Scielo RSS <![CDATA[SA Journal of Radiology ]]> http://www.scielo.org.za/rss.php?pid=2078-677820140001&lang=en vol. 18 num. 1 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Milestones and new ventures</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100001&lng=en&nrm=iso&tlng=en <![CDATA[<b>The importance of systematic reviews in radiology</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100002&lng=en&nrm=iso&tlng=en <![CDATA[<b>Reporting of diagnostic accuracy studies in radiology</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100003&lng=en&nrm=iso&tlng=en <![CDATA[<b>Multi-detector computed tomography radiation doses in the follow-up of paediatric neurosurgery patients in KwaZulu-Natal: A dosimetric audit</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100004&lng=en&nrm=iso&tlng=en BACKGROUND: Multi-detector computed tomography (MDCT) is the preferred modality for follow-up of paediatric neurosurgery patients. Serial imaging, however, has the disadvantage of an ionising radiation burden, which may be mitigated using the 'as low as reasonably achievable' (ALARA) principle. OBJECTIVES: The primary objectives were to determine the radiation dose exposure in paediatric patients subjected to MDCT imaging following neurosurgery and to compare these values with references in current literature. Our secondary objective was to assess the relationship between radiation dose and clinical scenario. METHOD: Retrospective descriptive data were collected from all paediatric postsurgical patients (n = 169) between the ages of 0 and 12 years who had their first followed-up scan in the year 2010 and were followed up for six months or less. Dose-length product (DLP) and current-time product were collected from the picture archiving and communication system. Demographic data including radiology reports were collected from the hospital information system. The effective doses (ED) were calculated from the corresponding DLP using age-adjusted conversion factors. For purposes of comparison with other studies, median dosimetric values were calculated and the children were grouped into three age ranges, namely younger than 3 years, 3-7 years and 8-12 years old. RESULTS: The highest median radiation doses were noted in patients being followed-up for intracranial abscesses (1183 mGy cm) in the 8-12 year age group, most of whom were female. The lowest radiation doses were for intracranial shunt follow-ups (447 mGy cm). Median values for DLP, ED and current-time product (mAs) were comparable to reference doses in all three age groups. However, our study showed a much broader distribution of values with higher upper limits relative to reference values. Indications for follow-up included shunts (n = 110; 65%), intracranial abscess (n = 31; 18%), subdural haematoma (n = 13; 8%) and tumour (n = 6; 4%). Head trauma only accounted for 5% of the cases. CONCLUSION: The median radiation doses measured were comparable to values in literature and therefore deemed acceptable. The wider dose distributions of all three dosimetric parameters (DLP, ED and mAs) were attributed to inappropriate use of scan length and reference effective mAs. Adherence to recommended scan length protocols should be encouraged. Evaluation of the current use of reference effective mAs is needed and will require a separate study to determine the smallest value that can be used without compromising image quality. Further dose reductions could be achieved by omission of unenhanced scans in the follow-up of intracranial abscesses. It is recommended that diagnostic reference levels specific to South African clinical scenarios be developed to make local dosimetric audits more relevant. <![CDATA[<b>The accuracy of after-hour registrar computed tomography (CT) reporting in a South African tertiary teaching hospital</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100005&lng=en&nrm=iso&tlng=en BACKGROUND: The Division of Radiodiagnosis at Tygerberg Academic Hospital, a 1384-bed tertiary training institution in Cape Town, South Africa provides a comprehensive 24-hour clinical radiology service, and has a duty registrar on-site at all times. The demand for computed tomography (CT) imaging is increasing and plays a pivotal role in patient management. OBJECTIVES: The purpose of this study was to determine the accuracy of after-hour registrar CT reporting, to identify possible factors that may affect the