Scielo RSS <![CDATA[SA Journal of Radiology ]]> vol. 22 num. 1 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>Interventionalists' perceptions on a culture of radiation protection</b>]]> BACKGROUND: Occupational exposure to ionising radiation poses potential health risks to radiation workers unless adequate protection is in place. The catheterisation laboratory is a highly contextualised workplace with a distinctive organisational and workplace culture. OBJECTIVE: This study was conducted to understand the culture of radiation protection (CRP). METHODS: This study was a qualitative study and data were collected through 30 in-depth and 6 group interviews with 54 purposively selected South African interventionalists (interventional radiologists and cardiologists). The participants included a diversity of interventionalists who varied in sex, geographic location and years of experience with fluoroscopy. The transcribed data were analysed thematically using a deductive and inductive approach. RESULTS: 'Culture of radiation protection' emerged as a complex theme that intersected with other themes: 'knowledge and awareness of radiation', 'radiation safety practice', 'personal protective equipment (PPE) utilisation' and 'education and training'. CONCLUSION: Establishing and sustaining a CRP provides an opportunity to mitigate the potentially detrimental health effects of occupational radiation exposure. Education and training are pivotal to establishing a CRP. The time to establish a culture of radiation in the catheterisation laboratory is now. <![CDATA[<b>Multidetector computed tomography has replaced conventional intravenous excretory urography in imaging of the kidneys: A scoping review of multidetector computed tomography findings in renal tuberculosis</b>]]> BACKGROUND: Tuberculosis (TB) is a worldwide infectious disease burden, especially in non-developed countries, with increased morbidity and mortality among human immunodeficiency virus (HIV)-infected patients. Extrapulmonary TB is rare and renal TB is one of the commonest manifestations. The end result of renal TB is end-stage renal disease; however, this can be avoided if the diagnosis is made early. The diagnosis of renal TB is challenging because of the non-specific presentation and low sensitivity of clinical tests. Although the sequel of TB infection in the kidney causes varying manifestations depending on the stage of the disease, multidetector computed tomography (MDCT) is capable of demonstrating early findings. We performed a 20-year scoping review of MDCT findings in renal TB to promote awareness. AIM: To identify specific MDCT imaging characteristics of renal TB, promote early diagnosis and increase awareness of the typical imaging features. METHODS AND MATERIAL: We searched published and unpublished literature from 1997 to 2017 using a combination of search terms on electronic databases. We followed the Joanna Briggs Institute guidelines. RESULTS: A total of 150 articles were identified, of which 145 were found through electronic search engines and 5 were obtained from grey literature. Seventy-nine articles that fulfilled our inclusion criteria were reviewed. These included original research, case reports, literature review, organisational reports and grey literature. CONCLUSION: Multidetector computed tomography can reproduce images comparable with intravenous excretory urography; together with advantages of being able to better assess the renal parenchyma and surrounding spaces, it is important in suggesting the diagnosis of renal TB and clinicians should consider including MDCT when investigating patients with recurrent urinary tract infection not responding to usual antimicrobial therapy. <![CDATA[<b>Imaging findings and outcomes in patients with carotid cavernous fistula at Inkosi Albert Luthuli Central Hospital in Durban</b>]]> BACKGROUND: Carotid cavernous fistulas (CCFs) are relatively uncommon and are difficult to diagnose clinically. Radiological imaging plays a significant role in making the diagnosis with recent advances improving the ability of radiologists to diagnose the condition. Despite these developments, digital subtracted angiography (DSA) remains the gold standard in diagnosing CCFs and simultaneously provides the opportunity for intervention. OBJECTIVES: To determine the imaging findings of patients presenting to Inkosi Albert Luthuli Central Hospital (IALCH) with a CCF and to assess the outcome of endovascular intervention. METHOD: We reviewed the electronic records and archived imaging data of consecutive patients diagnosed with CCF between January 2003 and May 2016 at IALCH, in particular, the imaging findings, intervention and subsequent outcomes. RESULTS: Computed tomography (CT) was the most utilised imaging modality prior to patients undergoing DSA. A dilated superior ophthalmic vein (96%) was the most prevalent imaging finding on axial imaging. At DSA, all except two patients had high-flow fistulas. The fistulas predominantly drained anteriorly (69.44%) and a cavernous internal carotid artery aneurysm was identified in eight patients. Occlusion of the fistula was attained in all patients that were compliant with follow-up and underwent intervention (n = 36, 100%), but parent artery sacrifice was required in 10 cases (27.78%). CONCLUSION: A wide range of imaging modalities can be used in the workup of a CCF. CT is currently the most accessible modality in our setting, with limited access to magnetic resonance imaging. On axial imaging, a dilated superior ophthalmic vein is the commonest finding. Classification of a fistula according to flow dynamics and noting the presence of aneurysms or pseudoaneurysms was found to be more practical in comparison to the traditional Barrow's classification. Management outcomes at our institution compare well with available local and international data. <![CDATA[<b>Reliability assessment of a mechanism-based approach to