SA Journal of Radiology最新文献

Background: The contrast-enhanced T2-FLAIR (CE-T2-FLAIR) sequence on MRI, through the suppression of CSF and vascular signals, can detect subtle meningeal enhancement in meningitis that may not be appreciable on the routinely used contrast-enhanced T1W (CE-T1W) sequence.

Objectives: To assess CE-T2-FLAIR compared to CE-T1W in the diagnosis of meningitis, using CSF analysis as the gold standard, using both qualitative and quantitative approaches for assessment.

Method: A retrospective study was conducted on 53 patients with clinically suspected meningitis referred for brain MRI. Twenty-seven patients, positive for meningitis on CSF analysis, were classified as the case group; the remaining patients were designated as controls. The pre-contrast, CE-T1W and CE-T2-FLAIR images were assessed and analysed, qualitatively for the detection of abnormal meningeal enhancement, and quantitatively by measuring single pixel signal intensities (SPSI) over the meninges and vessels.

Results: Contrast-enhanced T2-FLAIR demonstrated significantly higher sensitivity (92.59% vs. 57.69%), negative predictive value (92.59% vs. 70.27%) and diagnostic accuracy (94.34% vs. 78.85%) compared to CE-T1W. Additionally, CE-T2-FLAIR showed significantly greater meningeal SPSI and enhancement than CE-T1W.

Conclusion: Contrast-enhanced T2-FLAIR is better at detecting abnormal meningeal enhancement in meningitis than CE-T1W, because of significantly greater signal intensity and enhancement of the meninges compared to vessels.

Contribution: This study reiterates the usefulness of CE-T2-FLAIR as an additional sequence for the detection of abnormal meningeal enhancement in cases of meningitis as confirmed both qualitatively and quantitatively.

Background: Artificial intelligence (AI) is transforming industries, but its adoption in healthcare, especially radiology, remains contentious.

Objectives: This study evaluated the perceptions and attitudes of trainee and qualified radiologists towards the adoption of AI in practice.

Method: A cross-sectional survey using a paper-based questionnaire was completed by trainee and qualified radiologists. Survey questions covered AI knowledge, perceptions, attitudes, and AI training in the registrar programme on a 3-point Likert scale.

Results: A total of 100 participants completed the survey; 54% were aged 26-65 years and 61% were female, with none currently using AI in daily radiology practice. The majority (78%) of participants understood the basics and knew the role of AI in radiology. Most knew about AI from media reports (77%) and majority (95%) were never involved in AI training; only 3% of participants had no knowledge of AI at all. Participants agreed that AI could reliably detect pathological conditions (89%), reach reliable diagnosis (89%), improve daily work (78%), and 89% favoured AI practice; 89% believed that in the future, machine learning will not be independent of the radiologist. Participants were willing to learn (98%) and contribute towards advancing AI software (97%) and agreed that AI will improve the registrars' programme (97%), also noting that AI applications are as important as medical skills (87%).

Conclusion: The findings suggest AI in radiology is in its infancy, with a need for educational programmes to upskill radiologists.

Contribution: Participants were positive about AI implementation in practice and in the registrar learning programme.

A rare case of widespread disseminated cysticercosis was identified in a 32-year-old female patient from the Eastern Cape province, South Africa. Initially, she displayed generalised nonspecific symptoms, leading to a misinterpretation of disseminated tuberculosis (TB). However, further radiological, haematological and pathological investigations revealed extensive dissemination of cysticercosis.

Contribution: Disseminated cysticercosis (DC) is a rare condition that can mimic symptoms of other diseases, including tuberculosis, highlighting the importance of considering it in endemic areas.

Background: Magnetic resonance imaging (MRI) is used for the evaluation of degenerative spinal disease. However, its utility is restricted in routine practice because of contraindications and a lack of widespread availability. Dual-energy computed tomography (DECT) is a newer technique for the evaluation of degenerative spinal disease.

Objectives: This study aimed to evaluate the diagnostic performance of DECT with electron-density (ED) image reconstruction compared to standard CT for the detection of lumbar disc herniation, with MRI as the gold standard.

Method: The retrospective study included 84 patients between 01 July 2023 to 31 December 2023 who underwent DECT and 1.5-T MRI within 1 week. Four radiologists, blinded to the clinical and MRI information, independently evaluated the standard CT series and DECT series with ED reconstructions for lumbar disc herniation and spinal nerve root impingement. The gold standard for comparison was lumbar spine MRI, and diagnostic accuracy was measured with sensitivity and specificity.

Results: MRI revealed 417 lumbar disc herniations. Dual-energy computed tomography with ED reconstruction showed higher sensitivity (86.36% [532/616] vs. 57.79% [356/616]) and specificity (96.86% [1019/1052] vs. 95.82% [1008/1052]) for the detection of lumbar disc herniation compared to standard CT.

Conclusion: Dual-energy computed tomography with ED reconstruction shows better diagnostic performance for the detection of lumbar disc herniation compared to standard CT and can be a useful alternative imaging modality when MRI is contraindicated or unavailable.

Contribution: This study shows the usefulness of DECT as an alternative imaging technique for screening of degenerative spinal disease whenever MRI is contraindicated or unavailable.

Background: Studies have found that, at presentation, human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has a less advanced primary tumour, more advanced lymph node spread and commonly has cystic metastatic lymph nodes in comparison to HPV-negative OPSCC.

Objectives: To compare the radiological features of HPV-positive and HPV-negative OPSCC in South African patients.