error rate, and to assess whether or not errors had any clinical impact. METHOD: A set of senior registrar reports (provisional reports) issued during a 28-day period was compared with the corresponding consultant reports (final reports). Discrepancies were identified and quantified, based on their impact on patient management. RESULTS: The overall discrepancy rate was 8% (18 out of 225) and the overall accuracy rate was 92% (207 out of 225). The major error rate was 4% (9 out of 225) and the minor error rate was also 4% (9 out of 225). CONCLUSION: We observed that the accuracy of after-hour CT reporting by senior registrars at the Division of Radiodiagnosis at Tygerberg Hospital was on par with international standards. We investigated three factors which may have affected discrepancy rates, and only found one factor, namely the time of day, to be significant. Steps can be taken to create awareness of this fact amongst registrars, which hopefully would result in improved patient care and management. <![CDATA[<b>The radiological appearance of intracranial aneurysms in adults infected with the human immunodeficiency virus (HIV)</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100006&lng=en&nrm=iso&tlng=en BACKGROUND: The global prevalence of intracranial aneurysms is estimated at 2.3%. Limited literature is available on intracranial aneurysms in HIV-infected patients. OBJECTIVES: To describe the radiological appearance of intracranial aneurysms in HIV-positive adults. METHOD: In this retrospective analysis of data, 23 HIV-positive patients, of which 15 (65.2%) were female, with a total of 41 aneurysms were included. The mean age was 38 years, and their median CD4 count was 305 x 10(6)/L. Inclusion criteria comprised subarachnoid haemorrhage and confirmed intracranial aneurysms on four-vessel angiography. RESULTS: Fifteen (65.2%) patients had a single aneurysm, of which 12 (80.0%) had a saccular appearance. Seven (46.7%) of the single aneurysms had a neck width larger than 50% of the transverse aneurysm sac size. The mean longitudinal diameter of the aneurysm sac was 4.9 mm and the transverse diameter 4.4 mm. More than half of these aneurysms occurred at the anterior communicating artery. The median CD4 count of single-aneurysm patients was 319 x 10(6)/L. Eight patients (34.8%) had multiple aneurysms, with a total of 26 aneurysms (range 2-6 aneurysms per patient), of which 13 (50.0%) had a complex appearance. Twenty-four (92.3%) of the multiple aneurysms had a neck width larger than 50% of the transverse aneurysm sac size. The mean longitudinal diameter of the aneurysm sac was 4.0 mm and the transverse diameter 3.9 mm. The multiple aneurysms occurred more commonly in the internal carotid artery. These patients had a median CD4 count of 294 x 10(6)/L. CONCLUSION: HIV-associated intracranial aneurysms occur at a younger age, appear to be saccular and complex in shape, with a wide neck, and might rupture at small sizes. <![CDATA[<b>Evaluation of endometrial thickness in postmenopausal women by using 3.0-T MRI</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100007&lng=en&nrm=iso&tlng=en BACKGROUND: The accepted threshold for normal endometrial thickness is 5 mm; lesions with endometrial thickness < 5 mm are considered benign, whilst those &gt; 5 mm are considered malignant. However, endometrium ≥ 5 mm on transvaginal ultrasonography in postmenopausal woman is considered as asymptomatic endometrial thickening. However, recent studies suggest that asymptomatic endometrial thickness of even 8 mm - 11 mm in postmenopausal women may be normal. OBJECTIVES: The present study investigated the normal endometrial thickness range in 297 asymptomatic postmenopausal women using 3.0-T magnetic resonance imaging (MRI) T2-weighted sagittal images measured retrospectively by a single radiologist. METHOD: The data were classified according to patient age and postmenopausal duration, and the medical records and follow-up MR images were reviewed to assess the clinical outcome. RESULTS: The mean endometrial thickness was 2.4 ± 0.1 mm (range: 0.1-11.6). The endometrium in 21 of 297 subjects was ≥ 5 mm thick. Follow-up MR images were obtained in 17 of these 21 women, and their endometrial thickness was found to have decreased in all of them. To date, none of the subjects has been diagnosed with endometrial cancer. CONCLUSION: Although 5 mm is considered the conservative threshold