Feasibility, indications, and radiographically confirmed diagnoses of standing extremity cone beam computed tomography in the horse.
Authors: Pauwels Frederik E, Van der Vekens Elke, Christan Yan, Koch Christoph, Schweizer Daniela
Journal: Veterinary surgery : VS
Summary
# Standing CBCT in Equine Lameness Diagnosis: A Practical Assessment When traditional radiography and ultrasound fail to pinpoint the source of lameness, farriers and veterinarians often face diagnostic dead ends that delay treatment planning. Pauwels and colleagues evaluated the feasibility of standing cone beam computed tomography (CBCT) as a clinical tool by retrospectively reviewing 59 CBCT examinations of equine extremities performed under standing sedation, categorising cases by diagnostic certainty before imaging and recording acquisition time, image quality, and diagnostic yield. The technique proved efficient and reliable: median examination time was 14 minutes with three acquisitions per case, and in cases where a specific diagnosis was suspected beforehand, CBCT confirmed or definitively ruled out that diagnosis in 73% of cases (24/33); notably, in a further five of nine cases with no prior diagnosis, CBCT established a definitive diagnosis. Additional value emerged from contrast-enhanced imaging techniques, which yielded supplementary diagnostic information in 78% of cases (14/18) where employed. For equine practitioners, standing CBCT represents a practical middle ground between conventional imaging and general anaesthesia—capable of delivering timely, high-resolution three-dimensional information about bone, cartilage, and soft tissue structures whilst keeping horses standing, making it particularly valuable when standard modalities are inconclusive or when detailed surgical planning requires precise anatomical definition.
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Practical Takeaways
- •Standing CBCT is a practical option for diagnosing extremity lameness in horses without anesthesia risk, taking only ~14 minutes per examination
- •Use standing CBCT when radiographs and ultrasound are inconclusive but diagnosis is still unclear; it definitively confirms or rules out suspected conditions in ~73% of cases
- •Contrast-enhanced CBCT imaging significantly improves diagnostic yield and should be considered when additional detail is needed for surgical planning
Key Findings
- •Standing CBCT examinations were completed in median time of 14 minutes with 3 acquisitions per case
- •Suspected diagnoses were confirmed or definitively refuted in 73% (24/33) of cases with pre-existing diagnostic suspicion
- •Additional diagnostic information was obtained in 89% (16/18) of cases where contrast techniques were employed
- •Standing CBCT proved feasible and diagnostically useful without general anesthesia