Scielo RSS <![CDATA[SA Journal of Radiology ]]> http://www.scielo.org.za/rss.php?pid=2078-677820160001&lang=pt vol. 20 num. 1 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Chest X-ray patterns of pulmonary multidrug-resistant tuberculosis in children in a high HIV-prevalence setting</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782016000100001&lng=pt&nrm=iso&tlng=pt BACKGROUND: Paediatric multidrug-resistant tuberculosis (MDR-TB) necessitates a prolonged duration of treatment with an intensive treatment regimen. The chest X-ray patterns of pulmonary TB depend on a multiplicity of factors, including immune status, and therefore identifying the influence of HIV on the chest X-ray appearances of MDR-TB may assist with improving the diagnostic criteria. OBJECTIVES: To describe the demographic characteristics and chest X-ray patterns of children with pulmonary MDR-TB and to compare the chest X-ray patterns of pulmonary MDR-TB between children who are HIV-infected and HIV-uninfected. METHOD: Retrospective chart review of hospital notes and chest X-rays of children with pulmonary MDR-TB at King Dinuzulu Hospital, Durban. The chest X-rays were systematically reviewed for the presence of the following variables: hilar/mediastinal lymphadenopathy, bronchopneumonic opacification, segmental/lobar consolidation, cavities, miliary opacification and pleural effusion. RESULTS: Forty-five children (mean age, 6.29 years; median age, 6.00 years) with pulmonary MDR-TB met the inclusion criteria. The most common chest X-ray finding was consolidation (53.5%), followed by lymphadenopathy (35.6%), bronchopneumonic opacification (33.3%) and cavities (31.1%). Cavities were more common (OR 6.1; 95% CI 1.52-24.66) in children who had been initiated on standard anti-TB treatment for the current TB episode. There were no statistically significant differences in any of the chest X-ray patterns in HIV-uninfected (n = 22) compared with HIV-infected (n = 20) children. CONCLUSION: The most common chest X-ray finding was consolidation, followed by lymphadenopathy, bronchopneumonic opacification and cavities. The finding of a significantly higher frequency of cavities in children who had received prior standard anti-TB treatment for the current TB episode could reflect poor disease containment and increased parenchymal damage, owing to a delay in the recognition of MDR-TB. The development of cavitation in chest X-rays of children with TB could raise concern for the possibility of MDR-TB, and prompt further testing <![CDATA[<b>Temporal evaluation of computed tomographic scans at a Level 1 trauma department in a central South African hospital</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782016000100002&lng=pt&nrm=iso&tlng=pt BACKGROUND: Time is a precious commodity, especially in the trauma setting, which requires continuous evaluation to ensure streamlined service delivery, quality patient care and employee efficiency OBJECTIVES: The present study analyses the authors' institution's multi-detector computed tomography (MDCT) scan process as part of the imaging turnaround time of trauma patients. It is intended to serve as a baseline for the institution, to offer a comparison with institutions worldwide and to improve service delivery METHOD: Relevant categorical data were collected from the trauma patient register and radiological information system (RIS) from 01 February 2013 to 31 January 2014. A population of 1107 trauma patients who received a MDCT scan was included in the study. Temporal data were analysed as a continuum with reference to triage priority, time of day, type of CT scan and admission status RESULTS: The median trauma arrival to MDCT scan time (TTS) and reporting turnaround time (RTAT) were 69 (39-126) and 86 (53-146) minutes respectively. TTS was subdivided into the time when the patient arrived at trauma to the radiology referral (TTRef) and submission of the radiology request, to the arrival at the MDCT (RefTS) location. TTRef was statistically significantly longer than RefTS (p < 0.0001). RTAT was subdivided into the arrival at the MDCT to the start of the radiology report (STR) and time taken to complete the report (RT). STR was statistically significantly longer than RT (p < 0.0001 CONCLUSION: The time to scan (TTS) was comparable to, but unfortunately the report turnaround time (RTAT) lagged behind, the findings of some first-world institutions <![CDATA[<b>Uterine artery embolisation as an effective choice for symptomatic fibroids: Five-year outcome</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782016000100003&lng=pt&nrm=iso&tlng=pt BACKGROUND: Uterine artery embolisation for the treatment of symptomatic uterine fibroids is a relatively new but internationally recognised procedure. The present study seeks to report the results of the largest South African series of uterine artery embolisations for symptomatic fibroids to date. It is the fourth article to be published in South Africa on the outcomes of this procedure, and the largest South African series to date. OBJECTIVE: To evaluate the long-term efficacy of uterine artery embolisation in women with