SA Journal of Radiology最新文献

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.

Intercostal artery-to-pulmonary artery fistula is an extremely rare variant of systemic artery-to-pulmonary artery fistulas (SA-PAFs). A case of a 38-year-old man presenting with clinically significant haemoptysis secondary to an intercostal artery-to-pulmonary artery fistula in the setting of post-pulmonary tuberculosis (TB) bronchiectasis is described. The fistulae were successfully treated with endovascular coils.

Contribution: This case report illustrates an intercostal artery-to-pulmonary artery fistula associated with post-primary tuberculosis bronchiectasis, highlighting its multimodal radiological features and successful endovascular treatment.

Background: Some clinicians and radiologists in South Africa (SA) suspect that aggressive subtypes of breast cancer are becoming more prevalent and that patients are presenting at younger ages.

Objectives: This study aimed to analyse the prevalence and trends in female breast cancer presentations at a Breast Unit in Johannesburg, SA, by comparing data from 2012 and 2022.

Method: A retrospective study was conducted at a tertiary hospital in Johannesburg. Records of female patients diagnosed with breast cancer between 2012 and 2022 were analysed. Demographic data, ultrasound or mammography findings, and tumour characteristics were compared.

Results: A total of 493 records were reviewed: 165 (33.5%) from 2012 and 328 (66.5%) from 2022. The mean ± standard deviation (s.d.) age at presentation was 56.8 ± 16.8 years in 2012 and 54.1 ± 13.6 years in 2022 (p = 0.056). Tumours were smaller in 2022 (mean ± s.d., 35.0 mm ± 24.0 mm) compared to 2012 (48.1 mm ± 21.5 mm) (p < 0.001). A higher proportion of women had positive oestrogen receptor status in 2022 (p = 0.005). No differences were observed in molecular subtypes.

Conclusion: No significant change was found in the mean age at presentation, suggesting a stable demographic profile. However, reproductive, hormonal, and lifestyle factors may contribute to the rising prevalence among women aged 40-49 years. Smaller tumours likely reflect increased awareness and clinical breast examinations at local clinics.

Contribution: This single-institution study underscores the need for broader national research to inform breast cancer screening and imaging guidelines.

Nerve sheath tumours of the sympathetic chain are extremely rare and present a diagnostic challenge. A 42-year-old female presented with asymptomatic left cervical swelling. Imaging with sonography, CT, MR and angiography demonstrated a lesion splaying the carotid bifurcation, the lyre sign. Following surgical excision, histology revealed a schwannoma. Imaging features of carotid body tumours and parapharyngeal schwannomas can be similar, as both can cause splaying of the carotid bifurcation. The differential diagnosis of such tumours and their management are discussed.

Contribution: This article highlights another cause of the lyre sign on radiological imaging besides carotid body tumours.

Background: Evaluation of diffuse interstitial lung disease (ILD) in thoracic imaging is complicated. Radiologists often use a pattern approach to interpretation; however, they are rarely aware of the statistical frequency of disease presentation.

Objectives: To evaluate the relative frequency of causes of fibrotic ILD as a function of imaging patterns.

Method: A CT database of 396 cases of fibrotic ILD was amassed from an institutional diffuse lung disease registry and retrospective search of medical records. Three radiologists and one pulmonologist independently and blindly reviewed the CT scans for the distribution of fibrosis, predominant feature and non-pulmonary findings.

Results: Peripheral fibrosis was most common (291/396, 73.5%), usually caused by idiopathic pulmonary fibrosis (IPF) and connective tissue diseases-related interstitial lung disease (CTD-ILD) but occasionally by hypersensitivity pneumonitis (HP), idiopathic nonspecific interstitial pneumonia (iNSIP) and asbestosis. Peripheral fibrosis with honeycombing was usually IPF and without honeycombing, was usually CTD-ILD. Peripheral fibrosis with pleural plaques was always asbestosis. Peripheral fibrosis with oesophageal dilatation was usually connective tissue diseases. Consolidative-like peripheral fibrosis was CTD-ILD. Axial fibrosis (61/396, 15.4%) was usually sarcoidosis, HP, CTD-ILD or silicosis. Axial fibrosis with predominantly consolidative-like fibrosis, honeycombing, or reticulation was usually sarcoidosis. Axial fibrosis predominated by ground glass opacity was usually HP or CTD-ILD. Lymph node calcification or short axis > 17 mm increased the probability that axial fibrosis was due to sarcoidosis. The non-specific fibrosis phenotype was uncommon (44/396, 11.1%), usually CTD-ILD (25/44, 57%) but also HP, IPF, iNSIP or asbestosis.

