The West African Journal of Radiology is a peer-reviewed Print + Online Semiannual publication of the Association of Radiologists of West Africa (ARAWA). The journal was established in 1994 to promote research in the field of Radiation Medicine in the West African sub-region. The journal allows free access (Open Access) to its contents and permits authors to self-archive final accepted version of the articles on any OAI-compliant institutional / subject-based repository. More Details
Association of Radiologists of West Africa (ARAWA)
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Thickness and texture of the squamous temporal bone in a Nigerian tertiary hospital
Background: Thickness and texture of the squamous temporal bones (STBs) are the two main patient factors that determine the outcome of transtemporal transcranial Doppler ultrasound. The aim of this study was to determine the thickness and texture of the STB as well as their association with biodemographic characteristics in a tertiary hospital in Southwest Nigeria. Material and Methods: Cranial computed tomography (CT) images of 142 adults acquired on a 64-slice multi-detector Toshiba Aquilion scanner were retrospectively evaluated for the thickness and texture of the bilateral STB at the expected location of the temporal acoustic window on a ClearCanvas® Workstation. Associations of thickness and texture of the STB with biodemographic data were determined by statistical analysis at P < 0.05. Results: There were 79male (55.6%) participants and the overall mean age was 51 ± 17.3 years(49 ± 16.1 years in males and 53.4 ± 18.5 years in females). Mean thickness of the 284 STB was 3.21 ± 1.11 mm (range 1.2–8.7 mm), which was thicker on the left (3.3 ± 1.2 mm) than the right (3.1 ± 1.0 mm, P = 0.001). Thickness of STB showed significant increase (P < 0.05) with age on the right (β = 0.23) and left (β = 0.31). Controlling for age, males tend to have thicker STB than females. Thicknesses of STB in 61.3% were favorable for transcranial insonation bilaterally. Homogenous texture was found in 64.8% of STB while the rest were heterogeneous. A combination of both thickness and texture appear favorable for transcranial insonation in 76.8% of STB evaluated. Conclusion: Thickness of the squamous temporal bone varied significantly with age but not with gender, and the temporal squama were largely of a homogeneous texture. Overall, the important patient factors appear favorable for transtemporal cranial ultrasound in the majority of our participants.
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Radiobiological estimation of radiation‑induced heart complication of postmastectomy radiation therapy patients using the relative seriality model
Background and Aim: In Nigeria today, most radiotherapy (RT) centers do manual planning using anatomical landmarks rather than precise planning using imaging modalities such as Computerized Tomography and Magnetic Resonance Imaging. This puts the collateral organs at a greater risk of damage. The objective of this study is to carry out a comparison of the risk of cardiac complication in the right and left breasts of postmastectomy radiation therapy patients using radiobiological evaluation tools. Methods: Ninety-six patients treated in the University of Benin Teaching Hospital, RT Center, Nigeria, between January 2012 and March 2014 were recruited for this study. The relative seriality model was used to compute the risk of cardiac mortality to the breast of these patients. Results: The results showed that the equivalent uniform dose (EUD) to the heart for patients with left breast cancer is significantly (P < 0.05) higher than the EUD to the heart of patients with right breast and also the risk of cardiac mortality is significantly (P < 0.05) higher in the left breast than the right breast; due to proximity to the heart to the left side. Conclusion: This implies that the long-term risk of having cardiac disease should be of particular concern for women treated for left-sided breast cancer. As a result of this, care should be taken in planning patients using computerized treatment planning system that embraces imaging simulation rather than the conventional anatomical landmark; this will go a long way to prevent cardiac-induced mortality especially in cancer of the left breast.
Prevalence of ultrasound‑diagnosed asymptomatic simple renal cysts at the University College Hospital, Ibadan
Background: Renal cysts are thin-walled sacs of fluid that form within the renal parenchyma which may be simple or complex. Most simple renal cysts are asymptomatic and are found usually incidentally by ultrasonography and computed tomography. However, a small proportion may become symptomatic with pain being the most common symptom. The aim of the study is to determine the prevalence of asymptomatic simple renal cysts in patients presenting for abdominal ultrasound (US) and the associations of simple renal cysts with age and gender. Materials and Methods: This was a retrospective study which involved the retrieval of the results of abdominal US performed at the Radiology Department of the University College Hospital between January 2013 and December 2015. Data extracted included age, sex, and renal sonographic findings. The retrieved data were analyzed using Statistical Package for the Social Sciences (SPSS) version 20.0 software. Results: Two thousand and ninety-five patients had abdominal US done during the study period. The overall prevalence of asymptomatic simple renal cysts was 2.3% with the prevalence increasing with age (P < 0.001). Simple renal cysts were found in 2.3% of both males and females with a male-to-female ratio of 1:1.3. Conclusion: The overall prevalence of simple renal cyst in our study is 2.3% and it increased with age. Since simple renal cysts have been associated with some conditions and complications such as hypertension, polycythemia, hemorrhagic transformation, and cyst rupture, adequate follow-up is necessary to enable the prompt detection of complications and adequate intervention if the need arises.
