Research Articles (Radiology)

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Number of symptoms during the acute phase of SARS-CoV-2 infection in athletes is associated with multiorgan involvement : AWARE III
(Lippincott Williams and Wilkins, 2025) Snyders, Carolette; Dyer, Marlise; Jordaan, Esme; Scholtz, Leonie; Du Plessis, Andre; Mpe, Martin; Kaulback, Kelly; Schwellnus, Martin Peter; carolette.cloete@semli.co.za
OBJECTIVE : Acute respiratory infections (ARinf), including SARS-CoV-2 infection, can affect multiple organ systems that may influence return to sport (RTS) in athletes. Factors associated with multiorgan involvement in athletes with ARinf are lacking. The aim of this study was to explore whether factors such as demographics, sport participation, history of comorbidities/allergies, and number of acute symptoms are associated with multiorgan involvement in athletes with recent SARS-CoV-2 infection. DESIGN : Prospective cohort study with cross-sectional analysis. SETTING : Institutional clinical research facilities. PARTICIPANTS : Ninety-five athletes (18–60 years) underwent a comprehensive medical assessment 10 to 28 days after SARS-CoV-2 infection. INDEPENDANT FACTORS : Demographics, sport participation, history of comorbidities/allergies, and the number of acute symptoms (in 3 subgroups:1 = ≤5, 2 = 6-9, or 3 ≥ 10). MAIN OUTCOME MEASURES : Number of organs involved in athletes with recent SARS-CoV-2 infection. RESULTS : The number of organ systems involved was not associated with demographics (age, sex), sport participation (level and type), or history of comorbidities and allergies. However, the number of organ systems involved was significantly higher in athletes with 6 to 9 symptoms (subgroup 2) compared with those with ≤5 symptoms (subgroup 1) and this was more pronounced when comparing athletes with ≥10 symptoms (subgroup 3) with those with ≤5 symptoms (subgroup 1) (P < 0.0001). CONCLUSIONS : Total number of acute symptoms of SARS-CoV-2 infection is related to number of organ systems involved, which is a measure of disease severity, and could therefore influence RTS decision making. Future studies should explore whether this observation holds for athletes with ARinf caused by other pathogens.
Fibrous dysplasia : a tale of two syndromes
(AOSIS, 2024-05-23) Fourie, Jacques; Suleman, Farhana Ebrahim; Lockhat, Zarina I.; Kollapen, Kumeshnie
Fibrous dysplasia (FD) is a rare, non-inherited, congenital bone disorder which may be monostotic or polyostotic. The polyostotic form may rarely present in syndromic forms when associated with extra-skeletal manifestations. Mazabraud syndrome is a rare syndrome consisting of polyostotic FD presenting with intramuscular myxomas. McCune–Albright syndrome is recognised by polyostotic FD, precocious puberty and ‘café au lait’ spots. This report describes an adult patient with Mazabraud syndrome and a child with McCune– Albright syndrome. CONTRIBUTION : Radiographic findings are typical with bowing deformities, sclerotic, lucent or mixed lesions and bony expansion, often with endosteal scalloping. MRI is often noncontributory and may actually mimic a more aggressive process. Early detection and correct diagnosis allow for early preventative treatment and rehabilitation to prevent devastating neurological sequelae and disability.
