52 SAJSM vol 18 No.2 2006 Introduction In addition to the medical support that is offered to an inter- national team, medical coverage for spectators also needs to be provided at large sporting events. This has been high- lighted by a number of incidents at soccer matches in par- ticular. In 1992, 17 people were killed and 1 900 injured when a temporary stand collapsed in Corsica. In the same year 43 and 126 people were killed as a result of spectators attempt- ing to push their way into a soccer stadium in South Africa and Ghana, respectively. 1 Further, the terrorist attack at the 1996 Olympic Games in Atlanta where 111 people were injured 1 and the terrorist attacks in the USA on 11 September 2001 and in London in 2005, have made event organisers aware of the need for preparedness planning for large sporting events. Medical coverage for the needs of spectators at large sporting events should cater for situations where medical personnel are able to deal with one case at a time, to events with isolated major incidents or in extreme cases such as a mass casualty or disaster situation. In preparation for the 2002 FIFA World Cup in Japan, the Health Research Team (HRT-MHLW) was established by the Japanese government to provide an effective service for spectators attending the matches played in Japan, as well as to analyse factors regarding patient presentations with a view to develop a medical care plan for mass gatherings. 3 A total of 1 661 patients presented with illness or injuries to the medical stations during the 32 matches played in Japan. This patient presentation rate was 1.21/1 000 spectators, with a transport-to-hospital rate of 0.05/1 000 spectators. As the total number of spectators increased, the patient presentation rate decreased, while the patient presentation rates increased when spectators were not provided with shuttle-bus transport from the nearest railway station or had to walk for more than 12 minutes to gain access to the venue. While injuries to cricket players in South Africa, 6-12 Australia 5 and England 4 have been well documented over SHoRT CoMMUNICATIoN Analysis of patient load data from the 2003 Cricket World Cup in South Africa A Kilian1 (MB ChB) R A Stretch2 (D Phil) 1 Medical doctor in private practice, Port Elizabeth 2 Sport Bureau, Nelson Mandela Metropolitan University, Port Elizabeth Conclusion. The unique nature of cricket has shown a different patient presentation rate than for other similar mass gatherings, requiring additional factors be consid- ered when developing a medical care plan. Abstract objectives. The purpose of this study was to evaluate the patient presentation data for spectators attending the opening ceremony and all the 2003 Cricket World Cup matches played in South Africa in order to provide organ- isers with the basis of a sound medical care plan for mass gatherings of a similar nature. Methods. During the 2003 Cricket World Cup, data were collected on the spectators presenting to the medical fa- cilities during the opening ceremony and the 42 matches played in South Africa. Data included the total number of patient presentations and the category of illness or in- jury. This information was used to determine the venue accommodation rate and the patient presentation rate. The illness/injury data were classified into the following categories: (i) heat-related illness; (ii) blisters/scrapes/ bruises; (iii) headache; (iv) fractures/sprains/lacerations; (v) eye injuries; (vi) abdominal pain; (vii) insect bite; (viii) allergy-related illness; (ix) cardiac disorders, chest pains; (x) pulmonary disorder/shortness of breath; (xi) syncope; (xii) weakness/dizziness; (xiii) alcohol/drug-related con- ditions; (xiv) seizure; (xv) cardiac arrest; (xvi) obstetric/ gynaecological disorder; and (xvii) other. Results. The total number of patients who presented to the medical stations was 