Scielo RSS <![CDATA[SA Journal of Radiology ]]> vol. 21 num. 1 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>Clinically relevant magnetic resonance imaging (MRI) findings in elite swimmers' shoulders</b>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>Potential pitfalls in the anorectal region during CT colonography: A discussion and pictorial overview of common pitfalls</b>]]> 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. <link></link> <description/> </item> <item> <title><![CDATA[<b>The role of magnetic resonance cholangiopancreatography and diffusion-weighted imaging for the differential diagnosis of obstructive biliary disorders</b>]]> BACKGROUND: Although endoscopic retrograde cholangiopancreatography (ERCP) is accepted as the gold standard, there is a place for magnetic resonance cholangiopancreatography (MRCP) and diffusion-weighted imaging (DWI) in the diagnosis of obstructive biliary disorders AIM: To compare the findings of MRCP with ERCP in patients with obstructive biliary disorders and to investigate the diagnostic efficacy of MRCP combined with DWI STUDY DESIGN: Retrospective, analytic, cross-sectional study METHODS: The MRCP images of 126 patients who underwent both MRCP and ERCP owing to biliary obstruction were reviewed. Nine patients were excluded because of incomplete diagnostic workup or a long period (>3 months) between MRCP and ERCP. Ninety-two patients underwent DWI, which was also evaluated. The sensitivity, specificity and accuracy of MRCP and DWI were analysed RESULTS: The sensitivity, specificity and accuracy of MRCP according to ERCP results as the gold standard was 97%, 71% and 93% for assessment of biliary dilatation; 100%, 94.7% and 97.5% for the diagnosis of choledocholithiasis; 93.7%, 100% and 99% for the identification of benign strictures; 100%, 100% and 100% for the diagnosis of malignant tumours; and 100%, 100% and 100% for the detection of complicated hydatid cysts; respectively. The sensitivity and specificity of DWI for the diagnosis of malignant tumour was 100%. In the detection of choledocholithiasis, the sensitivity and specificity of DWI was 70.8% and 100% CONCLUSIONS: MRCP is an alternative, non-invasive, diagnostic modality, comparable with ERCP for the evaluation of pancreaticobiliary diseases. DWI can be helpful for diagnosis of choledocholithiasis and tumours <![CDATA[<b>Venous function after pharmacomechanical thrombolysis for extensive iliofemoral deep vein thrombosis</b>]]> BACKGROUND: Chronic venous insufficiency is an important complication following iliofemoral deep venous thrombosis. Early thrombus removal may preserve venous function and prevent this complication. This study represents the largest reported South African series of pharmacomechanical thrombolysis for iliofemoral deep venous thrombosis to date OBJECTIVE: To evaluate the long-term outcome following pharmacomechanical thrombolysis for proximal and extensive deep venous thrombosis in a private, specialist vascular unit METHODS: All patients who underwent pharmacomechanical thrombolysis for iliofemoral deep venous thrombosis between August 2009 and January 2016 were invited to return for clinical assessment and venous ultrasound. Clinical findings were recorded according to the Villalta score and clinical, etiology, anatomic and pathology (CEAP) classification. The quality of life (QoL) was assessed utilising the VEINES-QoL/Sym questionnaire, providing two scores per patient, one describing the QoL and the other symptom severity (Sym RESULTS: Thirty two patients (35 legs) were evaluated. There were 25 females and 7 males, with a mean age of 33.5 years (±14 years). The mean follow-up period was 31 months (range 3 months - 80 months). Results of the CEAP classification were C0 = 24 (75%), C1 = 1 (4%), C2 = 2 (6%), C3 = 2 (6%) and C4 = 3 (9%). Thirty-one (97%) patients had Villalta scores from 0 to 4, indicating no or mild evidence of venous disease. One patient (3%) had a Villalta score of 6, indicating post-thrombotic syndrome. The mean QoL score was 87% (±12) and the mean Sym score was 86% (±14). Twenty-four (75%) patients had no abnormality on ultrasound, with fibrosis the most observed abnormality CONCLUSION: Most patients who had undergone pharmacomechanical thrombolysis for extensive iliofemoral deep venous thrombosis showed few significant clinical signs of chronic venous insufficiency, had excellent function on venous ultrasound and reported excellent QoL <![CDATA[<b>Comparing computed tomography (CT) angiography versus digital subtraction angiography for the screening of traumatic pseudoaneurysms in transcranial stab injuries</b>]]> INTRODUCTION: Transcranial stab injuries among the civilian population in South Africa are more common than in the West. In a study conducted in Durban, South Africa, in 1992, transcranial stab injuries accounted for 6% of all head injuries admitted to the neurosurgical unit. Digital subtraction angiography (DSA) has been the gold standard for diagnosing traumatic pseudoaneurysms. Its use as a screening tool is, however, limited and carries risks of neurological deficits. We postulate that the newer generation computed tomography (CT) scanner would serve as a better screening tool for traumatic pseudoaneurysms following transcranial stab injuries with the blade removed, provided the image quality is good. METHODS: All patients admitted with a stab to the head with total calvarial penetration