The convergence of radiology and genomics : advancing breast cancer diagnosis with radiogenomics
(MDPI, 2024-03) Demetriou, Demetra Danielle; Lockhat, Zarina I.; Brzozowski, Luke; Saini, Kamal S.; Dlamini, Zodwa; Hull, Rodney
Despite significant progress in the prevention, screening, diagnosis, prognosis, and therapy of breast cancer (BC), it remains a highly prevalent and life-threatening disease affecting millions worldwide. Molecular subtyping of BC is crucial for predictive and prognostic purposes due to the diverse clinical behaviors observed across various types. The molecular heterogeneity of BC poses uncertainties in its impact on diagnosis, prognosis, and treatment. Numerous studies have highlighted genetic and environmental differences between patients from different geographic regions, emphasizing the need for localized research. International studies have revealed that patients with African heritage are often diagnosed at a more advanced stage and exhibit poorer responses to treatment and lower survival rates. Despite these global findings, there is a dearth of in-depth studies focusing on communities in the African region. Early diagnosis and timely treatment are paramount to improving survival rates. In this context, radiogenomics emerges as a promising field within precision medicine. By associating genetic patterns with image attributes or features, radiogenomics has the potential to significantly improve early detection, prognosis, and diagnosis. It can provide valuable insights into potential treatment options and predict the likelihood of survival, progression, and relapse. Radiogenomics allows for visual features and genetic marker linkage that promises to eliminate the need for biopsy and sequencing. The application of radiogenomics not only contributes to advancing precision oncology and individualized patient treatment but also streamlines clinical workflows. This review aims to delve into the theoretical underpinnings of radiogenomics and explore its practical applications in the diagnosis, management, and treatment of BC and to put radiogenomics on a path towards fully integrated diagnostics.
A morphoscopic exploration of cranial sexual dimorphism among modern South Africans using computed tomography scans
(Springer, 2024-11) Krüger, Gabriele Christa; Jantz, Richard L.; Van der Walt, Elizabeth; Lockhat, Zarina I.; L'Abbe, Ericka Noelle; gabi.kruger@up.ac.za
Continual re-evaluation of standards for forensic anthropological analyses are necessary, particularly as new methods are explored or as populations change. Indian South Africans are not a new addition to the South African population; however, a paucity of skeletal material is available for analysis from medical school collections, which has resulted in a lack of information on the sexual dimorphism in the crania. For comparable data, computed tomography scans of modern Black, Coloured and White South Africans were included in addition to Indian South Africans. Four cranial morphoscopic traits, were assessed on 408 modern South Africans (equal sex and population distribution). Frequencies, Chi-squared tests, binary logistic regression and random forest modelling were used to assess the data. Males were more robust than females for all populations, while White South African males were the most robust, and Black South African females were the most gracile. Population differences were noted among most groups for at least two variables, necessitating the creation of populations-specific binary logistic regression equations. Only White and Coloured South Africans were not significantly different. Indian South Africans obtained the highest correct classifications for binary logistic regression (94.1%) and random forest modelling (95.7%) and Coloured South Africans had the lowest correct classifications (88.8% and 88.0%, respectively). This study provides a description of the patterns of sexual dimorphism in four cranial morphoscopic traits in the current South African population, as well as binary logistic regression functions for sex estimation of Black, Coloured, Indian and White South Africans.
UNITY : a low-field magnetic resonance neuroimaging initiative to characterize neurodevelopment in low and middle-income settings
