Scielo RSS <![CDATA[SA Journal of Radiology ]]> http://www.scielo.org.za/rss.php?pid=2078-677820150002&lang=pt vol. 19 num. 2 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Paediatric imaging in South Africa - From baby steps to giant strides</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782015000200001&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Pearls in paediatric trauma neuroimaging reporting - What not to miss</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782015000200002&lng=pt&nrm=iso&tlng=pt The features of paediatric head trauma are well described. This article aims to highlight review areas and 'do not miss' lesions over and above the known and easily recognised injuries often sought when analysing computed tomography (CT) brains for head injury. Particular attention is paid to fractures and three-dimensional (3D) imaging. Emphasis is also placed on bridging vein thrombosis, retroclival hematomas and corpus callosum injuries. <![CDATA[<b>Where's the line/tube?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782015000200003&lng=pt&nrm=iso&tlng=pt Radiologists are confronted with a spectrum of catheters placed in various locations in routine radiology practice and have to be familiar with the different catheters, their uses and acceptable positioning for suggested safe practice. The commonly used vascular and non-vascular catheters are described and discussed in this brief guide. <![CDATA[<b>Krabbe disease - An unusual presentation of optic nerve enlargement</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782015000200004&lng=pt&nrm=iso&tlng=pt Krabbe disease is an autosomal recessive leukodystrophy that presents clinically with regression of milestones, excessive irritability and inconsolable crying. The pathologic basis of the disease is abnormal myelin metabolism resulting from a deficiency in the galactocerebrosidase enzyme with subsequent white matter destruction. Although optic atrophy is a classic presentation of Krabbe disease, we report on two patients who are biological brothers presenting with optic nerve enlargement in addition to other typical magnetic resonance imaging features of Krabbe disease, thereby confounding the initial diagnosis. <![CDATA[<b>Meconium pseudocyst associated with congenital CMV infection</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782015000200005&lng=pt&nrm=iso&tlng=pt Meconium pseudocyst is a rare complication of fetal bowel perforation in utero, following extravasation and localised containment of meconium within the intra-peritoneal cavity. <![CDATA[<b>Cystic hemispheric medulloepithelioma</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782015000200006&lng=pt&nrm=iso&tlng=pt Medulloepithelioma is a rare primitive embryonal tumour of the central nervous system which typically occurs in early childhood. The histopathological appearance has been confused with primitive neuroectodermal tumours (PNETs), but medulloepitheliomas have a more aggressive clinical course. Imaging typically demonstrates a well-circumscribed, poorly or non-enhancing solid mass, with cyst formation being infrequent. We report the imaging findings in a case of a cystic hemispheric medulloepithelioma. The importance of considering this diagnosis is discussed in view of the propensity to aggressive recurrence in subtotal resection. <![CDATA[<b>Fibrolipomatous hamartoma of the median nerve</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782015000200007&lng=pt&nrm=iso&tlng=pt Fibrolipomatous hamartoma is a rare benign tumour most commonly affecting the median nerve and is characterised by fibro-fatty nerve infiltration. It results in fusiform nerve enlargement with a pathognomonic 'spaghetti-like' imaging appearance. Patients present with numbness and paraesthesia and later with motor deficits in the affected nerve distribution. The condition frequently coexists with macrodystrophia lipomatosa in up to two-thirds of cases. <![CDATA[<b>Heterotaxy syndrome: This is the left, right?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782015000200008&lng=pt&nrm=iso&tlng=pt Heterotaxy syndrome is a rare and complex disorder of the chest and abdominal organ arrangements, and presents a diagnostic challenge to the radiologist. This article describes the morphological characteristics of heterotaxy and situs abnormalities, in particular left and right atrial isomerism, and suggests an approach in evaluating the spectrum of abnormalities associated with heterotaxy syndromes, using appropriate imaging modalities. <![CDATA[<b>Diagnostic reference levels for paediatric computed tomography</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782015000200009&lng=pt&nrm=iso&tlng=pt OBJECTIVES: To establish local diagnostic reference levels (LDRLs) for emergency paediatric head computed tomography (CT) scans performed at a South African (SA) tertiary-level hospital and to compare these with published data. MATERIALS AND METHODS: A retrospective analysis was conducted of volume-based CT dose index (CTDIvol) and dose length product (DLP) data from uncontrasted paediatric head CT scans performed in the Trauma and Emergency Unit of a tertiary-level SA hospital from January to June 2013. A random sample of 30 patients in each of 3 age groups (0-2, >2-5 and >5-10 years) was used. LDRL values were compared with several national DRLs from Europe and Australia. RESULTS: Mean CTDIvol and DLP values were: 30 mGy and 488 