Diagnostic utility of computed tomography imaging in equine intracranial conditions.
Authors: Lacombe V A, Sogaro-Robinson C, Reed S M
Journal: Equine veterinary journal
Summary
# Editorial Summary: CT Imaging for Equine Intracranial Disease Lacombe and colleagues evaluated the diagnostic accuracy of computed tomography (CT) and contrast-enhanced CT for detecting intracranial pathology in horses by comparing imaging findings against post-mortem examination of the brain and skull in 15 horses presenting with neurological signs. CT successfully identified space-occupying lesions (neoplasia, acute haemorrhage, skull fractures) in 8 cases and demonstrated excellent specificity (100%) for ruling out disease, meaning a normal scan reliably excludes intracranial abnormality; however, sensitivity was moderate at 57.1%, with particular limitations in detecting inflammatory conditions such as meningitis and meningoencephalitis, as well as non-acute haemorrhage and small parenchymal lesions that were only visible on histopathological examination. Contrast administration did not improve diagnostic yield for these problematic cases. Equine practitioners should recognise that whilst CT is highly valuable for confirming or excluding space-occupying intracranial lesions and acute bleeding, a normal or inconclusive CT scan does not exclude inflammatory brain disease; in such cases, cerebrospinal fluid analysis and advanced neuroimaging modalities may be warranted to reach a definitive diagnosis.
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Practical Takeaways
- •CT is excellent for ruling in skull fractures and intracranial space-occupying lesions but has significant limitations for detecting inflammatory brain disease and subtle parenchymal changes—negative CT does not exclude serious neurological disease
- •Horses with neurological signs and normal or inconclusive CT findings should prompt consideration of advanced diagnostics (MRI where available) or empirical treatment for meningitis/encephalitis rather than complete diagnostic reassurance
- •CT remains a valuable first-line tool for acute intracranial trauma and suspected neoplasia but should not be relied upon as definitive for all intracranial conditions
Key Findings
- •CT imaging had 100% specificity but only 57.1% sensitivity (95% CI: 29.6–81.2) for intracranial lesions in horses
- •CT successfully identified skull fractures, space-occupying lesions (neoplasia), and acute hemorrhage but failed to detect inflammatory disorders and small parenchymal lesions
- •Six of 15 cases with intracranial disease were missed by CT imaging despite abnormal neurological examinations; these lesions were only identifiable on histopathological examination
- •Contrast-enhanced CT did not improve detection of inflammatory lesions or small parenchymal brain pathology compared to standard CT