(Elsevier, 2024-10) Abate, F.; Adu-Amankwah, A.; Ae-Ngibise, K.A.; Agbokey, F.; Agyemang, V.A.; Agyemang, C.T.; Akgun, C.; Ametepe, J.; Arichi, T.; Asante, K.P.; Balaji, S.; Baljer, L.; Basser, P.J.; Beauchemin, J.; Bennallick, C.; Berhane, Y.; Boateng-Mensah, Y.; Bourke, N.J.; Bradford, L.; Bruchhage, M.M.K.; Cano Lorente, R.; Cawley, P.; Cercignani, M.; D Sa, V.; De Canha, A.; Navarro, N.D.; Dean, D.C., III; Delarosa, J.; Donald, K.A.; Dvorak, A.; Edwards, A.D.; Field, D.; Frail, H.; Freeman, B.; George, T.; Gholam, J.; Guerrero-Gonzalez, J.; Hajnal, J.V.; Haque, R.; Hollander, W.; Hoodbhoy, Z.; Huentelman, M.; Jafri, S.K.; Jones, D.K.; Joubert, Fourie; Karaulanov, T.; Kasaro, M.P.; Knackstedt, S.; Kolind, S.; Koshy, B.; Kravitz, R.; Lafayette, S.L.; Lee, A.C.; Lena, B.; Lepore, N.; Linguraru, M.; Ljungberg, E.; Lockhat, Zarina I.; Loth, E.; Mannam, P.; Masemola, K.M.; Moran, R.; Murphy, D.; Nakwa, F.L.; Nankabirwa, V.; Nelson, C.A.; North, K.; Nyame, S.; O Halloran, R.; O'Muircheartaigh, J.; Oakley, B.F.; Odendaal, H.; Ongeti, C.M.; Onyango, D.; Oppong, S.A.; Padormo, F.; Parvez, D.; Paus, T.; Pepper, Michael Sean; Phiri, K.S.; Poorman, M.; Ringshaw, J.E.; Rogers, J.; Rutherford, M.; Sabir, H.; Sacolick, L.; Seal, M.; Sekoli, M.L.; Shama, T.; Siddiqui, K.; Sindano, N.; Spelke, M.B.; Springer, P.E.; Suleman, Farhana Ebrahim; Sundgren, P.C.; Teixeira, R.; Terekegn, W.; Traughber, M.; Tuuli, M.G.; Van Rensburg, Jeanne; Váša, F.; Velaphi, S.; Velasco, P.; Viljoen, I.M.; Vokhiwa, M.; Webb, A.; Weiant, C.; Wiley, N.; Wintermark, P.; Yibetal, K.; Deoni, S.C.L.; Williams, S.C.R.
Measures of physical growth, such as weight and height have long been the predominant outcomes for monitoring child health and evaluating interventional outcomes in public health studies, including those that may impact neurodevelopment. While physical growth generally reflects overall health and nutritional status, it lacks sensitivity and specificity to brain growth and developing cognitive skills and abilities. Psychometric tools, e.g., the Bayley Scales of Infant and Toddler Development, may afford more direct assessment of cognitive development but they require language translation, cultural adaptation, and population norming. Further, they are not always reliable predictors of future outcomes when assessed within the first 12–18 months of a child’s life. Neuroimaging may provide more objective, sensitive, and predictive measures of neurodevelopment but tools such as magnetic resonance (MR) imaging are not readily available in many low and middle-income countries (LMICs). MRI systems that operate at lower magnetic fields (< 100mT) may offer increased accessibility, but their use for global health studies remains nascent. The UNITY project is envisaged as a global partnership to advance neuroimaging in global health studies. Here we describe the UNITY project, its goals, methods, operating procedures, and expected outcomes in characterizing neurodevelopment in sub-Saharan Africa and South Asia.
Lentiform fork sign on magnetic resonance imaging after methamphetamine and alcohol misuse
(American Medical Association, 2023-04) Hiesgen, Juliane; Badenhorst, Jacques; juliane.hiesgen@up.ac.za
A 37-year-old man presented to the emergency department with a 3-day history of acute blindness. He had delayed the consultation because of the belief that the symptoms were transient adverse reactions from an overuse of alcohol and drugs.
Spontaneous resolution of a patient with a symptomatic pheochromocytoma
(Elsevier, 2024-07) Jackson, Brandon Spencer; Ndhlebe, Gugulethu; Suleman, Farhana Ebrahim; brandon.jackson@up.ac.za
A 56-year-old woman presented with a 2-year history of chronic persistent right upper quadrant abdominal pain that was associated with intermittent nausea, vomiting, and unintentional weight loss. She had been on antihypertensive treatment—hydrochlorothiazide and amlodipine—for 2 years. Her blood pressure, 125/73 mm Hg, was well con- trolled and did not appear to be labile. She had tenderness in the right upper quadrant of the abdomen with no palpable masses. Oral analgesia was prescribed for the pain.