mGy.cm for the 0-2 years age group; 31 mGy and 508 mGy.cm for the >2-5 years group, and 32 mGy and 563 mGy.cm for the >5-10 years group, respectively. The mean DLP for 0-2 year-olds was the only parameter outside the range of corresponding published reference data. Stratification into narrower age groupings showed an increase in DLP values with age. CONCLUSION: An institutional review of the head CT scanning technique for emergency studies performed on children less than 2 years of age is recommended. The current study highlights the role of LDRLs in establishing institutional dosimetry baselines, in refining local imaging practice, and in enhancing patient safety. Standard age stratification for DRL and LDRL reporting is recommended. <![CDATA[<b>Imaging in anorectal malformations: What does the surgeon need to know?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782015000200010&lng=pt&nrm=iso&tlng=pt Imaging is essential in the diagnosis, management, surgical planning and eventual outcome in patients with anorectal malformation (ARM). This article outlines the imaging that may be required and the information needed by the surgeon to attain the best possible surgical outcome. ARM encompasses a wide spectrum of congenital malformations relating to the distal rectum and anus as well as the urinary and or gynaecological systems. The malformations range from a relatively simple perineal fistula with the potential for an excellent functional outcome, to complex cloacal malformation that requires specialist care and intervention. Approximately half of these children will have associated abnormalies. In the first 24-48 hours of life, imaging is used to determine if any associated anomalies are severe enough to preclude an operation, and what operation will be required so that the child can grow as normally as possible. If a colostomy is done, pre-definitive repair imaging in the form of a high-pressure distal colostogram determines the surgical approach required to repair the malformation. In more complicated cases of cloacal malformation, advanced imaging in the form of MRI or 3D fluoroscopy is valuable. In the South African setting, 2D fluoroscopy with the surgeon present is adequate to help in planning for the surgical management. Communication between the radiologist and paediatric surgeon is essential to ensure that such patients have the best possible outcome. <![CDATA[<b>The role of cardiac CT angiography in the pre- and postoperative evaluation of tetralogy of Fallot</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782015000200011&lng=pt&nrm=iso&tlng=pt Tetralogy of Fallot (TOF) is the first described and most common cyanotic congenital heart anomaly that generated the first successful surgical palliation procedure and definitive intracardiac repair. Classical TOF comprises the four typical features of right ventricular outflow tract obstruction (RVOTO), right ventricular hypertrophy (RVH), ventricular septal defect (VSD) and aortic dextroposition. Complex forms of the condition include TOF associated with absent pulmonary valve and TOF with pulmonary atresia (TOF-PA) with or without major aortopulmonary collateral arteries (MAPCAs). The pathophysiological understanding that the tetrad is basically the sequel of a singular abnormality of infundibular malformation, with anterior deviation of the infundibular septum, had major surgical consequences that improved survival. Diagnostic and functional imaging play a key role in the clinical and surgical management of patients with TOF. We revisit the role of traditionally employed imaging modalities (echocardiography and cardiac catheterisation) only briefly as these remain within the domain of cardiology practice. The emphasis of the present review is to outline the role of cardiac computed tomographic angiography (CTA) in the evaluation of TOF, with special reference to the technical considerations and best practice recommendations. Cardiovascular magnetic resonance imaging (CMR) is addressed only in passing, as this service is not currently available at our institution. <![CDATA[<b>Paediatric Neuroimaging</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782015000200012&lng=pt&nrm=iso&tlng=pt Tetralogy of Fallot (TOF) is the first described and most common cyanotic congenital heart anomaly that generated the first successful surgical palliation procedure and definitive intracardiac repair. Classical TOF comprises the four typical features of right ventricular outflow tract obstruction (RVOTO), right ventricular hypertrophy (RVH), ventricular septal defect (VSD) and aortic dextroposition. Complex forms of the condition include TOF associated with absent pulmonary valve and TOF with pulmonary atresia (TOF-PA) with or without major aortopulmonary collateral arteries (MAPCAs). The pathophysiological understanding that the tetrad is basically the sequel of a singular abnormality of infundibular malformation, with anterior deviation of the infundibular septum, had major surgical consequences that improved survival. Diagnostic and functional imaging play a key role in the clinical and surgical management of patients with TOF. We revisit the role of traditionally employed imaging modalities (echocardiography and cardiac catheterisation) only briefly as these remain within the domain of cardiology practice. The emphasis of the present review is to outline the role of cardiac computed tomographic angiography (CTA) in