https://sajr.org.za/index.php/sajr/issue/feedSouth African Journal of Radiology2024-03-02T12:54:01+01:00AOSIS Publishingsubmissions@sajr.org.zaOpen Journal Systems<a id="readmorebanner" href="/index.php/sajr/pages/view/journal-information" target="_self">Read more</a> <img style="padding-top: 2px;" src="/public/web_banner.svg" alt="" />https://sajr.org.za/index.php/sajr/article/view/2810Mimickers of hypoxic-ischaemic brain injury in term neonates: What the radiologist should know2024-03-02T12:54:01+01:00Shalendra K. Missershalendra.misser@lakesmit.co.zaMoherndran Archaryarchary@ukzn.ac.za<p>Patterns of neonatal hypoxic-ischaemic brain injury (HIBI) are fairly well known. There are, however, other diagnoses with imaging patterns that may mimic HIBI. A review of MRI studies was conducted for children with suspected cerebral palsy, correlated with prior imaging, clinical details and laboratory tests where available. In the 63 identified cases, imaging features were, in many cases, very similar to the known patterns of HIBI. The alternative diagnoses can be classified as developmental, vascular, chromosomal, infections, metabolic disorders, and congenital syndromes. These findings are described in this pictorial essay. The potential mimickers of HIBI described in this essay can demonstrate similar imaging appearances to HIBI.</p><p><strong>Contribution:</strong> There are multiple possible causes of neonatal encephalopathy other than hypoxic-ischaemic encephalopathy. Many conditions may mimic HIBI, each of which can be associated with significant morbidity. It is prudent for the reporting radiologist to be aware of these alternate clinico-radiological diagnoses.</p>2024-02-29T16:16:00+01:00Copyright (c) 2024 Shalendra K. Misser, Moherndran Archaryhttps://sajr.org.za/index.php/sajr/article/view/2726Benign paediatric liver tumours: The radiological maze demystified2024-03-01T13:19:43+01:00Poonam Sherwanisherwanipoonam@gmail.comDevasenathipathy Kandasamydevammc@gmail.comRaju Sharmaraju152@yahoo.comPrabudh Goeldrprabudhgoel@gmail.comManisha Janamanishajana@gmail.comNellai Krishnannellai93@gmail.com<p>The trajectory from the clinical identification of a benign liver mass to establishing a precise diagnosis is perplexing and arduous. Related contributory factors are that such lesions are encountered infrequently and that there is a nonavailability of dedicated paediatric radiologists in the developing world. The objective of this study was to review the spectrum of benign liver lesions in children and their typical imaging features. Cross-sectional imaging of all paediatric patients (< 18 years) with liver lesions (single and multiple) performed in the institute from 01 January 2018 to 01 January 2019 as well as those acquired at outside institutions and referred to the institute for management was included. Ultrasound was done as the first line of investigation in all the cases with suspicious liver masses and retrospectively performed in referral cases in whom CT or MRI was already done. Images were analysed by two senior radiologists. Most of the cases were diagnosed based on clinical, biochemical and imaging findings, and biopsy was only performed in equivocal cases. Most of the benign liver lesions in the paediatric age group were hepatic haemangioma and mesenchymal hamartomas. A simplified clinical-radiologic paradigm should be established for benign liver lesions in children to assist in reaching the correct diagnosis.</p><p><strong>Contribution:</strong> The article demonstrates the salient radiological findings of various benign liver lesions in the paediatric age group and the role of demographic, clinical and biochemical findings, which plays a substantial role in the diagnosis and avoids unnecessary biopsies.</p>2024-02-12T08:00:00+01:00Copyright (c) 2024 Poonam Sherwani, Devasenathipathy Kandasamy, Raju Sharma, Prabudh Goel, Manisha Jana, Nellai Krishnanhttps://sajr.org.za/index.php/sajr/article/view/2809Establishment of local diagnostic reference levels for CT colonography at a tertiary hospital2024-02-02T12:44:14+01:00Filip M. Kozłowskikozlowski.m.filip@gmail.comChristoffel J. van Reenenricus@sun.ac.zaChristoph J. Trauernichtcjt@sun.ac.za<div class="WordSection1"><p><strong>Background:</strong> Diagnostic reference levels (DRLs) are an important metric in identifying abnormally high radiation doses in diagnostic examinations. National DRLs for CT colonography do not currently exist in South Africa, but there are efforts to collect data for a national DRL project.