Transorbital neuroendoscopy-assisted resection of a giant optic pathway glioma in a neonate
(Springer, 2023-09) Maseko, Rodney; Mabogo, Maanda; Lockhat, Zarina I.; Makunyane, P.S. (Priscilla); Ahmad, Samia; Bida, Meshack; Padayachy, Llewellyn; lc.padayachy@up.ac.za
Congenitalgiant orbital tumors in infancy are relatively rare, especially when the tumors are associated with significant intracranial extension. We describe the use of a transorbital neuroendoscopy-assisted resection of such a lesion. While this approach is increasingly gaining popularity for certain anterior and middle skullbase lesions in adults, this report represents the youngest patient reported on where this minimally invasive approach has been successfully used to resect the intracranial tumor. This surgical approach obviated the need for a separate craniotomy, with the additional benefit of minimizing blood loss.
AI and precision oncology in clinical cancer genomics : from prevention to targeted cancer therapies-an outcomes based patient care
(Elsevier, 2022) Dlamini, Zodwa; Skepu, Amanda; Kim, Namkug; Mkhabele, Mahlori; Khanyile, Richard; Molefi, Thulo; Mbatha, Sikhumbuzo; Setlai, Botle; Mulaudzi, Thanyani Victor; Mabongo, Mzubanzi; Bida, Nndweleni Meshack; Kgoebane-Maseko, Minah; Mathabe, Kgomotso; Lockhat, Zarina I.; Kgokolo, C.M.; Chauke-Malinga, Nkhensani; Ramagaga, Serwalo; Hull, Rodney; zodwa.dlamini@up.ac.za
Precision medicine is the personalization of medicine to suit a specific group of people or even an individual patient, based on genetic or molecular profiling. This can be done using genomic, transcriptomic, epigenomic or proteomic information. Personalized medicine holds great promise, especially in cancer therapy and control, where precision oncology would allow medical practitioners to use this information to optimize the treatment of a patient. Personalized oncology for groups of individuals would also allow for the use of population group specific diagnostic or prognostic biomarkers. Additionally, this information can be used to track the progress of the disease or monitor the response of the patient to treatment. This can be used to establish the molecular basis for drug resistance and allow the targeting of the genes or pathways responsible for drug resistance. Personalized medicine requires the use of large data sets, which must be processed and analysed in order to identify the particular molecular patterns that can inform the decisions required for personalized care. However, the analysis of these large data sets is difficult and time consuming. This is further compounded by the increasing size of these datasets due to technologies such as next generation sequencing (NGS). These difficulties can be met through the use of artificial intelligence (AI) and machine learning (ML). These computational tools use specific neural networks, learning methods, decision making tools and algorithms to construct and improve on models for the analysis of different types of large data sets. These tools can also be used to answer specific questions. Artificial intelligence can also be used to predict the effects of genetic changes on protein structure and therefore function. This review will discuss the current state of the application of AI to omics data, specifically genomic data, and how this is applied to the development of personalized or precision medicine on the treatment of cancer.
Evolution of swallowing and feeding abilities of neonates with hypoxic-ischaemic encephalopathy during hospitalisation : a case series
(Taylor and Francis, 2023) Malan, Roxanne; Van der Linde, Jeannie; Kritzinger, Alta; Graham, Marien Alet; Kruger, Esedra; Kollapen, Kumeshnie; Lockhat, Zarina I.
PURPOSE : To describe the evolution of swallowing and feeding abilities of neonates with hypoxic-ischaemic encephalopathy (HIE) during hospitalisation. METHOD : A longitudinal cohort study was used. Twenty-nine participants (median age 39.0 weeks [IQR = 2.0 weeks]) with mild (n = 7), moderate (n = 19) and severe (n = 3) HIE were included. Clinical swallowing and feeding assessments were conducted at introduction of oral feeds and at discharge using the Neonatal Feeding Assessment Scale (NFAS). Videofluoroscopic swallow studies (VFSS) supplemented the NFAS before discharge. RESULT : Approximately two thirds of participants showed symptoms of oropharyngeal dysphagia (OPD) during initial NFAS and VFSS. Significantly fewer OPD symptoms occurred at discharge NFAS (p = 0.004). Endurance during non-nutritive sucking (p < 0.001) and nutritive sucking (p < 0.001) significantly improved. Nine participants (31.0%) demonstrated penetration or aspiration. Most aspiration events were silent (60%). Instrumental assessment identified pharyngeal phase dysphagia more effectively than bedside evaluation. High proportions of participants displayed OPD symptoms regardless of HIE severity. The correlation between OPD severity and the length of hospitalisation (p = 0.052) was not significant. CONCLUSION : All grades of HIE should be considered for early intervention by speech-language pathologists before discharge. Findings may be valuable to neonatal feeding teams.
