Page 1208 - Adams and Stashak's Lameness in Horses, 7th Edition

1174 Chapter 12

within normal limits, must be put into perspective based Although the gold standard of equine imaging, MRI
upon clinical findings in order to place appropriate rele­ should not be used as a scanning tool in the PPE. As
VetBooks.ir radiographic findings and the presence of lameness in sound horse, can be potentially confusing to communi­
with nuclear scintigraphy, abnormal MRI findings, in a
vance on the finding. For example, a study that correlated
cate to a prospective buyer. However, MRI for the pur­
PPEs found 85.5%, 70.0%, 37.5%, and 22.7% of horses
with grade 0–3 navicular bones, respectively, to be sound. pose of investigating lameness gives the veterinarian
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It is important to communicate to the prospective buyer much more detailed information to communicate the
that these findings can be identified in the absence of lame­ potential risk to the prospective buyer. The limitations
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ness. In contrast, it is important to communicate and doc­ of MRI are its narrow area of focus, making it inade­
ument that the absence of radiographic abnormalities quate as a screening imaging modality, and, if standing
does not guarantee the absence of future lameness. These MRI is not available, the need for general anesthesia.
situations support the importance of obtaining the horse’s MRI is useful for investigation once an area of interest
past medical history and records, including previous imag­ has been isolated. 14,15
ing, for comparison. If previous radiographs are available, Step Six: Interpretation of Findings and Reporting
comparing studies can help determine the significance of Once the examination is completed, the veterinarian
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an abnormal finding. In cases where there are concerns is tasked with interpreting their findings and communi­
with abnormalities identified on the physical examination cating the findings to the prospective buyer in a well‐
or radiographs and the prospective buyer wishes to con­ organized understandable format, both verbally and
tinue with the PPE, the veterinarian can recommend addi­ written. 1,2,11,13,15,16,21,23–26 The initial verbal report should
tional imaging (ultrasound, nuclear scintigraphy, MRI, be between the veterinarian and prospective buyer
etc.) to further evaluate the findings. Permission from the directly or via the phone. If an agent represents the pro­
owner must be obtained before performing advanced spective buyer, the communication is directed toward
imaging. the agent with the understanding that the prospective
Ultrasound is used commonly in PPEs either as a buyer will receive a copy of the written report. With per­
request of the prospective buyer or for evaluation of mission from the prospective buyer, findings of the PPE
an abnormal finding identified on the examination. can be discussed with the seller. 15,16,24–26
Ultrasound is a necessary skill for the equine practitioner There are numerous recommendation and examples
to have but a skill that is difficult to perfect. Having good‐ of what the final PPE report should contain and what the
quality equipment capable of producing high‐quality format should be. The AAEP has established guidelines
musculoskeletal images is also important. If the veterinar­ to help the examining veterinarian formulate a report
ian is not comfortable performing or interpreting an that is complete, concise, and accurate (Table 12.4). These
ultrasound study, referral to a skilled ultrasonographer are available at https://aaep.org/guidelines/reporting‐
should be offered to the prospective buyer. purchase‐examinations. While compliance with all of
Because of the large variation in ultrasonographic these guidelines helps to ensure a properly reported pur­
appearance between horses and even within the same chase examination, it remains the sole responsibility of
horse, ultrasound is probably best used for investigating the veterinarian to determine the extent and depth
areas of concern identified in the PPE or follow‐up in of each examination. The AAEP recognizes that for prac­
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horses with a history of having soft tissue injuries. The tical reasons, not all examinations permit or require
metacarpal and metatarsal regions are the most com­ veterinarians to adhere to each of these guidelines
mon areas to have ultrasound performed in the PPE. It is (Table 12.4).
common in the aged athlete to find subtle or chronic
changes in, for instance, the proximal suspensory, in an SUMMARY
otherwise sound horse. In a horse that has joint effusion
and no radiographic abnormalities, ultrasound can be The PPE exam is the most complete comprehensive
used to evaluate the surrounding soft tissues. Subtle examination that the veterinarian will be requested to
bony changes may also be evaluated more effectively perform. The information gained from the PPE will be
with ultrasound vs. radiographs. Similar to abnormal used to aid a prospective buyer in making a purchase
radiographs, these findings must be discussed with the decision. Obtaining the information (the PPE) and deliv­
prospective buyer along with their significance to future ering that information in a way that the client under­
soundness or lameness. The reader is referred to the stands and can use to make an informed decision is the
chapter on performing and interpreting ultrasound. sole responsibility of the veterinarian. The veterinarian
Nuclear scintigraphy may be considered when fur­ should be well versed in performing and documenting
ther investigation of a particular finding is of concern to PPEs and be aware of the potential risks. It is the veteri­
the potential buyer(s). It is usually not useful as a screen­ narian’s responsibility to determine the horse’s overall
ing tool. Depending on a horse’s level of activity, scintig­ health and serviceability to perform the prospective
raphy commonly results in a number of areas of buyer’s intended purpose for the horse. The veterinarian
increased radiopharmaceutical uptake that are not asso­ should not hold any responsibility for determining the
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ciated with pathology or lameness. This can cause con­ horse’s suitability for the prospective buyer.
fusion in communication with the prospective buyer, The key to avoiding an unpleasant and potentially liti­
difficulty in interpretation and reporting, and potential gious PPE is clear and open communication between all
termination of an otherwise good purchase. Examples parties involved in the transaction. The owner is respon­
for indications for recommending scintigraphy might sible for willingly supplying any and all performance and
include further investigation of radiographic abnormalities medical history. The prospective buyer is responsible for
in the feet, or neck and back pain. 14,15 clearly communicating their goals of the PPE, their