symptomatic fibroids in a tertiary hospital in South Africa. METHODS: Eighty-two women who presented for uterine artery embolisation at a single site in South Africa for symptomatic fibroids were retrospectively studied. Outcomes included recurrence and re-intervention rates, patient satisfaction and complication rate. RESULTS: Two patients required repeat embolisation, and one patient experienced fibroid recurrence without further intervention. No repeat myomectomies were performed. Eighty percent of patients reported being satisfied, 12% partially satisfied and 7% not satisfied. No major complications were reported. CONCLUSION: Uterine artery embolisation was shown to be a good choice in the treatment of symptomatic fibroids and presents favourable long-term outcomes in the South African population. <![CDATA[<b>Histological underestimation of a 9-gauge stereotactic vacuum-assisted breast biopsy system compared with surgical excision at a tertiary hospital in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782016000100004&lng=pt&nrm=iso&tlng=pt BACKGROUND: Breast cancer is a major cause of morbidity and mortality worldwide. Certain lesions encountered on mammography require histological assessment of biopsy samples to identify benign versus malignant disease. Stereotactic vacuum-assisted breast biopsy (SVAB) is a useful technique, especially for non-palpable microcalcific lesions, and was introduced at our institution in 2011. OBJECTIVES: To determine whether the histological underestimation from 9-gauge SVABs performed at our institution is within acceptable limits. METHOD: In this cross-sectional study, 9-gauge stereotactic biopsy histology results and breast imaging and reporting data system (BI-RADS) findings of 158 lesions (from 153 patients) were analysed and the histological findings compared with surgical excision histology results (54 lesions) to determine histological underestimation (upgrade rates). RESULTS: One out of eight cases of ductal carcinoma in situ (DCIS) was underestimated, yielding a DCIS underestimation rate of 12.5%. CONCLUSION: The DCIS underestimation obtained from the present study in our institution was on a par with other authors' findings and was therefore within acceptable limits. Atypical ductal hyperplasia underestimation could not be reliably obtained with the small study population. <![CDATA[<b>Role of cranial computed tomography in human immunodeficiency virus-positive patients with generalised seizures</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782016000100005&lng=pt&nrm=iso&tlng=pt BACKGROUND: Emergency neuroimaging of human immunodeficiency virus (HIV)-positive patients with generalised new onset seizures (NOS) and a normal post-ictal neurological examination remains controversial, with the general impression being that emergency imaging is necessary because immunosuppression may blur clinical indicators of acute intracranial pathology. The objectives of our study were to establish whether cranial computed tomography (CT) affects the emergency management of HIV-positive patients with generalised NOS and a normal post-ictal neurological examination. METHOD: We conducted a prospective descriptive observational study. Consecutive HIV-positive patients of 18 years and older, who presented to the Kimberley Hospital Complex's Emergency Department within 24 hours of their first generalised seizures and who had undergone normal post-ictal neurological examinations, were included. Emergency CT results as well as CD4-count levels were evaluated. RESULTS: A total of 25 HIV-positive patients were included in the study. The results of cranial CT brought about a change in emergency care management in 12% of patients, all of them with CD4 counts below 200 cells/mm³. CONCLUSION: We suggest that emergency cranial CT be performed on all HIV-positive patients presenting with generalised NOS and a normal post-ictal neurological examination, particularly if the CD4 count is below 200 cells/mm³. <![CDATA[<b>Multi-voxel proton magnetic resonance spectroscopy changes in neuropsychiatric lupus patients</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782016000100006&lng=pt&nrm=iso&tlng=pt PURPOSE: In this prospective study, we used 2D chemical shift imaging (CSI), a multi-voxel proton spectroscopy technique, to evaluate the brain metabolites on conventional magnetic resonance imaging (MRI) in normal-appearing white and grey matter in systemic lupus erythematosus (SLE) patients with neuropsychiatric symptoms (NPSLE); without neuropsychiatric symptoms (non-NPSLE); and healthy controls (HCs). Our objective was to find metabolites that discriminated NPSLE patients from the non-NPSLE and HC cohorts. MATERIALS AND METHODS: The study included 23 NPSLE patients, 20 non-NPSLE patients, and 21 HCs. A clinical assessment including the SLE disease activity index (SLEDAI) and systemic lupus international collaborating clinics (SLICC) scores was conducted. All patients underwent conventional MRI and 2D CSI technique to acquire the following metabolic ratios: NAA/Cr, Cho/Cr, and Cho/NAA in the anterior and posterior insula, anterior frontal and parietal white