2 118, with a mean of 50 (range 14 - 91) injuries per match. The mean for the patient pres- entation rate was 4/1 000 spectators. The most frequently encountered illness or injury was headache (954 patients, 45%), followed by fractures, sprains and lacerations (351 patients, 16%). CoRReSPoNDeNCe: R Stretch Sport Bureau Nelson Mandela Metropolitan University PO Box 77000 Port Elizabeth 6031 Tel: 041-504 2584 Fax: 041-583 2605 E-mail: Richard.Stretch@nmmu.ac.za pg52-56.indd 52 6/29/06 9:01:16 AM SAJSM vol 18 No.2 2006 53 the past number of years, there have not been any reported studies on the illness/injury rate of spectators attending major cricket matches or events. The purpose of this study was to evaluate the patient presentation data for spectators attending the opening ceremony and all the 2003 Cricket World Cup matches played in South Africa and to compare these with similar findings from the 2002 FIFA World Cup held in Japan, in order to provide organisers with a basis for a sound medical care plan for mass gatherings of a similar nature. Method The 2003 Cricket World Cup was organised in February and March 2003, with the opening ceremony staged in South Africa and 54 matches staged in South Africa, Zimbabwe and Kenya. Only the opening ceremony and the 42 matches played in South Africa formed part of this study. The opening ceremony was held in the evening, with the one-day interna- tional matches played either as day matches (10h00 to about 17h30) or as day-night matches (14h30 to about 22h00). All the planning and procedures relating to the medical management of the spectators and players for all matches were the responsibility of the medical committee. Only the spectator data are presented in this study. The medical committee held monthly meeting from January 2002 to May 2003 (16 meetings) and three seminars with the medical personnel prior to the start of the competition. Based on this a medical system was put in place for each venue that would be able to respond to a disaster, as well as providing routine on-site medical emergencies. To ensure adequate medical cover there was at least one medical station at each ground, staffed by 2 doctors, 2 nurses and on average 3 paramedics. The medical support was provided from 2 hours before the start of the match to 1 hour after the end of the match. The necessary medical supplies and equipment were available at each medical station. An ambulance was available at each venue to transfer patients to hospital if necessary. Further, at least one hospital in each city was put on stand-by in the event of an emergency, with the normal daily staff on stand-by. The data collected included the total number of spectators at each match and the maximum spectator capacity for each venue. The medical personnel in charge of the medical facility documented patient information which included the total number of patient presentations (PP) and the category of illness/injury (I). These data were used to determine the venue accommodation rate (VAR). This was defined as the actual number of spectators per game compared with the maximum spectator capacity of the venue. The patient presentation rate (PPR) was defined as the number of patients per 1 000 spectators per match. To allow comparisons with similar data from the 2002 FIFA World Cup 3 the illness/injury data were classified into the following: (i) heat-related illness; (ii) blisters/scrapes/ bruises; (iii) headache; (vi) fractures/sprains/lacerations; (v) eye injuries; (vi) abdominal pain; (vii) insect bite; (viii) allergy-related illness; (ix) cardiac disorders; chest pains; (x) pulmonary disorder/shortness of breath; (xi) syncope; (xii) weakness/dizziness; (xiii) alcohol/drug-related conditions; (xiv) seizure; (xv) cardiac arrest; (xvi) obstetric/gynaecological disorder; and (xvii) other. TABle I. Spectator, venue and patient presentation