of normal endometrial thickness on MRI of postmenopausal women, this figure should not, to avoid excessive false-positive diagnoses, be assumed as an indication of malignancy. <![CDATA[<b>The prevalence of undiagnosed abnormalities on non-contrast-enhanced computed tomography compared to contrast-enhanced computed tomography of the brain</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100008&lng=en&nrm=iso&tlng=en BACKGROUND: Even though magnetic resonance imaging (MRI) is the gold standard investigation for intracranial pathology, it is not widely available in developing countries and computed tomography (CT) of the brain remains the first-line investigation for patients with suspected intracranial pathology. It is generally accepted that certain intracranial pathology can be missed on non-contrast-enhanced CT (NECT) of the brain if a contrast-enhanced CT (CECT) is not done. We have to consider on the one hand the risk of delayed or missed diagnosis and on the other hand the cost, increased radiation exposure and contrast-induced reactions. Advances in CT technology have also improved the resolution of CT scan images, making it easier to identify pathology on an NECT of the brain. To date, no study comparing NECT to CECT of the brain, utilising 64-slice CT technology, has been published. OBJECTIVES: To determine the prevalence of undiagnosed abnormalities on non-contrast-enhanced computed tomography (NECT) scans of the brain reported as normal, on a 64-slice CT scanner. METHOD: A descriptive retrospective study was undertaken of CT brain scans done during a 12-month period at a tertiary provincial hospital in the Northern Tshwane district of Gauteng, South Africa. The CT brain scans were evaluated by three reviewers (general radiologists). The NECT and contrast-enhanced computed tomography (CECT) scans of the brain were reviewed independently on separate occasions. Reviewers were blinded to patient history, each other's interpretation, and to their own interpretation of the NECT when evaluating the CECT and vice versa. Discrepancies in interpretation were resolved during a consensus meeting between all three reviewers. The reviewers also re-evaluated the NECT scans of the cases with undiagnosed abnormal findings during this session. A decision was made pertaining to the visibility of the abnormal findings on the NECT scan. RESULTS: In this study, 3.28% of cases had abnormal findings undiagnosed by three reviewers on the NECT scans. Re-evaluation by the panel reduced this to 1.42%, indicating a reading error of 1.85%. CONCLUSION: There is a small prevalence of missed abnormal findings on the NECT scan when using only NECT. Omitting unnecessary CECT will reduce the radiation exposure to the patient and reduce the risk of adverse events from the use of intravenous iodinated contrast. Alternatively, doing only a CECT scan would reduce the risk of missing abnormal findings and would also decrease the patient's exposure to radiation. <![CDATA[<b><i>In vivo</i></b><b> determination of renal stone composition with dual-energy computed tomography</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100009&lng=en&nrm=iso&tlng=en BACKGROUND: Composition of renal stones influences management of patients with renal stone disease. Currently stone composition can only be analysed ex vivo after stone extraction or passage, but recent introduction of dual-energy computed tomography (CT) to clinical practice has raised interest in the ability of this technology to determine composition of renal stones in vivo. OBJECTIVES: To determine renal stone composition in patients using single-source dual-energy rapid-peak kilovolt (kVp) switching CT. METHOD: Nineteen patients with renal stones for percutaneous nephrolithotomy were evaluated with single-source dual-energy computed tomography on a Discovery CT 750HD. The Gemstone Spectral Imaging (GSI) effective atomic number (Zeff) and attenuation at 70 keV monochromatic energy were used to predict the stone composition. Infrared spectroscopy and x-ray diffraction of stones after extraction served as the reference standard. RESULTS: Two (10.5%) of the 19 stones had uric acid as major component. The other 17 (89.5%) were calcium-based stones. No statistically significant difference between the GSI Zeff and calculated effective atomic number (Z) for stone compounds was found. The GSI Zeff and attenuation could differentiate between