the evaluation of TOF, with special reference to the technical considerations and best practice recommendations. Cardiovascular magnetic resonance imaging (CMR) is addressed only in passing, as this service is not currently available at our institution. <![CDATA[<b>Paediatric radiology from a psychosocial lens</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782015000200013&lng=pt&nrm=iso&tlng=pt Globally, hospitals and medical centres have a reputation of causing individual patients an increased level of anxiety, stress and pain owing to their foreign environments, intimidating examinations and rigorous treatments. Because of children's cognitive and developmental levels of understanding and communication, they are more susceptible to increased levels of stress and trauma associated with medical examinations and hospitalisation. Certified Child Life Specialists (CCLSs) are professionals trained in child development and family systems expertise who work directly with children and families to meet their psychosocial and emotional needs in order to help them overcome some of life's most challenging events, including hospitalisation, illness and trauma. This article aims to address the history of the child life profession and the significance of child life in a paediatric imaging unit, and to discuss the current and future status of psychosocial services in South Africa. <![CDATA[<b>Imaging of intractable paediatric epilepsy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782015000200014&lng=pt&nrm=iso&tlng=pt Approximately 20% of paediatric patients with epilepsy are refractory to medical therapies. In this subgroup of patients, neuroimaging plays an important role in identifying an epileptogenic focus. Successful identification of a structural lesion results in a better outcome following epilepsy surgery. Advances in imaging technologies, methods of epileptogenic region localisation and refinement of clinical evaluation of this group of patients in epilepsy centres have helped to widen the spectrum of children who could potentially benefit from surgical treatment. In this review, we discuss ways to optimise imaging techniques, list typical imaging features of common pathologies that can cause epilepsy, and potential pitfalls to be aware of whilst reviewing imaging studies in this challenging group of patients. The importance of multidisciplinary meetings to analyse and synthesise all the non-invasive data is emphasised. Our objectives are: to describe the four phases of evaluation of children with drug-resistant localisation-related epilepsy; to describe optimal imaging techniques that can help maximise detection of epileptogenic foci; to describe a systematic approach to reviewing magnetic resonance imaging of children with intractable epilepsy; to describe the features of common epileptogenic substrates; to list potential pitfalls whilst reviewing imaging studies in these patients; and to highlight the value of multimodality and interdisciplinary approaches to the management of this group of children. <![CDATA[<b>Current updates on HIV-related pulmonary disease in children: What do radiologists and clinicians need to know?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782015000200015&lng=pt&nrm=iso&tlng=pt Despite substantial advances in diagnosis and treatment, pulmonary human immunodeficiency virus (HIV) infection continues to be a major cause of morbidity and mortality in infants and children particularly those who live in developing countries. This article provides an up-to-date review on underlying etiology, often characteristic imaging findings and current management of pulmonary HIV infection in infants and children. Increased understanding of clinical and unique imaging findings of pulmonary HIV infection has a great potential for early and accurate diagnosis which, in turn, can eventually improve pediatric patient care. <![CDATA[<b>Image Gently: A campaign to promote radiation protection for children worldwide</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67782015000200016&lng=pt&nrm=iso&tlng=pt With the goal of raising awareness and developing stakeholder educational tools for the appropriate imaging of children, the Image Gently campaign was launched in 2007. This campaign is a product of a multidisciplinary alliance with international representation which now numbers nearly 100 medical and dental professional societies and organisations, and includes regulatory organisations. The alliance focuses on increasing awareness and developing education materials that support the protection of children worldwide from unnecessary radiation in medicine. The alliance members work with agencies and regulatory bodies to improve standards and measures that are specific to children. The campaign has produced open source modules for all stakeholders regarding CT, fluoroscopy, nuclear medicine, interventional radiology, digital radiography and dental imaging. The philosophy of the Image Gently steering committee is to collaborate, to share information freely, to keep messaging simple and to commit to lifelong learning. Many healthcare practitioners may not understand how to decrease children's radiation exposure; the goal of Image Gently is to increase all stakeholders' understanding of both the benefits and the risks and to encourage radiation reduction strategies. This article summarises the rationale and goals of the global campaign to date.