SA Journal of Radiology最新文献

Imaging evaluation of the brain and cranium after cranial surgery is a routine and significant part of the workflow of a radiology department. Various normal expected findings and early and late complications are associated with the post-operative cranium. In this pictorial review, the authors describe the typical imaging features of the spectrum of various conditions associated with cranial surgery with illustrative cases.

Contribution: A good knowledge and understanding of the spectrum of imaging appearances in the post-operative cranium is vital for the radiologist to accurately diagnose potential complications and distinguish them from normal post-operative findings, improving patient outcomes and guiding further treatment.

Background: Breast conserving therapy (BCT) is the mainstay therapy in patients with early breast cancer and selected patients with locally advanced breast cancer. No formal audit has been performed on BCT at our institution.

Objectives: To determine the incidence and risk factors for ipsilateral breast tumour recurrence (IBTR). Study the imaging features of IBTR. Determine adherence to the proposed annual mammographic surveillance schedule.

Method: Clinical, radiological and histopathological records of patients who underwent BCT from 01 January 2011 to 31 December 2015 were reviewed. Patients were followed up for at least 5 years.

Results: Ninety-two patients were included in the study with a mean age of 54.3 years. Eighty of the 92 (87.0%) patients were imaged within 1-year post-BCT. Ipsilateral breast tumour recurrence was 6/92 (6.5%) with mean time to IBTR of 34.4 months. One of the 92 (1.0%) patients had a contralateral metachronous recurrence with no IBTR and 11/92 (12.0%) had distant metastases only. Pathological tumour size and extent (pT2) (68.5%) and pathological lymph node (pN0) (65.2%) were the most common locoregional staging. Infiltrating ductal carcinoma was the most common histological type (88%). Age < 35 years was associated with breast cancer recurrence (p < 0.01). Imaging findings of recurrence were microcalcification (odds ratio [OR]: 4), asymmetric density (OR: 4) and skin thickening (OR: 2.5).

Conclusion: The occurrence of IBTR following BCT in our unit is acceptable and comparable to local and international units. The accuracy of assessing the post-BCT breast for IBTR is in keeping with international standards.

Contribution: Improved radiological imaging interpretation of the post-BCT breast.

Sinonasal teratocarcinosarcoma (SNTCS) is a highly malignant and rare tumour characterised by a complex admixture of teratomatous and carcinosarcomatous components. In the head and neck area, it almost exclusively occurs in the sinonasal cavities; however, rare instances of nasopharyngeal and oral cavity involvement have been reported, with fewer than 100 cases reported in the literature.

Contribution: The contributed case involves the correlative CT, MRI and histopathology of a sinonasal teratocarcinosarcoma with intracranial involvement.

Background: Mechanical central venous catheter (CVC) placement complications are mostly malposition or iatrogenic pneumothorax. Verification of catheter position by chest X-ray (CXR) is usually performed postoperatively.

Objectives: This prospective observational study assessed the diagnostic accuracy of peri-operative ultrasound and a 'bubble test' to detect malposition and pneumothorax.

Method: Sixty-one patients undergoing peri-operative CVC placement were included. An ultrasound protocol was used to directly visualise the CVC, perform the 'bubble test' and assess for the presence of pneumothorax. The time from agitated saline injection to visualisation of microbubbles in the right atrium was evaluated to determine the correct position of the CVC. The time required to perform the ultrasound assessment was compared to that of conducting the CXR.

Results: Chest X-ray identified 12 (19.7%) malpositions while ultrasound identified 8 (13.1%). Ultrasound showed a sensitivity of 0.85 (95% confidence interval [CI]: 0.72 to 0.93) and a specificity of 0.5 (95% CI: 0.16 to 0.84). The positive and negative predictive values were 0.92 (95% CI: 0.80 to 0.98) and 0.33 (95% CI: 0.10 to 0.65), respectively. No pneumothorax was identified on ultrasound and CXR. The median time for ultrasound assessment was significantly shorter at 4 min (interquartile range [IQR]: 3-6 min), compared to performing a CXR that required a median time of 29 min (IQR: 18-56 min) (p < 0.0001).

Conclusion: This study showed that ultrasound produced a high sensitivity and moderate specificity in detecting CVC malposition.

Contribution: Ultrasound can improve efficiency when used as a rapid bedside screening test to detect CVC malposition.

Background: Teleradiology was implemented in South Africa in 1999, but the subsequent uptake was low and slow. The onset of the coronavirus disease 2019 (COVID-19) pandemic catapulted South African healthcare into the arena of teleradiology. This created the environment for re-examining the factors that enable or inhibit the uptake of teleradiology in both the public and private sectors.

Objectives: This article reports on a study of a select sample of private and public sector radiologists' experiences with, and perceptions of, the benefits, opportunities, challenges and barriers to the implementation of teleradiology in the South African context.

Method: Qualitative data on the perceived benefits and challenges of teleradiology, as well as on its enablers and the barriers to its implementation, were collected and analysed.