Acute obstructive hydrocephalus in posterior reversible encephalopathy syndrome
(Health and Medical Publishing Group, 2023-01) Hiesgen, Juliane; Annor, T.N.
Posterior reversible encephalopathy syndrome (PRES) is an uncommon, subacute neurological disorder that presents radiologically with a pattern of bilateral parieto-occipital areas of vasogenic oedema. Conditions commonly associated with PRES include autoimmune disorders, cytotoxic drugs, metabolic abnormalities and, most frequently, hypertensive emergencies. Clinically, headache, visual disturbances, seizures and an altered level of consciousness are often reported. The outcome is favourable if the underlying cause is addressed. Posterior fossa involvement resulting in obstructive hydrocephalus is a rare presentation and may be misdiagnosed as a mass lesion or infection, leading to delayed or unnecessary treatment. We describe the clinical presentation, findings on neuroimaging and conservative management of a man with PRES resulting in severe cerebellar oedema and acute obstructive hydrocephalus. This case illustrates that awareness of atypical neuroimaging in PRES is important for the management of these patients and to avoid morbidity and mortality.
The effectiveness of the pregnancy adapted YEARS algorithm to safely identify patients for CT pulmonary angiogram in pregnant and puerperal patients suspected of having pulmonary embolism
(AOSIS, 2022-07-29) Potgieter, Riaan; Becker, Piet J.; Suleman, Farhana Ebrahim
BACKGROUND: Pulmonary thromboembolism is one of the leading causes of maternal death worldwide. Globally there has been increasing physician reliance on CT pulmonary angiogram for definitive diagnoses and exclusion of pulmonary thromboembolism. The problem, however, arises when considering the high radiation penalty from performing these investigations, highlighted by the low diagnostic yield. Of recent, the pregnancy-adapted YEARS algorithm has shown promise in international studies as a possible alternative for stratifying risk of pulmonary thromboembolism during the pregnancy and puerperal period. OBJECTIVES: To determine the effectiveness of the pregnancy adapted YEARS algorithm to safely minimise the number of true negative CT pulmonary angiograms for patients suspected of having pulmonary embolism in our clinical setting. METHOD: A cross-sectional study was performed in a tertiary hospital in Gauteng on puerperal and pregnant patients suspected of having pulmonary embolism. We retrospectively applied the pregnancy adapted YEARS algorithm and reviewed the various outcomes. RESULTS: The pregnancy adapted YEARS algorithm proved effective in safely identifying patients for CT pulmonary angiography. By retrospectively applying the algorithm, there could have been a 25.7% scan reduction, whilst maintaining a negative predictive value of 100.0%. CONCLUSION: As physician reliance on radiological investigations increases, we must remain cognisant of the added radiation exposure and the long-term adverse effects of ionising radiation. The pregnancy-adapted YEARS algorithm provides a safe, reproducible alternative to aid our bid going forward.
Primary giant cell tumour of the breast with recurrence : a rare case report
(AOSIS, 2022-04-20) Suleman, Farhana Ebrahim; Vilakazi, Moipone N.; Bida, Nndweleni Meshack; Edwards, Richard
Giant cell tumour (GCT) arising from the soft tissues of the breast is a rare disease with only eight cases previously reported in the literature. We present a case of histologically proven GCT of the breast, which demonstrated recurrence a few months after resection.
