Browsing by Subject "Radiology"
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- ItemOpen AccessAn analysis of the CT and CT angiogram findings of methamphetamine induced stroke in young adults (≤45 years) presenting to GSH Emergency department(2023) Ngamolane, Aaron; Candy, SallyMMED Title: An analysis of the CT and CT angiogram findings of methamphetamine induced stroke in young adults (≤ 45 years) presenting to GSH emergency department. The recreational use of methamphetamine in the Republic of South Africa is on the rise accounting for 30% of patients admitted to addiction rehabilitation centres countrywide1 . In the Western Cape province alone methamphetamine is the commonly abused drug, detected in 44% of patients admitted for addiction rehabilitation2 . Methamphetamine is a risk factor for stroke especially in young adults, it is therefore important to determine key radiological features of methamphetamine related stroke for prompt and accurate differentiation from other stroke aetiologies. Study of stroke in this group of participants is of paramount importance as stroke is the second most common cause of death worldwide, responsible for 11.8% of all deaths after ischaemic heart disease (14.8%)3 . Stroke is also responsible for 4.5% of disability adjusted life years (DALYs)3 . The aim of the study was to determine whether stroke in young adults (≤ 45 years) exposed to methamphetamine can be differentiated from other stroke aetiologies on brain CT and CT angiogram. A cross-sectional retrospective study was performed in the department of radiology in Groote Schuur Hospital on brain CT and CT angiograms and their final reports from October 2012 to October 2020. All patients aged 45 years old or younger with clinical features of stroke and a history of methamphetamine or polysubstance abuse were included. Data collection tools were designed to suit inclusion criteriums and used as search keywords in the PACS for GSH. A re-read was done by the principal investigator as a second-year radiology registrar with limited neuroradiology experience guided by the study parameters outlined in the data collection tool. The obtained data was correlated with the finalized reports from each study. Our study has shown that in a group of young patients who admitted to using tik and who presented to the emergency room with clinical features of cerebral stroke, ischaemic infarct was found significantly more often than intracerebral haemorrhage. This study demonstrated that MCA territories were most frequently involved with occlusion of the M1 segments bilaterally. Radiologically loss of grey-white matter interface and a wedge-shaped appearance are the predominant patterns of radiographic presentation. This study has demonstrated that CT appearance of methamphetamine induced stroke does not differ from stroke patterns seen with traditional risk factors.
- ItemOpen AccessBreast ultrasound in females 35 years old and below at a tertiary referral academic center in Cape Town, South Africa: indications and outcomes analysis, a retrospective quantitative study(2024) Juggath, Nitin; Gamieldien, RufkahTitle: Breast ultrasound in females 35 years old and below at a tertiary referral academic center in Cape Town, South Africa: indications and outcomes analysis, a retrospective quantitative study. Background A high number of patients are referred to our resource limited tertiary institution for specialty breast imaging. Despite the accepted application of ultrasound in young women with focal signs/symptoms, there are sparse outcomes data to validate its use in this clinical setting for certain indications and no prior study done at our facility. Objectives To decrease morbidity and expenditure related to breast imaging in young women by correlating clinical predictors for worrisome or benign findings, thus allowing refinement of referral criteria. Methods Ultrasounds performed on females below 35 years old in a 1-year period between 1 st March 2019-1 st March 2020 at Groote Schuur Hospital were retrospectively analyzed. Evaluation of the reports stored on the hospitals PACS system and review of the histological diagnosis of biopsies-if performed, from the NHLS. Clinical data and indication for referral was assessed and imaging results were categorised as either positive or negative. Positive findings were subcategorized into benign breast disease, breast abscess or malignancy. Results 352 breast ultrasound studies were performed. 65% were palpable mass referrals, and one-third were referred without any palpable mass or focal breast pain. 67% of the studies had a positive imaging result and 33% had a negative result. 214 were classified as benign breast disease, 11 as breast abscesses and 12 were malignant. Conclusions Majority of disease encountered was benign breast disease. Most referrals were appropriate and predominantly for a palpable mass. One-third of studies were inappropriately referred, adding to the burden on an already strained specialty center. Keywords Benign breast disease, breast abscess, malignancy, palpable mass, focal breast pain.