uric acid and non-uric acid stones. No differentiation between different calcium stones could be made. CONCLUSION: Uric acid and non-uric acid renal stones can be differentiated with single-source dual-energy in vivo. The GSI Zeff reflects the dominant material in polycrystalline stones. <![CDATA[<b>A retrospective study of computed tomography angiography versus digital subtraction angiography in penetrating neck trauma at Groote Schuur Hospital, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100010&lng=en&nrm=iso&tlng=en BACKGROUND: Penetrating neck trauma is commonly encountered in South African trauma units, and is associated with high mortality and morbidity rates. The imaging protocol for stable patients with penetrating neck trauma remains controversial. There is only sparse data validating the use of computed tomography angiography (CTA) in the evaluation of penetrating neck trauma in South Africa. OBJECTIVES: To assess the sensitivity and specificity of CTA versus digital subtraction angiography (DSA) in detecting arterial injury and secondarily evaluate the ability of CT to assess non-arterial injury. METHOD: Using hospital and radiology databases, 23 patients were identified who had undergone both CTA and DSA for penetrating neck trauma. The data was retrospectively anonymised and randomised. A radiologist experienced in the interpretation of both trauma CTA and DSA re-reported all the imaging and the findings were compared and analysed. RESULTS: Twenty-four arterial injuries were detected. The sensitivity of CTA for detecting arterial injury was 78% and the specificity 83%. The ability of CTA to delineate wound track and detect non-arterial visceral injury was also confirmed. CONCLUSION: CTA is an attractive initial diagnostic investigation that, along with clinical evaluation, effectively guides further investigation and intervention. It is important for the radiologist to understand the limitations of CTA and have a low threshold for DSA in equivocal cases. <![CDATA[<b>An audit of elective outpatient magnetic resonance imaging in a tertiary South African public-sector hospital</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100011&lng=en&nrm=iso&tlng=en BACKGROUND: Increasing demand for magnetic resonance imaging (MRI) has resulted in longer waiting times for elective MRI, particularly in resource-limited healthcare environments. However, inappropriate imaging requests may also contribute to prolonged MRI waiting times. At the time of the present study, the waiting time for elective MRI studies at Tygerberg Hospital (TBH), a tertiary-level public-sector healthcare facility in Cape Town (South Africa), was 24 weeks. OBJECTIVES: To document the nature and clinical appropriateness of scheduled TBH outpatient MRI examinations. METHOD: A retrospective analysis of the referral forms of all elective outpatient MRI examinations scheduled at TBH from 01 June to 30 November 2011 was conducted. Patient age, gender, clinical details, provisional diagnosis, examination requested and referring clinician were recorded on a customised data sheet. Two radiologists independently evaluated the appropriateness of each request by comparing the clinical details and the provisional diagnosis provided with the 2012 American College of Radiology (ACR) guidelines for the appropriate use of MRI. RESULTS: Four hundred and sixty-six patients (median age 42 years; interquartile range 19-55) who had 561 examinations were scheduled in the review period; 70 (15%) were children less than 6 years old. Neurosurgery (n = 164; 35%), orthopaedic (n = 144; 31%), neurology (n = 53; 11%) and paediatric (n = 27; 6%) outpatients accounted for the majority (81%) of referrals; 464 (99.6%) were from specialist clinics. MRIs of the spine (n = 314; 56%), brain (n = 152; 27%) and musculoskeletal system (n = 70, 13%) accounted for more than 95% of the investigations. In 455 cases (98%), the referral was congruent with published ACR guidelines for appropriate MRI utilisation. CONCLUSION: Scheduled outpatient MRI examinations at TBH reflect optimal clinical use of a limited resource. MRI utilisation is largely confined to traditional neuro-imaging. Any initiative to decrease the elective MRI waiting time should focus on service expansion. <![CDATA[<b>The impact of optic nerve movement on optic nerve magnetic resonance diffusion parameters</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100012&lng=en&nrm=iso&tlng=en