Online Supplementary Material to:
Usefulness of multidetector computed
tomography in the evaluation of spinal
neuromusculoskeletal injuries
Mario Ricciardi
Pingry Veterinary Hospital, Bari, Italy
Vet Comp Orthop Traumatol 2016; 31:
http://dx.doi.org/10.3415/VCOT-15-05-0082
Supplementary Figures
Figure 1 1-year-old male Labrador Retriever dog: Oblique incomplete linear fracture of the
body and right vertebral lamina of T13 (arrows). A) Lateral and B) ventrodorsal survey
radiographs of the thoracolumbar spine; C) sagittal multiplanar reformatted multidetector
computed tomography (MDCT) image of the thoracolumbar spine; D) transverse MDCT
image at level of T13; E) dorsal volume rendered MDCT image at level of vertebral laminae
of T13; F) transverse volume rendered MDCT image at level of T13. The dog was evaluated
for a right scapular fracture and signs of thoracolumbar pain (without neurological
impairment) following a car accident. On survey radiographs, the vertebral abnormalities are
difficult to see because of bone and visceral superimpositions (more evident on ventrodorsal
view – B) MDCT imaging supercedes this major limitation of conventional radiology and
reveals a subtle vertebral fracture of T13 (arrows).
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Figure 2 7-month-old female mongrel dog: Suspected bite wound of the spine. Transverse
multidetector computed tomography (MDCT) images at the level of the (A) caudal and (B)
cranial part of L2 and at (C) level of T11. D) Dorsal multiplanar reformatted image at level of
L2 and L3. E) Ventral and (F) right lateral volume rendered images of thoracolumbar spine.
Transverse and dorsal reformatted images show a fracture of the right lateral vertebral arch
of L2 (A: empty arrowheads) with dislocation of bone fragments within vertebral canal (A, D:
thin arrows), and incomplete fractures of the body of L2 and T11 (B, C: empty arrowheads).
Multiplanar reformatted images clarify extent of displaced fragments within vertebral canal.
Volume rendered images clarify shape of vertebral fracture: they appear as rounded
concavities compatible with tooth imprints (E, F: empty arrowheads) confirming clinical
suspicion. Fracture of the right transverse processes of L1, L2 and L3 (E: arrowheads) and
spinose processes of T11, L2 and L4 (A, B, C, F: thick arrows) are evident.
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Figure 3 3-year-old male Dachshund dog: Fracture of right articular process of L1 (arrows)
with ipsilateral paraspinal muscle contusion (arrowhead). Right (A) lateral and (B) dorsal
volume rendered multidetector computed tomography (MDCT) images of thoracolumbar
spine. Transverse (C) MDCT image and (D) STIR MRI images at level of L1. Computed
tomography images provide high detail for bone tissue but no attenuation changes are seen
in right paravertebral muscle which shows evident pathologic hyperintensity on the MRI
image.
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Figure 4 6-year-old male Breton dog: Post-traumatic C2-C3 acute non-compressive
nucleus polposus extrusions (high speed low volume disc herniation). A) Sagittal T2weighted MRI image of cervical spine showing dishomogeneous focal intramedullary
hyperintensity at C2-C3 level (arrow). B) Sagittal multiplanar reformatted multidetector
computed tomography image of cervical spine of same dog with no evidence of attenuation
changes within cervical spinal cord at C2-C3 level. Computed tomography shows less
sensitivity for spinal cord lesions in comparison to MRI.
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Figure 5 9-year-old female mixed breed dog: L1-L2 subluxation and comminuted fracture
of caudal margin of the body of L1 with displaced fragments within the spinal canal. A)
Sagittal and B) dorsal multiplanar reformatted multidetector computed tomography (MDCT)
images acquired without apnea (tachypnoic patient). C) Sagittal and D) dorsal multiplanar
reformatted MDCT images acquired with apnea induced by manual hyperventilation. Note
vertical (A: short arrow) and horizontal (B: short arrow) lines that deform the edges of the
vertebral bodies, vertebral laminae (B: empty arrowhead), paraspinal muscles (B: filled
arrowhead) and ribs. Breathing artefacts are clearly seen, even on intra-canalar fragments
deforming their real shape (A, B, C: long arrows).
