SA Journal of Radiology最新文献

Background: Triple-negative breast cancer (TNBC) is considered an aggressive subtype, defined by the absence of oestrogen, progesterone and HER2 receptors. It typically presents earlier and more aggressively. Limited data exist on its prevalence, age of onset and imaging features in South Africa.

Objectives: This study aimed to assess the prevalence of TNBC at Helen Joseph Tertiary Hospital (HJTH), describe its histopathological features and explore trends in age at diagnosis and imaging patterns-including early-onset disease.

Method: A retrospective review of 280 female patients with histologically confirmed breast cancer, diagnosed between January 2021 and December 2023, was conducted. Demographic, imaging and histopathology data were analysed using descriptive statistics and chi-square tests.

Results: The diagnosis of TNBC accounted for 17% (48/280) of all breast cancer cases in the cohort. The TNBC lesions typically measured 1-5 cm and showed nodal involvement in 73% of cases. Despite their aggressive biology, many TNBC lesions appeared circumscribed or only mildly irregular on imaging, mimicking benign masses. Among all the 280 breast cancer cases, 61% were high-grade. The mean Ki-67 index for TNBC was the highest at 52%, followed by HER2+ (39%), Luminal B (33%) and Luminal A (21%). Notably, some HER2+ and TNBC cases exhibited lower Ki-67 indices, highlighting heterogeneity within these subtypes.

Conclusion: This study highlights the complexity of breast cancer presentation in a South African setting, particularly the discordance between tumour biology and imaging.

Contribution: These findings contribute local data on TNBC in an urban public healthcare context, supporting improved imaging awareness and clinical vigilance in resource-limited settings.

Background: Interventional radiology (IR) is rapidly growing as a critical subspeciality, yet in South Africa (SA) IR training remains underdeveloped, with no national data to guide structured training and workforce expansion.

Objectives: This study aimed to assess South African radiology registrars' interest in IR, their exposure, and the existing training environment.

Method: A cross-sectional, electronic quantitative and qualitative survey was conducted from 09 February 2024 to 08 March 2024 among registrars affiliated with the Radiological Society of South Africa. The survey gauged their interest in IR, exposure, training infrastructure, learning tools, satisfaction with training and potential areas for improvement.

Results: Response rate: 45% (100/221 registrars); 54% were female, median age was 33.4 years and 51% in their first or second year. Interest in IR as a subspeciality was expressed by 40%, 27% were not interested and 33% were unsure. Only 27% reported adequate exposure; 56% had limited exposure and 17% had none. Dissatisfaction with IR training was noticed by 47%, 37% were undecided and 16% were satisfied. Only 9% had a structured curriculum, while 23% relied on mentorship. Major themes for improvement included structured training, mentorship, supervision, training facilities and hands-on exposure.

Conclusion: Despite strong interest, radiology registrars (including international supernumerary registrars) face significant gaps in IR training and exposure in SA.

Contribution: This is the first national study to provide essential baseline data to inform targeted reforms and development of structured, locally relevant IR training.

Background: Breast cancer remains a major public health burden in South Africa, with diagnostic delays contributing to poor outcomes. Ultrasound is effective for early detection but is limited by access and operator variability. Integrating artificial intelligence (AI) into point-of-care ultrasound (POCUS) offers a potential solution.

Objectives: To evaluate the diagnostic performance of a locally developed AI-enabled POCUS system (Breast AI) in predicting malignancy among women with palpable breast abnormalities.

Method: A prospective cohort study was conducted between June 2024 and November 2024 at Groote Schuur Hospital. Women aged ≥ 25 years with suspicious breast lesions underwent Breast AI ultrasound prior to biopsy. Real-time malignancy risk scores were compared with histopathological results. Diagnostic accuracy was assessed using sensitivity, specificity, positive predictive value (PPV), F1 score and area under the curve (AUC).

Results: Among 159 participants, Breast AI achieved a sensitivity of 67.2%, specificity of 79.4% and PPV of 70.3% at a 51% threshold. The AUC was 0.76, reflecting moderate discriminatory performance. F1 score analysis identified 51% as the optimal cut-off (F1 = 65.7%). Benign pathologies such as fibroadenomas and fat necrosis correlated with low AI scores. A three-tiered risk model was developed: < 30% (low), 30% - 51% (intermediate) and > 51% (high risk).

Conclusion: Breast AI demonstrates promising diagnostic accuracy for triaging suspicious breast lesions, particularly in resource-constrained settings.

