SA Journal of Radiology - Volume 20, Issue 1, 2016
Volume 20, Issue 1, 2016
The prevalence of abnormal findings in screening CT brains performed on patients admitted with psychiatric symptomsAuthor Praniel BennimahadeoSource: SA Journal of Radiology 20, pp 1 –5 (2016) http://dx.doi.org/10.4102/sajr.v20i1.976More Less
Background: No clear guidelines exist regarding the role of computerised tomography (CT) as a screening neuroimaging tool in psychiatric practice. The aim of this study was to evaluate the usefulness of historical and clinical parameters on the CT request form, identify the spectrum of CT findings and correlate these to develop guidelines for the use of screening CT brains in patients who present with psychiatric symptoms.
Methods: Requests and reports for the brain CT’s of 507 consecutive patients over a 2-year period, between 2013 and 2014, referred from a psychiatric institute for screening CT brain scans, were reviewed. Analysis was performed for the history of trauma and seizures, Glasgow Coma Scale (GCS) score, focal neurological signs, papilloedema, electroencephalograph, relevant blood results and abnormal CT findings. All reports were approved by a consultant radiologist.
Results: No abnormality was noted in 69% of CT scans. Cerebral atrophy, infarcts, cysts and calcific foci were present in 30% of patients. One patient presenting with focal neurology had a CT demonstrating an extradural haematoma which required neurosurgical intervention. No focal brain lesions, potentially responsible for the psychosis, were identified in any other patient.
Conclusion: Routine CT screening of patients who present with psychotic symptoms, in the absence of focal neurological deficit, does not add value to patient outcome, but rather contributes to the escalating health care expenses and unnecessary radiation dose. CT screening of psychiatric patients should be reserved for patients with reliable predictors of intracranial abnormalities such as lateralising signs, seizures, persistent or worsening headaches; decrease in GCS, papilloedema and in patients where the onset of symptoms occurred at an age above 50.
Digital subtraction angiography findings and population demographics of patients with subarachnoidal haemorrhage and subsequent causative aneurysms at Universitas Academic Hospital, BloemfonteinSource: SA Journal of Radiology 20, pp 1 –6 (2016) http://dx.doi.org/10.4102/sajr.v20i1.1030More Less
Background: Subarachnoid haemorrhage (SAH) secondary to aneurysmal rupture may be associated with serious neurological sequelae or even mortality. According to international literature, only aneurysms >7 mm or aneurysms in the posterior circulation require treatment. Retrospective single-centre studies have, however, disputed this after demonstrating that the average size of ruptured aneurysms are <7 mm. More recent guidelines place less emphasis on size and more on associated risk factors.
Objectives: The aim of this investigation was to assess the aneurysm characteristics and demographics of patients who presented to our institution with SAH secondary to an aneurysm detected at digital subtraction angiography (DSA).
Method: A retrospective descriptive study was conducted. Patients who presented with SAH over a 6-year period, from 2008 to 2013, were included. The average size of the intracranial aneurysms at the time of rupture was analysed. Data about aneurysm characteristics and patient demographics were obtained from patient files. Data were analysed by the researchers with assistance from the Department of Biostatistics.
Results: In total, 161 of 374 patients who underwent DSA had ruptured aneurysms. Most patients were women with ages ranging from 18 to 73 years (mean 45 years). The mean size of aneurysms were 5.8 mm (range 1.2 mm – 20 mm), with 74.5% of aneurysms <7 mm. Most aneurysms were noted involving the anterior circulation (72%), with the majority arising from the anterior communicating artery (36.7%).
Conclusion: We found that aneurysms rupture at sizes <7 mm and are commonly located in the anterior circulation. Our findings emphasise the importance of conducting institutional reviews to consider adapting international treatment guidelines for the local South African situation.
Source: SA Journal of Radiology 20, pp 1 –6 (2016) http://dx.doi.org/10.4102/sajr.v20i1.1014More Less
Background: The purpose of this study was to evaluate the splenic salvage rate with angioembolisation in the non-operative management (NOM) of blunt splenic injury.