Location of femoral/tibial tunnels in anterior cruciate ligament reconstruction and their impact on graft integrity: Magnetic resonance imaging review
Context: Despite advances in surgical techniques for anterior cruciate ligament (ACL) repair, a significant proportion of patients encounter persisting pain/instability of the knee postoperatively. Objectives: To assess the location of femoral/tibial tunnels on magnetic resonance imaging (MRI) and to correlate the findings with the ACL graft integrity/graft-related complications. Study Design/Settings: This was a cross-sectional study done at Burjeel Medical Centre, Muscat, Oman. Materials and Methods: The study period was between November 2015 and June 2017 on Philips Ingenia 1.5 Tesla MRI machine. A total of 30 male patients, age ranged from 20 to 43 years who presented with knee pain/instability 1 year postreconstruction of ACL, were recruited for the study. Results: Of 30 cases, 10 (33.33%) patients had an intact graft on MRI. Of the remaining 20 patients, graft impingement was noted in 15 patients (50%), graft tear in 3 cases (10%), and graft stretching with abnormal high T2 signal in the remaining 2 cases (6.67%). Associated findings of focal arthrofibrosis in the anterior knee joint space and tibial tunnel cysts were encountered in few patients who were not dealt with in this study. Out of 20 patients with graft abnormality, femoral tunnel was abnormally located in 3 (15%), tibial tunnel was located anterior to the MRI equivalent of Blumensaat’s extension line partly or completely in 16(80%) and both tunnels were normally located in 1(5%). Conclusion: The location of the femoral/tibial tunnels is the most important determinant factor of postoperative graft integrity in ACL reconstruction patients.
Anterior cruciate ligament reconstruction
Diverticulosis among patients referred for barium enema studies at Dr George Mukhari Academic Hospital, Ga‑Rankuwa, Pretoria, South Africa
Background: A possible increasing trend in the incidence of diverticulosis was observed in adult patients referred to the Diagnostic Radiology department of Dr George Mukhari Academic Hospital (DGMAH), Ga-Rankuwa, Pretoria, for barium enema studies. The study will be the first to document the magnitude of this condition at our hospital since its inception. Objective: The aim of this study is to evaluate the current prevalence of diverticulosis at DGMAH Ga-Rankuwa whose patients are predominantly South Africans of African descent. Materials and Methods: We reviewed the medical records of all adult patients referred to DGMAH for barium enema investigations for 1 year. Barium enema studies of 166 patients who met the inclusion criteria were systematically evaluated radiologically for the presence of diverticulosis. Data from the records were analyzed using the Statistical Package for Social Sciences (SPSS, version 22.0) software program. Results: The patients' ages ranged between 18 and 95 years, with a mean age of 60.1 years. From the records analyzed, 77.7% were radiologically negative, whereas 22.3% were positive for diverticulosis. There was a female preponderance (23 cases [62.2%] among females versus 14 cases [37.8%] among males; P < 0.0001) and the diverticulosis had a diffused pattern. The increasing trend of diverticulosis observed at DGMAH did not reflect any statistically significant difference when compared with previous studies done in sub-Saharan Africa. Conclusion: This study demonstrates a possible trend of diverticulosis previously unrecorded in barium enema studies at DGMAH, probably attributable to the effects of urbanization and higher consumption of refined carbohydrate with low fiber residue.
Distensibility coefficient of the common carotid artery in acute cerebral infarct by M‑mode ultrasound: A cross‑sectional study
Introduction: Distensibility coefficient (DC) is abnormal in most cases of acute cerebral infarct patients. Intima-media thickness (IMT) is measured by B (brightness)-mode and distensibility by M (motion)-mode ultrasound. DC is not routinely measured in clinical practice even though it is the earliest functional change to occur in common carotid arteries. IMT represents structural change and DC represents functional changes that occur in common carotid. Aim: DC is a valid independent indicator for risk assessment of acute cerebral infarcts. The present study is aimed at knowing the association of abnormal DC with acute cerebral infarct patients. Materials and Methods: Cross sectional study was undertaken over a period of 9 months with 210 cases of acute cerebral infarct. Distensibility of common carotid artery was measured by M-mode ultrasound. Cramer’s V value ranged from 0.0 to 1.0 and P < 0.05 was considered statistically significant. Results: DC was reduced in 62.8% of the total 210 cases of acute cerebral infarct. Maximum cases (38%) were in the age groups of 61–70 years. Cramer’s V value ranged from <15 to <24 × 10−3 kPa (P < 0.001). There was a good association between reduced DC and acute cerebral infarct in the present study. Conclusion: DC is a valid independent risk factor for acute cerebral infarct. DC represents functional vessel wall property and decreases with age. M-mode-derived measurements for DC are valid, and abnormal DC value is associated well with acute cerebral infarct.