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Figure 6 9-year-old female mixed breed dog: L1-L2 subluxation and comminuted fracture
of the caudal margin of the body of L1 with fragment displacement within the spinal canal
(arrows). A) Sagittal multiplanar reformatted multidetector computed tomography (MDCT)
image acquired with bone algorithm; B) sagittal multiplanar reformatted MDCT image
reconstructed with spine algorithm from raw data of previous scan; C) sagittal multiplanar
reformatted MDCT image acquired with soft tissue algorithm after IV administration of
iodinate contrast medium; D) sagittal T2-weighted MRI image. MRI show extensive
intramedullary T2 signal change cranially to site of luxation (D: asterisks) compatible with
compressive myelopathy or myelomalacia (note the signal intensity of normal spinal cord –
arrowhead). Native, reconstructed and post-contrast MDCT images were unable to clearly
demonstrate correspondent intramedullary attenuation changes.
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Figure 7 1-year-old female Main Coon cat: T6-T7 vertebral fracture-luxation. A) Sagittal
multiplanar reformatted multidetector computed tomography (MDCT) image of thoracic
spine. B) Transverse multiplanar reformatted MDCT image at level of T6 (vertical line in A
indicates the level of transverse image in (B). C, D) Sagittal and transverse multiplanar
reformatted MDCT images at the same level after decompressive surgery. Sagittal images
show dorsoventral spinal cord compression due to vertebral misalignment while transverse
images show fracture of the T6 body and lateral compression of the spinal cord by a large
bone fragment inside the vertebral canal (arrow). D) Post-surgery evaluation shows complete
removal of the fragment.
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Figure 8 3-year-old male Poodle dog: C5-C6 vertebral luxation. A) Sagittal multiplanar
reformatted multidetector computed tomography (MDCT) image of C4-C7 cervical spine. B)
Dorsal, C) right lateral, and D) transverse volume rendered images of C5-C6 articulation.
Dorsoventral vertebral misalignment and right torsion of C5 respect to C6 with right articular
process\facet joints disarticulation.
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Figure 9 2-year-old mixed breed dog: L4-L5 extension vertebral fracture and luxation with
associate retroperitoneal haemorrhage. A) Midsagittal volume rendered image of
lumbosacral spine. B) Transverse multiplanar reformatted MDCT image at level of L4-L5
intervertebral space. Inciting force induced extreme extension of vertebral column with
consequent vertebral luxation and fracture of ventro-caudal margin of body of L4 (A:
arrowhead). In this case, an irregular retroperitoneal effusion, isoattenuating to soft tissue
and suggestive of retroperitoneal haemorrhage, was associated (B: arrow).
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Figure 10 2-year-old female mixed breed dog: Atlanto-axial subluxation secondary to
fracture of the dens. A) Sagittal multiplanar reformatted multidetector computed tomography
(MDCT) image of atlanto-axial articulation. B) Left lateral volume rendered image of atlantoaxial articulation. Clear visualisation of fragmented apex of dens (arrows) and dorsal
displacement with respect to the ventral arch of the atlas.
Figure 11 A, B) 2-year-old female mixed breed dog: Normal atlantoaxial articulation with
normally developed dens (asterisk). A) Sagittal multiplanar reformatted multidetector
computed tomography (MDCT) image; B) volume rendered image at level of dens (asterisk).
C, D) 1-year-old female Volpino Italiano dog: Traumatic atlanto-axial subluxation in patient
with hypoplasic dens. C) Midsagittal and D) dorsal volume rendered images of the
atlantoaxial articulation at the level of the dens. Hypoplasic dens appears as a short
prominence on the cranial margin of the axis body favouring atlantoaxial subluxation.
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Figure 12 12-year-old male mixed breed dog: Multiple fractures of the atlas and atlantoaxial subluxation. A) Transverse and B) sagittal multiplanar reformatted multidetector
computed tomography (MDCT) images of atlanto-axial articulation. C) Dorsal and D) ventral
volume rendered images of atlas. Complete fragmentary fracture of the dorsal arch of the
atlas on the left side (A: arrow; C) and complete simple fracture of the ventral arch on the
right side (A: arrowhead; D). Cranial displacement of the dens on the ventral arch of the atlas
is also evident (B: arrow).
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Figure 13 12-year-old male mixed breed dog: Compression fracture of the body of T12
with T12-T13 subluxation. A) Midsagittal, B) dorsal, and C) ventral volume rendered images
of T12-13 articulation. Inciting force in caudocranial direction induced compression fracture of
the caudal part of the body of T12 (A, C: arrows). Associated torsional forces led to lateral
T12-T13 luxation with disarticulation of articular processes (B arrowhead).