from September 2014 to January 2016 were included in the study. Those with a retained metallic fragment, incomplete imaging protocols, no penetration of the blade into the brain parenchyma or other causes of penetrating head injury were not included in the study. A retrospective chart review was then done on a prospectively recruited patient cohort. All CT angiograms were performed using a dual source CT scanner. RESULTS: A total of 26 patients met the inclusion criteria. There were seven vascular injuries identified on DSA: three traumatic pseudoaneurysms and four vessel cut-offs. One traumatic pseudoaneurysm was missed on computed tomography angiography (CTA) because of a poor quality scan. The average sensitivity and specificity of CTA compared with DSA was 67% and 95.5%, respectively. Negative predictive value for CTA was 99.5%. CONCLUSION: A good quality CTA carried out on the newer generation CT scanners allows for use of CTA as a screening tool for patients with a transcranial stab injury and no retained blade or metallic foreign bodies. <![CDATA[<b>Dynamic ultrasound evaluation of the syndesmosis ligamentous complex and clear space in acute ankle injury, compared to magnetic resonance imaging and surgical findings</b>]]> BACKGROUND: Syndesmosis injuries are often more serious than an injury to the lateral ligament complex of the ankle, with double the recovery time, chronic discomfort and joint instability. Although magnetic resonance imaging (MRI) is considered as the best imaging modality to assess the integrity of the syndesmotic ligamentous complex and clear space, a dynamic ultrasound evaluation may provide an alternative imaging option worthy of exploring AIM: The aim of this article is to compare the sensitivity and specificity of musculoskeletal ultrasound and MRI, in the diagnosis of syndesmosis pathology, with surgical findings as the reference point METHOD: MRI was performed on 114 participants presenting with pain over the lateral aspect of the ankle after injury. This was followed by a dynamic ultrasound examination during which the anterior tibiofibular ligament (ATiFL) was assessed for continuity, contour and haematoma. The tibiofibular clear space was measured with the ankle in a neutral position, followed by internal and external rotation RESULTS: The Fisher's exact test was used to determine non-random associations between variables and compute statistical significance (p < 0.05). Ultrasound achieved a sensitivity of 86.3%, specificity of 97% with a false-positive rate of 3%. The sensitivity of MRI is similar to that of ultrasound (86%) with a specificity of 100% CONCLUSION: Although both imaging tests performed very well, MRI was slightly better at excluding pathology while both tests performed equally in demonstrating pathology. As a simple, inexpensive and reproducible test, dynamic ultrasound can thus be considered as an alternative to MRI in acute ankle pathology <![CDATA[<b>Central vein rupture during percutaneous transluminal angioplasty for central vein stenosis or occlusion in haemodialysis patients</b>]]> BACKGROUND: Endovascular treatments such as percutaneous transluminal angioplasty (PTA) and stent placements are becoming the standard method in managing haemodialysis access failure. Venous rupture is the most common complication during endovascular procedures. Complications during endovascular treatments of central venous stenosis or occlusion have been rarely reported OBJECTIVES: To investigate the incidence and management of central vein rupture while performing PTA for central vein stenosis or occlusion in haemodialysis patients METHOD: Between 1998 and 2013, PTA was performed using various techniques in haemodialysis patients for central vein stenoses (n = 2437) and occlusions (n = 666). When the guide wire passed through the stenosis or the occlusion, PTA was performed regardless of the presence of a venous rupture. The incidence of central vein rupture was analysed using the chi-square test according to the gender, location, right versus left, presence of thrombosis and stenosis versus occlusion. Percutaneous management of central vein rupture was also evaluated RESULTS: Central vein rupture occurred in 12 cases (0.39%). All ruptures occurred in the cases with occlusion. Only stenosis versus occlusion reflected a significant correlation (p < 0.001) with central vein rupture. Central vein ruptures were managed by low-pressure balloon tamponade (n = 2), stent/stent-graft (n = 5) and balloon-mediated haemostasis blocking venous inflow followed by the observation (n = 5 CONCLUSION: Central vein rupture is a rarely occurring complication while performing PTA for central vein stenosis and occlusion, and the majority can be successfully managed by percutaneous techniques <![CDATA[<b>Extraosseous Ewing's sarcoma, a case report on a rare diagnosis in an 80-year-old woman with a large abdominal mass</b>]]> Extraosseous or extraskeletal Ewing's sarcoma is a very rare mesenchymal soft tissue malignancy. We report on a case of abdominal swelling in an 80-year-old woman caused by a large intra-abdominal EES. This case report illustrates that Ewing's sarcoma can occur in adults and elderly, and highlights the importance of early diagnosis because of poor prognosis. <![CDATA[<b>Limiting foetal doses during a four-vessel angiogram and endovascular stent-assisted berry aneurysm repair: A case report</b>]]> A 36-year-old female patient, 