data during the 2003 Cricket World Cup Maximum Mean venue Presentations/ spectator accommodation % of Total spectator Patient 1 000 Matches capacity rate capacity attendance presentations Mean/match spectators venues (N) (N) (N) (%) (N) (N) (N) (N) Paarl 3 9 030 4 207 47 12 620 57 19 4 Durban 5 19 980 16 292 82 81 459 215 43 2 Pietermaritzburg 3 7 091 3 883 55 7 765 42 21 5 Potchefstroom 2 10 169 5 902 58 17 706 44 14 2 Pretoria 4 21 160 15 427 72 61 706 366 91 5 Johannesburg 5 30 542 26 235 86 131 175 427 85 3 Kimberley 2 6 056 3 328 55 6 655 48 24 7 Port Elizabeth 5 18 109 12 206 67 61 031 241 48 3 Cape Town* 6 23 141 20 170 87 121 020 508 85 4 East London 2 13 248 5 610 42 11 220 36 18 3 Benoni 2 9 812 4 719 48 9 437 49 25 5 Bloemfontein 3 13 954 4 792 34 14 377 85 28 5 Total 42 738 508 536 171 - 536 171 2 118 - - * The opening ceremony is included in these figures. pg52-56.indd 53 6/29/06 9:01:16 AM 54 SAJSM vol 18 No.2 2006 Results There were 12 venues used to stage the 42 World Cup matches, with an average of 4 (range 2 - 6) matches per ven- ue. The mean maximum venue capacity was 17 583 (range 6 056 - 30 542) spectators, with a total capacity of 738 508 spectators for the venues for all 42 matches. The total at- tendance at all 42 matches was 536 171 spectators, with a mean actual attendance of 12 765 (range 3 328 - 26 235) or 73% (range 34 – 87%) of the total capacity for all the venues (Table I). The total number of patients who presented to the medical stations was 2 118, with a mean of 50 (range 14 - 91) injuries or illnesses per match. The mean patient presentation rate was 4/1 000 spectators, with the matches played in Potchefstroom and Durban (3/1 000 spectators) and at Kimberley (71/1 000 spectators) reporting the lowest and highest rates, respectively (Table I). The most frequently encountered illness or injury was headache (954 patients, 45%), followed by fractures, sprains and lacerations (351 patients, 16%) (Table II). Other presentations included allergy-related illnesses (129 patients, 6%), abdominal pain (120 patients, 6%) and heat- related illnesses (103 patients, 5%). The ‘Other’ category of illnesses or injuries (322 patients, 15%) included 88 (4%) patients with gastric problems and 48 (2%) and 19 (1%) with urinary tract and respiratory tract infections, respectively. Discussion The unique nature of cricket, which is played over an ex- tended period of time, has shown a different patient presen- tation rate than that of soccer.3 Firstly, the cricket spectators showed a greater patient presentation rate per 1 000 specta- tors, although it still falls within the range of 0.14 - 90 patients per 1 000 spectators. 2 A number of factors may influence the patient presentation rate, with venue capacity and the crowd size being identified as the more important factors. 13 The crowd density is indicated by the venue accommodation rate. However, neither of these variables were factors in the patient presentation rate. The matches played at Kimberley, the venue with the lowest mean venue accommodation rate, had the highest rate of injuries per 1 000 spectators. Conversely, Johannesburg, the venue with the greatest mean venue accommodation rate, had one of the lower rates of injuries per 1 000 spectators. This may possibly be due to the fact that a number of other factors such as weather conditions and location of seating may play a more significant role in the risk illness or injury to spectators at cricket matches. A second difference was that more than half of the patients at cricket matches presented with headaches and heat-related illnesses, while at soccer matches 3 this only made up about 15% of the recorded injuries/illnesses. Again this may be related to other factors, some of which may be beyond the control of the event organisers. During the 2002 Soccer World Cup temperature had an effect on the number of injuries, with an increase in temperature associated with an increased risk of illness or injury, particularly heat-related illnesses, headaches and weakness or dizziness. 