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Figure 14 5-year-old male mixed breed dog: Compression fracture of the body of L1 (A, C,
D) and simple complete linear fracture of vertebral lamina (B, E: arrows). A) Midsagittal, C)
parasagittal and D) dorsal multiplanar reformatted multidetector computed tomography
(MDCT) images of toracolumbar spine. B) Dorsal volume rendered image of T12-L2 segment
and C) transverse volume rendered image at level of L1. A vacuum phenomenon is also
visible at the L1-L2 intervertebral space (C: arrowhead).
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Figure 15 5-year-old female mixed breed dog: Burst fracture of the body of L4. A) Sagittal
multiplanar reformatted multidetector computed tomography (MDCT) image of lumbar spine.
B) Dorsal volume rendered image of L3-L5 segment at the level of the vertebral bodies.
Severe axial load on the L4 vertebral body provoked a multifragmentary burst fracture
(arrow).
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Figure 16 1-year-old male Domestic Shorthair car: Transverse sacral fracture (Type III) at
the level of the caudal part of S2. A) Sagittal multiplanar reformatted and B) dorsal volume
rendered multidetector computed tomography images of lumbosacral spine.
Figure 17 12-year-old male mixed breed dog: Avulsion fracture at the origin of the left
sacrotuberous ligament (Type IV). A) Dorsal multiplanar reformatted and B) dorsal volume
rendered multidetector computed tomography images of lumbosacral spine.
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Figure 18 Schematic representation of three-compartment model on sagittal (A) and
transverse (B) volume rendered image of canine vertebrae. Red lines illustrate the dorsal,
middle and ventral spinal compartments. In case of damage to more than one of these
compartments, the vertebral injury should be considered unstable.
Figure 19 13-year-old female Yorkshire Terrier dog: Transverse multidetector computed
tomography (MDCT) image at the level of caudal portion of L5 showing selective atrophy of
left epaxial (musculus spinalis lumborum and longissimus lumborum) (arrow) and hypaxial
(musculus quadratus lumborum and psoas maior) (arrowhead) musculature. Left epaxial
muscles appear hypoattenuating compared to contralateral ones, with mean attenuation
value of -44 Hounsfield Units suggestive of fatty replacement. The dog had a 2-month
history of non-progressive left hindlimb lameness following car accident; MRI showed
selective lesion of left fifth lumbar nerve root leading to selective atrophy of the
corresponding ipsilateral paravertebral lumbar musculature (extending from L4 to L6) and
corresponding thigh muscles. Fatty infiltration in association with muscle atrophy is often
considered a consequence of chronic denervation, developing months after the nerve root
damage and indicating irreversible changes.
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Figure 20 1-year-old male French Bulldog: Multiple pelvic fractures and L3-L4
intramedullary damage, compatible with spinal cord contusion, following a car accident. A)
ventral, B) dorsal and C) left lateral volume rendered multidetector computed tomography
(MDCT) images of the pelvis. D) Sagittal multiplanar reformatted MDCT image of the
lumbosacral spine. E) Transverse multiplanar reformatted MDCT image at L3 level. F)
Sagittal T2-weighted MRI image of lumbosacral spine. G) Transverse T2-weighted MRI
image at level of L3. Use of MDCT provides good bone detail (contrast resolution) accurately
showing multiple ischiatic (long arrows), pubic (short arrows), and iliac (arrowheads)
fractures of pelvis but no attenuation changes can be detected within the spinal cord. MRI
show intramedullary signal changes as abnormal T2-hyperintensity at L3-L4 level (empty
arrowshead) compatible with spinal cord contusion. On T1-weighted images this lesion was
isointense.
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Figure 21 2-year-old female mixed breed dog: Gunshot lesions of the lumbosacral
vertebral column. A) Midsagittal, B) transvere, and C) dorsal multiplanar reformatted
multidetector computed tomography (MDCT) images of the lumbosacral spine. D)
Transverse multiplanar reformatted MDCT image at the level of L6. Multiple metallic foreign
bodies (firearms bullets) are present within the epaxial musculature (arrows) in close contact
with S3-Cd1 articulation (A, B, C). Visibility of image detail is hindered by star-shaped beam
hardening artefacts radiating from the metallic bodies.
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