SA Journal of Radiology最新文献

Background: Incidentally detected unruptured intracranial aneurysms have a prevalence of 3% with some predisposed to rupture and others remaining static. Diagnostic knowledge of previous aneurysmal subarachnoid haemorrhage (ASAH) in the chronic phase could identify patients requiring treatment.

Objectives: To assess the sensitivity of susceptibility weighted imaging (SWI) in the detection of ASAH at 3 months post ictus and determine any influencing effects.

Method: A retrospective chart analysis of 46 patients with ASAH who underwent post-embolisation SWI imaging at 3 months. The SWI and available initial CT brain scans or CT reports were evaluated and correlated with patient demographics and clinical severity.

Results: Susceptibility weighted imaging indicated a sensitivity of 95.7% in the detection of ASAH at 3 months. Increased number of haemosiderin zones on SWI correlated with older patient age (p = 0.0003). Clinical severity (World Federation Neurosurgical Societies Score) showed a tendency towards a statistically relevant relationship (p = 0.07). No statistically significant relationship was identified between the number of haemosiderin zones and initial CT modified Fisher score (p = 0.34) or the causative aneurysm location (p = 0.37).

Conclusion: Susceptibility weighted imaging is sensitive in the detection of ASAH at 3 months, increasing in sensitivity with patient age and higher initial clinical severity.

Contribution: In patients presenting in the subacute to chronic phase with a clinically suspicious history of previous aneurysm rupture but without convincing CT or spectrophotometry evidence, SWI can detect previous rupture. This can identify patients who could benefit from endovascular treatment and those who can safely undergo follow-up imaging.

Isosexual precocious puberty with ovarian masses in long-standing juvenile hypothyroidism is well described in the literature as Van Wyk Grumbach syndrome (VWGS). The present case reports this rare entity in a 4-year-old girl who was referred for imaging to evaluate the cause of non-traumatic bleeding per vagina. Antecedent history, clinical features and thyroid function tests were consistent with long-standing juvenile hypothyroidism with documented clinical response to thyroxine replacement therapy.

Contribution: Typical clinical and radiological features of the syndrome are reported, which helps in the early diagnosis and management, henceforth avoiding the associated complications.

Background: The blue-light hazard is a well-documented entity addressing the detrimental health effects of high-energy visible light photons in the range of 305 nm - 450 nm. Radiologists spend long hours in front of multiple light-emitting diode (LED)-based diagnostic monitors emitting blue light, predisposing them to potentially higher blue-light dosages than other health professionals.

Objectives: The authors aimed to quantify the blue light that radiology registrars are exposed to in daily viewing of diagnostic monitors and compared this with international occupational safety standards.

Method: A limited cross-sectional observational study was conducted. Four radiology registrars at two academic hospitals in Bloemfontein from 01 October 2021 to 30 November 2021 participated. Diagnostic monitor viewing times on a standard workday were determined. Different image modalities obtained from 01 June 2019 to 30 November 2019 were assessed, and blue-light radiance was determined using a spectroscope and image analysis software. Blue-light radiance values were compared with international safety standards.

Results: Radiology registrars spent on average 380 min in front of a diagnostic display unit daily. Blue-light radiance from diagnostic monitors was elevated in higher-intensity images such as chest radiographs and lower for darker images like MRI brain studies. The total blue-light radiance from diagnostic display units was more than 10 000 times below the recommended threshold value for blue-light exposure.

Conclusion: Blue-light radiance from diagnostic displays measured well below the recommended values for occupational safety. Hence, blue-light exposure from diagnostic monitors does not significantly add to the occupational health burden of radiologists.

Contribution: Despite spending long hours in front of diagnostic monitors, radiologists' exposure to effective blue-light radiance from monitors was far below hazardous values. This suggests that blue-light exposure from diagnostic monitors does not increase the occupational health burden of radiologists.

Congenital anatomical variations of the terminal aorta are rare. Given the increasing number of endovascular and laparoscopic procedures, such variations are likely to assume greater clinical significance. A 15-year-old male sustained a pelvic vascular injury following a stab to the left gluteus. Computed tomographic angiography and digital subtraction angiography demonstrated a left superior gluteal artery pseudoaneurysm and absence of the common iliac arteries consistent with congenital quadrifurcation of the terminal aorta. The patient was subsequently treated with endovascular coil embolisation with a good angiographic and clinical outcome.

Contribution: Terminal aortic variants are rare and given the increasing number of interventional endovascular procedures performed in the aorta, an awareness of the potential anatomical configurations of the distal aortic branches is of increasing relevance. The authors describe the imaging findings of one such anatomical variant.

Background: Worldwide, intracranial aneurysms are associated with a high mortality rate. While endovascular management has proven to be the choice of treatment in selected patients, patient demographics and aneurysm characteristics differ between study populations.

Objectives: This study aimed to investigate the profile of patients with intracranial aneurysms who underwent endovascular management in the Interventional Neuroradiology Unit at Chris Hani Baragwanath Academic Hospital. Patient demographics, risk factors, indications, aneurysm characteristics and intra-operative complications were studied.

Method: This was a 3-year retrospective study of all adult patients between 01 January 2018 and 31 January 2021. The Chi-square test was used to compare categorical variables.

Results: A total of 77 patients were included in this study. The mean age of the patients was 47 ± 11.6 with a male-to-female ratio of 1:1.8. Hypertension was the most reported risk factor in 27% of patients. There was no statistical correlation between the gender groups according to presentation, multiplicity, aneurysmal size dimensions and locations. According to the presentation, there was statistical significance in ruptured intracranial aneurysms (p = 0.020), neck size dimensions less than 4 mm (p = 0.010), and aneurysms located in the internal cerebral artery (ICA) circulation (p = 0.001).

Conclusion: The study findings support known parameters including females and anterior circulation aneurysm preponderance, and the low complication risk of endovascular management. Interestingly, intracranial aneurysms presented with rupture at smaller size dimensions.

Contribution: This study provides valuable insights into intracranial aneurysm characteristics and endovascular management efficacy in a resource-limited setting.

Scar endometriosis usually affects the abdominal wall or the perineum. Virtually all cases are linked with some form of surgical manipulation. Although the clinical diagnosis of scar endometriosis may be straightforward with classical symptomology, imaging with ultrasound and MRI are important for the determination of its extent, which is imperative for adequate preoperative planning. In addition, assessment of perineal scar endometriosis also requires the identification of anal sphincter complex involvement, which can significantly impact the surgical approach. Radiology plays a vital role in its diagnosis in atypical clinical scenarios.

Contribution: This series of four cases describes the morphology and highlights the importance of imaging in the surgical management of scar endometriosis; three with abdominal wall involvement and one with the involvement of perineum.