Scielo RSS <![CDATA[SA Journal of Radiology ]]> vol. 19 num. 1 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>The <i>South African Journal of Radiology</i> growing in leaps and bounds</b>]]> <![CDATA[<b>A comparative cost analysis of picture archiving and communications systems (PACS) versus conventional radiology in the private sector</b>]]> BACKGROUND: Radiology is rapidly advancing, with a global transition to digital imaging technology to improve productivity and enhance communication. The major challenge confronting radiology practices is to demonstrate cost savings and productivity gains when a picture archiving and communication system (PACS) is established AIM: To undertake an incremental cost analysis of PACS compared with conventional radiology to determine productivity gains, if any, at two private hospitals in Durban METHOD: An incremental cost analysis for chest radiographs,, computed tomography and magnetic resonance imaging brain scans with and without contrast were performed. The overall incremental cost for PACS in comparison with a conventional radiology site was determined. The net present value was also determined to evaluate the capital budgeting requirements for both systems RESULTS: The incremental cost of both capital and the radiology information system for installing PACS shows an expected increase. The incremental PACS image cost shows a reduction CONCLUSION: The study provides a benchmark for the cost incurred when implementing PACS. It also provides a decision framework for radiology departments that plan to introduce PACS and helps to determine the feasibility of its introduction <![CDATA[<b>Percutaneous placement of peritoneal dialysis catheters in resource-limited developing countries as an alternative to conventional placement methods</b>]]> BACKGROUND: The percutaneous placement of peritoneal dialysis (PD) catheters using conscious sedation with ultrasound and fluoroscopic guidance is underutilised and has several advantages over the open surgical and laparoscopic placement methods, especially in the resource-limited developing world OBJECTIVES: To describe our patients' demographics and clinical characteristics, our method of PD catheter placement within the Radiology Department at Kimberley Provincial Hospital, compare our early complication types and frequencies, overall peritonitis rate and one-year catheter survival rate with findings in the international literature and, by demonstrating comparable outcomes, propose that percutaneous placement be considered as a feasible alternative to conventional placement techniques METHOD: We conducted a retrospective study on 25 patients who had their PD catheters inserted between January 2009 and May 2013. Medical records were reviewed for demographic and clinical information as well as type and frequency of early (within 30 days) and late (between 30 days and one-year) complications related to the PD catheter. Early complication types and frequencies were then compared with similar internationally published data. The overall peritonitis rate, in terms of episodes per patient-year, was calculated and compared with international recommendations, and our one-year catheter survival rate was calculated using the Kaplan Meier method and compared with similarly calculated international studies RESULTS: The study group comprised 16 male and 9 female patients with a median age of 44 years. Hypertension was the primary cause of end-stage renal disease (ESRD), and was found in 10 (40%) patients. Our early exit site infection rate of 12% was slightly higher than that found in the literature. Literature varies on the overall infection rates; however, our overall peritonitis rate of 0.75 episodes per patient-year was higher than that recommended by the International Society of Peritoneal Dialysis. This finding might be attributed to the lower socio-economic grouping of our patients and the small number in the study group. All but two peritonitis cases were successfully treated with antibiotics, and we had no major procedure-related complications. Our early peritonitis rate of 8%, as well as the other early complication types and rates, and our one-year catheter survival rate of 84%, compared favourably with international studies CONCLUSION: Percutaneous PD catheter placement under conscious sedation with the aid of ultrasound and fluoroscopy is a sound alternative to conventional methods in the resource-limited developing world <![CDATA[<b>Pre-interventional assessment and calcification score of the aortic valve and annulus, with multi-detector CT, in transcatheter aortic valve implantation (TAVI) using the Medtronic CoreValve</b>]]> BACKGROUND: Transcatheter aortic valve implantation (TAVI) provides an acceptable alternative for aortic valve replacement in the elderly, but needs accurate pre-procedural imaging to optimise intervention OBJECTIVES: To evaluate an alternative manual aortic valve calcification scoring system with computed tomography, for patients undergoing TAVI. We hypothesise a correlation between the Free State aortic valve calcium computed tomography score (FACTS) scoring system, valve plaque density and procedure-related complications METHODS: Twenty patients suitable for TAVI were selected according to standard international guidelines