Neuro-Behcet – clinical and radiological findings in a patient of sub-Saharan African origin
(Elsevier, 2022-03) Pretorius, Johannes Jacobus; Hiesgen, Juliane; Myburgh, Michael; Suleman, Farhana Ebrahim; farhanah.suleman@up.ac.za
Behçet’s disease is a rare, systemic variable vessel vasculitis mostly seen in patients from the Middle East, Northern Africa and Central Asia. Neuro-Behçet disease (NBD) is often diagnosed in patients with known Behçet’s disease who present with neurological symptoms and radiological features of central nervous system involvement. There are very few cases with neuro-Behcet reported from Sub-Saharan Africa in the literature. We report a case of severe parenchymal neuro-Behçet with pseudo-tumoral brainstem lesions in a young male patient of South African origin.
Medullary neuroschistosomiasis in a pediatric patient : a case report
(Elsevier, 2022-03) Kollapen, Kumeshnie; Suleman, Farhana Ebrahim; Smuts, Izelle; Siwela, Lebohang
A pediatric patient with neurological deficit was examined using magnetic resonance imaging (MRI]. The images revealed abnormal signal intensity and enhancement of the spinal cord, indicating myelopathy. Identifying the cause of the myelopathy required a differential diagnosis. Images from MRI included a pre-contrast T1 weighted sagittal sequence, which revealed expansion of the distal lumbar spinal cord and conus medullaris from T10-L1. The T2 weighted sagittal sequence revealed patchy areas of hyperintense signal. We did not notice any chronic hemorrhagic products or cysts. Within the field of view, we saw multifocal areas of bladder wall thickening. Sagittal and axial T1 weighted post gadolinium images demonstrated mixed linear and nodular patchy enhancement of the conus medullaris predominantly anteriorly and along the anterior surface of the meninges. On the 18 day of hospitalization, a spinal biopsy revealed the presence of granuloma with non-viable bilharzia ova, and schistosomiasis of the spinal cord was diagnosed. Although uncommon, when it does occur, schistosomiasis has significant implications. Using MRI, the medical team noticed abnormal features that called for a biopsy, and were thus able to differentiate between medullary schistosomiasis and other infective/inflammatory conditions. A prompt diagnosis is vital for initiating early treatment, and avoiding complications and invasive surgery.
Foetal magnetic resonance imaging : a necessity or adjunct? A modality comparison of in-utero ultrasound and ultrafast foetal magnetic resonance imaging
(AOSIS, 2021-03-19) Ramdass, Sunaina; Adam, Sumaiya; Lockhat, Zarina I.; Masenge, Andries; Suleman, Farhana Ebrahim
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.
Traumatic aortic injury : computed tomography angiography imaging and findings revisited in patients surviving major thoracic aorta injuries
(AOSIS, 2021-03-12) Edwards, Richard; Khan, Nausheen
Blunt chest trauma related acute thoracic aortic injury (TAI) is a life-threatening condition that requires prompt diagnosis and appropriate management because of high mortality. Computed tomography angiography (CTA) is the imaging of choice for evaluation of patients with major chest trauma findings suspicious of TAI on chest radiography. This case series describes the CTA findings in four high-velocity incident survivors with associated TAIs, discusses the injury type and treatment, and reviews the literature.