3 One of the limitations of the study was that no information was obtained on the weather conditions. Although the effect of heat on the risk of illnesses or injury could not be determined, the 2003 Cricket World Cup was played in the hot summer months of February and March. In conclusion, the basic epidemiological data collected at the 2003 Cricket World Cup should assist organisers of future Cricket World Cup competitions to predict patient presentation rates. However, the unique nature of cricket requires additional factors that need to be considered when collecting similar data. This should include weather conditions, time of day or night when the patient presented, and information on whether the patient was seated in undercover seating or on the open grass banks that are common at many cricket grounds. This could then assist in developing a medical care plan in accordance with the capacity of the venue in order to provide the most efficient medical care possible. RefeRences 1. Delaney JS, Drummond R. Mass casualties and triage at a sporting event Br J Sports Med 2002; 36: 85-8. 2. De Lorenzo RA. Mass gathering medicine: A Review. Prehosp Disast Med 1997; 12: 68-72. 3. Morimura N, Katsumi A, Koido Y, et al. Analysis of patient load data from the 2002 FIFA World Cup Korea/Japan, Prehosp Disast Med 2004; 19: 278 - 4. TABle II. Category of medical condition and the number (N) of patient presentations at the 2003 Cricket World Cup Patient Presentations (N) (%) Blisters, scrapes and bruises 23 1 Headache 954 45 Abdominal pain 120 6 Heat-related illnesses 103 5 Fracture, sprain and lacerations 351 16 Weakness/dizziness 6 1 Cardiovascular disorders/chest pains 16 1 Insect bites 25 1 Pulmonary disorders/shortness of breath 19 1 Alergy-related 129 6 Eye injury 40 2 Other 322 15 Total 2 118 100 pg52-56.indd 54 6/29/06 9:01:29 AM pg52-56.indd 55 6/29/06 9:01:46 AM 56 SAJSM vol 18 No.2 2006 4. Newman DA. Prospective survey of injuries at first class counties in Eng- land and Wales 2001 and 2002 seasons. In: Stretch RA, Noakes, TD, Vaughan CL, eds. Science and Medicine in Cricket Compress: Cape Town, 2003; 343-50. 5. Orchard J, James T, Alcott E, Carter S, Farhart P. Injuries in Australian cricket at first class level 1995/1996 to 2000/2001. Br J Sports Med 2002; 36: 270-5. 6. Stretch RA. Injuries to South African cricketers playing at first-class level. S Afr Med J 1989; 4: 3-20. 7. Stretch RA. The incidence and nature of injuries in club and provincial cricketers. South African Medical Journal 1993; 83: 339-41. 8. Stretch RA. The incidence and nature of injuries in schoolboy cricketers. S Afr Med J 1995; 85: 1182-4. 9. Stretch RA. Incidence and nature of epidemiological injuries to elite South African cricket players. S Afr Med J 2001a; 91:336-9. 10. Stretch RA. The incidence and nature of epidemiological injuries to elite South African cricket players over a two-season period, South African Med- ical Journal 2001b; 8:17 - 20. 11. Stretch RA. Cricket injuries: a longitudinal study of the nature of injuries to South African cricketers. Br J Sports Med 2003; 37: 250 - 3. 12. Stretch RA, Venter DJL. Cricket injuries: A longitudinal study of the nature of injuries to South African cricketers. South African Medical Journal 2003; 15: 4 - 8. 