SA Journal of Radiology最新文献

Metronidazole is a widely used antibacterial and antiprotozoal agent for a number of conditions. Whilst its more common gastrointestinal side effects are well known, neurotoxicity remains under-recognised. Both central and peripheral neurological side effects have been described. This report describes a case of radiologically confirmed metronidazole-induced cerebellar ataxia in a cirrhotic patient with a review of the literature. Awareness of this side effect is essential for prompt recognition as early drug withdrawal leads to resolution in the majority of cases.

Blunt chest trauma related acute thoracic aortic injury (TAI) is a life-threatening condition that requires prompt diagnosis and appropriate management because of high mortality. Computed tomography angiography (CTA) is the imaging of choice for evaluation of patients with major chest trauma findings suspicious of TAI on chest radiography. This case series describes the CTA findings in four high-velocity incident survivors with associated TAIs, discusses the injury type and treatment, and reviews the literature.

For a definitive diagnosis of abdomino-pelvic lesions, percutaneous aspiration or biopsy is often necessary; however, finding a safe 'window' for access is challenging. This case report discusses a novel method to approach a deep pelvic collection and also briefly reviews the various approaches to access such lesions. A sample was obtained from a non-resolving presacral collection using a CT-guided percutaneous, trans-perineal approach with repeated sessions of hydro-dissection. Successful aspiration and analysis revealed multi-drug resistant tuberculosis, thus guiding appropriate management.

Background: The use of computed tomography (CT) for estimation of split renal function (SRF) has been reported previously. However, most of these studies have small samples, and many do not account for the renal attenuation at CT.

Objective: The aim of this study was to compare multidetector computed tomography (MDCT) volumetry-attenuation-based SRF with that obtained via Tc99m-diethylenetriaminepentaacetic acid (DTPA) renal scintigraphy in voluntary renal donors.

Methods: Between January 2017 and January 2020, 526 voluntary renal donors were enrolled prospectively. All donors underwent contrast CT and DTPA scan before surgery. The semiautomatic region of interest (ROI) tool was applied slice by slice on axial CT images acquired in the arterial phase. The renal contour was drawn semiautomatically with mouse clicks around the renal parenchyma, and the renal volume was ascertained. Using renal volume and attenuation, SRF was determined and compared with results obtained at DTPA imaging.

Results: The mean age was 44.91 ± 10.97 years (mean ± s.d.). There was no significant difference in SRF based on DTPA and MDCT volumetry for the left kidney (49.18% ± 3.40% vs. 49.15% ± 3.38%, p = 0.540) and for the right kidney (50.82% ± 3.40% vs. 50.86% ± 3.39%, p = 0.358). A very good correlation was observed between the two methods for the left kidney (r = 0.953, p = 0.000) and the right kidney (r = 0.955, p = 0.000). On simple linear regression analysis, 90.8% of DTPA SRF values for the left kidney and 91.3% of DTPA SRF values for the right kidney could be predicted correctly using the corresponding MDCT SRF values.

Conclusion: MDCT volumetry-attenuation-derived estimation of SRF for living renal donors could be an alternative to renal scintigraphy-based SRF estimation.

Background: South Africa (SA) has no national injury surveillance system, and hence, non-fatal gunshot injuries are not routinely recorded. Most firearm-related injuries require multi-detector computer tomography (MDCT) assessment at a tertiary-level facility. MDCT scanning for victims with gunshot injuries thus provide an indication of the societal burden of firearm trauma. The potential of the modern radiology information system (RIS) to serve as a robust research tool in such settings is not fully appreciated.

Objective: The aim of this study was to evaluate the use of institutional RIS data in defining MDCT scanning trends for gunshot victims presenting to a tertiary-level SA hospital.

Method: A single-institution, retrospective, comparative study was conducted at the Tygerberg Hospital (TBH) Trauma Unit for the years 2013 and 2018. Using data-mining software, customised RIS searches for information on all gunshot-related emergency computed tomography scans in the respective years were performed. Demographic, temporal, anatomical and scan-protocol trends were analysed by cross tabulation, Chi-squared and Fisher's exact tests.