MRI findings in chronic exertional compartment syndrome of the forearm : using signal intensity ratio as a diagnostic tool
(AOSIS, 2021-10) Badenhorst, Jacques; Velleman, Mark D.; Jansen van Rensburg, Audrey; Botha, Tanita; Van der Walt, Nikki; Janse van Rensburg, Dina Christina; u27113796@tuks.co.za
BACKGROUND : Chronic exertional compartment syndrome (CECS) of the forearm is a rare but important cause of morbidity amongst athletes involved in strenuous upper limb activities. The diagnosis remains challenging due to the absence of objective, reproducible diagnostic studies. OBJECTIVES : To assess and quantify signal intensity (SI) changes of involved muscles in patients with CECS of the forearm compared to healthy control subjects competing in similar sporting disciplines. Also, to objectively measure MRI SIs within muscle compartments when using a pre- and post-exercise regime and calculating a signal intensity ratio (SIR) between post- and pre-exercise studies. METHOD : The study retrospectively examined MRI scans of patients treated for CECS of the forearm and compared these to the MRI scans of asymptomatic high-level rowers. A specific, reproducible pre- and post-exercise MRI scanning protocol was utilised in both patient and control subjects between 2011 and 2020. Signal intensities were evaluated pre- and post- exercise in involved muscle groups and ratios were calculated. RESULTS : A total of 86 SIs were measured (43 pre- and 43 post-exercise) in nine study participants (five patients and four controls). After post:pre-exercise comparisons, a statistically significant difference was found between control and patient groups (p = 0.0010). The extensor carpi radialis, flexor digitorum profundus and flexor digitorum superficialis muscles were most commonly involved. CONCLUSION : This study confirms that significant SI changes are apparent in patients with CECS of the forearm when making use of a standardised pre- and post-exercise MRI protocol. Furthermore, SIR may be used to accurately diagnose CECS of the forearm
Accessory articulation of the cervical vertebrae transverse processes simulating a fracture : incidental findings of an uncommon anatomical variant
(British Institute of Radiology, 2021-09) Naidoo, Natasha; Khan, Nausheen
Accessory articulation of the transverse processes of the cervical vertebrae is an extremely rare congenital anomaly. We present two cases of accessory articulation of the transverse processes of the left C5/C6 and C6/C7 cervical vertebrae. The articulation at C5/C6 was found in a 34-year-old male following a mob assault, the C6/C7 accessory articulation occurred in a 28-year-old female involved in a high velocity motor-vehicle accident. Cervical spine fractures were suspected in both cases. Recognition of this variant anatomy and differentiation from a fracture is important especially in an acute trauma setting to prevent unnecessary immobilization and inappropriate specialist referral of these patients. Our search revealed only five previously reported cases in the literature mostly occurring at the C5/C6 level. This is only the second case ever described at the C6/C7 level.
Intracellular signaling responses induced by radiation within an in vitro bone metastasis model after pre-treatment with an estrone analogue
(MDPI, 2021-08-17) Helena, Jolene Michelle; Joubert, Anna Margaretha; Mabeta, Peaceful Lucy; Coetzee, Magdalena; Lakier, Roy; Mercier, Anne Elisabeth; joji.mercier@up.ac.za
2-Ethyl-3-O-sulfamoyl-estra-1,3,5(10)16-tetraene (ESE-16) is an in silico-designed estradiol analogue which has improved the parent compound’s efficacy in anti-cancer studies. In this proofof- concept study, the potential radiosensitizing effects of ESE-16 were investigated in an in vitro deconstructed bone metastasis model. Prostate (DU 145) and breast (MDA-MB-231) tumor cells, osteoblastic (MC3T3-E1) and osteoclastic (RAW 264.7) bone cells and human umbilical vein endothelial cells (HUVECs) were representative components of such a lesion. Cells were exposed to a low-dose ESE-16 for 24 hours prior to radiation at non-lethal doses to determine early signaling and molecular responses of this combination treatment. Tartrate-resistant acid phosphatase activity and actin ring formation were investigated in osteoclasts, while cell cycle progression, reactive oxygen species generation and angiogenic protein expression were investigated in HUVECs. Increased cytotoxicity was evident in tumor and endothelial cells while bone cells appeared to be spared. Increased mitotic indices were calculated, and evidence of increased deoxyribonucleic acid damage with retarded repair, together with reduced metastatic signaling was observed in tumor cells. RAW 264.7 macrophages retained their ability to differentiate into osteoclasts. Anti-angiogenic effects were observed in HUVECs, and expression of hypoxia-inducible factor 1- was decreased. Through preferentially inducing tumor cell death and potentially inhibiting neovascularization whilst preserving bone physiology, this low-dose combination regimen warrants further investigation for its promising therapeutic application in bone metastases management, with the additional potential of limited treatment side effects.

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