Paranasal sinus variants

Normal variations of the the paranasal sinuses tend to be overlooked but can have pathological consequences, making identification important.http://www.journals.co.za/sama/m_sajr.htm

Nuclear medicine-induced allergic reactions

Immunologic reactions to radiopharmaceuticals are usually mild and transient and require little or no medical treatment. As the usage of radiopharmaceuticals has increased, the reported adverse reactions remain comparatively few in number. Although the low reported numbers demonstrate that radiopharmaceuticals are safe and the pharmaceutical amount used in the formulation is small, it is worrisome that there is no single system for reporting adverse events associated with radiopharmaceuticals. The most commonly described allergic reactions still remain 99mTc-labelled diphosphonates, colloids and albumin. The likelihood of a reaction to PET radiopharmaceutical administration is low due to the chemical used being too small to induce a physiologic effect. Reports on allergic reactions to therapeutic radiopharmaceuticals are rare. Although the advent of adverse events from the administration of this therapy may occur due to the deterministic effects of these radiopharmaceuticals, this is usually related to the amount of radiation administered rather than the pharmaceutical effects. The advancement in technology has catapulted imaging into a new era allowing for hybrid imaging with SPECT/ CT or MRI and PET/CT or MRI. This brings with it further risks for adverse events which have been associated with these radiological modalities and necessitates a discussion of allergic reactions from iodinated contrast media as well as gadolinium contrast. As there is no alternative to the use of radiopharmaceuticals for nuclear medicine and the added benefit of a diagnostic radiology in one-sitting for certain cases, it is important to document and report on these few adverse reactions in order to improve the imaging methodology and possi ble prophylactic measures.http://www.allergysa.org/journal.htmhttp://reference.sabinet.co.za/sa_epublication/caciam201

Current clinical applications of cardiovascular magnetic resonance imaging

Cardiovascular magnetic resonance (CMR) imaging is unsurpassed in the evaluation of myocardial anatomy, function and mass. Myocardial perfusion pre- and post-stress, as well as late enhancement is increasingly used in the work-up for ischaemic heart disease, especially in establishing the presence of myocardial viability. Late enhancement patterns can contribute substantially to the diagnosis of myocarditis and various cardiomyopathies as well as infiltrative diseases and tumours. With their high incidence of cardiovascular disease, patients on the African continent could potentially benefit enormously from the proper utilisation of this exciting, continually evolving and versatile technique, via thorough didactic and clinical training as well as interdisciplinary co-operation.http://www.cvja.co.zaam201

MRI imaging of vein of Galen malformations at Steve Biko Academic Hospital : a mini case series

No abstract available.http://www.journals.co.za/sama/m_sajr.htm

Pseudomyxoma peritonei (PMP) – a rare entity

Pseudomyxoma peritonei (PMP) is a rare complication of mucinous tumours of appendiceal or ovarian origin that results in peritoneal and omental implants. Clinical morbidity and mortality arise from the fact that copious amounts of extracellular and peritoneal mucin result in distortion and loss of function of visceral organs. Therapeutic paracentesis is not possible because of the nature of the mucin. Currently, new techniques are being used to attempt to debulk the mucin volume; none, however, has lead to superior outcome.http://www.sajr.org.za/index.php/saj

Isolated posterior fossa involvement of progressive multifocal leucoencephalopathy in HIV : a case series with review of the literature

Progressive multifocal leucoencephalopathy (PML) is a progressive demyelinating condition resulting from infection with the John Cunningham virus and precipitated by immunocompromised states. The HIV pandemic, especially in sub-Saharan Africa, has resulted in an increase in the number of patients presenting with PML. Imaging plays an important role in diagnosis and the distribution of the disease is predominantly supratentorial. Isolated posterior fossa involvement is a rare finding with very few cases described in the literature. We present the largest case series of patients described in the literature, with isolated posterior fossa involvement of PML, in HIV-positive patients.http://www.sajr.org.zaam2018NeurologyRadiolog

PACS : do clinical users benefit from it as a training adjunct?