and received multimodality imaging prior to intervention. Images were reviewed by two reviewers who were blinded to each other's scores. Where large inter-individual score variations existed, retraining was done and scores repeated, using a double-blinded method. Matched scores were included in the final analysis. Rosenhek calcification scores were used as a standard of reference RESULTS: The study comprised 9 (45%) men and 11 (55%) women, with a median age of 83.5 years. Median EuroSCORE was 15.5. FACTS scores ≥6 were associated with the presence of a paravalvular leak (p = 0.01). Procedure-related complications (left bundle branch block, repositioning of the valve and anaemia) were seen in patients with plaques measuring ≥1000 HU (p = 0.07 CONCLUSION: The FACTS score and averaged valve plaque HU showed potential for predicting a paravalvular leak and procedure-related complications, and could be valuable in the future for optimising patient selection for TAVI <![CDATA[<b>Post-treatment surveillance abdominopelvic computed tomography in children with Wilms tumour: Is it worth the risk?</b>]]> BACKGROUND: Wilms tumour is a comparatively common paediatric malignancy with a relatively good prognosis. Routine post-treatment surveillance at our institution currently includes regular abdominopelvic computed tomography (CT) over a two-year period for the early detection of disease recurrence. The rationale is that early salvage therapy may improve overall patient survival, and thus justifies the exposure to potentially harmful ionising radiation OBJECTIVE: To critically evaluate the routine use of post-treatment abdominopelvic CT by determining the detection rate of disease recurrence and associated clinical outcomes METHODS: Sixty-four patients in remission following initial treatment for Wilms tumour were included in this retrospective study. Variables obtained from patient records included gender, age, histological grading and tumour stage at presentation, number of abdominopelvic CT scans, site(s) of relapse, method of recurrence detection and confirmation, time to recurrence and clinical outcome RESULTS: The patients received a total of 334 surveillance abdominopelvic CT scans. Nine (14%) patients developed disease recurrence during the follow-up period. In three cases, the initial detection method was abdominopelvic CT. All three of these patients subsequently died despite salvage therapy (22 months median survival). Five false-positive diagnoses of recurrence occurred, with two being made on abdominopelvic CT CONCLUSION: Routine post-treatment abdominopelvic CT showed a low detection rate of disease recurrence in children treated for Wilms tumour, while subjecting patients to a large radiation burden. The recommendation is that current practice be changed in line with the ultrasound-based Société Internationale d'Oncologie Pédiatrique (SIOP) imaging guidelines. <![CDATA[<b>Ultrasound diagnosis of ulnar nerve entrapment by confirming baseline cross-sectional area measurement for normal and abnormal nerves</b>]]> BACKGROUND: Magnetic resonance imaging is most commonly employed, alongside electro-diagnostic studies, in the diagnosis of ulnar nerve entrapment. It is expensive, time consuming, not readily available to the general public, and limits imaging to a segment of the nerve at any given time. In contrast, high-frequency ultrasound is an inexpensive imaging modality with a flexible field of view through which the nerve can be traced. An ultrasound cross-sectional area (CSA) &gt;0.075 cm² has previously been suggested as indicative of nerve entrapment OBJECTIVES: To confirm the suggested CSA measurement of 0.075 cm² and discuss the difference in CSA measurement between abnormal nerves, nerves in the contra-lateral elbow of the same participant, and those of asymptomatic participants METHODS: Ultrasonography was performed on both elbows of 25 patients with confirmed unilateral ulnar nerve entrapment and on 25 healthy controls for comparison. Three CSA measurements were taken of the ulnar nerve along its course, and the mean measurement was recorded RESULTS: CSA measurements were significantly different between patients with ulnar nerve entrapment and healthy controls (p < 0.05). In our study, a CSA &gt;0.070 cm² defined ulnar nerve entrapment at the elbow CONCLUSION: Ultrasound CSA measurement of the ulnar nerve is accurate in the diagnosis of ulnar nerve entrapment. The range of values and varied criteria previously reported call for standardisation of the procedure and CSA measurement. We suggest that a measurement of 0.070 cm2 be considered as a new baseline for the optimal diagnosis of ulnar nerve entrapment. <![CDATA[<b>How accurate is ultrasound of the optic nerve sheath diameter performed by inexperienced operators to exclude raised intracranial pressure?