- ItemOpen AccessComputed tomography findings in patients with minor head trauma presenting with a history of loss of consciousness and/or amnesia, Glasgow Coma Scale 15 and no focal neurological deficit(2017) Singata, Chuma; Candy, SallyBackground: South Africa is a developing country with limited resources. Currently, in our institution, patients who have suffered a minor head injury with a Glasgow Coma Scale (GCS) 15, loss of consciousness (LOC) and amnesia obtain a computed tomography (CT) scan, regardless of the cost that is incurred by the use of this limited resource. Applying recommendations in developing countries requires consideration of resource limitations and patient burden. Objective: Our objectives were twofold: 1. To determine the number of abnormalities found on routine head CTs in patients who have a history of LOC and amnesia/PTA post trauma, but with a normal mental status (GCS 15) on presentation to the trauma unit. 2. To determine the clinical value of routine CT scan of the head in patients who have suffered minor head injury with GCS 15, LOC and amnesia. Methods: The CT scan reports of 460 patients with minor head injury, GCS 15, LOC and amnesia were reviewed retrospectively in the radiology unit of Groote Schuur Hospital between the years 2012 and 2014. These patients were assessed by the trauma doctor and referred to the radiology department for a CT scan of the head. Reports had been prepared and verified by a radiology specialist or senior registrar. Results: The findings on CT were categorized as significant and insignificant. A total of 33 patient reports (7%) met the criteria of significant findings that required neurosurgical intervention. (CI 4, 7-9, 6). 320 patients (70%) had normal findings while 107 patients (23%) had insignificant findings. Conclusion: CT scan of the head in minor head injury patients with normal mental status (GCS 15) is recommended even in the face of the limited resource in view of our study results.
- ItemOpen AccessCT angiogram findings in patients presenting with mechanical strangulation and near hanging injuries(2019) September-Jaffer, Zorina; Candy, SallyBackground: Blunt cerebrovascular injury (BCVI) is relatively uncommon in near-hanging and strangulation injuries but may have devastating neurological outcome. In developed countries, CT angiography (CTA) of the head and neck is performed as a screening tool in the acute clinical setting. This study was undertaken to assess the prevalence of vascular injury in patients presenting acutely to GSH trauma unit with these injuries and to recommend guidelines to ensure rational use of CTA in our resource restricted environment. Aim: 1. To assess the prevalence and nature of vascular injury in patients referred for CTA imaging following strangulation or hanging injury at our institution. 2. To determine if international criteria (modified Denver Criteria) for CTA referral for suspected BCVI due to strangulation or hanging injuries are followed at our institution. 3. To determine if international criteria for CTA imaging following suspected BCVI are appropriate following strangulation or hanging in a resource-restricted environment, and to identify aspects of existing protocols that may require future discussion. Method: This is a retrospective, quantitative, cross-sectional review of patients who had CTA studies after presenting with either strangulation or hanging to an urban Level 3 Trauma Unit. Radiological reports for the 45-month period ranging from January 2013 until September 2016 were reviewed and the frequency of positive findings was recorded. Results: 45 patients met the inclusion criteria after presenting with a history of strangulation (n=8) or hanging (n=37). The average age was 31 years, 73% were male, 18% presented with strangulation injuries and 82% presented after hanging. 82% received a non-enhanced CT head scan and all patients had CTA scans of the neck and head. Six (13%) vascular injuries were reported on CTA (2 arterial and 4 venous). Both arterial injuries were reported in the strangulation group and none after hanging (p < 0.05). Two venous injuries were reported in each group). No base of skull, cervical spine or Le Fort facial fractures were demonstrated and there was no correlation between nadir of GCS and the presence of vascular injury on CTA. Conclusions: In this study comparing BCVI in strangulation and hanging, arterial injury was reported only in patients presenting after strangulation. Although such injury may be partially attributable to other co-existing mechanisms of trauma we support the continued use of CTA screening in the setting of strangulation injury in a resource restricted environment. The absence of arterial injury in the setting of near-hanging, however, argues against routine screening CTA screening even in patients with depressed level of consciousness.