</p><p><strong>Objectives:</strong> This study investigated radiation doses for CT colonography in adult patients at a large tertiary hospital in South Africa with the aim of setting local DRLs.</p><p><strong>Method:</strong> Patient data from two CT scanners (Philips Ingenuity and Siemens Somatom go.Top) in the period March 2020 – March 2023 were obtained from the hospital’s picture archiving and communication system (PACS) (<em>n</em> = 115). Analysis involved determining the median computed tomography dose index-volume (CTDI<sub>vol</sub>) and dose-length product (DLP) values. The findings were compared with DRLs established internationally.</p><p><strong>Results:</strong> Ingenuity median CTDI<sub>vol</sub> was 20 mGy and DLP was 2169 mGy*cm; Somatom median CTDI<sub>vol</sub> was 6 mGy and DLP was 557 mGy*cm. Ingenuity exceeded the United Kingdom’s (UK) recommended DRLs by 82% and 214%, respectively. Somatom median CTDI<sub>vol</sub> and DLP were 45% and 19% lower than UK NDRLs.</p><p><strong>Conclusion:</strong> Somatom’s tin filter and other dose reduction features provided significant dose reduction. These data were used to set DRLs for CT colonography at the hospital; CTDI<sub>vol</sub>: 6 mGy and DLP: 557 mGy*cm.</p><p><strong>Contribution:</strong> In addition to informing radiation protection practices at the level of the institution, the established local DRLs contribute towards implementing regional and national DRLs.</p></div>2024-01-31T17:00:00+01:00Copyright (c) 2024 Filip M. Kozłowski, Christoffel J. van Reenen, Christoph J. Trauernichthttps://sajr.org.za/index.php/sajr/article/view/2724Our experience with liver and spleen elastography in the prediction of oesophageal varices2024-02-01T13:20:27+01:00Shivali Aryashivaliarya93@gmail.comRashmi Dixitdrrashmidixit@gmail.comSneha Harish Csnehaharishc@gmail.comAnjali Prakashanjali_prakash@hotmail.comAmarender S. Puriamarender.puri@gmail.com<p><strong>Background:</strong> Variceal bleeding is an important cause of mortality in patients with chronic liver disease (CLD). The gold standard for detection and grading of oesophageal varices (EV) is upper gastrointestinal endoscopy. However, it is expensive, time-consuming and invasive.</p><p><strong>Objectives:</strong> This study aimed to find any association between splenic shear wave velocity (SWV) measured by acoustic radiation force imaging (ARFI) and the presence of EV.</p><p><strong>Method:</strong> The quasi-experimental study included 50 patients with CLD and 50 subjects without CLD as the control group. Both underwent upper abdominal ultrasonography followed by elastographic assessment on a Siemens Acuson S2000<sup>TM</sup> ultrasound system. A comparison of the findings was made between the control and patient groups.</p><p><strong>Results:</strong> Both groups had similar hepatic size while patients with CLD had larger splenic size and area (<em>p</em> < 0.05). The CLD patients had higher mean hepatic and splenic SWV compared with the control group (<em>p</em> < 0.05). The mean splenic size and splenic SWV were higher in patients with varices than in those without varices (<em>p</em> < 0.05).</p><p><strong>Conclusion:</strong> Chronic liver disease causes significant increase in liver and splenic stiffness with splenic SWV values being higher for patients with varices emphasising the role of elastography as a non-invasive predictor for the presence of EVs. Splenic SWV had the highest sensitivity and specificity, which was augmented by a combination of hepatic and splenic SWV. Thus, splenic SWV alone or in combination with hepatic SWV is a useful technique for prediction of the presence of EVs.</p><p><strong>Contribution:</strong> This study aims to find an alternative non-invasive and cost-effective technique for screening of EV.</p>2024-01-25T04:00:00+01:00Copyright (c) 2024 Shivali Arya, Rashmi Dixit, Sneha Harish C, Anjali Prakash, Amarender S. Purihttps://sajr.org.za/index.php/sajr/article/view/2728Neuroquantification enhances the radiological evaluation of term neonatal hypoxic-ischaemic cerebral injuries2024-01-10T13:10:06+01:00Shalendra K. Missershalendra.misser@lakesmit.co.zaNobuhle Mchununobuhle.mchunu@mrc.ac.zaJan W. Lotzlotz@sun.ac.zaLisa Kjonigsenlisa.kjonigsen@gmail.comAziz Ulugaulug@cortechslabs.comMoherndran Archaryarchary@ukzn.ac.za<p><strong>Background:</strong> Injury patterns in hypoxic-ischaemic brain injury (HIBI) are well recognised but there are few studies evaluating cerebral injury using neuroquantification models.</p><p><strong>Objectives:</strong> Quantification of brain volumes in a group of patients with clinically determined cerebral palsy.