Results: The uptake of teleradiology in the sample increased by 15.9% during the COVID-19 pandemic. The results demonstrated that teleradiology was perceived to have clear benefits on operational, personal and societal levels.

Conclusion: It is important to address structural barriers to the implementation of teleradiology. Clear communication strategies and multistakeholder engagement are also required.

Contribution: By investigating radiologists' experience with teleradiology, this study provides an understanding of the benefits, opportunities, challenges and barriers to implementation of services. These insights enable informed decision-making and stakeholder engagement and provide a foundation for establishing recommendations for the viable implementation of teleradiology in South Africa and other lower- and middle-income countries to promote access to healthcare.

Background: In developing countries, many diagnosed cases of ameloblastoma (AB) have a significant delay in receiving treatment because of patient factors and healthcare facility constraints.

Objectives: The radiologic progression of ABs with delayed treatment was analysed using panoramic radiographs and cone-beam computed tomography imaging.

Method: Histopathologically confirmed cases of AB with follow-up radiographs indicating no treatment were retrospectively reviewed over a study period of 10 years. Fifty-seven cases with 57 initial and 107 follow-up radiographs were included. Each follow-up radiograph was analysed for changes in borders, locularity, effects on surrounding structures and lesion size.

Results: There was a general increase in poorly-demarcated lesions, with seven cases transforming from an initial unilocular to a multilocular appearance. At follow-up, there was an increase in cortical thinning and cortical destruction. Ameloblastomas presented with a three-fold increase in average size from the initial to follow-up visits. Regression analysis showed a statistically significant relationship between lesion duration and length (p = 0.001). A statistically significant relationship existed between duration and overall lesion dimensions when only the first and last observations per patient were used (p = 0.044).

Conclusion: Considering the aggressive nature and unlimited growth potential, ABs with delayed treatment may show extensive growth, complicating their eventual management.

Contribution: This study aimed to raise awareness of the importance of the timeous management of patients with AB by highlighting the detrimental effects of delayed treatment.

A 77-year-old woman with suspected lung carcinoma had multiple bladder masses and lymphadenopathy outside the normal urinary bladder drainage area. Fine needle aspiration and immunocytochemistry of the cervical lymph node complex and transurethral biopsy of the bladder masses confirmed metastatic small-cell neuroendocrine carcinoma.

Contribution: Clinical correlation, imaging findings, tumour markers and immunohistochemistry are necessary for metastatic bladder tumour work-up.

Human parechovirus-3 (HPeV-3) infection is one of the differential diagnoses of neonatal meningoencephalitis. A 13-day-old full-term female neonate presented with a seizure. Brain MRI showed classic imaging findings of the meningoencephalitis which was confirmed on cerebrospinal fluid analysis.

Contribution: The HPeV-3 is an emerging pathogen for neonatal meningoencephalitis. The case in this study is unique with classic imaging findings, which are not routinely encountered in day-to-day practice. This case raises reader awareness.

Background: Interventional radiology (IR) is becoming more relevant in patient care and is associated with increased patient radiation exposure and radiation-induced adverse effects. Diagnostic reference levels (DRLs) are crucial for radiation control. There is a paucity of published DRLs for IR in South Africa and sub-Saharan Africa.

Objectives: This study aimed to determine local DRLs for fluoroscopically-guided IR procedures and compare the achieved DRLs with published local and international DRLs.

Method: Retrospective, descriptive, single-centre study. Kerma air product (KAP), reference point air kerma (K_a,r) and fluoroscopy time (FT) were collected for patients (12 years and older) who underwent IR procedures at a university hospital from 01 January 2019 to 31 December 2019. The 75th percentile of the distribution of each dose parameter (KAP, K_a,r and FT) per procedure was calculated and taken as the local diagnostic reference levels (LDRL). The established LDRLs were compared to published DRLs.

Results: A total of 564 cases were evaluated. The 13 most frequent procedures (with 15 or more cases) represented 86.1% (487/564). Percutaneous transhepatic biliary drainage was the most common procedure (n = 146, 25.9%). Diagnostic cerebral angiogram DRLs exceeded the published DRL data ranges for all parameters (DRL 209.3), and interventional cerebral angiogram exceeded published ranges (DRL 275). Uterine artery embolisation (UAE) exceeded these ranges for KAP and K_a,r. (KAP-954.9 Gy/cm², K_a,r-2640.8 mGy).

Conclusion: The LDRLs for diagnostic cerebral angiogram, interventional cerebral angiogram and UAE exceeded published international DRL ranges. These procedures require radiation optimisation as recommended by the International Commission on Radiological Protection (ICRP).

Contribution: In addition to informing radiation protection practices at the level of the institution, the established LDRLs contribute towards Regional and National DRLs.

Dynamic contrast-enhanced (DCE) lymphangiography is a novel imaging technique with a potential role in suspected cases of lymphatic leaks. A 15-year-old male with a post operative chylous leak and an 8-year-old male who developed chylous ascites secondary to disseminated tuberculosis are presented. Both children underwent MR lymphangiography.

Contribution: The role of DCE-MR lymphangiography in cases of chylous ascites to help guide appropriate management.