SA Journal of Radiology最新文献

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.

Background: Artificial intelligence (AI) is transforming industries, but its adoption in healthcare, especially radiology, remains contentious.

Objectives: This study evaluated the perceptions and attitudes of trainee and qualified radiologists towards the adoption of AI in practice.

Method: A cross-sectional survey using a paper-based questionnaire was completed by trainee and qualified radiologists. Survey questions covered AI knowledge, perceptions, attitudes, and AI training in the registrar programme on a 3-point Likert scale.

Results: A total of 100 participants completed the survey; 54% were aged 26-65 years and 61% were female, with none currently using AI in daily radiology practice. The majority (78%) of participants understood the basics and knew the role of AI in radiology. Most knew about AI from media reports (77%) and majority (95%) were never involved in AI training; only 3% of participants had no knowledge of AI at all. Participants agreed that AI could reliably detect pathological conditions (89%), reach reliable diagnosis (89%), improve daily work (78%), and 89% favoured AI practice; 89% believed that in the future, machine learning will not be independent of the radiologist. Participants were willing to learn (98%) and contribute towards advancing AI software (97%) and agreed that AI will improve the registrars' programme (97%), also noting that AI applications are as important as medical skills (87%).

Conclusion: The findings suggest AI in radiology is in its infancy, with a need for educational programmes to upskill radiologists.

Contribution: Participants were positive about AI implementation in practice and in the registrar learning programme.

A rare case of widespread disseminated cysticercosis was identified in a 32-year-old female patient from the Eastern Cape province, South Africa. Initially, she displayed generalised nonspecific symptoms, leading to a misinterpretation of disseminated tuberculosis (TB). However, further radiological, haematological and pathological investigations revealed extensive dissemination of cysticercosis.

Contribution: Disseminated cysticercosis (DC) is a rare condition that can mimic symptoms of other diseases, including tuberculosis, highlighting the importance of considering it in endemic areas.

Background: Magnetic resonance imaging (MRI) is used for the evaluation of degenerative spinal disease. However, its utility is restricted in routine practice because of contraindications and a lack of widespread availability. Dual-energy computed tomography (DECT) is a newer technique for the evaluation of degenerative spinal disease.

Objectives: This study aimed to evaluate the diagnostic performance of DECT with electron-density (ED) image reconstruction compared to standard CT for the detection of lumbar disc herniation, with MRI as the gold standard.

Method: The retrospective study included 84 patients between 01 July 2023 to 31 December 2023 who underwent DECT and 1.5-T MRI within 1 week. Four radiologists, blinded to the clinical and MRI information, independently evaluated the standard CT series and DECT series with ED reconstructions for lumbar disc herniation and spinal nerve root impingement. The gold standard for comparison was lumbar spine MRI, and diagnostic accuracy was measured with sensitivity and specificity.

Results: MRI revealed 417 lumbar disc herniations. Dual-energy computed tomography with ED reconstruction showed higher sensitivity (86.36% [532/616] vs. 57.79% [356/616]) and specificity (96.86% [1019/1052] vs. 95.82% [1008/1052]) for the detection of lumbar disc herniation compared to standard CT.

Conclusion: Dual-energy computed tomography with ED reconstruction shows better diagnostic performance for the detection of lumbar disc herniation compared to standard CT and can be a useful alternative imaging modality when MRI is contraindicated or unavailable.

Contribution: This study shows the usefulness of DECT as an alternative imaging technique for screening of degenerative spinal disease whenever MRI is contraindicated or unavailable.

Background: Studies have found that, at presentation, human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has a less advanced primary tumour, more advanced lymph node spread and commonly has cystic metastatic lymph nodes in comparison to HPV-negative OPSCC.

Objectives: To compare the radiological features of HPV-positive and HPV-negative OPSCC in South African patients.

Method: A retrospective cross-sectional study was conducted at a large South African hospital. Eligibility required a histologically proven OPSCC between 2007 and 2023; a p16 antigen test and, if positive, a confirmatory HPV DNA PCR test and a baseline pre-treatment contrast enhanced neck CT scan. All eligible HPV-positive OPSCC patients and a random sample of eligible HPV-negative OPSCC patients were enrolled.

Results: Twenty-one HPV-positive and 55 HPV-negative OPSCC patients were recruited. There was no statistically significant difference in the tumour epicentre location, local advancement (≥ T3 in 67% and 71%, respectively, p = 0.54), mean primary tumour size (41 mm vs. 39 mm, p = 0.73), lymph node spread (bilateral or more in 67% vs. 82%, p = 0.22) or morphologically cystic lymph nodes (10% and 4%, p = 0.61).

Conclusion: There was no statistically significant difference in the CT imaging appearances of HPV-positive and HPV-negative OPSCC in the studied sample of South African patients.

Contribution: This study documents the radiological features of OPSCC in a small South African sample population, where HPV-positive and HPV-negative OPSCC could not be distinguished on CT criteria and did not display the classic features described in the literature.