</b>]]> BACKGROUND: It has been well documented that ultrasound measurement of the optic nerve sheath diameter performed by an experienced operator shows good correlation with raised intracranial pressure, irrespective of the cause OBJECTIVE: To establish the accuracy of this technique performed by inexperienced operators METHOD: A prospective analytical cross-sectional study was conducted. All patients ≥18 years of age who presented at our medical casualty and emergency departments with suspected meningitis were enrolled in the study. All patients were evaluated with the use of optic nerve sheath diameter ultrasound with or without computed tomography brain scan prior to lumbar puncture. Lumbar puncture opening pressure measurements were compared with the ultrasound measurements RESULTS: A total of 73 patients were enrolled in the study, of whom 14 had raised intracranial pressure. The study had a sensitivity of 50% (95% confidence interval (CI) 26.8%-73.2%) and specificity of 89.8% (95% CI 79.5%-95.3%) with a positive predictive value of 54.8% (95% CI 29.1%-76.8%) and negative predictive value of 88.3% (95% CI 77.8%-94.2%). The likelihood ratio of a positive test was 4.92 (95% CI 1.95-11.89) and that of a negative test 0.56 (95% CI 0.29-0.83). Cohen's kappa value was 0.41 which indicates a moderate agreement. The receiver operating characteristic (ROC) curve had an area under the curve (AUC) of 0.73 (95% CI 0.51-0.95 CONCLUSION: Ultrasound measurement of the optic nerve sheath diameter can be used to exclude raised intracranial pressure, even in the hands of inexperienced operators. <![CDATA[<b>Diagnosis of nerve root avulsion injuries in adults with traumatic brachial plexopathies: MRI compared with CT myelography</b>]]> BACKGROUND: Computed tomography myelography (CTM) has been broadly adopted as the 'gold standard' imaging technique in the diagnosis of nerve root avulsion injuries in traumatic brachial plexopathies. CTM has the distinct advantage of better spatial resolution than magnetic resonance imaging (MRI); however, this technique is invasive and can result in significant patient discomfort. MRI, therefore, seems relatively more advantageous as it is less invasive (requires no lumbar puncture), lacks radiation exposure, has no adverse reactions related to intrathecal contrast agents and confers excellent soft-tissue contrast OBJECTIVES: To compare the sensitivity and specificity of MRI with CTM in the diagnosis of preganglionic nerve root avulsion injuries in adults with traumatic brachial plexopathies at the Inkosi Albert Luthuli Central Hospital METHOD: A retrospective comparative analysis was performed on 16 adult patients with traumatic preganglionic brachial plexopathies who underwent both MRI and CTM at Inkosi Albert Luthuli Central Hospital. Radiologists experienced in both CTM and MRI interpreted the data and a comparison was made using CTM as the gold standard RESULTS: The sensitivity and specificity for MRI detecting preganglionic nerve root avulsion injuries and pseudomeningoceles was 82% and 100% respectively. The interobserver agreement between CTM and MRI for the detection of preganglionic nerve root avulsion injuries was 81.25% (Kappa = 0.77) and 87.5% (Kappa = 0.84) for the detection of pseudomeningoceles CONCLUSION: MRI was as sensitive as CTM at detecting preganglionic nerve root avulsion injuries and pseudomeningoceles of spinal nerve roots C7-T1 of the brachial plexus. Some mild discrepancies existed at the C5 and C6 nerve root levels. Owing to the invasiveness of the procedure and resultant patient discomfort, CTM should be reserved for complicated cases or for patients with contraindications to MRI. <![CDATA[<b>Referring physician perceptions of picture archive and communication systems</b>]]> The picture archive and communication system (PACS) is a digital radiographic system that is steadily replacing the older film-based radiographic records. Despite the various benefits associated with PACS implementation, it is not yet clear what referring physicians think of such systems. This article reviews their thoughts and perceptions, which were obtained via surveys that were completed by referring physicians with practices at private hospitals in Port Elizabeth. A critical analysis of the data collected indicated that most referring physicians perceive PACS to be beneficial. <![CDATA[<b>Two unusual cases of external rotator muscle pathology producing hip pain</b>]]> Two unusual cases of inflammation of the external rotator muscles of the hip are presented. In each case, the patient presented with acute hip pain. The diagnoses of acute calcific periarthritis involving the gluteus medius muscle, and pyomyositis of the obturator internus muscle secondary to a perianal fistula, were made with the aid of diagnostic imaging and histology. The importance of reviewing the pelvic viscera is highlighted. <![CDATA[<b>Painful snapping hip owing to bifid iliopsoas tendon and concurrent labral tear</b>]]> A case of internal snapping hip owing to a bifid iliopsoas tendon is described with a concurrent labral tear in a young active female. The labral tear was identified on magnetic resonance imaging, and the snapping bifid tendon on dynamic ultrasound. The patient was administered bupivicaine and steroid around the tendon and symptoms resolved. A snapping bifid tendon must be identified pre-operatively to avoid incomplete release. Labral repair may be accompanied by psoas release when psoas impingement is suspected owing to a labral tear at the 3 o'clock position in an otherwise normal hip. <![CDATA[<b>Inverted appendix: Computed tomographic colonography diagnosis in a patient and lesson learned</b>]]> The role of computed tomographic colonography in the diagnosis of an inverted