Diagnostic performance of ultrasonography, bursography and standing magnetic resonance to detect navicular intrabursal pathology in horses with foot pain.
Authors: Maleas, Werpy, Joostens, Bladon, Gerlach, Mageed
Journal: Equine veterinary journal
Summary
# Editorial Summary Navicular intrabursal pathology remains a significant diagnostic challenge in horses presenting with chronic forelimb lameness, as accurate identification of the specific structures involved—including deep digital flexor tendon (DDFT) lesions, fibrocartilage defects, dorsal fibrillations and adhesions—directly influences treatment strategy and prognostication. Researchers compared the diagnostic accuracy of three non-invasive imaging modalities (ultrasonography, standing MRI and bursography) against bursoscopy as the gold standard, evaluating 21 feet from 17 lame horses that underwent all four procedures with blinded image interpretation. Standing MRI demonstrated superior performance for detecting dorsal fibrillations (94% accuracy) and DDFT splits (81%), but performed poorly for fibrocartilage defects (58%) and adhesions (37.5%), whilst bursography achieved moderate accuracy for fibrocartilage defects (68%) and DDFT lesions (85%), and ultrasonography was least reliable overall, particularly for adhesions (25% accuracy) and showing the poorest inter-observer agreement. These findings suggest that standing MRI remains the preferred single imaging modality when available, though practitioners without access to this technology could employ complementary ultrasonography and bursography to improve diagnostic confidence, with the understanding that adhesions and fibrocartilage defects remain challenging to identify reliably with non-invasive techniques.
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Practical Takeaways
- •For horses with suspected navicular disease, combine ultrasonography and bursography as a practical alternative when standing MRI is unavailable or unaffordable, particularly for detecting DDFT pathology
- •Be aware that no single imaging modality reliably detects adhesions or fibrocartilage defects; if these are clinically suspected, consider bursoscopy as the only definitive diagnostic tool
- •MRI excels at identifying dorsal fibrillations and DDFT splits, making it valuable when available, but ultrasonography alone has significant limitations and requires careful interpretation
Key Findings
- •MRI demonstrated 94% accuracy for detecting dorsal fibrillations and 81% accuracy for DDFT splits, but only 58% accuracy for fibrocartilage defects and 37.5% for adhesions
- •Bursography showed 85% accuracy for DDFT lesions and 68% for fibrocartilage defects, with similar poor performance for adhesions compared to MRI
- •Ultrasonography had 65% accuracy for DDFT lesions but only 25% accuracy for adhesions, and showed the poorest inter-observer agreement of the three modalities
- •Bursoscopy identified lesions in 95% of feet (20/21), confirming high prevalence of navicular intrabursal pathology in this lame population