and grey matter, thalamus, basal ganglia, and occipital grey matter. RESULTS: In terms of metabolic differences, the NPSLE patients had significant differences compared with the non-NPSLE and HC groups in the: left posterior insula (increased Cho/NAA; p = 0.008), right internal capsule (increased Cho/Cr; p < 0.05), left thalamus (increased NAA/Cr; p = 0.011), anterior grey matter (increased NAA/Cr; p = 0.004), posterior grey matter (increased Cho/NAA; p = 0.016), anterior white matter (increased NAA/Cr; p = 0.012), and left posterior white matter (increased Cho/NAA; p = 0.022). The NPSLE patients showed significantly higher SLEDAI scores (p < 0.001). CONCLUSION: We found several significant distinct metabolic differences between NPSLE and non-NPSLE/HC patients in various brain locations. <![CDATA[<b>Assessment of the impact of application of single-photon emission computed tomography and SPECT-CT on lesion categorisation in bone scintigraphy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782016000100007&lng=pt&nrm=iso&tlng=pt OBJECTIVES: To assess initial experience with the use of a new single-photon emission computed tomography-computed tomography (SPECT-CT) in the evaluation of lesions METHODS: The folder number, radiopharmaceutical used and type of scan of patients examined with a new Siemens T6 SPECT-CT between 02 April 2016 and 31 December 2013 were retrieved. The number of 99mTc-MDP bone scans was sufficient for a detailed analysis. The scans were re-processed and reported by the observer before he was given any clinical information. Whole body planar, whole body planar plus SPECT and whole body planar plus SPECT-CT images were assessed successively in three separate sessions at least 2 weeks apart. At each session, the certainties of detection, localisation and categorisation of each lesion were recorded RESULTS: A total of 539 lesions were seen on the whole body, SPECT and computed tomography (CT) images in 133 patients. The whole body images showed no lesions in 3 patients and 378 lesions in 130 patients. SPECT detected 122 additional lesions in 79 patients. Thirty-nine (12.2%) lesions were seen only on CT in 32 (24.1%) patients. For the 261 lesions seen on the planar images in the SPECT field of view, lesion detection was definite in 233 (89.3%), localisation definite in 151 (57.9%) and categorisation definite in 123 (47.1%) lesions. On the SPECT, definite lesion detection, localisation and categorisation were recorded, respectively, for 259 (99.2%), 228 (87.4%) and 176 (67.4%) of the 261 lesions. Lesion detection, localisation and categorisation certainties were definite for 100%, 99.1% and 94.7% of the SPECT-CT lesions, respectively CONCLUSION: SPECT markedly improves lesion detection and localisation, and CT enhances lesion categorisation <![CDATA[<b>A retrospective analysis of ultrasound-guided large core needle biopsies of breast lesions at a regional public hospital in Durban, KwaZulu-Natal, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782016000100008&lng=pt&nrm=iso&tlng=pt BACKGROUND: Histological confirmation of a breast lesion is an important step to determine the aetiology and direct further management. Evidence supports ultrasound-guided large core needle biopsy (US-LCNB) (14 gauge) as the preferred diagnostic method over traditional open surgical biopsy OBJECTIVE: To assess the influence of technical variables on the diagnostic yield of breast specimens obtained by using US-LCNB, and the sensitivity of detecting malignancy during the study period METHODS: A retrospective chart review was conducted of all patients who had US-LCNBs from March 2011 - September 2012 at Addington Hospital in Durban, KwaZulu-Natal. Histopathological findings were correlated to the size of the breast lesion, rank of the radiologist performing the procedure and the number of cores obtained. The sensitivity of the technique was determined RESULTS: During the study period, 147 biopsies were performed. The majority of lesions were >5 mm (85.5%). The average number of cores was 4, and 79.5% of the biopsies were performed by the senior radiologist. Of the 147 biopsies, 132 specimens were eligible for inclusion in the study. Histopathology revealed 71 malignant lesions of which 60 were confirmed histologically at excision. In 11 patients, no excision was performed. Therefore, the sensitivity of detecting malignancy was 100% CONCLUSION: Although the study did not establish a statistically significant relationship between the abovementioned technical variables and the histological outcome, the overall diagnostic yield and the sensitivity of detecting malignancy using US-LCNB is comparable to other similar international studies. A prospective study with long-term follow-up of patients would be of value <![CDATA[<b>Investigation of the growth patterns of non-functioning pituitary macroadenomas using volumetric assessments on serial MRI investigations</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782016000100009&lng=pt&nrm=iso&tlng=pt BACKGROUND: Benign non-functioning pituitary macroadenomas (NFMA) often cause mass effect on the optic chiasm necessitating transsphenoidal