- ItemOpen AccessHigh density exudates and basal meningeal enhancement in computed tomography of the head in the diagnosis of paediatric tuberculous meningitis(2005) Andronikou, SavvasIncludes bibliographical references (leaves 81-86).
- ItemOpen AccessA prospective study: Investigating the use of oncologist-read CT scans in the investigation of suspected malignant spinal cord compression(2018) Fairhead, Sarah; Niaker, ThuranBackground: Spinal cord compression is a common complication of advanced cancer with significant consequences for individual patients and health care systems as a whole. This condition requires a radiologist reported MRI scan to diagnose, which is a limited resource in many settings. There are no data comparing MRI with multi-detector CT scan, a more accessible resource, for the diagnosis of this condition. Objectives: To investigate whether CT scans assessed by radiation oncologists should be used to diagnose and manage spinal cord compression in patients with advanced cancer by assessing its overall accuracy, including sensitivity and specificity, as a diagnostic test. To collect preliminary data to assist in ethically sound decision making regarding the rational allocation of MRI scans, which are known to be a scarce medical resource. Methods: Eight radiation oncologists (RO's) were given case histories and CT scan images for twenty cancer patients who had presented with possible spinal cord compression (SCC). They were asked to answer questions aimed to assess whether CT scan can be used to diagnose and guide treatment for spinal cord compression and how accurate an investigation CT scan is in this setting compared to the gold standard, MRI. Results: In 84% of assessments, RO's were able to correctly identify the absence or presence of SCC using CT scan. In 38% of assessments, RO's were able to correctly identify the level of SCC and would have treated that level exclusively. In 69% of assessments, the correct level would have been treated with or without additional non-compressed levels. The overall accuracy of CT scan to detect the absence or presence of SCC was 84%. The overall sensitivity was 83%. The overall specificity was 85%. Individual RO's scored an average of 83% (range 62-100%) for questions testing their ability to diagnose the absence or presence of SCC using a CT scan. Individual RO's scored an average of 69% (range 38-89%) for questions testing their ability to treat the level of compression and an average of 38% (range 13-56%) for questions testing their ability to treat the level exclusively. In 40% of assessments RO's reported that they would feel confident treating with only a CT scan. Individual RO confidence levels ranged from 0-66%. In 51% of assessments, the RO's would have changed their treatment plans if an MRI reported by a radiologist was available. Conclusion: Spinal CT scans reported by radiation oncologists are reasonably sensitive and specific for the detection of spinal cord compression. However, this imaging modality should not be used, in centers where radiology reported MRI is available, to diagnose and treat spinal cord compression, due to the relative inaccuracy of this test in determining the appropriate treatment for this condition.
- ItemOpen AccessRange and frequency of AORTIC arch variants in a South African population(2019) Kasirye, Napo Nalunga Sayfa; Andronikou, Savvas; Said-Hartley, QonitaThe purpose of this study was to describe the range and frequency of aortic arch (AA) branching patterns using multi-detector computed tomography (MDCT). MDCT images of 400 patients who attended Groote Schuur Hospital between January 2013 and December 2014 for CT Chest and CT Thoracic angiogram were assessed. Six different branching patterns were observed. A left-sided AA with three major branches was present in 67% of the patients. Bovine-type AA (26 %) and independent origin of the left vertebral artery (5%) were the next two most common patterns. The pattern and distribution of aortic arch branching patterns demonstrated in our study matches those found in studies conducted in other populations in South Africa, Kenya and other countries around the world. In addition, a link between gender and aortic arch branching patterns has been demonstrated in our study. Knowledge of the presence of variant aortic arch branching patterns will aid interventionists and surgeons to better plan procedures in order to avoid complications. Therefore, performing CT Angiograms of the chest in patients admitted for procedures involving the thorax would be beneficial.
