Contrast-enhanced ultrasonography has the potential to aid in diagnosis of vascular, inflammatory, and neoplastic diseases and may prove especially useful in determining small intestinal viability intraoperatively. The goal of this study was to determine the optimum dose of contrast medium for evaluating normal perfusion patterns in the canine jejunum. Healthy male and female juvenile dogs (n = 9) that were being anesthetized for routine spay or neutering were included. Following midline celiotomy, the abdominal cavity was filled with warm sterile saline and a probe wrapped in a sterile sleeve was placed directly on a segment of jejunum. Each dog received 3 serial doses (0.007 mL/kg, 0.015 mL/kg, and 0.03 mL/kg) of Definity contrast medium (definityimaging.com). Contrast was administered via peripheral vein by rapid IV bolus with approximately 5 minutes between doses. Images were then downloaded and timeintensity curves were analyzed for each dose. The peak intensity was directly proportional to the dose, and the best images were obtained when a dose of 0.03 mL/kg was used. This was a pilot study and provided normal jejunal perfusion parameters. Further study is needed to evaluate this technique both preoperatively and when intestinal disease is present.
Commentary: Evaluation of intestinal integrity and viability is an important component of surgical decision-making when faced with potentially compromised intestinal tissue. Traditional assessment remains subjective, based on bowel color and motility along with anecdotal surgical experience. Contrast-enhanced ultrasonography has been studied in animal models in the liver, spleen, and kidney with encouraging results. The use of this imaging modality is particularly attractive for intraoperative evaluation of bowel viability because of its rapid nature and relative accessibility. It could provide helpful guidance intraoperatively when tumor margins or bowel viability is in question. Further work is needed to evaluate this technique in infiltrative (inflammatory, neoplastic) or ischemic (volvulus, intussusception) intestinal diseases. Intraoperative or preoperative contrast-enhanced ultrasonography may be a useful and objective adjunct to the traditional methods of evaluating these conditions in dogs and may help guide treatment.—Jason Bleedorn, DVM, Diplomate ACVS
Intraoperative contrast-enhanced ultrasonography of normal canine jejunum. Jiménez DA, O’Brien RT, Wallace JD, Klocke E. VET RADIOL ULTRASOUND 52:196-200, 2011.