</p><p><strong>Method:</strong> In this retrospective study, 297 children with cerebral palsy were imaged for suspected HIBI with analysis of various cerebral substrates. Of these, 96 children over the age of 3 years with a clinical diagnosis of cerebral palsy and abnormal MRI findings underwent volumetric analyses using the NeuroQuant<sup>®</sup> software solution. The spectrum of volumetric changes and the differences between the various subtypes (and individual subgroups) of HIBI were compared.</p><p><strong>Results:</strong> Compared with the available normative NeuroQuant<sup>®</sup> database, the average intracranial volume was reduced to the 1st percentile in all patient groups (<em>p</em> < 0.001). Statistically significant differences were observed among the types and subgroups of HIBI. Further substrate volume reductions were identified and described involving the thalami, brainstem, hippocampi, putamina and amygdala. The combined volumes of five regions of interest (frontal pole, putamen, hippocampus, brainstem and paracentral lobule) were consistently reduced in the Rolandic basal ganglia-thalamus (RBGT) subtype.</p><p><strong>Conclusion:</strong> This study determined a quantifiable reduction of intracranial volume in all subtypes of HIBI and predictable selective cerebral substrate volume reduction in subtypes and subgroups. In the RBGT subtype, a key combination of five substrate injuries was consistently noted, and thalamic, occipital lobe and brainstem volume reduction was also significant when compared to the watershed subtype.</p><p><strong>Contribution:</strong> This study demonstrates the value of integrating an artificial intelligence programme into the radiologists’ armamentarium serving to quantify brain injuries more accurately in HIBI. Going forward this will be an inevitable evolution of daily radiology practice in many fields of medicine, and it would be beneficial for radiologists to embrace these technological innovations.</p>2023-12-26T06:05:00+01:00Copyright (c) 2023 Shalendra K. Misser, Nobuhle Mchunu, Jan W. Lotz, Lisa Kjonigsen, Aziz Ulug, Moherndran Archaryhttps://sajr.org.za/index.php/sajr/article/view/2694Imaging of inferior vena cava normal variants, anomalies and pathologies, Part 2: Acquired2023-12-19T08:50:50+01:00Ranjit K. Chaudharyranjitkchaudhary@hotmail.comPankaj Nepalpankaj-123@live.comShruti Kumarshrutikumar2506@gmail.comElina Guptadrelinagupta12@gmail.comNikita Sangroulanikitasangroula7@gmail.comArpit Nagararpitnagar@gmail.comVijayanadh Ojiliojili@uthscsa.edu<p>The inferior vena cava (IVC) is an uncommon site for primary pathologies and secondary involvement is also infrequent, but involvement of the IVC can often drastically change management. It is therefore important to be cognizant of IVC pathologies. This review discussed common and rare neoplastic and non-neoplastic pathologies of the IVC as well as pathology mimics. Primary and secondary neoplasms can lead to tumour extension or bland thrombus formation and it is often important to distinguish between these two entities. It is also important to be aware of pseudo-lesions for accurate diagnosis. Inferior vena cava filter placement and endovascular treatment of the aorta are commonly performed procedures that can be associated with devastating complications, which are luckily infrequent. The calibre of the IVC also has its own clinical significance. Inferior vena cava pathologies, although rare, have a dramatic impact on the patient’s outcome and knowledge of these pathologies is prudent.</p><p><strong>Contribution:</strong> Understand the principles of IVC imaging, the common as well as the rare primary and secondary IVC tumours, differentiate between tumour thrombus and bland thrombus, and recognise IVC lesion mimics and life-threatening pathologies involving the IVC.</p>2023-12-08T08:00:00+01:00Copyright (c) 2023 Ranjit K. Chaudhary, Pankaj Nepal, Shruti Kumar, Elina Gupta, Nikita Sangroula, Arpit Nagar, Vijayanadh Ojilihttps://sajr.org.za/index.php/sajr/article/view/2707Superior labrum anterior to posterior lesions: Part 2 – Classification with arthroscopic correlation2023-12-04T08:09:36+01:00Peter Mercourispmercouris@iafrica.comMatthew Mercourismercouris@gmail.com<p>The glenoid labrum deepens the glenoid fossa and allows for the attachment of the long head of the biceps tendon and glenohumeral ligaments, contributing to the stability of the glenohumeral joint. The superior labrum is a common site of labral injury. The acronym SLAP (superior labrum anterior to posterior or anteroposterior) lesion was introduced by Snyder and colleagues in 1990 to describe superior labral tears based on arthroscopic evaluation. This original classification has since been expanded, and there are currently 10 types of SLAP lesions. The article will describe and illustrate the 10 types of SLAP lesions by means of colour illustrations, MRI images and correlative arthroscopy images. A practical approach to the assessment of SLAP lesions will be recommended.