appendix is described in an adult woman, with Mayer-Rokitansky-Küster-Hauser syndrome, who underwent a laparotomy during her childhood for severe abdominal pain. According to the patient, both a hysterectomy and an incidental appendectomy were performed. <![CDATA[<b>Giant peritoneal loose bodies</b>]]> Giant peritoneal loose bodies are rare lesions, originating from auto-amputated appendices epiploicae. They may cause urinary or gastrointestinal obstruction and, should the radiologist not be familiar with the entity, can potentially be confused with malignant or parasitic lesions. Familiarity with their characteristic computed tomographic features is essential to prevent unnecessary surgery in the asymptomatic patient. We present a case of a 70-year-old man diagnosed with two giant peritoneal loose bodies. <![CDATA[<b>Congenital infiltrating lipomatosis of the face with enlargement of the ipsilateral cerebellar hemisphere</b>]]> Congenital infiltrating lipomatosis of the face (CILF) is a rare disorder in which overgrowth of fatty tissue with infiltration of underlying structures leads to craniofacial deformities and asymmetry. Imaging plays an important role in the diagnosis, surgical planning and evaluation of underlying structures. To our knowledge, our case is the first to describe CILF associated with isolated enlargement of a cerebellar hemisphere in the absence of an enlarged ipsilateral cerebral hemisphere (hemimegalencephaly). <![CDATA[<b>Double trouble: Bilateral cerebral involvement in Sturge-Weber syndrome</b>]]> Sturge-Weber syndrome, also known as encephalotrigeminal angiomatosis or meningofacial angiomatosis, is characterised in its classical form by a congenital, usually unilateral, 'port-wine stain' (capillary naevus) on the face, convulsions, typical intracranial calcification and some degree of mental retardation and hemiparesis. The clinical correlation of intractable seizures with the presence of bilateral intracranial disease has management and prognostic implications, thus making the presence of bilateral disease an important factor to all those involved in the management of the child with Sturge-Weber syndrome. <![CDATA[<b>Breast hamartoma: Is this an uncommon or an under-recognised lesion?</b>]]> A hamartoma is a disorganised focus of a mature overgrowth of cells composed of tissue elements of the organ in which it is found, and it can occur anywhere in the body. A breast hamartoma is a rare, benign tumour consisting of fat, glandular and fibrous tissue, and is known by various names such as lipofibroadenoma or fibroadenolipoma, depending on the dominant tissue found within the lesion. The reported incidence is low (0.1% - 0.7%), but is increasingly thought to be because of under-diagnosis of the condition. <![CDATA[<b>Answer to musculoskeletal imaging quiz case</b>]]> A hamartoma is a disorganised focus of a mature overgrowth of cells composed of tissue elements of the organ in which it is found, and it can occur anywhere in the body. A breast hamartoma is a rare, benign tumour consisting of fat, glandular and fibrous tissue, and is known by various names such as lipofibroadenoma or fibroadenolipoma, depending on the dominant tissue found within the lesion. The reported incidence is low (0.1% - 0.7%), but is increasingly thought to be because of under-diagnosis of the condition. <![CDATA[<b>Temporal bone imaging</b>]]> A hamartoma is a disorganised focus of a mature overgrowth of cells composed of tissue elements of the organ in which it is found, and it can occur anywhere in the body. A breast hamartoma is a rare, benign tumour consisting of fat, glandular and fibrous tissue, and is known by various names such as lipofibroadenoma or fibroadenolipoma, depending on the dominant tissue found within the lesion. The reported incidence is low (0.1% - 0.7%), but is increasingly thought to be because of under-diagnosis of the condition. <![CDATA[<b>Answer to quiz case: Temporal bone imaging</b>]]> Computed tomographic scanning of the petrous bone and magnetic resonance imaging sequences of the inner ear and cerebellopontine angle of a deaf patient were performed to find an explanation for his deafness, and to establish whether he would be a good candidate for cochlear implantation. The imaging features were considered pathognomonic for incomplete partition type III (IP type III). Further management and discussion of this deafness subtype are detailed. <![CDATA[<b>Pitfalls and mimics: The many facets of normal paediatric thymus</b>]]> The thymus is a lymphatic organ that was often thought of as an organ of mystery by the ancient Greeks. A soft, pliable lymphatic organ positioned in the anterior superior mediastinum, it does not compress or displace the adjacent structures. It is disproportionately larger in the paediatric population and then gradually regresses to 'hide' in the mediastinum as the child advances into puberty. It regresses in size under conditions of stress and may be absent in various congenital abnormalities such as DiGeorge syndrome and conditions of stress. The thymus appears in a variety of shapes and sizes on a paediatric chest radiograph and at times may be misinterpreted as pathology. This article describes the normal thymus as it appears on paediatric radiography, and addresses mimickers.