This case series highlights the importance of multimodal imaging in distinguishing Klippel-Trenaunay syndrome (KTS) from Parkes Weber syndrome (PWS) and guiding management. Both KTS and PWS are rare congenital vascular disorders characterised by the classic triad of cutaneous vascular malformations, venous varicosities and limb overgrowth. The three cases in this report highlight the spectrum of vascular malformations and their imaging characteristics, emphasising the importance of flow assessment in distinguishing low-flow venous malformations (KTS) from high-flow arteriovenous malformations (PWS). Multimodal cross-sectional imaging is essential for accurate diagnosis and treatment planning in vascular overgrowth syndromes. Contribution: This case series illustrates the critical role of multimodal imaging in differentiating Klippel-Trenaunay syndrome from Parkes Weber syndrome. It emphasizes the distinct imaging findings, particularly vascular flow characteristics, which are essential for accurate diagnosis, guiding appropriate therapeutic interventions, and preventing serious complications.

Background: Transjugular intrahepatic portosystemic shunt (TIPS) procedures are vital in managing complications of portal hypertension. The Viatorr stent is the standard for TIPS, but availability constraints often necessitate the use of alternatives such as WallFlex. Comparative data on their outcomes are limited. Objectives: This study aimed to compare 12-month clinical outcomes of WallFlex and Viatorr stents in patients undergoing TIPS creation at a single tertiary centre. Method: A retrospective review of 83 adult patients who underwent TIPS placement between June 2018 and November 2023 was performed. Forty patients received WallFlex stents (June 2018 – October 2020) and 43 received Viatorr stents (November 2020 – November 2023). Baseline clinical parameters, procedural data and outcomes were analysed. The primary outcome was the need for TIPS revision within 12 months; secondary outcomes included post-TIPS complications, hepatic encephalopathy, liver transplantation and mortality. Results: Baseline characteristics were comparable. There were no significant differences between WallFlex and Viatorr stents for TIPS revision, complications, hepatic encephalopathy, transplantation or mortality. At 12 months, TIPS revision rates were 28% for WallFlex and 35% for Viatorr (p = 0.79). Complications occurred in 80% and 60% of patients, respectively; hepatic encephalopathy in 20% versus 21%; transplantation in 38% versus 26%; and mortality in 38% versus 21% (p > 0.05). Conclusion: WallFlex and Viatorr stents demonstrated comparable 12-month outcomes in TIPS procedures. WallFlex represents a clinically acceptable alternative in resource-constrained settings. Contribution: This study provides the first local comparative data on WallFlex and Viatorr stents for TIPS in South Africa, highlighting WallFlex as a viable alternative where Viatorr availability is limited.

Background: Anterior Cruciate Ligament (ACL) reconstruction is a common orthopaedic procedure, the success of which is ultimately affected by the graft healing process. Quantification of graft healing can be performed non-invasively, using signal-intensity (SI) or signal noise quotient (SNQ) on MRI, however, the variable factors affecting graft healing are still being studied. Objectives: To non-invasively evaluate the normal morphology of the ACL graft on MRI and assess factors affecting graft healing post-arthroscopic ACL reconstruction. Method: A single-centre cross-sectional study was performed using MRI scans for assessment of the ACL graft at 6 months to 2 years post-surgery. Signal noise quotient was correlated with tibial tunnel diameter, femoral tunnel diameter, tibial tunnel location (antero-posterior and medio-lateral), femoral tunnel location (high-low and deep-shallow), graft bending angle (GBA) and notch volume. Results: Twenty-four of 42 patients had normal grafts (mean ± standard deviation post-operative time: 10.15 ± 4.38 months). The SNQ levels were highest at the proximal part of the graft. Graft SNQ correlated positively with tibial (p = 0.020) and femoral (p ≤ 0.001) tunnel diameters, tibial tunnel location in the medio-lateral direction (P ≤ 0.001), femoral tunnel location in the high-low direction (p ≤ 0.001) and patients having complications. Graft SNQ correlated negatively with tibial tunnel location in the antero-posterior (AP) direction (p ≤ 0.001). Univariate analysis revealed a significant correlation between SNQ and tibial and femoral tunnel diameter, tibial tunnel location in both AP and medio-lateral directions, femoral tunnel location in high-low direction and patients having complications. Multivariate analysis showed the tibial tunnel location (medio-lateral) and the femoral tunnel location (high-low) as the significant independent factors. Conclusion: Intraoperative factors, predominantly the positions of the tibial and femoral tunnels, are the major factors affecting graft healing. Contribution: This study provides greater awareness regarding the factors affecting graft healing, helps establish MRI as an effective non-invasive post-operative imaging modality, and helps surgeons in providing a better individualised approach to surgery.

