SA Journal of Radiology - Volume 17, Issue 1, 2013
Volume 17, Issue 1, 2013
Author Razaan DavisSource: SA Journal of Radiology 17 (2013)More Less
The endeavors of my predecessor, Professor Jan Lotz, a committed visionary who served the South African Journal of Radiology (SAJR) in a permanent capacity for 5 years (2008 - 2012), are gratefully acknowledged. Under his stewardship, the SAJR benefited from a consistent editorial policy. The journal grew in size to an average of 40 pages per issue, with broader editorial variety accordingly. The online manuscript management system revolutionised the submission and review process. The promised CPD programme was delivered and the journal took major steps toward international recognition, being invited to join GO RAD (Global Outreach - Radiology), a global outreach programme of the International Society of Radiology.
Multimodal magnetic resonance imaging increases the overall diagnostic accuracy in brain tumours : correlation with histopathology : original articleSource: SA Journal of Radiology 17, pp 4 –10 (2013)More Less
Background. The aim of this retrospective study was to assess the contribution of multimodal MRI techniques, specifically perfusion-weighted imaging (PWI), and/or MR spectroscopy (MRS), in increasing the diagnostic accuracy of MRI in brain tumours.
Methods. Forty-four patients with suspected brain tumours (27 (61%) patients male, mean age 58 (standard deviation ±17) years) were included in this retrospective analysis. Patients were examined with conventional MR sequences, DWI, and with PWI and/or MRS. The concordance between the diagnoses obtained with multimodal MRI and with the conventional MR sequences, and the final diagnosis obtained by biopsy, was estimated. Fisher's exact test and/or chi-square test was performed to estimate the added utility of multimodal MRI. Statistical significance was set at p<0.05.
Results. With multimodal MRI, the diagnosis in 41 (93%) patients was the same as that obtained by biopsy, compared with 39% (17/44) patients when the readers were allowed to give one diagnostic possibility during the evaluation of the conventional MR sequences alone (p<0.001). The concordance between the diagnoses provided by evaluating the multimodal MRIs and the final diagnoses was almost perfect (κ value 0.92, 95% CI 0.82 - 1.0). PWI primarily helped to differentiate lymphomas from other solid tumours, whereas MRS helped to differentiate malignant glioma from metastasis. Both PWI and MRS helped in grading astrocytomas.
Conclusion. Multimodal MRI increases diagnostic accuracy and should, wherever available, be performed in the work-up of brain tumours, although this entails increased examination cost and time.
Value of apparent diffusion coefficient (ADC) in evaluating response of carcinoma of the cervix treated with chemoradiotherapy : original articleSource: SA Journal of Radiology 17, pp 11 –15 (2013)More Less
Objective. To determine whether the apparent diffusion coefficient (ADC) value obtained by diffusion-weighted magnetic resonance imaging (DW-MRI) can be used as a reliable detector of response of carcinoma of the cervix treated with chemoradiotherapy, compared with conventional T2-weighted MRI.
Design. A prospective cohort study was performed.
Setting. Department of Oncology, Universitas-National Hospital Complex, Bloemfontein.
Subjects. Seventeen women with advanced cervical cancer, FIGO staging IIB - IVB, were selected for chemoradiation.
Outcome measures. Patients underwent pelvic MRI before therapy, 14 days after onset of therapy, and in the last week of treatment (5th/6th week). Axial and sagittal conventional T2 was followed by DW-MRI in the axial plane from which a tumour region of interest (ROI) was manually drawn to calculate ADC values using b-values of 500 and 1 000 s/mm2.
Results. ADC values for cervical carcinoma increased after treatment with chemoradiation. The most significant observation was seen 14 days after treatment was started. The mean ADC value increased with 20% (b=500 s/mm2) and 24% (b=1 000 s/mm2) (statistically significant, p<0.05) compared with a decrease in tumour size of only 8%, which was not statistically significant (p=0.075). Responders showed a larger change in ADC values than non-responders.
Conclusion. The study showed considerable promise in the ability of ADC to identify early tumour response to therapy. DW-MRI is a non-invasive functional imaging technique that may in future change management in oncology by early identification of non-responders, hence avoiding unnecessary treatment.
Source: SA Journal of Radiology 17, pp 16 –18 (2013)More Less
Agenesis of the dorsal mesentery is a rare occurrence that usually presents in children. It is associated with proximal small-bowel malrotation as well as high jejunal atresia with discontinuity of the small bowel. We present a case report of an adolescent presenting with clinical features of proximal small-bowel obstruction (confirmed on imaging) as well as acute pancreatitis. At laparotomy, he was found to have no dorsal mesentery, without small-bowel atresia, and the duodenum was fixed to the posterior abdominal wall. The patient recovered well and remained symptom-free.