Contribution: This study provides real-world evidence supporting the integration of AI into POCUS to improve breast cancer detection and clinical decision-making in low-resource environments.

Tracheo-oesophageal fistula (TOF) is a significant congenital anomaly characterised by an abnormal communication between the trachea and the oesophagus. Prompt diagnosis and surgical intervention are crucial, but long-term outcomes depend on accurate imaging and postoperative monitoring. The article discusses the embryological basis, clinical presentation and various types of TOF with their imaging techniques. Immediate and long-term postoperative complications are also discussed. Recent advances such as Ultrashort Echo Time (UTE), MRI and the Oesophageal Anastomotic Stricture Index (OASI) have expanded the capabilities of imaging in predicting surgical outcomes and guiding follow-up.

Contribution: This review highlights the pivotal role of imaging in the diagnosis, classification, surgical planning and follow-up of TOF, focusing on current and emerging modalities.

Background: Intussusception is a common cause of paediatric bowel obstruction requiring urgent management to prevent ischaemia. Fluoroscopy-guided air enema reduction (FGAR) is the standard non-surgical treatment for uncomplicated cases.

Objectives: To identify factors associated with FGAR outcomes in paediatric intussusception.

Method: A retrospective analytical study was conducted at Universitas Academic Hospital, Bloemfontein, South Africa, including 110 patients with radiologically confirmed intussusception from November 2016 to December 2022. Data encompassed demographics, clinical presentation, laboratory results, and imaging findings.

Results: Among 110 cases (median age 7 months, symptom duration 2 days), 37 were primarily surgically managed, while 73 underwent FGAR attempts (31 successful, 42 unsuccessful, requiring surgery). Of the 79 surgical cases, 24 had manual reduction without resection. Unsuccessful FGAR was significantly associated with younger age (p = 0.0249), dehydration (p = 0.0299), ascites (p = 0.0172), and increased outer wall intussusception diameter on ultrasound (p = 0.0026).

Conclusion: In this South African cohort, unsuccessful FGAR was linked to younger age, dehydration, ascites, and larger intussusception size on ultrasound. Early recognition and routine ultrasound use are critical in resource-limited settings to enhance non-surgical outcomes and reduce surgical burden.

Contribution: This study identifies predictors of FGAR failure in a low-resource context, informing clinical decision-making and addressing a gap in the literature on intussusception management in low- and middle-income countries.

Gallstone ileus is a mechanical bowel obstruction caused by a gallstone within the intestinal tract. It occurs secondary to a fistulous communication between the gallbladder and intestine and commonly causes a small bowel obstruction termed gallstone ileus. It rarely causes a large bowel obstruction termed gallstone sigmoid ileus (GSI) or gallstone coleus.

Contribution: A case of gallstone sigmoid ileus with typical plain radiography and CT scan findings and a review of different imaging modalities for this condition.

Background: Magnetic resonance fistulography (MRF) is a key non-invasive imaging technique for mapping perianal fistulas before surgery. The instillation of aqueous jelly, like ultrasound gel, enhances the signal-to-noise ratio, improving image quality and MRF accuracy. This low-cost approach improves accessibility, especially in resource-limited settings, while ensuring patient comfort and safety.

Objectives: To determine the impact of aqueous jelly on the accuracy of MRF in identifying fistulous tracts, internal openings, secondary ramifications and abscesses and the quality of visualisation of MRF with and without jelly instillation.

Method: A cross-sectional study at Krishna Rajendra and Cheluvamba Hospitals, Mysore (October 2024-March 2025), included 40 patients with perianal fistulas. Magnetic resonance fistulography was performed using a 1.5 Tesla uMR 570 system, without and with 5 mL - 7 mL of sterile aqueous jelly instilled percutaneously. MRI findings were compared with intraoperative results. Data were analysed using Statistical Package for the Social Sciences (SPSS) to assess sensitivity, specificity and accuracy.

Results: Magnetic resonance fistulography with gel improved visualisation, identifying internal openings in 92.5% of cases (vs. 24% without gel) and secondary tracts in 40% (vs. 17.5%). The accuracy compared to surgery was 97.5% for internal openings, 95% for secondary tracts, 97.5% for abscesses and 100% for supralevator extension.

Conclusion: Aqueous jelly instillation enhances MRF accuracy, improving fistula visualisation and aiding in preoperative planning. This technique reduces recurrence and incontinence risk and supports more accurate surgical interventions.