- ItemOpen AccessRelationship of HHV8 serum levels and clinical features of Kaposi's sarcoma among patients in South Africa(2023) Tibenderana, Rebecca; Mohamed, ZainabBackground. Kaposi's sarcoma is an AIDS-defining illness caused by Kaposi's Sarcomaassociated Herpesvirus (KSHV). The level of HIV immune suppression and extent of KSHV DNA determine the development of Kaposi's sarcoma. Common manifestations of Kaposi's sarcoma include skin and mucosa} involvement. lympboedema. and viscera] disease. Objectives. The purpose of this study was to explore the association between KSHV DNA viral load and clinical extent of Kaposi's sarcoma. Methods. This was a cross sectional study involving 100 patients with Kaposi sarcoma who attended Groote Schuur Hospital for treatment. The cohort had previously participated in a study investigating polymorphisms in the KSHV G-protein coupled receptor gene. KSHV viral load was determined by PCR of DNA extracted from peripheral blood mononuclear cells. Demographic and clinical data were collected. and logistic regression was applied to study association of KSHV viral load with the predominant presenting feature in patients with symptomatic KS. Results The cohort was predominantly male (63.16%) with a median age of 37.76 years. Median CD4 count was 235 cells/microlitre (64.0-418.0) and most patients (95.7%) had Tl disease. There was no association between KSHV DNA levels and clinical extent of Kaposi's sarcoma. Relative risk ratio (RRR) of l.006 (95% CI 0.974-1.006) p=0.174. Serum KSHV levels were not associated with outcome of treatment. however, patients who had poor outcomes had elevated KSHV levels. Conclusion. There was no relationship between KSHV viral load and clinical extent of Kaposi's sarcoma in this study. KSHV DNA viral load may be useful in predicting which patients will require aggressive treatment for Kaposi's sarcoma
- ItemOpen AccessA review of antenatal MR imaging and correlation with antenatal ultrasound, postnatal imaging and post morem findings(2013) Daire, Arthur; Candy, S; Moosa, STo determine the most common indication for foetal MRI, and to correlate ante-natal MRI with ante-natal ultrasound, post-natal imaging and post mortem findings. This was a retrospective study of imaging between January 2006 and December 2011. Seventy foetal MRI cases with complete medical records (antenatal and postnatal) were included in the study. Antenatal ultrasound and antenatal MR imaging was compared and also compared with the postnatal imaging findings. Stata 12 was used to analyse the Data. Spearman’s test was used to test the agreement between the results. Intracranial pathology was the most common indication for foetal MRI, with ventriculomegaly being the commonest indication determined from prenatal ultrasound. There was 72% agreement between antenatal ultrasound and foetal MRI. Post-natal findings showed 28% agreement with antenatal ultrasound and 39% agreement with foetal MRI. Intracranial pathology was the major indication for foetal MRI. The study found good agreement between prenatal ultrasound and foetal MRI but poor agreement between antenatal and postnatal findings.
- ItemOpen AccessTreatment outcomes of Her-2 positive Breast Cancer in the absence of Her-2 targeting agents at Groote Schuur Hospital, Cape Town, South Africa. Are we doing enough?(2024) Sirkhotte, Aqeela; Punt, Lydia; Hunter AlistairPurpose: Breast Cancer has an estimated 2.3 billion cases globally. It is the second most common cause of cancer-related mortality in Sub-Saharan Africa. The addition of anti- Her-2 targeted therapy (Trastuzumab) to either adjuvant or neo-adjuvant treatment significantly improves disease-free survival and overall survival of women with early-stage Her-2 positive breast cancer. However, at Groote Schuur Hospital anti-Her-2 targeted treatment is not available. We have therefore evaluated to what extent our patients may be disadvantaged. The primary aims of this study were to evaluate the 3 and 5-year overall survival (OS) and recurrence free survival (RFS) of patients treated for Her-2 positive breast cancer at Groote Schuur Hospital. Secondary outcomes were to compare the OS and RFS of patients with hormone- receptor positive (HR+) and hormone-receptor negative (HR-) Her-2 positive (Her-2+) breast cancer. Methods: A retrospective folder review was conducted of all patients treated for Her-2 positive breast cancer between January 2016 and December 2016 at the