BACKGROUND: Optic nerve diffusion imaging is a useful investigational tool of optic nerve microstructure, but is limited by eye-movement-induced optic nerve movement and artifacts from surrounding cerebrospinal fluid, fat, bone and air. Attempts at improving patient cooperation, thus voluntarily limiting eye movement during a standard diffusion imaging sequence, are usually futile. The aim of this study was to establish the impact of optic nerve movement on clinical diffusion parameters of the optic nerve. METHOD: Twenty-nine healthy volunteers with intact vision and intact conjugate gaze were recruited and subjected to magnetic resonance diffusion-weighted imaging (DWI) and diffusion-tensor imaging (DTI) of the optic nerves. Twenty right eyes had nerve tracking done using single-shot echo-planar imaging at 20 time points over 3 minutes. Optic nerve movement measurements were correlated with diffusion parameters of apparent diffusion coefficient (ADC), mean diffusivity (MD), fractional anisotropy (FA) and anisotropic index (AI) using Spearman's rank correlation. RESULTS: No significant correlations were noted between optic nerve movement parameters and ADC in the axial plane and MD of the optic nerve. Low to moderate negative correlations were noted between optic nerve movement parameters and AI and FA and positive correlation with ADC in the radial plane. CONCLUSION: Optic nerve movement documented during the timespan of standard diffusion sequences (DWI and DTI) has a negative effect on the anisotropic diffusion parameters of the optic nerve. With greater eye movement, optic nerve diffusion appears less anisotropic owing to greater radial diffusion. <![CDATA[<b>Computed tomographic colonography: Diagnosis of an incarcerated Spigelian hernia</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100013&lng=en&nrm=iso&tlng=en A 68-year-old obese man underwent computed tomographic colonography (CTC) scanning to investigate worsening constipation and lower abdominal discomfort on his left side. Optical colonoscopy was contraindicated because of his comorbidities. A preliminary CTC diagnosis of incarcerated Spigelian hernia was made, based on lateral deviation of the sigmoid colon to the left as well as extrinsic impressions on it, and the central location of the small bowel. Spigelian hernia is a rare form of anterior abdominal wall hernia. CTC can play a role in its diagnosis. <![CDATA[<b>Incidental right Bochdalek hernia with interruption of the inferior vena cava and hepatic venous collateral continuation: A case report</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100014&lng=en&nrm=iso&tlng=en A 36-year-old asymptomatic female had a routine chest radiograph to exclude pulmonary tuberculosis, as part of an employee wellness programme. There was opacification of the right lower thorax. Computed tomography and venography demonstrated an incidental right Bochdalek hernia with interruption of the inferior vena cava (IVC) and hepatic venous collateral continuation. The association of a Bochdalek hernia with an anomaly of the IVC is rare, with only one case described in the literature. <![CDATA[<b>Unusual cause of paraplegia in a child of 5 years</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100015&lng=en&nrm=iso&tlng=en 'Hydatid' originates from the Greek word meaning 'watery vesicle'. It refers to a cyst formed as a result of infestation by larvae of the tapeworm Echinococcus granulosus, endemic to sheep-raising areas of the world. Humans are an accidental intermediary host, with lungs and liver most commonly affected. Hydatid involvement of the spine accounts for less than 1% of the total cases of hydatid disease and isolated extradural involvement is even rarer. We report a case of extradural hydatid cyst involving a boy of 5 years. <![CDATA[<b>An unusual case of bilateral renal lymphangiectasia</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100016&lng=en&nrm=iso&tlng=en Renal lymphangiectasia is a very rare benign disorder characterised by dilatation of the perirenal and peripelvic lymphatics. The condition is commonly misdiagnosed for other cystic lesions of the kidney such as polycystic kidneys. The diagnosis can be made with near-certainty if classical imaging findings are recognised. We report a case of bilateral renal lymphangiectasia, diagnosed on ultrasonography and computed tomography based on