No abstract available.

Chemical abscesses following EVOH embolisation are scarce - with imaging differentials, which include brain abscess and onyx granuloma. Knowledge and successful identification of this entity are essential as its management as prognoses differ. Chemical abscess is managed conservatively and has a good prognosis.

A description of the imaging features in four cases of HL, with their associated malformations and a review of the nomenclature.

Breast cancer is the most common cancer in females, usually diagnosed after the age of 50 years. There is a perceived increase in breast cancer cases in young women in two public sector Johannesburg academic hospitals; however, there is a shortage of data to confirm this. This study aimed to assess data on breast cancer in young patients and determine any increase in the number of cases in patients 40 years and younger. A retrospective analysis of radiology and histopathology reports of patients 40 years and younger, seen at the radiology departments of two Johannesburg academic hospitals, was performed over a 5-year period. The frequency, histology and immunohistochemical results of breast cancer diagnoses were determined in patients with a Breast Imaging - Reporting and Data System (BI-RADS) classification of 4 or above. Breast cancer was diagnosed in 73% of the total eligible 469 patients. The mean patient age was 34.35 years. Invasive ductal carcinoma was diagnosed in 83% (n = 283) of patients classified as BI-RADS 5 on imaging. Luminal A and B subtypes were the most common. The highest number of patients (n = 142) were seen in 2016 of which 92 had breast cancer. In this very specific sample set, there was a lower number of breast cancer diagnoses in 2015 and then an increase of breast cancer diagnoses in young patients from 2016 to 2018. Earlier breast cancer detection benefits the patient, their families and their reproductive ability. Knowledge of breast cancers in young patients can increase awareness, leading to effective, early diagnoses.

Intracranial meningiomas consist of a heterogenous group of histological subtypes, some of which are rare. Data that may play an important role in neurosurgical decision-making regarding the incidence and MRI features of these histological subtypes in the South African population groups, are lacking. This study aimed to assess the spectrum of MRI findings and histological subtypes of meningiomas in the South African context, with the goal of improving the paucity of literature on the topic. A retrospective review of the MRI features of 41 cases of histologically confirmed intracranial meningiomas was performed at a tertiary hospital level. Imaging features were audited and correlated with histological subtypes during statistical analysis. Eleven different histological subtypes of meningioma were encountered. World Health Organization (WHO) Grade I meningothelial meningiomas were the most common histological subgroup. Overall, meningiomas were found to be predominantly isointense to grey matter on T1-weighted imaging, irrespective of the histological subtype, with greater signal variability on T2-weighted imaging. Morphologies of specific subtypes are in keeping with the literature. Analysis of this series of intracranial meningiomas did not demonstrate statistically significant differences in MRI features between histological subtypes to allow for accurate preoperative prediction of meningioma subtype or WHO grade. This highlights the importance of definitive histopathological diagnosis rather than over-reliance on presumed benign imaging features. This original research article discusses the impact of histological subtype on the MRI appearance of intracranial meningiomas, with the aim to improve the paucity of literature on the subject in the context of the South African population.

A rare case of papillary meningioma and its differentiating features from typical meningiomas have been discussed considering its implications for management as well as prognostication to reduce morbidity and mortality.