SA Journal of Radiology最新文献

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.

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.