breast oncology clinic at Groote Schuur Hospital, Cape Town. All patients with histologically proven Her-2 2+ and 3+ breast cancer stage I to III between 25 and 70 years old were included. Of the 561 patients on the hospital's electronic patient registry (EPR), 112 fulfilled the inclusion criteria and of these 87 patients were included for formal analysis due to missing folders. OS and RFS were calculated using Kaplan Meier analysis. A multivariate analysis using the Cox regression model and log rank testing was used to determine any association between OS or RFS and age, hormone receptors, or clinical stage. A p-value of <0.05 was used to determine statistical significance. Results: The cumulative OS and RFS at 3 years were 87% and 80%, respectively. The 5-year cumulative OS were 78% (Her-2 2+) and 73% (Her-2 3+) respectively. The 5-year RFS was 73%. The OS and RFS for patients with HR+ tumours were statistically significantly greater than those of HR- tumours (p=0.006 and p=0.024 respectively). The 3-year OS for HR+ and HR- was 92% and 77%. The 5-year OS for HR+ and HR- tumours was 89% and 55%, respectively. The RFS at 3 years for HR+ and HR- was 84 % and 69 % respectively, and 82% and 55%, respectively at 5 years. The Cox regression analysis showed stage and HR status had a contribution to RFS. The log rank testing showed HR+ has a significant contribution to both OS and RFS. Conclusion: The 5-year OS and RFS rates of our study were similar to those reported in long term prospective trials published in the pre-Trastuzumab era. In comparison to data published with the addition of Trastuzumab to treatment, our results were inferior. In addition, Her-2 positive HR+ tumors had superior outcomes to Her-2 positive HR- breast cancer tumors. Twenty-five years since the advent of Trastuzumab, at Groote Schuur Hospital does not have access. In a resource limited setting where Her-2 targeted agents for all indicated patients may not be possible, a case may be made for provision to patients with Her-2 HR- disease.
- ItemOpen AccessVariation in thoracic wall thickness on multi-detector CT in adult patients and its implications in needle thoracostomy for tension pneumothorax(2022) Chang, Ju-Mei; Said-Hartley, QonitaBackground: Traditional treatment guideline for chest trauma to prevent tension pneumothorax is needle thoracostomy with a large-calibre catheter needle inserted in the second intercostal space (ICS) in the midclavicular line (MCL). However, due to variations of chest wall thickness, the 50mm needle-mounted catheter is insufficient and may only reach the pleural space. Objectives: To investigate whether the recommended anatomical site and the length of the angiocatheter used for patients in Western Cape, South Africa was optimal and explore alternative locations. Methods: We performed retrospective study measuring chest wall thickness (CWT) of adult patients treated for chest injuries in the Groote Schuur Hospital (GSH) trauma unit between 2014 and 2016. These patients underwent contrasted CT chest studies and image data were obtained via GSH Picture Archiving and Communication System. Multiple levels and sites of CWT were measured, using multiplanar CT acquisition. Patients with underlying chest wall pathology that is not trauma related, congenital anatomical abnormality, foreign bodies or partially imaged chest were excluded. Result: A total of 153 patients were eligible for the study. The mean ± SD chest wall thicknesses of the left and right 2nd ICS MCL were 41,03 ± 15,24mm and 41,77 ± 15,83mm, respectively. Thus, suggesting that 20.9% of patients (n=32) would fail needle decompression at 2nd ICS MCL. The average CWT of the 3rd ICS MCL, 4th ICS MCL, 4th ICS AAL, 4th ICS MAL, 5th ICS MCL, 5th ICS AAL, 5th ICS MAL were 33.95, 27.18, 34.41, 41.31, 21.68, 28.42 and 36.31mm, respectively. The location with the highest needle decompression failure rate was the right 4th ICS MAL (26.1%), whereas the lowest failure rate was the right 5th ICS MCL (3.9%). The location with the highest rate of organ injury was the 4th ICS MCL (26%), and the safest location was at the 4th ICS MAL with no organ injury. Conclusion: Failure rate for needle decompression using the traditional 14G 50 mm angiocatheter at the 2nd ICS MCL in the South African population is high. We recommend that needle decompression should be performed at the 5th ICS AAL, due to the low failure rate and reduced risk of iatrogenic organ injury.