Method: A retrospective cross-sectional study was conducted at a large South African hospital. Eligibility required a histologically proven OPSCC between 2007 and 2023; a p16 antigen test and, if positive, a confirmatory HPV DNA PCR test and a baseline pre-treatment contrast enhanced neck CT scan. All eligible HPV-positive OPSCC patients and a random sample of eligible HPV-negative OPSCC patients were enrolled.

Results: Twenty-one HPV-positive and 55 HPV-negative OPSCC patients were recruited. There was no statistically significant difference in the tumour epicentre location, local advancement (≥ T3 in 67% and 71%, respectively, p = 0.54), mean primary tumour size (41 mm vs. 39 mm, p = 0.73), lymph node spread (bilateral or more in 67% vs. 82%, p = 0.22) or morphologically cystic lymph nodes (10% and 4%, p = 0.61).

Conclusion: There was no statistically significant difference in the CT imaging appearances of HPV-positive and HPV-negative OPSCC in the studied sample of South African patients.

Contribution: This study documents the radiological features of OPSCC in a small South African sample population, where HPV-positive and HPV-negative OPSCC could not be distinguished on CT criteria and did not display the classic features described in the literature.

Background: In CT, the volumetric CT dose index (CTDI_vol), dose-length product (DLP) and patient's size-specific dose estimates (SSDE) are used as diagnostic reference level (DRL) metrics.

Objectives: To develop clinical local DRL values for CT chest-abdomen-pelvis (CAP) examinations using the CTDI_vol, DLP and SSDE, and to determine the image quality achieved.

Method: In total, 201 cancer patients were included in the study. The scanning parameters, dose metrics from the CT unit and participants' body mass index (BMI) were documented. The local CT DRL values for CAP examinations were defined as the median and 75th percentiles of the dose distribution.

Results: The local DRL values given in terms of median CTDI_vol ranged between 8.4 mGy and 12.7 mGy for the different types of cancers. The median DLPs ranged from 848 to 1173.4 mGy.cm for the various cancers. Generally, the radiation dose was directly proportional to the BMI and number of scan phases. Significant differences were observed between the DRLs for the various size-related parameters, number of scan phases and BMI classifications. The image quality was clinically satisfactory.

Conclusion: No baseline data for clinical DRL values were available for this medical oncology department. The achieved DRLs were similar to published size-specific DRLs. The image quality was maintained during CT imaging. Dose optimisation and image quality assessment should be implemented to ensure optimal scanning parameters for different cancers in CT CAP examinations.

Contribution: The first size-specific local DRL values for CT CAP investigations carried out on oncology patients in South Africa have been established.

Phosphaturic mesenchymal tumours (PMT) are rare, benign lesions and the most common tumour to cause tumour-induced osteomalacia (TIO), a paraneoplastic syndrome. Patients frequently exhibit severe osteomalacia, accompanied by multiple fractures, which significantly impair their quality of life. Complete surgical resection is curative.

Contribution: A rare case of sinonasal PMT is presented, with a focus on the imaging findings and role of the radiologist and nuclear physician.

Disorders related to defaecation are widely common in the population and are often overlooked. Patients may present with a wide variety of symptoms such as constipation, faecal incontinence, painful defaecation, incomplete defaecation, hard stools, rectal bleeding, and mass per rectum. Complete clinical examination with radiological imaging, using dynamic MR Defaecography, can help in assessing, grading, and managing posterior compartment pelvic floor disorders and complex dysfunctions. The cases reveal a spectrum of pelvic floor disorders and complex dysfunctions including spastic pelvic floor syndrome, Grade 3 anorectal descent with rectocoele and cystocoele, tri-compartmental descent with obstructed defaecation syndrome, complete external rectal prolapse with Grade 3 abnormal anorectal descent and rectal intussusception.

Contribution: This case series emphasises the importance of understanding the correlation of clinical and radiological imaging findings in posterior compartment pelvic floor dysfunctions through a series of cases presenting with clinical complaints related to defaecation.

Background: The radiology report is the primary means of conveying imaging findings between radiologists and clinicians. As a result, clinician satisfaction with the radiology report is an indicator of its quality and clinical relevance. It is crucial to identify factors that can enhance the radiology report in order to improve service delivery.

Objectives: This study evaluates clinician and radiologist opinions, preferences and clinician utilisation of the radiology report.

Method: Mixed quantitative and qualitative survey questionnaires were distributed in-person and online from December 2022 to February 2023 to a total of 287 clinicians and 43 independent medical practitioners specialising in radiology.

Results: A total of 73.0% of radiologists and 56.5% of clinicians expressed satisfaction with the radiology reports. Additionally, 72.0% of radiologists expressed dissatisfaction with the history provided on the referral forms. It was found that 87.6% of clinicians read the radiology report, while 26.2% reviewed the radiological imaging without referring to it. Interestingly, 77.8% of clinicians preferred itemised listed reports, whereas 53.8% of radiologists preferred reports in paragraph format. It was discovered that 69.6% of radiologists and 65.4% of clinicians preferred a standardised reporting format.

Conclusion: More than half of the clinicians and most of the radiologists expressed satisfaction with the radiology report. Both clinicians and radiologists showed a preference for a structured reporting format. A crucial element in constructing a good radiology report was having a relevant clinical history. The radiologist continued to be the preferred professional for interpreting radiological imaging.

Contribution: This survey was a good starting point for improving communication between clinicians and radiologists. This will ultimately result in reports that are more useful to clinicians and radiologists who have a better understanding of what should be included in reports and how they should be structured.