BACKGROUND: Over the past four years, Steve Biko Academic Hospital has been in the process of implementing and refining the use of a picture archiving and communications system (PACS). As part of a post-implementation refining process, it was necessary to evaluate user-perceptions in order to improve on good system qualities and correct flaws. AIM: The aim of this study was to assess whether medical clinicians perceived PACS as a positive adjunct to training and teaching opportunities – specifically those opportunities related to radiological image viewing and interpretation as part of patient case discussions. METHOD: Standardised questionnaires with ‘free text’ and ‘option selection’ questions were distributed to clinicians who, as part of their training, rotated at Steve Biko Academic Hospital (where a PACS is in place) as well as other teaching hospitals without a PACS. Between February 2009 and May 2009, approximately 400 questionnaires were distributed. As a result of constant academic rotations, leave schedules of medical staff and posts vacated, questionnaires could not be distributed to the entire target population that was estimated to be in the region of 550 medical clinicians (comprising senior medical students, interns, medical officers, registrars and consultants). Of the 400 questionnaires distributed, 189 completed questionnaires were returned. Completion of the questionnaires was voluntary and anonymous. RESULTS AND CONCLUSION: Although a PACS relates specifically to the archiving and retrieval of radiological images and reports, it became clear from the feedback received from medical clinicians (who are ward-based, theatre-based or clinic-based users of a digital system) that many other factors, such as lack of adequate hardware and sub-optimal personal IT proficiency, contributed to some of the negative PACS-related perceptions and ‘lost teaching opportunities’ reported. Negative comments specifically related to PACS as a training adjunct included the frustrations associated with PACS downtime (especially during the period in 2009 when many electrical power cuts were experienced nationwide, resulting in network interruptions) and slow image retrieval during peak work-flow times. The advantages of PACS as a positive training adjunct were highlighted in the areas of multi-site viewing and consultation, the possibility of image manipulation and measurement tools, and better overall image quality. Clinicians felt that their training experience was also enhanced because of better patient follow-up made possible by access to all previous radiological imaging of a particular patient. Of the clinicians who completed the questionnaires, 63.5% felt that the PACS at Steve Biko Academic Hospital contributed positively to their training by creating more overall learning opportunities than other training environments without a PACS.http://www.sajr.org.za/index.php/saj

Toothy craniopharyngioma : a literature review and case report of craniopharyngioma with extensive odontogenic differentiation and tooth formation

No abstract available.http://www.springerlink.com/content/100510

Foetal magnetic resonance imaging : a necessity or adjunct? A modality comparison of in-utero ultrasound and ultrafast foetal magnetic resonance imaging

BACKGROUND: Congenital anomalies occur in approximately 2% of newborns, resulting in severe medical, physical and social disabilities. Managing clinicians, therefore, require more confidence in their diagnosis and prognostic accuracy before appropriately counselling the parents regarding termination of pregnancy. OBJECTIVE: The aim of this study was to investigate the role of magnetic resonance imaging (MRI) following the diagnosis of foetal anomalies at a foetomaternal unit of a tertiary South African institution. METHODS: Eighty-eight pregnant women in their late second/third trimester who underwent both an ultrasound (US) at the foetomaternal unit and foetal MRI at the Radiology Department from 01 July 2013 to 30 September 2019 were included in this clinical study conducted at Steve Biko Academic Hospital. RESULTS: Despite the high degree of concurrence (73.9%) between both modalities regarding the main diagnoses, MRI provided additional information in 45.5% of patients and changed the diagnosis in 25% of the patients. It further demonstrated superiority in providing diagnostic information in 97% of cases where the US alone was inadequate to counsel parents regarding the termination of pregnancy, and it completely changed the clinical management in 42% of cases. CONCLUSION: It is clearly evident from this study that foetal MRI is a necessity when termination of pregnancy is being considered following an US conducted by the foetomaternal unit. This allows for a complete foetal assessment and gives the managing clinician sufficient diagnostic confidence to prognosticate the future quality of life of the child.https://sajr.org.zaRadiologyStatistic

Heterotaxy syndrome : this is the left, right?

Heterotaxy syndrome is a rare and complex disorder of the chest and abdominal organ arrangements, and presents a diagnostic challenge to the radiologist. This article describes the morphological characteristics of heterotaxy and situs abnormalities, in particular left and right atrial isomerism, and suggests an approach in evaluating the spectrum of abnormalities associated with heterotaxy syndromes, using appropriate imaging modalities.This article was adapted from an electronic poster entitled ‘This is the left, right?’ presented at the European Congress of Radiology in Vienna, Austria, in 2013.http://www.sajr.org.zaam201