</p><p><strong>Contribution:</strong> The illustrated review functions as a crucial radiological guide for both radiologists and orthopaedic surgeons. The combination of illustrations, MR and correlative arthroscopic images enhances the comprehensive understanding of labral pathology. The value of the review lies in the presentation of imaging findings and classification, coupled with findings on arthroscopy. This understanding is vital in guiding orthopaedic management for patients, ensuring appropriate treatment strategies.</p>2023-11-28T06:00:00+01:00Copyright (c) 2023 Peter Mercouris, Matthew Mercourishttps://sajr.org.za/index.php/sajr/article/view/2747Imaging spectrum of spinal dysraphism: A diagnostic challenge2023-12-04T08:09:36+01:00Mohit K. Shrivastvamohit.nishu08@gmail.comMousam Panigrahimousampanigrahi@gmail.com<p>Spinal dysraphism (SD) is a collective term for congenital malformations of the spine and spinal cord. It includes a wide range of congenital anomalies resulting from aberrations in the stages of gastrulation, primary neurulation and secondary neurulation. Spinal dysraphism may lead to neurological impairment of varying severity including weakness of the extremities, incontinence of bowel and bladder, sexual dysfunction, among others. Diagnosis of SDs is quite challenging because of its wide spectrum and complex cascade of embryologic events. Knowledge of normal embryology and proper understanding of imaging features of SD are important for early accurate diagnosis.</p><p><strong>Contribution:</strong> This series of five cases describes the imaging spectrum of spinal dysraphism and highlights the embryological basis for their development, which could facilitate early correct diagnosis, surgical planning and reduced morbidity related to these malformations. It also includes an extremely rare case of complex spinal dysraphism (Type II diastematomyelia with right hemimyelomeningocoele and left hemilipomyelomeningocoele) with Chiari II malformation.</p>2023-11-27T06:15:00+01:00Copyright (c) 2023 Mohit K. Shrivastva, Mousam Panigrahihttps://sajr.org.za/index.php/sajr/article/view/2687Imaging of inferior vena cava normal variants, anomalies and pathologies, Part 1: Congenital2023-12-04T08:09:36+01:00Ranjit K. Chaudharyranjitkchaudhary@hotmail.comPankaj Nepalpankaj-123@live.comShruti Kumarshrutikumar2506@gmail.comElina Guptadrelinagupta12@gmail.comNikita Sangroulanikitasangroula7@gmail.comArpit Nagararpitnagar@gmail.comVijayanadh Ojiliojili@uthscsa.edu<p>The embryology of the inferior vena cava (IVC) is complex, involving the sequential appearance and regression of multiple segments that ultimately form the IVC. Any alteration in this process during embryogenesis can result in congenital anomalies of the IVC. This study aimed to recognise common as well as rare anomalies of the IVC and associated veins, and their clinical implications. The anomalies tend to have diverse appearances based on the timing and segments involved. The development of the IVC is intertwined with the development of other veins like the renal vein, azygos vein and portal vein, and these veins may also be anomalous. Additionally, IVC anomalies are associated with various other congenital anomalies including cardiac anomalies, the recognition of which may be important for patient care. The IVC tends to have multiple normal variants and anomalies because of a complex process involving multiple segments contributing to the adult IVC. Knowledge of these variants is crucial for preoperative planning of procedures.</p><p><strong>Contribution:</strong> This study would help in understanding the embryogenesis of the IVC and correlation with the imaging appearances and the clinical implications of each of these common as well as rare types of congenital anomalies.</p>2023-11-24T06:00:00+01:00Copyright (c) 2023 Ranjit K. Chaudhary, Pankaj Nepal, Shruti Kumar, Elina Gupta, Nikita Sangroula, Arpit Nagar, Vijayanadh Ojilihttps://sajr.org.za/index.php/sajr/article/view/2793Surfing the intelligence with chatbots2023-12-04T08:09:36+01:00Maya Pateleditor@sajr.org.zaNo abstract available.2023-11-17T06:00:00+01:00Copyright (c) 2023 Maya Patel