13. Zeitz KM, Schneider DP, Jarrett D. Mass gathering events: Retrospective analysis of patient presentations over seven years. Prehosp Disast Med 2002; 17: 147-50. CASE REPORT 20 SA JOURNAL OF RADIOLOGY • March 2006 the diaphragm was demonstrated more clearly on the MRI sequences and infiltration of the diaphragm could not be excluded on CT. Another important role of CT or MRI is to determine resectability and to detect metastases.2,3 They are also used in follow up to determine response to treatment2 and to detect recurrences. TC 99m-MDP (bone scan) is of value in detecting distant bony metastases8 and 8 F-fluoro-2-deoxy-glu- cose (FDG)-position emission tomography (PET) scan can be used to detect recurrence of intraspinal PNET.1,9 CT The CT picture is usually of heterogeneous soft tissue density.2,3 The mass can be isodense or slightly hypodense to muscle3 and larger tumours commonly have hypodense necrotic/cystic areas.2,3,6,8 Post-con- trast enhancement is mostly inhomogeneous.3,6,8 Calcifications are seen in less than 10% of cases, but could be faint and speckled or stippled.6,8 Haemorrhage can be seen as a hyperdense area in the mass if present. Regional lymphadenopathy is rarely seen but chest wall invasion is more common and would be evidenced by pleural effusion, bony destruction, tumour nodules in the muscles and abnormal enhancement of the chest wall.8 MRI MRI T1-weighted images would show a mass isointense or slightly hyperintense to muscle2,3,5,6,8 with low-intensity areas correlating to cys- tic/necrotic areas in the tumour and hyperintense areas correlating to haemorrhage. Post-gadolinium enhancement may be seen uniformly or inhomogeneously.2,3,5,6,8 Heterogeneous high signal intensity is typically seen on T2-weighted images;2,3,5,6,8 this sequence usually demonstrates the cystic components best. A STIR sequence would also demonstrate a heterogeneous high signal intensity mass.3,6 Conclusion PNETs are aggressive neoplasms and should therefore be diagnosed accurately and as early as possible. The distinction between PNET and ES cannot be made radiologically and could even be difficult on histological examination. Neural differentiation, immunostaining and immunohistochemistry can help to distinguish these tumours. Unfortunately a standard therapy does not exist yet and patients are offered a combination of surgery, chemo- and radiotherapy. Prognosis depends on the location of the tumour but PNET has a generally poor prognosis. Alternative treatment should be investigated further. 1. Virani MJ, Jain S. Primary intraspinal primitive neuroectodermal tumor (PNET): a rare occurrence Neurology India 2002; 50: 75-80. 2. Khong PL, Chan GCF, Shek TWH, Tam PKH, Chan FL. Imaging of peripheral PNET: Common and uncommon locations. Clin Radiol 2002; 57: 272-277. 3. Ibarburen C, Haberman JJ, Zerhouni EA. Peripheral primitive neuroectodermal tumors. CT and MRI evaluation. Eur J Radiol 1996; 21: 225-232. 4. Mawrin C, Synowitz HJ, Kirches E, Kutz E, Knut D, Weis S. Primary primitive neuroectodermal tumor of the spinal cord: case report and review of literature. Clin Neurol Neurosurg 2002; 104: 36-40. 5. Kim YW, Jin BH, Kim TS, Cho YE. Primary intraspinal primitive neuroectodermal tumor at conus medul- laris. Yonsei Med J 2004; 45: 538. 6. Dorfmuller G, Wurtz FG, Umschaden HW, Kleinert R, Ambros PF. Intraspinal primitive neuroectodermal tumour: Report of two cases and review of literature. Acta Neurochirur 1999; 141: 1169-1175. 7. Isotalo PA, Agbi C, Davidson B, Girard A, Verma S, Robertson SJ. Primitive neuroectodermal tumor of the cauda equina. Hum Pathol 2000; 31: 999-1001. 8. Dick EA, McHugh K, Kimber C, Michalski A. Imaging of non-central nervous system primitive neuroecto- dermal tumours: Diagnostic features and correlation with outcome. Clin Radiol 2001; 56: 206-215. 9. Meltzer CC, Townsend DW, Kottapally S, Jadali F. FDG imaging of spinal cord primitive neuroectodermal tumor. J Nucl Med 1998; 39: 1207-1209. 