Scielo RSS <![CDATA[SA Journal of Radiology ]]> http://www.scielo.org.za/rss.php?pid=2078-677820170001&lang=pt vol. 21 num. 1 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Clinically relevant magnetic resonance imaging (MRI) findings in elite swimmers' shoulders</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782017000100001&lng=pt&nrm=iso&tlng=pt BACKGROUND: Shoulder pain is the most common and well-documented site of musculoskeletal pain in elite swimmers. Structural abnormalities on magnetic resonance imaging (MRI) of elite swimmers' symptomatic shoulders are common. Little has been documented about the association between MRI findings in the asymptomatic shoulder versus the symptomatic shoulder. OBJECTIVE: To assess clinically relevant MRI findings in the shoulders of symptomatic and asymptomatic elite swimmers. METHOD: Twenty (aged 16-23 years) elite swimmers completed questionnaires on their swimming training, pain and shoulder function. MRI of both shoulders (n = 40) were performed and all swimmers were given a standardised clinical shoulder examination. RESULTS: Both shoulders of 11 male and 9 female elite swimmers (n = 40) were examined. Eleven of the 40 shoulders were clinically symptomatic and 29 were asymptomatic. The most common clinical finding in both the symptomatic and asymptomatic shoulders was impingement during internal rotation, with impingement in 54.5% of the symptomatic shoulders and in 31.0% of the asymptomatic shoulders. The most common MRI findings in the symptomatic and asymptomatic shoulders were supraspinatus tendinosis (45.5% vs. 20.7%), subacromial subdeltoid fluid (45.5% vs. 34.5%), increased signal in the AC Joint (45.5% vs. 37.9%) and AC joint arthrosis (36.4% vs. 34.5%). Thirty-nine (97.5%) of the shoulders showed abnormal MRI features. CONCLUSION: MRI findings in the symptomatic and asymptomatic shoulders of young elite swimmers are similar and care should be taken when reporting shoulder MRIs in these athletes. Asymptomatic shoulders demonstrate manifold MRI abnormalities that may be radiologically significant but appear not to be clinically significant. <![CDATA[<b>Evaluation of hypofunctioning thyroid nodules with technetium-99m MIBI and ultrasonography</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782017000100002&lng=pt&nrm=iso&tlng=pt BACKGROUND: Fine needle aspiration cytology (FNAC) cannot reliably differentiate follicular adenoma from follicular carcinoma (FC), which requires histological evidence of capsular or vascular invasion. FC is the most predominant thyroid cancer in our loco-regional environment, indicating the need for improvement in preoperative diagnostic accuracy of thyroid nodules to ensure appropriate and timely interventions. OBJECTIVE: The purpose of this study was to assess the role of technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy and ultrasonography (USG) in the differential diagnosis of thyroid nodules. METHODS: Forty-two patients with hypofunctioning thyroid nodules were prospectively studied with 99mTc-MIBI scintigraphy and USG to differentiate benign from malignant nodules. An injection of 740 MBq of 99mTc-MIBI was intravenously administered, followed by semiquantitative analysis of dual-phase scans using a 4-point (0 to 3) scoring system. USG was subsequently performed and interpretation was based on some sonographic criteria for malignancy. In the following days and weeks, patients underwent FNAC followed by surgery and histopathologic examination. RESULTS: All malignant nodules were positive on 99mTc-MIBI and all but two malignant nodules were positive on USG. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy are, respectively, 100%, 70%, 65%, 100%, and 81% for 99mTc-MIBI scintigraphy; 87%, 78%, 68%, 91% and 81% for USG; and 83%, 100%, 100%, 96% and 64% for FNAC. There was no statistically significant difference between 99mTc-MIBI scintigraphy and USG performance for both benign (p = 0.317) and malignant (p = 0.573) nodules. CONCLUSION: 99mTc-MIBI scintigraphy and USG are important imaging modalities in the evaluation of thyroid nodules, particularly follicular neoplasms which are frequently associated with non-diagnostic cytology. <![CDATA[<b>Adult intussusception: An unlikely diagnosis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782017000100003&lng=pt&nrm=iso&tlng=pt Intussusception happens when a portion of bowel telescopes into the adjacent bowel segment. It is a rare condition in the adult population, particularly in the young adult, and poses a diagnostic dilemma to the attending clinician because