Page 330 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Musculoskeletal system: 1.8 Soft-tissue injuries 305

VetBooks.ir BAPTEN trial protocol, is to sum up the lesion be measured, and yet they carry a worse progno-
sis than well-defined core lesions. Special soft-
CSA at each level 1A to 3C (forelimb), 1A to 4C
(hindlimb) or PA to PC for the pastern, and divide
accuracy.
it by the sum of the total tendon CSAs at each level ware may be used on recorded images to improve
(×100). This provides an estimate of lesion volume
and can be used for follow-up. Lesion echogenicity grade
Echogenicity cannot be measured quantitatively but
Havemeyer consensus severity score a semi-subjective assessment of lesion echogenicity
(Thoroughbred forelimb) can be obtained from good-quality images. Common
Lesions may be graded as mild (grade 1) if ratio = grading scales range from 0 to 3 (0 = normal;
0–15%; moderate (grade 2) if ratio = 16–25% and 1 = mostly echogenic; 2 = approximately 50%
severe (grade 3) if ratio >25%. echogenic; 3 = anechogenic) or 0 to 4 (0 = normal;
A major drawback is that the margins of the 1 = mostly echogenic; 2 = half echogenic/half anecho-
lesion are nearly always poorly defined and there genic; 3 = mostly hypoechogenic; 4 = anechogenic)
is a huge interoperator, or even intraoperator, (Figs. 1.584–1.587). This is only part of the story as
variation in measurements, so the accuracy of such a small but very hypoechogenic lesion may not be as
methods remains debatable. Diffuse lesions cannot severe as a large, less hypoechogenic one.

1.584 1.585

Figs. 1.584–1.587
Echogenicity may be
subjectively assessed by
comparing the lesion 1.586 1.587
echogenicity to that of
the normal surrounding
parenchyma. This is very
subjective as it will depend on
the timing of the examination
(acute versus subacute) and
machine settings (gain,
contrast, etc.). Examples on a
grading scale of 0–4: (1.584)
grade 1; (1.585) grade 2;
(1.586) grade 3; and
(1.587) grade 4.