20 SA JOURNAL OF RADIOLOGY • March 2006 paraspinal.indd 20 3/27/06 12:25:57 PM CASE REPORT 20 SA JOURNAL OF RADIOLOGY • March 2006 the diaphragm was demonstrated more clearly on the MRI sequences and infiltration of the diaphragm could not be excluded on CT. Another important role of CT or MRI is to determine resectability and to detect metastases.2,3 They are also used in follow up to determine response to treatment2 and to detect recurrences. TC 99m-MDP (bone scan) is of value in detecting distant bony metastases8 and 8 F-fluoro-2-deoxy-glu- cose (FDG)-position emission tomography (PET) scan can be used to detect recurrence of intraspinal PNET.1,9 CT The CT picture is usually of heterogeneous soft tissue density.2,3 The mass can be isodense or slightly hypodense to muscle3 and larger tumours commonly have hypodense necrotic/cystic areas.2,3,6,8 Post-con- trast enhancement is mostly inhomogeneous.3,6,8 Calcifications are seen in less than 10% of cases, but could be faint and speckled or stippled.6,8 Haemorrhage can be seen as a hyperdense area in the mass if present. Regional lymphadenopathy is rarely seen but chest wall invasion is more common and would be evidenced by pleural effusion, bony destruction, tumour nodules in the muscles and abnormal enhancement of the chest wall.8 MRI MRI T1-weighted images would show a mass isointense or slightly hyperintense to muscle2,3,5,6,8 with low-intensity areas correlating to cys- tic/necrotic areas in the tumour and hyperintense areas correlating to haemorrhage. Post-gadolinium enhancement may be seen uniformly or inhomogeneously.2,3,5,6,8 Heterogeneous high signal intensity is typically seen on T2-weighted images;2,3,5,6,8 this sequence usually demonstrates the cystic components best. A STIR sequence would also demonstrate a heterogeneous high signal intensity mass.3,6 Conclusion PNETs are aggressive neoplasms and should therefore be diagnosed accurately and as early as possible. The distinction between PNET and ES cannot be made radiologically and could even be difficult on histological examination. Neural differentiation, immunostaining and immunohistochemistry can help to distinguish these tumours. Unfortunately a standard therapy does not exist yet and patients are offered a combination of surgery, chemo- and radiotherapy. Prognosis depends on the location of the tumour but PNET has a generally poor prognosis. Alternative treatment should be investigated further. 1. Virani MJ, Jain S. Primary intraspinal primitive neuroectodermal tumor (PNET): a rare occurrence Neurology India 2002; 50: 75-80. 2. Khong PL, Chan GCF, Shek TWH, Tam PKH, Chan FL. Imaging of peripheral PNET: Common and uncommon locations. Clin Radiol 2002; 57: 272-277. 3. Ibarburen C, Haberman JJ, Zerhouni EA. Peripheral primitive neuroectodermal tumors. CT and MRI evaluation. Eur J Radiol 1996; 21: 225-232. 4. Mawrin C, Synowitz HJ, Kirches E, Kutz E, Knut D, Weis S. Primary primitive neuroectodermal tumor of the spinal cord: case report and review of literature. Clin Neurol Neurosurg 2002; 104: 36-40. 5. Kim YW, Jin BH, Kim TS, Cho YE. Primary intraspinal primitive neuroectodermal tumor at conus medul- laris. Yonsei Med J 2004; 45: 538. 6. Dorfmuller G, Wurtz FG, Umschaden HW, Kleinert R, Ambros PF. Intraspinal primitive neuroectodermal tumour: Report of two cases and review of literature. Acta Neurochirur 1999; 141: 1169-1175. 7. Isotalo PA, Agbi C, Davidson B, Girard A, Verma S, Robertson SJ. Primitive neuroectodermal tumor of the cauda equina. Hum Pathol 2000; 31: 999-1001. 8. Dick EA, McHugh K, Kimber C, Michalski A. Imaging of non-central nervous system primitive neuroecto- dermal tumours: Diagnostic features and correlation with outcome. Clin Radiol 2001; 56: 206-215. 9. Meltzer CC, Townsend DW, Kottapally S, Jadali F. FDG imaging of spinal cord primitive neuroectodermal tumor. J Nucl Med 1998; 39: 1207-1209. 