post-injury knee magnetic resonance imaging interpretation by general radiologists</b>]]> BACKGROUND: A mechanism-based approach to post-injury knee magnetic resonance imaging (MRI) interpretation, following acute complex knee injury, is cited by several authors to provide increased reporting accuracy and efficiency, by allowing accurate prediction of injury to at-risk structures. This remains to our knowledge untested in a developing world setting and is of interest to us as South African general radiologists. OBJECTIVE: To assess the reliability of a mechanism-based approach to complex post-trauma knee MRI interpretation when implemented by general radiologists in a South African setting, and compare our results with the findings of North American authors who compiled and assessed the same classification. To measure the agreement between the observers. METHODS: A quantitative, observational, investigative, retrospective study was performed using a sample of 50 post-trauma knee MRI studies conducted at Grey's Hospital, Pietermaritzburg. Two investigators independently applied the consolidated mechanism-based approach compiled by Hayes et al. as a research tool to interpret the knee MRI studies, blinded to each other's findings. RESULTS: Injury mechanism was assigned in 32% of cases by the principle investigator and in 20% of cases by the supervisor, with fair agreement between the observers (k = 0.39). The investigators agreed that 62% of cases were not classifiable by mechanism, 26% because of highly complex injury and 26% because of non-specific findings. CONCLUSION: Our findings indicate that the Hayes et al. classification is a non-ideal tool when used by general radiologists in our setting, as the pure injury mechanisms described in the classification were rare in our study group. Patient epidemiology and investigator experience are highlighted as potential limiting factors in this study. Despite this, we advocate that the concept of a mechanism-based approach for the interpretation of acute post-trauma knee MRI holds value for general radiologists, particularly in patients imaged before resolution of bone bruising (within 12-16 weeks of injury), and those injured in sporting and similar athletic activities. <![CDATA[<b>Pictorial essay: Computed tomography findings in acute aortic syndromes</b>]]> Acute aortic emergencies are life-threatening conditions that may require urgent surgical or interventional management. Imaging plays an important role in the diagnosis and planning of the management, and timely intervention helps in reducing mortality and morbidity. <![CDATA[<b>Anti-Ma2-antibody-associated encephalitis: An atypical paraneoplastic neurologic syndrome</b>]]> Paraneoplastic syndromes are a heterogeneous group of conditions affecting cancer patients, where the signs and symptoms are not owing to the local effects of the tumour but instead owing to humoral or immunologic effects. We describe an unusual presentation of a paraneoplastic neurologic syndrome presenting with predominant involvement of the hypothalamus and deep grey nuclei secondary to an anterior mediastinal germinoma and associated with anti-Ma2 antibody. <![CDATA[<b>Magnetic resonance imaging of classified and unclassified Müllerian duct anomalies: Comparison of the American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology classifications</b>]]> Magnetic resonance imaging (MRI), due to its optimal delineation of anatomy, has become the mainstay in imaging for diagnosing Müllerian duct anomalies (MDA). Pelvic MRI is requested for various conditions such as primary amenorrhoea, infertility or poor obstetric history with regard to MDA, as identifying the exact aetiology for these conditions is vital. Knowledge regarding the classification of MDA is important, as the treatment varies with respect to the different classes. As all the lesions do not fit within the classification of the American Society for Reproductive Medicine, a new anatomy-based classification was established by the European Society of Human Reproduction and Embryology and the European Society for Gynecological Endoscopy, to fulfil the needs of experts. We aim to discuss various classes of classified and unclassified MDA with regard to both the above-mentioned classifications and illustrate some of them using various cases based on pelvic MRI studies. <![CDATA[<b>Magnetic resonance imaging in exertional compartment syndrome of the forearm: Case-based pictorial review and approach to management</b>]]> Exercise-related limb pain poses a management dilemma to the clinician. The term 'chronic exertional compartment syndrome' (CECS) (previously known as 'anterior tibial syndrome') refers to a condition characterised by exercise-induced pain in one or more muscle groups and is more commonly seen in the lower limbs. Much less has been reported about the upper limbs where the muscular compartments are variably noted to be involved. A high index of clinical suspicion should therefore be maintained to avoid missing the diagnosis. Although commonly noted in athletes, CECS can occur in any age group with any level of exercise activity. In addition, there is no age predilection and the syndrome may be bilateral. The exact prevalence is not known as many athletes modify their training methods, thus delaying or avoiding medical assistance and imaging. The pathophysiology of compartment syndrome is complex. In this review of the syndrome, we describe the cycle of intracellular events leading to CECS and the eventual destruction of muscle. There is considerable overlap with the many possible causes of limb pain. Even the most experienced clinicians experience some difficulty in making this diagnosis of CECS, but with increasing awareness of this entity and availability of good-quality magnetic resonance imaging to confirm the suspicion, upper limb CECS is being more commonly diagnosed and patients more timeously managed.