Methods: We conducted a retrospective analysis of patients presenting to our Level I trauma centre with computed tomography (CT)-confirmed splenic injury following blunt trauma and in whom angioembolisation was utilised in the algorithm of NOM. Data review included CT and angiography findings, embolisation technique and patient outcomes.
Results: Between January 2005 and April 2010, 60 patients with splenic injury following blunt trauma underwent NOM, which included splenic artery embolisation (SAE). All patients included in the study required a preadmission. CT scan was used to document the American Association for the Surgery of Trauma (AAST) grade of splenic injury. The average injury grade was 3.0. The non-operative splenic salvage rate following SAE was 96.7% with statistically similar salvage rates achieved for grades II to IV injuries. The quantity of haemoperitoneum and the presence of a splenic vascular injury did not significantly affect the splenic salvage rate. The overall complication rate was 27%, of which 15% were minor and 13% were major.
Conclusion: SAE is a safe and effective treatment strategy in the NOM of blunt splenic injury. The quantity of haemoperitoneum, the presence of vascular injury and embolisation technique did not significantly affect the splenic salvage rate.
The relationship between computed tomography measurement of the optic nerve sheath diameter and elevated intracranial pressure in non-trauma patientsSource: SA Journal of Radiology 20, pp 1 –4 (2016) http://dx.doi.org/10.4102/sajr.v20i1.1060More Less
Background: The early detection and treatment of raised intracranial pressure (ICP) is critical in the prevention of mortality and morbidity as a result of secondary ischemic brain injury. Measuring the optic nerve sheath diameter (ONSD) on computed tomography (CT) to predict raised ICP may be useful in cases where routine CT investigations of the brain are indicated and invasive ICP monitoring is not available, or a lumbar puncture (LP) is contraindicated.
Objective: The purpose of this study was to determine if the ONSD can be measured on digital images obtained by routine CT investigations of the brain, to identify patients with nontraumatic causes of elevated ICP, and to provide the observer with a non-invasive, objective measurement to predict elevated ICP.
Method: We conducted a cross-sectional, retrospective analysis of anonymised patient data, comparing the ONSD on CT imaging with the opening pressure manometry during LP on patients who presented with focal neurology or with a Glasgow coma scale score of less than 15. The study sample consisted of 67 patients, ≥18 years of age, treated at the emergency department of the Kimberly Hospital Complex from 01 March 2013 to 31 December 2014.
Results: An ONSD measurement of ≥4.8 mm identified patients with an elevated ICP with a sensitivity of 92.9% and a specificity of 97.6%, using a 95% confidence interval. Raising the ONSD cut-off value to ≥5.0 mm decreased the sensitivity to 85.7% but increased the specificity to 100%, eliminating all patients with a normal ICP.
Conclusion: The ONSD can be measured on digital images obtained by routine CT investigations of the brain to predict elevated ICP in non-trauma patients, ≥18 years of age, with acceptable sensitivity and specificity.
Source: SA Journal of Radiology 20, pp 1 –3 (2016) http://dx.doi.org/10.4102/sajr.v20i1.1036More Less
This is a case report of a 24-year-old female who presented with galactorrhoea and elevated serum prolactin levels of 150 ng/mL. The intrasellar pituitary gland demonstrated normal morphology and characteristic enhancement. The pituitary stalk was thickened and revealed a non-enhancing lesion on dynamic contrast imaging, which was interpreted as a functioning microadenoma. The patient exhibited significant clinical improvement after initiation of therapy with a dopamine agonist, Cabergoline.
Source: SA Journal of Radiology 20, pp 1 –7 (2016) http://dx.doi.org/10.4102/sajr.v20i1.1112More Less
A 32-year-old woman presented with shortness of breath, NYHA grade 2–3, becoming progressively worse and affecting her activities of daily living. She underwent extensive investigations shown in the series of images including chest radiograph, abdominal sonar, computed tomography of chest and abdomen as well as a cardiac magnetic resonance imaging study.
Source: SA Journal of Radiology 20, pp 1 –5 (2016) http://dx.doi.org/10.4102/sajr.v20i1.957More Less
A 50-year-old man of otherwise excellent health presented with recent onset of left upper limb weakness and left facial nerve palsy. Figures 1-7 are selected magnetic resonance (MR) images.
