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Improved Identification of the Palmar Fibrocartilage of the Navicular Bone with Saline Magnetic Resonance Bursography

Schramme M., Kerekes Z., Hunter S., et al.

Veterinary Radiology & Ultrasound, 2009. 50(6): p.606-614.

Fibrocartilage degeneration is the earliest pathologic finding in navicular disease but remains difficult to detect, even with magnetic resonance (MR) imaging. We hypothesized that injection of the navicular bursa with saline would improve accuracy of MR imaging evaluation of palmar fibrocartilage. Thoracic limbs were collected from 11 horses within 6†h of death. Imaging was performed with a 1.5†T magnet using sagittal 2D proton density and transverse 3D FLASH sequences with fat saturation. For the purpose of determining sensitivity and specificity of the MR images, fibrocartilage was classified as normal or abnormal, based on combination of the findings of gross and microscopic pathology. Thickness of fibrocartilage was measured on histologic sections and corresponding transverse FLASH MR images before and after injection of saline. A paired Student's t-test was used for comparison of measurements. Partial thickness fibrocartilage loss was present in 6 of 22 limbs. Sensitivity of precontrast MR images for detection of lesions was 100% while specificity was 6%. Saline MR arthrography resulted in both sensitivity and specificity of 100% based on consensus review. Mean histologic fibrocartilage thickness was 0.75±0.12†mm. Mean fibrocartilage thickness on precontrast transverse FLASH images was 0.93±0.065 and 0.73±0.09†mm on postsaline images. The histologic cartilage thickness was signficantly different from that in precontrast images (P<0.001) but not in images acquired after saline injection (P=0.716). Based on our results, and using pulse sequences as described herein, navicular fibrocartilage can only be evaluated reliably for the presence of partial thickness lesions after intrabursal injection of saline.