of its variable clinical presentation. Radiological imaging is important in the early diagnosis, and it allows prompt surgical management to avoid severe complications, particularly bowel ischaemia and necrosis. This case report describes the clinical and multimodality radiological findings of an ileocolic intussusception secondary to a mucosa-associated lymphoid tissue (MALT) lymphoma in a young adult patient. <![CDATA[<b>The FC Rad Diag(SA): Stretched, but still in step - Report on a Royal College observership</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782017000100004&lng=pt&nrm=iso&tlng=pt A delegation of the College of Radiologists of the overarching Colleges of Medicine of South Africa observed the spring sitting of the Part 2B Examination of the Fellowship of the Royal College of Radiologists (FRCR) in London, in April 2016. Although the principal focus of the Observership was the Part 2B examination, the delegates also assessed broader aspects of the FRCR. This report presents an overview of current FRCR practices, including the findings of an independent review of the FRCR, and reflects on the implications for the South African Fellowship examination. The report is based on discussions with key Royal College role players, direct observation of the Part 2B examination and web-based documentation. It allows appreciation of the continued close alignment of the FC Rad Diag(SA) (Fellowship of the College of Radiologists of the Colleges of Medicine of South Africa) with the FRCR and highlights expected trends in the FC Rad Diag(SA). It also documents the increasing human resources required for successful conduct of examinations. It is hoped that the report will be of interest and relevance to the broad South African radiological community and to those contemplating specialist training in the discipline. It is trusted that it will encourage wider involvement of radiological and medical physics colleagues in the various FC Rad Diag(SA) examination processes. <![CDATA[<b>An analysis of diagnostic practices in a mammography unit in a tertiary hospital in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782017000100005&lng=pt&nrm=iso&tlng=pt BACKGROUND: Breast cancer is the most common cancer in females in South Africa. The reporting of breast imaging has been standardised internationally using the Breast Imaging and Reporting Data System (BI-RADS), which includes guidelines for reporting of breast lesions and further management. Ultrasound-guided core-needle breast (UGCNB) biopsy is a widely used method of obtaining histological diagnoses of breast lesions to assist with planning definitive management. OBJECTIVES: To perform an audit of the UGCNB biopsies performed at the Grey's Hospital Mammography Department and assess the accuracy of the radiologists' use of the BI-RADS scoring system. METHODS: Records of all patients who underwent UGCNB biopsy between 01 January 2014 and 31 October 2015 were reviewed. A retrospective study was performed. RESULTS: A total of 304 UGCNB biopsies were performed on 291 patients. The mean age was 49.2 (s.d. = 15.9) years. Tissue samples from 303 lesions were adequate for histological assessment, and of these, 51% of the lesions were malignant whilst 49% were benign. The most common malignant and benign diagnoses were invasive ductal carcinoma and fibroadenoma respectively. The BI-RADS scoring of the radiologists demonstrated a positive predictive value of 61.6% for the identification of possible malignant lesions. CONCLUSION: This study describes the patient and lesion profile and unit practices in a tertiary hospital setting in South Africa. The radiologists' application of the BI-RADS scoring largely conforms to the BI-RADS guidelines. The study highlights several challenges encountered by a breast imaging programme in an under-resourced setting as well as making recommendations in overcoming these challenges. <![CDATA[<b>An assessment of the accuracy of contrast enema for the diagnosis of Hirschsprung disease at a South African tertiary hospital</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782017000100006&lng=pt&nrm=iso&tlng=pt OBJECTIVES: To compare radiological findings with the histological diagnosis of Hirschsprung disease (HD) to establish the usefulness of contrast enema as an initial screening and diagnostic tool. To correlate accuracy of radiological diagnosis at Grey's Hospital with international standards. MATERIALS AND METHODS: Systematic searches were conducted through the Picture Archiving and Communication System and the National Health Laboratory