Positive contrast magnetic resonance bursography for assessment of the navicular bursa and surrounding soft tissues.
Authors: Maher, Werpy, Goodrich, McIlwraith
Journal: Veterinary radiology & ultrasound : the official journal of the American College of Veterinary Radiology and the International Veterinary Radiology Association
Summary
# Editorial Summary: Positive Contrast MR Bursography for Navicular Assessment Palmar heel pain remains a diagnostic challenge in equine practice, and magnetic resonance imaging alone may not clearly identify adhesions within the navicular bursa—a common source of chronic lameness. Maher and colleagues used positive contrast bursography (injecting contrast solution directly into the bursa) during MR imaging of normal cadaver limbs and those from lame horses, varying injection volumes from 2–6 ml to establish how progressive distension affected tissue visualisation and adhesion identification. Progressive distension revealed distinct anatomical details: 2 ml adequately distended the proximal recess, 4 ml separated the collateral sesamoidean ligament from the deep digital flexor tendon, and 6 ml was required to separate the navicular bone from both the tendon and distal sesamoidian impar ligament. In pathological specimens and clinical cases, contrast distension substantially improved visualisation of adhesions that would otherwise remain indeterminate on standard MRI. For practitioners managing horses with suspected navicular bursa pathology, this technique offers a definitive diagnostic approach when conventional imaging cannot confirm adhesion presence—potentially guiding more targeted therapeutic intervention and improving prognostic accuracy.
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Practical Takeaways
- •If standard MRI is inconclusive about adhesions in the navicular bursa, MR bursography with controlled distension can provide diagnostic clarity for horses with palmar heel pain
- •Adhesions in the navicular bursa may not be visible on conventional MRI and require contrast distension to be reliably detected
- •This advanced imaging technique can guide treatment decisions in cases where conventional diagnostics cannot rule out bursal adhesions as a pain source
Key Findings
- •2 ml of solution distends the proximal recess of the navicular bursa; 4 ml separates the collateral sesamoidean ligament from the DDFT; 6 ml separates the navicular bone from the DDFT and distal sesamoidean impar ligament
- •Adhesions were more clearly visualized following bursal distension in pathologic cadaver limbs compared to undistended bursae
- •MR bursography enabled definitive determination of adhesion presence or absence in clinical cases where standard MRI was inconclusive