseanu, M., Motoi, S., Onet, D., Aboud, I., 2002, Lucrari

practice de radiologie – Atlas, Timisoara.

2. Falcă C. (coordonator), Mircean M.V., Moţ T., Brăslaşu C.M., Giurgiu G.,

Vlăgioiu C., Pop C., Papuc I., Solcan Gh., Vulpe V., 2011. Medicina internă a

animalelor, vol. I şi II, Ed. Eurostampa, Timişoara

3. Lăcătuş R, 2013, Utilizarea substanţelor de contrast nonionice în radiodiagnostic

la câine şi pisică, Ed. Academicpres, Cluj-Napoca, România.

4. Morar G, Lăcătuş R, Purdoiu RC, Papuc I, 2014, Radiological investigations of

head pathology in dogs. Bulletin of University of Agricultural Sciences and

Veterinary Medicine Cluj-Napoca. Veterinary Medicine, Vol 71, No 2

5. Morar G, Purdoiu RC, Lăcătuş R, Tule H, Papuc I, 2014, Arthrography in cats

with non-ionic contrast agent ULTRAVIST 300, Bulletin of University of

Agricultural Sciences and Veterinary Medicine Cluj-Napoca. Veterinary

Medicine, Vol 71, No 1.

6. Moţ T., 2006, Patologie medicala veterinara. Aparatul respirator. Aparatul

cardiovascular, Ed. Eurostampa, Timisoara.

7. Papuc I., 2013, Semiologie şi semiotică medicală veterinară, Ed. Accent, Cluj-

Napoca.

8. Papuc, I., R. Lăcătuş, F. Stan, A. M. Covaciu, R. C. Purdoiu, 2009, Semiologie,

imagistică medicală şi laborator clinic veterinar, Accent Publishing, Cluj

Napoca.

9. Purcell, EM, Torrey, H.C., Pound, R.V., 1946, Resonance absorption by nuclear

magnetic moments in a solid. Phys. Rev. 69, 37-38..

10. Vulpe, V., 2004, Semiologie şi imagistică veterinară. Semiologie specială, Ed.

ETP Tehnopress, Iaşi.

11. Salanţiu, V., Ulici-Petruţ, I., 1995, Semiologie medicală veterinară şi diagnostic

pe imagine, curs intern. Tipo Agronomia, Cluj-Napoca

phd thesis summary · afectiuni dermatologice afectiuni neurologice probleme stomatologice. 9 chart...

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