Service records for patients aged 0-12 years, with clinically suspected HD, for whom both contrast enemas and rectal biopsies were performed between 01 January 2011 and 31 August 2015 in a tertiary-level hospital. A total of 54 such patients were identified. Diagnostic accuracy levels were calculated by comparing radiological results with histology results, which is the gold standard. RESULTS: Diagnostic accuracy of contrast enema was 78%, sensitivity was 94.4% and the negative predictive value was 95.7%. Specificity (68.8%) and positive predictive values (63%) were considerably lower. A lower false-negative rate of 5.6% was obtained at Grey's Hospital as compared with the international reports of up to 30%. CONCLUSION: Contrast enema remains useful as an initial screening and diagnostic test for HD. Results of this South African tertiary referral hospital were consistent with the best international results for sensitivity of the contrast enema (approximately 80% - 88% in excluding the disease. <![CDATA[<b>Cherubism: A case report</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782017000100007&lng=pt&nrm=iso&tlng=pt Cherubism is rarely described in the African paediatric population. Orphanet currently lists cherubism as a rare disease; its prevalence is unknown and difficult to determine because of the wide clinical spectrum. Approximately 300 cases have been reported in various ethnic groups worldwide. This report analyses a child referred to our hospital for bilateral jaw swelling, diagnosed with cherubism based on clinical and radiological findings, and confirmed on histology. <![CDATA[<b>Rare case of solitary plasmacytoma of the skull in a young male patient</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782017000100008&lng=pt&nrm=iso&tlng=pt Solitary plasmacytoma of bone without signs of multiple myeloma is a rare entity. It usually presents as an osteolytic lesion in the axial skeleton of an elderly patient. Here, we report a case of solitary plasmacytoma in the skull of a young male patient which emphasises the need to consider it in the differential diagnosis of a destructive calvarial mass lesion even in this age group. <![CDATA[<b>An analysis of diagnostic practices in a mammography unit in a tertiary hospital in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782017000100009&lng=pt&nrm=iso&tlng=pt BACKGROUND: Breast cancer is the most common cancer in females in South Africa. The reporting of breast imaging has been standardised internationally using the Breast Imaging and Reporting Data System (BI-RADS), which includes guidelines for reporting of breast lesions and further management. Ultrasound-guided core-needle breast (UGCNB) biopsy is a widely used method of obtaining histological diagnoses of breast lesions to assist with planning definitive management. OBJECTIVES: To perform an audit of the UGCNB biopsies performed at the Grey's Hospital Mammography Department and assess the accuracy of the radiologists' use of the BI-RADS scoring system METHODS: Records of all patients who underwent UGCNB biopsy between 01 January 2014 and 31 October 2015 were reviewed. A retrospective study was performed. RESULTS: A total of 304 UGCNB biopsies were performed on 291 patients. The mean age was 49.2 (s.d. = 15.9) years. Tissue samples from 303 lesions were adequate for histological assessment, and of these, 51% of the lesions were malignant whilst 49% were benign. The most common malignant and benign diagnoses were invasive ductal carcinoma and fibroadenoma respectively. The BI-RADS scoring of the radiologists demonstrated a positive predictive value of 61.6% for the identification of possible malignant lesions. CONCLUSION: This study describes the patient and lesion profile and unit practices in a tertiary hospital setting in South Africa. The radiologists' application of the BI-RADS scoring largely conforms to the BI-RADS guidelines. The study highlights several challenges encountered by a breast imaging programme in an under-resourced setting as well as making recommendations in overcoming these challenges. <![CDATA[<b>Potential pitfalls in the anorectal region during CT colonography: A discussion and pictorial overview of common pitfalls</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782017000100010&lng=pt&nrm=iso&tlng=pt Common potential anorectal pitfalls are presented with accompanying CT colonography images. Although most lesions are benign, care must be taken in not missing an underlying cancer. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782017000100011&lng=pt&nrm=iso&tlng=pt