20 weeks pregnant, was diagnosed with a left internal carotid artery aneurysm. Fluoroscopically guided repair was justified. A four-vessel cerebral angiogram was performed, and a left paraclinoid aneurysm was demonstrated. The patient subsequently underwent endovascular stent-assisted berry aneurysm repair. As the patient was pregnant, the procedure was preceded by consideration of the required radiation protection. The foetal dose was estimated as negligible. Active management of foetal exposures may improve radiation protection during pregnancy. <![CDATA[<b>Dyke-Davidoff-Masson syndrome with crossed cerebellar atrophy</b>]]> Dyke-Davidoff-Masson syndrome is a rare condition with classical, clinical and radiological changes - mental retardation, hemiparesis, facial asymmetry, seizures and cerebral hemiatrophy with calvarial changes. Contralateral cerebellar atrophy is rare and occurs if insult occurs after 1 month of age. We report a case of a 6-year-old female child presenting with right-sided hemiparesis, convulsions and left cerebral hemiatrophy with an old infarct in left middle cerebral artery (MCA) territory, ipsilateral calvarial thickening and right (crossed) cerebellar atrophy. <![CDATA[<b>First presentation of Crohn's disease complicated with hepatic portal venous gas and pylephlebitis</b>]]> The authors present a rare case where radiological findings provided an important diagnostic and prognostic role in a surgical patient with abdominal sepsis. The case in interest describes an extremely rare surgical complication of intestinal Crohn's disease (CD), namely, pylephlebitis and hepatic portal venous gas (HPVG). Key radiological findings and their clinical significance are described to further add to the limited published data available on CD with pylephlebitis and HPVG. <![CDATA[<b>Pulmonary venous abnormalities encountered on pre-radiofrequency ablation mapping multidetector computed tomography</b>]]> Multidetector computed tomography (MDCT) elegantly renders pulmonary venous anatomy. With increasing numbers of radiofrequency ablation procedures being performed, there is now a greater emphasis on pre-procedure imaging to delineate this anatomy. Pulmonary venous mapping studies can be performed with or without ECG-gating. However, ECG-gating improves both the quality of 3D images and the accuracy of pulmonary vein (PV) ostial diameter measurements. Including the superior thorax, and not just the left atrium and central PVs, allows visualization of aberrant pulmonary venous drainage to the brachiocephalic veins or superior vena cava. Normally, there are two superior PVs, one right and one left, and two inferior PVs, one right and one left. The right superior vein usually drains the right upper and middle lobe. The left superior vein drains the left upper lobe including the lingula. The inferior veins drain their respective lower lobe. PV anatomy is more variable than pulmonary arterial anatomy, and developmental anomalies are common. This article describes, illustrates and reviews the common anomalies of the PVs in our experience performing over 1000-pre-radiofrequency ablation cardiac MDCT studies. The commonest anomalies are supernumerary or accessory veins (on the right) and a (left) common trunk. More rarely, partial anomalous pulmonary venous return and Cor triatriatum are seen, and rarest of all is total anomalous pulmonary venous return, PV varix and single or multiple vein stenosis or atresia. <![CDATA[<b>Eagle syndrome - An overview</b>]]> Eagle syndrome represents symptoms brought about by compression of vital neurovascular and muscular elements adjoining the styloid process because of the elongation of styloid process or ossification of the stylohyoid or stylomandibular ligament. It is crucial for dentists, otolaryngologists and neurologists to be aware of the elongation of the styloid process and associated signs and symptoms. This article reviews the aetiopathogenesis, classification, investigative procedures and treatment modalities associated with Eagle syndrome. <link></link> <description/> </item> <item> <title><![CDATA[<b>Corrigendum: Uterine artery embolisation as an effective choice for symptomatic fibroids: Five-year outcome</b>]]> Eagle syndrome represents symptoms brought about by compression of vital neurovascular and muscular elements adjoining the styloid process because of the elongation of styloid process or ossification of the stylohyoid or stylomandibular ligament. It is crucial for dentists, otolaryngologists and neurologists to be aware of the elongation of the styloid process and associated signs and symptoms. This article reviews the aetiopathogenesis, classification, investigative procedures and treatment modalities associated with Eagle syndrome. <![CDATA[<b>Corrigendum: Paediatric doctors' error rate in detection of paediatric elbow injuries in Rahima Moosa Mother and Child Hospital</b>]]> Eagle syndrome represents symptoms brought about by compression of vital neurovascular and muscular elements adjoining the styloid process because of the elongation of styloid process or ossification of the stylohyoid or stylomandibular ligament. It is crucial for dentists, otolaryngologists and neurologists to be aware of the elongation of the styloid process and associated signs and symptoms. This article reviews the aetiopathogenesis, classification, investigative procedures and treatment modalities associated with Eagle syndrome.