Results: Gunshot-related emergency MDCT scans increased by 62% (546 vs. 887) from 2013 to 2018. Lower-limb CT angiography was the commonest investigation in both periods. A higher proportion of victims in 2018 sustained thoracic injuries (12.5% vs. 19.8%; p < 0.01) and required imaging of more than two body parts (13.1% vs. 19.2%; p < 0.01).

Conclusion: By using RIS data to demonstrate the increasing gunshot-related MDCT workload in the review period, as well as a pattern of more complex and potentially life-threatening injury, this study highlights the burden of firearm trauma in the society and the potential role of the modern RIS as a robust research tool.

Background: The claw sign is advocated as a discriminant of renal versus non-renal origin of tumours. The accuracy of the claw sign on magnetic resonance imaging (MRI) is unknown and is potentially hindered by the inferior spatial resolution and the larger tumour sizes at presentation in developing countries.

Objectives: To define and evaluate the claw sign in differentiating renal from non-renal retroperitoneal masses in children undergoing MRI.

Methods: A definition of the claw sign was proposed. Magnetic resonance imaging studies, clinical and laboratory records of 53 children were reviewed to test the diagnostic accuracy, inter- and intra-observer reliability. Three tumour-mass interface characteristics, inherent to the claw sign, were tested: (1) a smooth tapering kidney edge blending continuously with the tumour, (2) absence of infolding of the kidney and (3) an obtuse superficial angle.

Results: The sensitivity, specificity, negative predictive value and positive predictive values of the claw sign were 97%, 74%, 83% and 94%. The Cohen's kappa values for intra-rater reliability were 0.72 (95% confidence interval 0.54-0.86) for the first reader and 0.83 (0.66-1.00) for the second reader. The Cohen's kappa values for inter-rater reliability were 0.67 (0.50-0.85) and 0.65 (0.44-0.86) for the second reading respectively (p < 0.0001).

Conclusion: The three tumour-mass interface characteristics investigated are all important characteristics of the claw sign. Intra- and inter-rater reliability is moderate to strong for all characteristics and overall impression of the claw sign. The claw sign is therefore sensitive in the accurate placement of an intra-renal mass but lacks specificity.

Synovial plicae are normal remnants of synovial membranes within the knee joint cavity and are usually asymptomatic. Pathological infrapatellar plica, which is mostly due to plica injury, may be a potential cause of anterior knee pain, but is often overlooked and under-reported on magnetic resonance imaging (MRI). This pictorial review illustrates the MRI findings of infrapatellar plica injury and associated knee injuries, with emphasis on its differentiation from the mimics of plica injury.

This report describes a case of chronic recurrent multifocal osteomyelitis (CRMO) in an 11-year-old girl, involving the iliac bone as an initial, solitary site. Atypical imaging features were suspicious of a bone tumour, such as Ewing's sarcoma. Chronic recurrent multifocal osteomyelitis is a great masquerader and can present atypically. Radiologists should be familiar with both typical and atypical presentations, to determine an accurate diagnosis and guide appropriate management. Timely diagnosis may avoid invasive bone biopsy and inappropriate long-term antibiotic prescription for children.

Left paraduodenal hernia (PDH), may present as a surgical emergency with an increased risk of strangulation and incarceration. The diagnosis is challenging because of the non-specific presentation. In the absence of common epigastric or upper abdominal pathology and non-resolving symptoms, a high index of suspicion is required to diagnose left PDH. This report describes a case of radiologically diagnosed left paraduodenal hernia and subsequent successful surgery. It also includes a review of midgut embryology, and the anatomy and radiology of left PDH.

Pathologies of the male urethra are mostly obstructive in nature and require imaging to delineate the lesion type, site, extent and associated abnormality of the urinary bladder. Contrast urethrography (CU) is the gold standard investigation for urethral assessment but has many limitations. Cross-sectional imaging is infrequently used for the evaluation of the urethra but has been gaining importance recently. Multidetector computed tomographic urethrography (MDCTU) has the capability of evaluating the entire length of a male urethra in a single setting and overcomes many technical and patient limitations of CU. Being a novel technique, most radiologists are not familiar with MDCTU and the imaging spectrum of various urethral and bladder pathologies. This pictorial review attempts to present the imaging appearance of the normal male urethra and spectrum of pathological findings, with highlights on its advantages over the CU technique.