Contribution: This study re-emphasises the value of aqueous jelly in improving diagnostic accuracy and accessibility, especially in resource-limited settings.

Background: Ultrasound elastography, with the measurement of the lesional width ratio between elasticity imaging (EI) and B-mode image (BI) (EI/BI), provides a non-invasive method for breast cancer (BC) characterisation. Evidence from a limited number of researchers supporting the efficacy of this ratio in avoiding unnecessary biopsies warrants further exploration.

Objectives: To assess the role of the EI/BI ratio in the evaluation of solid breast lesions and correlate the findings with histopathological results.

Method: The study enrolled 54 female patients with clinically palpable breast lesions, non-palpable breast lesions (seen on mammography or ultrasound) and high-risk female participants with a positive family history of BC. Using ultrasound elastography, the EI/BI ratio was calculated and correlated with the histology using the Chi-square test and Cramer's V test.

Results: The mean age was 41.9 ± 11.8 years, and 59.2% had fibroadenomas. The EI/BI ratio was ≥ 1 in 16 (29.6%) cases, where malignancy was confirmed on histology in all cases. Thirty-eight cases were benign as per the EI/BI ratio (< 1), of which 2 were found to be malignant. A significant correlation was seen between the EI/BI ratio and histopathology findings (p < 0.001). The specificity, sensitivity, positive and negative predictive values and diagnostic accuracy of the EI/BI ratio were 100%, 88.9%, 94.7%, 100% and 96.3%, respectively.

Conclusion: The EI/BI ratio is effective in differentiating between benign and malignant solid breast lesions, with a statistically significant correlation with histopathology.

Contribution: The study validates the use of EI/BI ratio by radiologists to effectively differentiate between benign and malignant breast lesions in patients.

Background: 4-Dimensional computed tomography (4DCT) is a specialised examination used to locate diseased parathyroid glands in a confirmed case of primary hyperparathyroidism.

Objectives: To define the role of 4DCT as a first-hand diagnostic tool in locating the abnormal parathyroid gland.

Method: A retrospective cohort study of 44 patients with primary hyperparathyroidism was performed. Patients with preoperative 4DCT findings and surgical findings with histopathological results were included in the study to assess the effectiveness of 4DCT in locating the diseased parathyroid glands.

Results: Of the 44 patients who underwent 4DCT, operative findings of three patients were discordant with the 4DCT findings. The calculated sensitivity of 4DCT was 93%. 4DCT was able to identify lesions in ectopic locations in two cases and missed one case in an intra-thyroidal location, misinterpreted as a suspicious thyroid lesion. The sensitivity of 4DCT in detecting multiglandular disease was 75%. Of the diagnosed parathyroid lesions, 52.1% were located on the left, 35.4% on the right and 12.5% were located bilaterally. Additionally, 76% were seen inferiorly and 24% were seen superiorly.

Conclusion: 4DCT has high utility in the presurgical localisation of the eutopically or ectopically placed diseased parathyroid glands in single and multiglandular disease and also provides additional anatomical details.

Contribution: 4DCT identified additional findings such as aberrant origin of right subclavian artery, which is an important pre-operative finding for the surgeon to be aware of. This study contributes to the existing literature on the role of 4DCT.

Background: Interventional radiology (IR) is a rapidly advancing speciality which uses various imaging modalities to guide diagnostic and therapeutic procedures. Because of its many proven benefits, IR is becoming an integral part of clinical medicine, often taking preference over traditional therapies. While a vast amount of data have been published on IR experiences, there is a paucity of data from South Africa. An objective understanding of the scope and trajectory of our local IR practice is warranted given the global increasing demand for IR services.

Objectives: This study investigated the scope of IR practice in a tertiary public hospital in South Africa over a period of 5 years.

Method: Records for all IR procedures performed at Groote Schuur Hospital (GSH) from 01 January 2019 to 30 December 2023 were retrieved from the hospital Picture Archiving and Communications System (PACS) and radiographers' records.

Results: The unit performed a total of 7438 procedures ranging from body, biliary, urology, angiography to oncology interventions over the 5-year period. Across all years, abscess drainages were consistently the most common procedure, followed by percutaneous transhepatic cholangiogram (PTC) drainages and nephrostomies.

Conclusion: The unit plays a major role in infection control with an increase in oncologic interventions in line with international practices. There is room for growth in refining the role of IR in trauma and other lifesaving emergency procedures.

Contribution: This study provides information on the scope and utilisation patterns of IR services in South Africa and can serve as a baseline for future monitoring and comparison studies.