Source: SA Journal of Radiology 17, pp 19 –20 (2013)More Less
A bezoar is an agglomeration of food or indigestible foreign material in the gastro-intestinal tract. It is an uncommon cause of abdominal symptomatology and can result in intestinal obstruction. This report is of an adolescent girl with a history of abdominal distension and trichophagia.
Author A. AhmedSource: SA Journal of Radiology 17, pp 21 –23 (2013)More Less
Acute gastric volvulus is a rare, but potentially life-threatening, cause of upper gastro-intestinal obstruction. The diagnosis can prove clinically challenging, and hence there is increased reliance on imaging. There are different types of gastric volvulus, with the variant presented in our case being the less commonly encountered mesenteroaxial gastric volvulus. Some of the CT features of gastric volvulus are described, and the usefulness of CT in assisting with the diagnosis is highlighted.
Source: SA Journal of Radiology 17, pp 24 –25 (2013)More Less
Source: SA Journal of Radiology 17, pp 26 –29 (2013)More Less
Imaging techniques may be underutilised when clinicians are unaware of the technique or do not recognise its potential. Phase-contrast MR imaging (PC-MRI) is a rapid, simple and non-invasive technique that is sensitive to CSF flow. It demonstrates a mechanical coupling between cerebral blood and CSF flow throughout the cardiac cycle. Neurosurgeons should be able to request this procedure routinely as part of an MRI request. This paper gives an overview of the indications, technical requirements, technique and interpretation, using image examples. Indications for CSF flow studies in children include assessment and functionality of shunt treatment in patients with hydrocephalus; hydrocephalus associated with achondroplasia; Chiari I malformation; confirmation of aqueductal stenosis; and determining patency of a third ventriculostomy.
Source: SA Journal of Radiology 17, pp 30 –33 (2013)More Less
Primary bone tumours account for 5% of all adolescent and child cancers. When Ewing's sarcoma arises in soft tissue rather than bone, it is referred to as extraskeletal Ewing's sarcoma (ESS). Computed tomography (CT) scanning and magnetic resonance imaging (MRI) features of Ewing's sarcoma are non-specific, and a radiological differential diagnosis should be considered. Ewing's sarcoma is confirmed by features on histological analysis. In young people who present with soft-tissue tumours, ESS should be considered. In the management of patients with tumours, imaging techniques are useful for biopsy guidance, evaluating the possibility of resection, and tumour response to treatment.
Substantive incidental cardiac findings revealed by non-cardiac CT examination of the thorax : case seriesSource: SA Journal of Radiology 17, pp 34 –37 (2013)More Less
Limitations inherent in CT imaging of the thorax left the heart as an ill-defined and largely ignored area. The advent of multi-detector CT scanning and shortened imaging times has allowed clear identification of cardiac structures and pathology. Motion-free cardiac images require synchronisation of image acquisition with the cardiac cycle (cardiac 'gating' or 'triggering'). However, significant information can be obtained from careful scrutiny of ungated chest CT images, which may then direct further imaging or investigation. We review 5 cases demonstrating interesting cardiac findings identified on non-cardiac scans.
Coronal views of the paediatric mandibular condyle on computerised tomography brain (CTB) studies : an important review area : radiological tipsSource: SA Journal of Radiology 17, pp 38 –39 (2013)More Less
This article highlights the importance of routinely reviewing the mandibular condyle on computerised tomography brain studies in a trauma setting, that often extends to involve the mandibular condyles in the scan parameters. We discuss 4 cases seen over the last 18 months at our institution, and review the relevant literature regarding paediatric mandibular fractures.
Transitional cell carcinoma developing in a bladder diverticulum : early diagnosis by computed tomography : radiological tipsAuthor J. ShahSource: SA Journal of Radiology 17, pp 39 –40 (2013)More Less
Computed tomography confirmed a left-sided narrow neck urinary bladder diverticulum, with wall thickening, in a 56-year-old man. These findings were initially detected on ultrasonographic investigation. Transitional cell carcinoma was confirmed histologically. There is an increased incidence of neoplastic transformation in urinary bladder diverticuli, and therefore an early search for subtle imaging signs should be implemented.
Author G. BydawellSource: SA Journal of Radiology 17, pp 41 –42 (2013)More Less
Pseudoaneurysm of the femoral artery is a well-documented complication following arterial access. There are several treatment options, but percutaneous injection of thrombin, using ultrasound guidance, has become increasingly popular worldwide and is the therapy of choice in most vascular centres. This short review highlights the procedure and provides step-by-step guidance for radiologists who are interested in performing thrombin injection.
Source: SA Journal of Radiology 17, pp 43 –45 (2013)More Less
We congratulate Dr Omar (details not to hand at time of going to press) for his close to spot-on diagnosis, for which he receives the award of R1 000 from the RSSA. Professor Beningfield et al. elaborate below on the condition and its imaging. Please refer to page 152 of the December 2012 issue of the SAJR (http://dx.doi.org/10.7196/SAJR.795) for the presentation details and unannotated images.