Accuracy of the modified vertebral heart score and the cardio-vertebral ratio for radiographic evaluation of cardiomegaly in ferrets

Pierre-Olivier Godart, Yannick Ruel, Mileva Bertal, Shanti Esmieu, Vassiliki Gouni, Albert Agoulon, Hugues Gaillot

Background: Cardiac diseases are common in pet ferrets and thoracic radiography is usually initially implemented in ferrets with suspected heart disease. Several standardized radiographic heart size indicators have been introduced in this species and values in healthy ferrets have been reported. However, none of these indicators has been tested in ferrets with cardiac disease.

Study: The aim of this prospective and retrospective, analytical observational design study was to assess the accuracy of the modified vertebral heart score (mVHS) and the cardio-vertebral ratio (CVR) in the radiographic detection of cardiomegaly in ferrets.

Methods: Thoracic radiographs of 24 ferrets with confirmed heart diseases, 22 ferrets with non-cardiac diseases and normal-sized hearts on echocardiogram, and 24 healthy ferrets were mixed and examined by three independent and blinded radiologists who measured mVHS and CVR in right lateral (RL) and ventrodorsal (VD) radiographs.

Results: For all readers, ferrets with cardiac disease had significantly higher mVHS and CVR than ferrets without cardiac disease on echocardiography. Optimal cut-points for predicting cardiac enlargement were 6.25 vertebrae and 7.25 vertebrae for RL-mVHS and VD-mVHS, and 1.58 and 1.80 for RL-CVR and VD-CVR, respectively. The accuracy was good for indicators measured in RL radiographs (92.9% for RL-mVHS; 91.4% for RL-CVR) and moderate for indicators measured in VD radiographs (88.6% for VD-mVHS; 85.7% for VD-CVR).

Limitations: Echocardiography was the reference modality for distinguishing cardiomegaly from normal-sized heart in diseased ferrets, based on the presence of any cardiac wall hypertrophy or chamber dilation. However, some changes in wall thickness or chamber diameter detected by echocardiography may not have resulted in an increase in external dimensions of the heart.

Conclusions: This study is the first one assessing the accuracy of standardized radiographic heart size indicators for predicting cardiomegaly in pet ferrets in clinical setting. Two previously introduced indicators, the CVR and mVHS, were assessed in RL and VD projections. The performance of all readers was excellent using both indicators in RL projection, and was non-significantly weaker using both indicators in VD projection.

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