SA Journal of Radiology最新文献

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.

Background: Breast cancer presents a significant global health burden. An accurate differentiation between benign and malignant lesions is imperative for timely intervention. While dynamic contrast enhanced MRI (DCE-MRI) is highly sensitive, its specificity is limited. This has led to the exploration of diffusion-weighted imaging (DWI) in distinguishing between benign and malignant breast lesions.

Objectives: The study aimed to explore the diagnostic utility of DWI in distinguishing between benign and malignant breast lesions.

Method: Assessment of 38 breast lesions using DWI with a b value of 800 s/mm², performed with 3 Tesla MRI. The diagnostic performance of two different region of Interest (ROI) placement approaches was compared to obtain a feasible cut-off value of apparent diffusion coefficient (ADC) to differentiate between malignant and benign lesions. The histopathological reports were used as the gold standard.

Results: ADC values of malignant lesions were significantly lower than those of benign lesions (0.84 × 10^-3 mm²/s vs. 1.54 × 10^-3 mm²/s). The average ADC measured using a small-sized 2D ROI including the darkest part in the ADC map, performed better than the large 2D ROI covering the entire lesion.

Conclusion: Using a cut-off value of 0.98 × 10^-3 mm²/s, ADC obtained high sensitivity (90%) and specificity (88.9%) in distinguishing between benign and malignant breast lesions.

Contribution: Utilising quantitative analysis of DWI with ADC value measurement, reliably distinguished between benign and malignant breast lesions in this cohort, especially when employing a higher b value of 800 s/mm².

Background: Timely detection of oesophageal injuries post-penetrating neck trauma is imperative because of the associated high morbidity and mortality. Patients commonly undergo both CT angiography (CTA) and contrast swallow studies (fluoroscopic oesophagography) when oesophageal injury is suspected.

Objectives: To determine the radiological findings of oesophageal injury after penetrating neck trauma comparing CTA and fluoroscopic oesophagography at a single tertiary centre.

Method: The study retrospectively reviewed the data from CTA and fluoroscopic oesophagography reports of patients suspected of oesophageal injuries secondary to penetrating neck trauma at a tertiary hospital in South Africa from January 2018 to December 2022.

Results: A total of 76 records were reviewed. The mean age for the participants was 31.5 years, ranging from 0.75-66 years. In this study 6/76 (8%) patients had confirmed oesophageal injury on fluoroscopy, which is considered the gold standard. The majority of penetrating neck injuries were in the 20-29 year age group, with 33/76 (43%) injuries. Stab wounds as the mechanism of injury accounted for 57/76 (75%). Dysphagia was experienced by 10/76 (13%) of those who had injuries. Zone I injuries accounted for 33/76 (43%) of the injuries.

Conclusion: The incidence of oesophageal injuries secondary to penetrating neck injuries is comparable to previous studies. This study determined that CTA has a high sensitivity but low specificity.

Contribution: Fluoroscopic oesophagography should, therefore, be performed in patients who have an abnormal CTA coupled with clinical signs and symptoms of oesophageal injury.

Background: Liver transplantation is the definitive management for patients with end-stage liver disease. Preoperative computed tomography (CT) is used in living donor liver transplant (LDLT) for donor and graft selection as well as predicting graft weight.

Objectives: The aim of this study is to establish the relationship between estimated graft volume (EGV) and actual graft weight (AGW) and ascertain a correlation coefficient that will improve the accuracy of EGV in a South African population.

Method: The study included 117 LDLT between March 2013 and August 2022. Of these, 86 were left lateral (LL), 15 right lobe (R), 10 left lobe with caudate (LC), five left lobe (L) and one segment two (monosegment) grafts. Estimated graft volume and actual graft weight were compared using the Pearson coefficient and the relationship was illustrated with scatter plots.

Results: Estimated graft volume and AGW had a strong positive correlation with a Pearson correlation (R) of 0.95 (p < 0.001). The relationship was significantly linear with a correlation coefficient of 0.71. The mean EGV was significantly higher than that of AGW (388 mL ± 249 mL vs. 353 g ± 184 g) with overestimation in 61% of cases. Left lateral and R grafts were the most prevalent LDLT graft type, both having a strong linear correlation between EGV and AGW.

Conclusion: Applying a correlation coefficient of 0.71 will improve the accuracy of CT volumetry graft weight predictions.

Contribution: A unique correlation coefficient will improve EGV accuracy, aiding in preoperative planning and mitigating post-operative complications in both donors and recipients.

Urgent investigation is crucial for infants with bilious vomiting, potentially indicating bowel obstruction. Upper gastrointestinal fluoroscopy aids diagnosis, but is not without its challenges. This case report describes a rare case of neonatal intestinal malrotation and mid-gut volvulus with an additional complication of congenital peritoneal encapsulation.

Contribution: This case study offers insights into associated diagnostic challenges and underscores the value of utilising fluoroscopy in diagnosing complex gastrointestinal conditions.

Thyroid gland vascular proliferations pose a challenge to pathologists, radiologists and surgeons. This is illustrated in the case of a 36-year-old woman who underwent a diagnostic thyroid lobectomy for a suspected follicular neoplasm according to cytology. Histological diagnosis confirmed a follicular adenoma as well as a cavernous haemangioma or venous malformation.

Contribution: Thyroid vascular lesions are rare. Evolving nomenclature and application of the International Society for the Study of Vascular Anomalies classification are discussed. Pertinent radiological clues are highlighted to pre-empt the diagnosis and avoid potential surgical complications.

Plasma cell neoplasia has a wide presentation of disease (localised or systemic) according to the International Myeloma Working Group. Radiological imaging identifies plasmacytomas as solitary lesions or part of multiple myeloma. We present a rare case of a 21-year-old female who presented with a skull-base tumour.

Contribution: A head and neck plasmacytoma with further lytic bone lesions was confirmed on imaging. This article presents and discusses the clinical, CT, MRI, positron emission tomography (PET)-CT, histology and laboratory findings.

This report describes a rare case in which double calcifications of the acetabular labrum and rectus femoris occurred concomitantly in a middle-aged female patient who was treated successfully with surgical intervention via hip arthroscopy.

Contribution: This case highlights the existence of various types of calcifications around the acetabulum, with a proposed new classification system for acetabular and periacetabular rim ossifications.