We congratulate Dr Thato Sefanyetso for his submission of the correct findings and diagnosis of this quiz case.
Uterine artery embolisation as an effective choice for symptomatic fibroids : five-year outcome : original researchSource: SA Journal of Radiology 20, pp 1 –5 (2016) http://dx.doi.org/10.4102/sajr.v20i1.959More Less
Background : Uterine artery embolisation for the treatment of symptomatic uterine fibroids is a relatively new but internationally recognised procedure. The present study seeks to report the results of the largest South African series of uterine artery embolisations for symptomatic fibroids to date. It is the fourth article to be published in South Africa on the outcomes of this procedure, and the largest South African series to date.
Objective : To evaluate the long-term efficacy of uterine artery embolisation in women with symptomatic fibroids in a tertiary hospital in South Africa.
Methods : Eighty-two women who presented for uterine artery embolisation at a single site in South Africa for symptomatic fibroids were retrospectively studied. Outcomes included recurrence and re-intervention rates, patient satisfaction and complication rate.
Results : Two patients required repeat embolisation, and one patient experienced fibroid recurrence without further intervention. No repeat myomectomies were performed. Eighty percent of patients reported being satisfied, 12% partially satisfied and 7% not satisfied. No major complications were reported.
Conclusion : Uterine artery embolisation was shown to be a good choice in the treatment of symptomatic fibroids and presents favourable long-term outcomes in the South African population.
Temporal evaluation of computed tomographic scans at a Level 1 trauma department in a central South African hospital : original researchSource: SA Journal of Radiology 20, pp 1 –5 (2016) http://dx.doi.org/10.4102/sajr.v20i1.836More Less
Background : Time is a precious commodity, especially in the trauma setting, which requires continuous evaluation to ensure streamlined service delivery, quality patient care and employee efficiency.
Objectives : The present study analyses the authors' institution's multi-detector computed tomography (MDCT) scan process as part of the imaging turnaround time of trauma patients. It is intended to serve as a baseline for the institution, to offer a comparison with institutions worldwide and to improve service delivery.
Method : Relevant categorical data were collected from the trauma patient register and radiological information system (RIS) from 01 February 2013 to 31 January 2014. A population of 1107 trauma patients who received a MDCT scan was included in the study. Temporal data were analysed as a continuum with reference to triage priority, time of day, type of CT scan and admission status.
Results : The median trauma arrival to MDCT scan time (TTS) and reporting turnaround time (RTAT) were 69 (39-126) and 86 (53-146) minutes respectively. TTS was subdivided into the time when the patient arrived at trauma to the radiology referral (TTRef) and submission of the radiology request, to the arrival at the MDCT (RefTS) location. TTRef was statistically significantly longer than RefTS (p < 0.0001). RTAT was subdivided into the arrival at the MDCT to the start of the radiology report (STR) and time taken to complete the report (RT). STR was statistically significantly longer than RT (p < 0.0001).
Conclusion : The time to scan (TTS) was comparable to, but unfortunately the report turnaround time (RTAT) lagged behind, the findings of some first-world institutions.
Chest X-ray patterns of pulmonary multidrug-resistant tuberculosis in children in a high HIV-prevalence setting : original researchSource: SA Journal of Radiology 20, pp 1 –6 (2016) http://dx.doi.org/10.4102/sajr.v20i1.829More Less
Background : Paediatric multidrug-resistant tuberculosis (MDR-TB) necessitates a prolonged duration of treatment with an intensive treatment regimen. The chest X-ray patterns of pulmonary TB depend on a multiplicity of factors, including immune status, and therefore identifying the influence of HIV on the chest X-ray appearances of MDR-TB may assist with improving the diagnostic criteria.
Objectives : To describe the demographic characteristics and chest X-ray patterns of children with pulmonary MDR-TB and to compare the chest X-ray patterns of pulmonary MDR-TB between children who are HIV-infected and HIV-uninfected.