20 SA JOURNAL OF RADIOLOGY • March 2006 paraspinal.indd 20 3/27/06 12:25:57 PM CASE REPORT 20 SA JOURNAL OF RADIOLOGY • March 2006 the diaphragm was demonstrated more clearly on the MRI sequences and infiltration of the diaphragm could not be excluded on CT. Another important role of CT or MRI is to determine resectability and to detect metastases.2,3 They are also used in follow up to determine response to treatment2 and to detect recurrences. TC 99m-MDP (bone scan) is of value in detecting distant bony metastases8 and 8 F-fluoro-2-deoxy-glu- cose (FDG)-position emission tomography (PET) scan can be used to detect recurrence of intraspinal PNET.1,9 CT The CT picture is usually of heterogeneous soft tissue density.2,3 The mass can be isodense or slightly hypodense to muscle3 and larger tumours commonly have hypodense necrotic/cystic areas.2,3,6,8 Post-con- trast enhancement is mostly inhomogeneous.3,6,8 Calcifications are seen in less than 10% of cases, but could be faint and speckled or stippled.6,8 Haemorrhage can be seen as a hyperdense area in the mass if present. Regional lymphadenopathy is rarely seen but chest wall invasion is more common and would be evidenced by pleural effusion, bony destruction, tumour nodules in the muscles and abnormal enhancement of the chest wall.8 MRI MRI T1-weighted images would show a mass isointense or slightly hyperintense to muscle2,3,5,6,8 with low-intensity areas correlating to cys- tic/necrotic areas in the tumour and hyperintense areas correlating to haemorrhage. Post-gadolinium enhancement may be seen uniformly or inhomogeneously.2,3,5,6,8 Heterogeneous high signal intensity is typically seen on T2-weighted images;2,3,5,6,8 this sequence usually demonstrates the cystic components best. A STIR sequence would also demonstrate a heterogeneous high signal intensity mass.3,6 Conclusion PNETs are aggressive neoplasms and should therefore be diagnosed accurately and as early as possible. The distinction between PNET and ES cannot be made radiologically and could even be difficult on histological examination. Neural differentiation, immunostaining and immunohistochemistry can help to distinguish these tumours. Unfortunately a standard therapy does not exist yet and patients are offered a combination of surgery, chemo- and radiotherapy. Prognosis depends on the location of the tumour but PNET has a generally poor prognosis. Alternative treatment should be investigated further. 1. Virani MJ, Jain S. Primary intraspinal primitive neuroectodermal tumor (PNET): a rare occurrence Neurology India 2002; 50: 75-80. 2. Khong PL, Chan GCF, Shek TWH, Tam PKH, Chan FL. Imaging of peripheral PNET: Common and uncommon locations. Clin Radiol 2002; 57: 272-277. 3. Ibarburen C, Haberman JJ, Zerhouni EA. Peripheral primitive neuroectodermal tumors. CT and MRI evaluation. Eur J Radiol 1996; 21: 225-232. 4. Mawrin C, Synowitz HJ, Kirches E, Kutz E, Knut D, Weis S. Primary primitive neuroectodermal tumor of the spinal cord: case report and review of literature. Clin Neurol Neurosurg 2002; 104: 36-40. 5. Kim YW, Jin BH, Kim TS, Cho YE. Primary intraspinal primitive neuroectodermal tumor at conus medul- laris. Yonsei Med J 2004; 45: 538. 6. Dorfmuller G, Wurtz FG, Umschaden HW, Kleinert R, Ambros PF. Intraspinal primitive neuroectodermal tumour: Report of two cases and review of literature. Acta Neurochirur 1999; 141: 1169-1175. 7. Isotalo PA, Agbi C, Davidson B, Girard A, Verma S, Robertson SJ. Primitive neuroectodermal tumor of the cauda equina. Hum Pathol 2000; 31: 999-1001. 8. Dick EA, McHugh K, Kimber C, Michalski A. Imaging of non-central nervous system primitive neuroecto- dermal tumours: Diagnostic features and correlation with outcome. Clin Radiol 2001; 56: 206-215. 9. Meltzer CC, Townsend DW, Kottapally S, Jadali F. FDG imaging of spinal cord primitive neuroectodermal tumor. J Nucl Med 1998; 39: 1207-1209. 20 SA JOURNAL OF RADIOLOGY • March 2006 paraspinal.indd 20 3/27/06 12:25:57 PM To order contact Carmen or Avril: Tel: (021) 530-6520 Fax: (021) 531-4126/3539 email: carmena@hmpg.co.za The South African Medical Association, Health & Medical Publishing Group 1-2 Lonsdale Building, Gardener Way, Pinelands, 7405. pg52-56.indd 56 6/29/06 9:02:06 AM