the typical imaging findings and the laboratory analysis of aspirated fluid. The patient was managed conservatively. <![CDATA[<b>Imaging of compound palmar ganglion with pathologic correlation</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100017&lng=en&nrm=iso&tlng=en Compound palmar ganglion, or chronic flexor tenosynovitis, most commonly of tuberculous origin, is a rare extrapulmonary manifestation of tuberculosis (TB). The flexor synovial sheath is not a common site for TB but, once involved, causes rapid involvement of all flexor tendons. We discuss the case of a 70-year-old farmer who presented to us with pain and progressive swelling of the palmar aspect of the wrist. On clinical examination, swelling both above and below the proximal wrist crease was found, with positive cross-fluctuation. On ultrasonography and magnetic resonance imaging, features suggestive of compound palmar ganglion were present. The patient underwent surgical resection (extensive tenosynovectomy) and chemotherapy. Post-operative histopatholgical findings correlated with the radiological features. <![CDATA[<b>Obituary - Dr. Christian George Albertyn</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100018&lng=en&nrm=iso&tlng=en Compound palmar ganglion, or chronic flexor tenosynovitis, most commonly of tuberculous origin, is a rare extrapulmonary manifestation of tuberculosis (TB). The flexor synovial sheath is not a common site for TB but, once involved, causes rapid involvement of all flexor tendons. We discuss the case of a 70-year-old farmer who presented to us with pain and progressive swelling of the palmar aspect of the wrist. On clinical examination, swelling both above and below the proximal wrist crease was found, with positive cross-fluctuation. On ultrasonography and magnetic resonance imaging, features suggestive of compound palmar ganglion were present. The patient underwent surgical resection (extensive tenosynovectomy) and chemotherapy. Post-operative histopatholgical findings correlated with the radiological features. <![CDATA[<b>Tele-nuclear medicine</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100019&lng=en&nrm=iso&tlng=en This article presents a description of tele-nuclear medicine and, after outlining its history, a wide, representative range of its applications. Tele-nuclear medicine has benefited greatly from technological progress, which for several decades has provided greater data transfer rates and storage capacity at steadily decreasing cost. Differences in the practice of nuclear medicine between developed and developing countries arise mainly from disparities in their available infrastructure, funding and education levels of personnel involved. Consequently there are different emphases in their tele-nuclear medicine, which are elaborated. It is concluded that tele-nuclear medicine is important for all countries, but the emphasis on its application may differ between developed and developing nations, with an emphasis on distance learning in the latter. <![CDATA[<b>An approach for performing a successful computed tomography colonography examination</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100020&lng=en&nrm=iso&tlng=en Computed tomography colonography (CTC) is a minimally invasive, fast, safe and accurate screening examination for colorectal cancer. It also allows evaluation of structures outside the colon. A successful CTC examination requires good bowel preparation, adequate patient hydration, tagging agents, the use of automated carbon dioxide insufflation, and correct positioning for two view and additional view scans. Knowledge of polyp morphology and measurement of polyps are important when interpreting 2D or 3D scans. <![CDATA[<b>Current radiological strategies for the assessment of right lower quadrant abdominal pain</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100021&lng=en&nrm=iso&tlng=en Right lower quadrant abdominal pain is a common clinical entity. Imaging and the radiologist play an integral role in achieving a diagnosis, so guiding prompt management of patients. This review discusses the spectrum of pathology and imaging findings, and highlights and contrasts the preferred imaging modalities in different subsets of patients. <![CDATA[<b>Pseudomyxoma</b><b> peritonei</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100022&lng=en&nrm=iso&tlng=en Pseudomyxoma peritonei is a rare complication of