Method : Retrospective chart review of hospital notes and chest X-rays of children with pulmonary MDR-TB at King Dinuzulu Hospital, Durban. The chest X-rays were systematically reviewed for the presence of the following variables: hilar/mediastinal lymphadenopathy, bronchopneumonic opacification, segmental/lobar consolidation, cavities, miliary opacification and pleural effusion.
Results : Forty-five children (mean age, 6.29 years; median age, 6.00 years) with pulmonary MDR-TB met the inclusion criteria. The most common chest X-ray finding was consolidation (53.5%), followed by lymphadenopathy (35.6%), bronchopneumonic opacification (33.3%) and cavities (31.1%). Cavities were more common (OR 6.1; 95% CI 1.52-24.66) in children who had been initiated on standard anti-TB treatment for the current TB episode. There were no statistically significant differences in any of the chest X-ray patterns in HIV-uninfected (n = 22) compared with HIV-infected (n = 20) children.
Conclusion : The most common chest X-ray finding was consolidation, followed by lymphadenopathy, bronchopneumonic opacification and cavities. The finding of a significantly higher frequency of cavities in children who had received prior standard anti-TB treatment for the current TB episode could reflect poor disease containment and increased parenchymal damage, owing to a delay in the recognition of MDR-TB. The development of cavitation in chest X-rays of children with TB could raise concern for the possibility of MDR-TB, and prompt further testing.
Source: SA Journal of Radiology 20, pp 1 –5 (2016) http://dx.doi.org/10.4102/sajr.v20i1.999More Less
A three-and-a-half-year-old male child was referred for neuroimaging under general anaesthesia for intractable seizures. A final diagnosis of probable tuberous sclerosis with associated left hippocampal sclerosis was made. Differential diagnosis of malformation of cortical development with hippocampal sclerosis (Type 3a) was considered with respect to the left temporal lobe abnormality. It is heartening to note that several good submissions were received for the paediatric quiz case. Noteworthy responses were received from Dr Samuel Mannikam, Dr Thandi Buthelezi, Dr Philip Janse van Rensburg and Dr Ian Haynes, however, the prize of R2000 was awarded to Dr Richard Busayo Ulatunji for the most inclusive answer.
Source: SA Journal of Radiology 20, pp 1 –3 (2016) http://dx.doi.org/10.4102/sajr.v20i1.1029More Less
A 40-year-old lady had a CT and an MRI scan of her brain for investigation of severe headache following recent recurrent bowel surgery. The post-operative course was complicated by abdominal wall haematoma, and she required multiple blood transfusions. The background history of multiple previous bowel resections and chronic anti-inflammatory therapy for inflammatory bowel disease was noted.
Author Gulraiz ChaudrySource: SA Journal of Radiology 20, pp 1 –6 (2016) http://dx.doi.org/10.4102/sajr.v20i1.940More Less
Paediatric interventional radiology (IR) is a rapidly developing subspecialty, seeking to meet the increasing demand for image-guided minimally invasive procedures. The wide range of procedures performed and the conditions treated reflect the varying ages and complexity of the patient population. This article reviews the various interventional procedures performed and the unique challenges faced in paediatric IR. Conditions, such as vascular anomalies, that are primarily treated by paediatric interventional radiologists are highlighted. The requirements for establishing a paediatric IR practice are reviewed, as are the challenges facing the future development of the specialty.
Assessment of the impact of application of single-photon emission computed tomography and SPECT-CT on lesion categorisation in bone scintigraphy : original researchSource: SA Journal of Radiology 20, pp 1 –5 (2016) http://dx.doi.org/10.4102/sajr.v20i1.990More Less
Objectives: To assess initial experience with the use of a new single-photon emission computed tomography-computed tomography (SPECT-CT) in the evaluation of lesions.
Methods: The folder number, radiopharmaceutical used and type of scan of patients examined with a new Siemens T6 SPECT-CT between 02 April 2016 and 31 December 2013 were retrieved. The number of 99mTc-MDP bone scans was sufficient for a detailed analysis. The scans were re-processed and reported by the observer before he was given any clinical information. Whole body planar, whole body planar plus SPECT and whole body planar plus SPECT-CT images were assessed successively in three separate sessions at least 2 weeks apart. At each session, the certainties of detection, localisation and categorisation of each lesion were recorded.