surgery to prevent blindness. However, surgery is complicated and there is a high tumour recurrence rate. Currently, very little is known about the natural (and residual post-surgical) growth patterns of these NFMA. Conflicting data describe decreased growth to exponential growth over various time periods. Due to lack of information on growth dynamics of these NFMA, suitable follow-up imaging protocols have not been described to date OBJECTIVE: To determine if NFMA grow or stay quiescent over a time period using serial MRI investigations and a stereological method to determine tumour volume. In addition, to evaluate if NFMA adhere to a certain growth pattern or grow at random METHOD: Thirteen patients with NFMA had serial MRI investigations over a 73-month period at the Universitas Academic Hospital. Six of the selected patients had undergone previous surgery, while seven patients had received no medical or surgical intervention. By using a stereological method, tumour volumes were calculated and plotted over time to demonstrate growth curves. The data were then fitted to tumour growth models already described in literature in order to obtain the best fit by calculating the r² value RESULTS: Positive tumour growth was demonstrated in all cases. Tumour growth patterns of nine patients best fitted the exponential growth curve while the growth patterns of three patients best fitted the logistic growth curve. The remaining patient demonstrated a linear growth pattern CONCLUSION: A specific growth model best described tumour growth observed in non-surgical and surgical cases. If follow-up imaging confirms positive growth, future growth can be predicted by extrapolation. This information can then be used to determine the relevant follow-up-imaging interval in each individual patient <![CDATA[<b>Paediatric interventional radiology</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782016000100010&lng=pt&nrm=iso&tlng=pt Paediatric interventional radiology (IR) is a rapidly developing subspecialty, seeking to meet the increasing demand for image-guided minimally invasive procedures. The wide range of procedures performed and the conditions treated reflect the varying ages and complexity of the patient population. This article reviews the various interventional procedures performed and the unique challenges faced in paediatric IR. Conditions, such as vascular anomalies, that are primarily treated by paediatric interventional radiologists are highlighted. The requirements for establishing a paediatric IR practice are reviewed, as are the challenges facing the future development of the specialty. <![CDATA[<b>Abdominal and neuroimaging quiz case</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782016000100011&lng=pt&nrm=iso&tlng=pt Paediatric interventional radiology (IR) is a rapidly developing subspecialty, seeking to meet the increasing demand for image-guided minimally invasive procedures. The wide range of procedures performed and the conditions treated reflect the varying ages and complexity of the patient population. This article reviews the various interventional procedures performed and the unique challenges faced in paediatric IR. Conditions, such as vascular anomalies, that are primarily treated by paediatric interventional radiologists are highlighted. The requirements for establishing a paediatric IR practice are reviewed, as are the challenges facing the future development of the specialty. <![CDATA[<b>Answer to neuroimaging quiz case</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782016000100012&lng=pt&nrm=iso&tlng=pt Paediatric interventional radiology (IR) is a rapidly developing subspecialty, seeking to meet the increasing demand for image-guided minimally invasive procedures. The wide range of procedures performed and the conditions treated reflect the varying ages and complexity of the patient population. This article reviews the various interventional procedures performed and the unique challenges faced in paediatric IR. Conditions, such as vascular anomalies, that are primarily treated by paediatric interventional radiologists are highlighted. The requirements for establishing a paediatric IR practice are reviewed, as are the challenges facing the future development of the specialty. <![CDATA[<b>Answer and discussion paediatric neuroimaging quiz case</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782016000100013&lng=pt&nrm=iso&tlng=pt A three-and-a-half-year-old male child was referred for neuroimaging under general anaesthesia for intractable seizures. A final diagnosis of probable tuberous sclerosis with associated left hippocampal sclerosis was made. Differential diagnosis of malformation of cortical development with hippocampal sclerosis (Type 3a) was considered with respect to the left temporal lobe abnormality. It is heartening to note that several good submissions were received for the paediatric quiz case. Noteworthy responses were received from Dr Samuel Mannikam, Dr Thandi Buthelezi, Dr Philip Janse van Rensburg and Dr Ian Haynes, however, the prize of R2000 was awarded to Dr Richard Busayo Ulatunji for the most inclusive answer.