Conclusion: Patterns of lung fibrosis provide guidelines to identify the cause.

Contribution: A flow diagram that predicts the relative frequency of the causes of 10 patterns of ILD.

Background: Breast cancer ranks globally as the most prevalent cause of female deaths. Papillary breast carcinoma (PBC), a rare subtype of breast cancer, presents distinct challenges in diagnosis and management because of its unique histopathological features.

Objectives: This study aims to determine the prevalence and main imaging findings of PBC in women attending a tertiary breast imaging centre.

Method: A retrospective review of mammography and ultrasound imaging findings of female patients with histologically proven PBC, referred to a tertiary breast imaging centre over a 5-year period, was conducted.

Results: The study included 102 female patients with a mean age of 53.8. Mammography detected masses in 93.02%, with calcifications in 41.2% and abnormal borders in 56.8%. Architectural distortion and asymmetry occurred in 27.5% and 28.4% respectively, both showing moderate correlation with PBC (r = 0.50, p = 0.009; r = 0.51, p = 0.0057). Ultrasound findings indicated irregular mass shapes (mean = 1.53), with hypoechoic patterns significantly associated with PBC (r = 0.40, p = 0.0013). Correlation analysis revealed strong associations between PBC and breast pain (r = 0.74, p < 0.0001), and erythema (r = 0.62, p < 0.0001). There was no significant association between the mammography and ultrasound findings (p = 0.495).

Conclusion: The findings underscore the value of using mammography and ultrasound in the diagnosis of PBC, as the two modalities offer complementary information.

Contribution: There is a paucity of data on the radiological findings of PBC in Africa. The current study prevalence mirrors global trends, highlighting the importance of ongoing surveillance and diagnostic accuracy.

Background: The Greulich and Pyle (GP) method is the most commonly used manual bone age assessment method but it is associated with interrater variability. The BoneXpert method is fully automated, eliminates interrater variability and has been validated for use in various populations.

Objectives: To compare the manual GP method with the automated BoneXpert method in performing bone age assessment of children with various paediatric endocrinology diagnoses.

Method: Three manual readers performed manual bone age assessment, and BoneXpert software performed automated bone age assessment on 260 left hand-wrist radiographs. Images where the average of three manual readers (Manual BA) deviated from BoneXpert BA by > 1.5 years, were re-read by an external reader, producing a Reference BA. Manual BA was compared to Carpal BA that was produced by the software. A composite bone age (Comp BA) for the software was defined to estimate the weighting on carpal and tubular bones to achieve the best agreement with Manual BA.

Results: The interclass correlation (ICC) between each manual reader was > 0.9, indicating a high positive correlation. The ICC between Manual BA and BoneXpert BA was 0.982. The Comp BA for BoneXpert that would achieve the best fit with Manual BA, places a 50% weighting on Carpal BA and 50% weighting on Tubular BA.

Conclusion: The BoneXpert method is efficient, well-validated and shows a positive correlation with the manual GP method. An estimated weightage of 50% to carpal bones and 50% to tubular bones resulted in an automated Comp BA with the best agreement with Manual BA.

Contribution: This original research article compares manual and automated bone age assessment methods to evaluate the use of artificial intelligence tools in the South African context.

Supernumerary kidney (SK) is an uncommon anomaly of the urinary tract, usually occurring on the left side. A rare case of a partially-fused, SK on the right side is presented. The diagnosis is made through the identification of a distinct pelvicalyceal system along with its supplying renal artery and vein, utilising ultrasound, CT, or MRI.

Contribution: Correct diagnosis of partially-fused, supernumerary kidneys based on imaging is crucial to avoid unnecessary procedures, so that asymptomatic cases are managed conservatively.

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.