Results: A total of 539 lesions were seen on the whole body, SPECT and computed tomography (CT) images in 133 patients. The whole body images showed no lesions in 3 patients and 378 lesions in 130 patients. SPECT detected 122 additional lesions in 79 patients. Thirty-nine (12.2%) lesions were seen only on CT in 32 (24.1%) patients. For the 261 lesions seen on the planar images in the SPECT field of view, lesion detection was definite in 233 (89.3%), localisation definite in 151 (57.9%) and categorisation definite in 123 (47.1%) lesions. On the SPECT, definite lesion detection, localisation and categorisation were recorded, respectively, for 259 (99.2%), 228 (87.4%) and 176 (67.4%) of the 261 lesions. Lesion detection, localisation and categorisation certainties were definite for 100%, 99.1% and 94.7% of the SPECT-CT lesions, respectively.
Conclusion: SPECT markedly improves lesion detection and localisation, and CT enhances lesion categorisation.
Multi-voxel proton magnetic resonance spectroscopy changes in neuropsychiatric lupus patients : original researchSource: SA Journal of Radiology 20, pp 1 –5 (2016) http://dx.doi.org/10.4102/sajr.v20i1.974More Less
Purpose: In this prospective study, we used 2D chemical shift imaging (CSI), a multi-voxel proton spectroscopy technique, to evaluate the brain metabolites on conventional magnetic resonance imaging (MRI) in normal-appearing white and grey matter in systemic lupus erythematosus (SLE) patients with neuropsychiatric symptoms (NPSLE); without neuropsychiatric symptoms (non-NPSLE); and healthy controls (HCs). Our objective was to find metabolites that discriminated NPSLE patients from the non-NPSLE and HC cohorts.
Materials and methods: The study included 23 NPSLE patients, 20 non-NPSLE patients, and 21 HCs. A clinical assessment including the SLE disease activity index (SLEDAI) and systemic lupus international collaborating clinics (SLICC) scores was conducted. All patients underwent conventional MRI and 2D CSI technique to acquire the following metabolic ratios: NAA/Cr, Cho/Cr, and Cho/NAA in the anterior and posterior insula, anterior frontal and parietal white and grey matter, thalamus, basal ganglia, and occipital grey matter.
Results: In terms of metabolic differences, the NPSLE patients had significant differences compared with the non-NPSLE and HC groups in the: left posterior insula (increased Cho/NAA; p = 0.008), right internal capsule (increased Cho/Cr; p < 0.05), left thalamus (increased NAA/Cr; p = 0.011), anterior grey matter (increased NAA/Cr; p = 0.004), posterior grey matter (increased Cho/NAA; p = 0.016), anterior white matter (increased NAA/Cr; p = 0.012), and left posterior white matter (increased Cho/NAA; p = 0.022). The NPSLE patients showed significantly higher SLEDAI scores (p < 0.001).
Conclusion: We found several significant distinct metabolic differences between NPSLE and non-NPSLE/HC patients in various brain locations.
Role of cranial computed tomography in human immunodeficiency virus-positive patients with generalised seizures : original researchSource: SA Journal of Radiology 20, pp 1 –5 (2016) http://dx.doi.org/10.4102/sajr.v20i1.965More Less
Background: Emergency neuroimaging of human immunodeficiency virus (HIV)-positive patients with generalised new onset seizures (NOS) and a normal post-ictal neurological examination remains controversial, with the general impression being that emergency imaging is necessary because immunosuppression may blur clinical indicators of acute intracranial pathology. The objectives of our study were to establish whether cranial computed tomography (CT) affects the emergency management of HIV-positive patients with generalised NOS and a normal post-ictal neurological examination.
Method: We conducted a prospective descriptive observational study. Consecutive HIV-positive patients of 18 years and older, who presented to the Kimberley Hospital Complex's Emergency Department within 24 hours of their first generalised seizures and who had undergone normal post-ictal neurological examinations, were included. Emergency CT results as well as CD4-count levels were evaluated.
Results: A total of 25 HIV-positive patients were included in the study. The results of cranial CT brought about a change in emergency care management in 12% of patients, all of them with CD4 counts below 200 cells/mm3.