mucinous tumours of appendiceal or ovarian origin. Other associations are malignancies of the colon, urachus and biliary tree. Large amounts of extracellular and peritoneal mucin result in distortion and loss of function of visceral organs. Currently, radiology plays a critical role in diagnosing this rare entity, in follow-up and in predicting the outcome of cytoreductive surgeries. <![CDATA[<b>Head and neck imaging</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100023&lng=en&nrm=iso&tlng=en Pseudomyxoma peritonei is a rare complication of mucinous tumours of appendiceal or ovarian origin. Other associations are malignancies of the colon, urachus and biliary tree. Large amounts of extracellular and peritoneal mucin result in distortion and loss of function of visceral organs. Currently, radiology plays a critical role in diagnosing this rare entity, in follow-up and in predicting the outcome of cytoreductive surgeries. <![CDATA[<b>Body imaging: Diagnosis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100024&lng=en&nrm=iso&tlng=en Pseudomyxoma peritonei is a rare complication of mucinous tumours of appendiceal or ovarian origin. Other associations are malignancies of the colon, urachus and biliary tree. Large amounts of extracellular and peritoneal mucin result in distortion and loss of function of visceral organs. Currently, radiology plays a critical role in diagnosing this rare entity, in follow-up and in predicting the outcome of cytoreductive surgeries. <![CDATA[<b>Head and neck imaging</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100025&lng=en&nrm=iso&tlng=en Pseudomyxoma peritonei is a rare complication of mucinous tumours of appendiceal or ovarian origin. Other associations are malignancies of the colon, urachus and biliary tree. Large amounts of extracellular and peritoneal mucin result in distortion and loss of function of visceral organs. Currently, radiology plays a critical role in diagnosing this rare entity, in follow-up and in predicting the outcome of cytoreductive surgeries. <![CDATA[<b>Answer to head and neck imaging</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100026&lng=en&nrm=iso&tlng=en Several answers to the quiz question were received from all quarters of the country. Noteworthy responses came from Drs Ian Haynes, Nikelo Mabandla, Francois Roux, Mlindeli Masango, Andrew Lawson, Zakariya Vawda and Zain Ally. Spot-on diagnoses with the best radiological descriptions obtained were from Dr Naye Sihlali and Dr Fourie Bezuidenhout, who share the prize. Congratulations to all respondents. <![CDATA[<b>Musculoskeletal imaging</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100027&lng=en&nrm=iso&tlng=en Several answers to the quiz question were received from all quarters of the country. Noteworthy responses came from Drs Ian Haynes, Nikelo Mabandla, Francois Roux, Mlindeli Masango, Andrew Lawson, Zakariya Vawda and Zain Ally. Spot-on diagnoses with the best radiological descriptions obtained were from Dr Naye Sihlali and Dr Fourie Bezuidenhout, who share the prize. Congratulations to all respondents. <![CDATA[<b>The ivy sign</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100028&lng=en&nrm=iso&tlng=en The ivy sign refers to diffuse bilateral leptomeningeal enhancement on post- contrast T1-weighted magnetic resonance imaging (MRI) and increased signal intensity in bilateral subarachnoid spaces and perivascular spaces on T2-weighted fluid attenuation inversion recovery (FLAIR) MRI sequences in patients with moyamoya disease. <![CDATA[<b>Persistent hyperplastic primary vitreous - The martini glass sign</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100029&lng=en&nrm=iso&tlng=en The ivy sign refers to diffuse bilateral leptomeningeal enhancement on post- contrast T1-weighted magnetic resonance imaging (MRI) and increased signal intensity in bilateral subarachnoid spaces and perivascular spaces on T2-weighted fluid attenuation inversion recovery (FLAIR) MRI sequences in patients with moyamoya disease. <![CDATA[<b>Intramedullary spinal masses: A pictorial essay</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782014000100030&lng=en&nrm=iso&tlng=en This pictorial essay provides a classification system for the most common intramedullary spinal masses and describes distinguishing imaging features that will aid the radiologist in providing a relevant differential diagnosis to guide further management.