Conclusion: We suggest that emergency cranial CT be performed on all HIV-positive patients presenting with generalised NOS and a normal post-ictal neurological examination, particularly if the CD4 count is below 200 cells/mm3.
Histological underestimation of a 9-gauge stereotactic vacuum-assisted breast biopsy system compared with surgical excision at a tertiary hospital in South Africa : original researchSource: SA Journal of Radiology 20, pp 1 –5 (2016) http://dx.doi.org/10.4102/sajr.v20i1.818More Less
Background: Breast cancer is a major cause of morbidity and mortality worldwide. Certain lesions encountered on mammography require histological assessment of biopsy samples to identify benign versus malignant disease. Stereotactic vacuum-assisted breast biopsy (SVAB) is a useful technique, especially for non-palpable microcalcific lesions, and was introduced at our institution in 2011.
Objectives: To determine whether the histological underestimation from 9-gauge SVABs performed at our institution is within acceptable limits.
Method: In this cross-sectional study, 9-gauge stereotactic biopsy histology results and breast imaging and reporting data system (BI-RADS) findings of 158 lesions (from 153 patients) were analysed and the histological findings compared with surgical excision histology results (54 lesions) to determine histological underestimation (upgrade rates).
Results: One out of eight cases of ductal carcinoma in situ (DCIS) was underestimated, yielding a DCIS underestimation rate of 12.5%.
Conclusion: The DCIS underestimation obtained from the present study in our institution was on a par with other authors' findings and was therefore within acceptable limits. Atypical ductal hyperplasia underestimation could not be reliably obtained with the small study population.
Source: SA Journal of Radiology 20, pp 1 –7 (2016) http://dx.doi.org/10.4102/sajr.v20i1.1088More Less
A 40 year old lady had a CT and an MRI scan of her brain for investigation of severe headache following recent recurrent bowel surgery. The post-operative course was complicated by abdominal wall haematoma and she required multiple blood transfusions. Background history of multiple previous bowel resections and chronic anti-inflammatory therapy for inflammatory bowel disease was noted.
Source: SA Journal of Radiology 20, pp 1 –3 (2016) http://dx.doi.org/10.4102/sajr.v20i1.1053More Less
A 32-year-old lady presented with shortness of breath, (New York Heart Association [NYHA] grade 2-3), becoming progressively worse, associated with cough, chest pain and constitutional symptoms. She underwent extensive investigations shown in the series of images including chest radiograph, abdominal sonar, computed tomography of chest and abdomen as well as a cardiac magnetic resonance imaging study.
Computed tomography stroke findings and population demographics at Pelonomi Hospital, Bloemfontein : original researchSource: SA Journal of Radiology 20, pp 1 –6 (2016) http://dx.doi.org/10.4102/sajr.v20i1.993More Less
Background: Stroke remains the highest cause of death in patients more than 50 years old in South Africa, and the fourth highest cause of death overall. There is a paucity of information regarding this disease in the Free State Province.
Objectives: To assess the stroke profile of patients referred for computed tomography (CT) imaging to our institution along with evaluating factors that could improve stroke management.
Method: The demographic information, stroke risk factors, stroke types and time to imaging were evaluated for all patients who presented for CT stroke imaging from July 2014 until July 2015. Information was gathered prospectively from the hospital and radiology information systems.
Results: The study included 174 patients (53.5% female, 46.5% male). Their mean age was 59 years (standard deviation (SD) 14.6). The most prevalent risk factors were hypertension (83.7%), smoking (20.5%) and diabetes (15.0%). The population group consisted of 67.8% ischaemic (n = 118) and 32.2% (n = 56) haemorrhagic strokes. The majority of patients with a known time of symptom onset (n = 102) presented after 8 hours (82.4%). The median order to report time (ORT) was 61 min (range 18 min-1361 min). The median arrival to report time (ART) was 32 min (range 4 min-893 min).
Conclusion: Our stroke population did not differ significantly from others in South Africa and Africa overall. Pre- and in-hospital delays significantly influenced patient numbers qualifying for thrombolysis.