A comparative ultrasonographic evaluation of intrarenal artery resistive index among hypertensive and normotensive adults in north-western Nigeria
Introduction: Hypertension is a sustained systolic blood pressure equal to or above 140 mmHg or diastolic blood pressure equal to or above 90 mmHg. The kidneys play a central role in the control of high blood pressure through the renin–angiotensin system. Thus, renovascular changes of myointimal hyperplasia in the intrarenal arteries may cause an increase in renal arterial impedance and eventually irreversible hypertensive nephropathy. The early detection of these renovascular changes using ultrasonography can provide opportunity for immediate intervention toward preventing or at least delaying the irreversible hypertensive nephropathy. Aims and Objectives: The objective of this study is to determine and compare intra-renal resistive index (RRI) in normotensive and hypertensive adults within the age range of 35–70 years at Aminu Kano Teaching Hospital, Kano, Nigeria. Materials and Methods: A prospective case–control study of intra-RRI using ultrasound in 150 hypertensive patients and 150 normotensive controls. The mean RRI of the interlobar arteries of both kidneys was measured and recorded. The data were analyzed with the aid of computer-based SPSS 16.0 software for windows. Results: The ages of the study participants ranged between 35 and 70 years. The age difference was not statistically significant (P = 0.88). The mean interlobar artery resistive index (RI) values were 0.59 ± 0.04 and 0.59 ± 0.03 on the right and left sides, respectively, in normotensive controls while those of hypertensive patients were 0.73 ± 0.03 and 0.73 ± 0.03 for the mean interlobar artery RI values on the right and left sides, respectively, and both were statistically significant. Conclusion: The intra-RRIs were lower in normotensive participants when compared with the hypertensive patients which were statistically significant. These showed that hypertension has significant effects on the kidneys, and with early detection and intervention, irreversible renal damage may be prevented.
Unusual sites of intracranial metastases from renal cell carcinoma presenting only with neurological symptoms
We report a case where patient presented only with neurological symptoms from the metastases of an asymptomatic primary renal cell maligancy , alongwith review of literature for unusual sites of intracranial metastases in the clivus and choroid plexus.
Nutcracker syndrome presenting as recurrent hematuria
Nutcracker syndrome (NCS) occurs from compression of the left renal vein between the abdominal aorta and the superior mesenteric artery. It is rare and commonly presents with hematuria, flank pain, and dysuria. A 27-year-old male with sickle cell trait presented with a 9-month history of total hematuria complicated with anemia necessitating blood transfusion. He had no overt signs of urogenital infestation, renal impairment, or trauma. Genotype was AS. Intravenous urography was normal. On cystoscopy, the bleeding was seen to be coming through the left ureteral orifice. Renal angiography showed left renal venous stasis and contrast extravasation into the upper calyces. An impression of NCS was made. Other imaging modalities (computed tomography and ultrasound) supported NCS. NCS should be suspected in cases of recurrent hematuria.
Hajdu–Cheney syndrome: A rare acro‑osteolytic disorder
We report a case of a 35-year-old woman with Hajdu–Cheney syndrome, a very rare connective tissue disorder with about 70 cases reported worldwide since 1948. No similar disease occurred in her family. She presented with clinical features of the syndrome and left seventh cranial nerve palsy after several dental procedures. The radiographs of the skull and the hands demonstrate the abnormalities clearly.
Further observations on the “spaghetti sign” in upper urinary tract hemorrhage
The “spaghetti sign” is recognized as a radiological sign of upper urinary tract hemorrhage. The sign was first described in the urinary bladder during intravenous urography, but it has subsequently been described on retrograde pyelography and in the urographic phase of contrast CT. We report the observation of the “spaghetti sign” in the bladder on ultrasonography and on Magnetic Resonance Urography (MRU), modalities in which the sign has not been previously described. We suggest that the observations may provide a useful guide when ultrasonography and/or MRU are employed in the search for the source of massive hematuria. We also report two additional cases of hematuria in whom the “spaghetti sign” is demonstrated in the urographic phase of contrast CT.
Utility of contrast‑enhanced fluid‑attenuated inversion recovery in magnetic resonance imaging of intracranial lesions
Aim: The aim of this study is to determine utility of contrast-enhanced fluid-attenuated inversion recovery (FLAIR) imaging by comparing results with contrast-enhanced T1-weighted imaging (T1WI) in various intracranial lesions. Materials and Methods: Forty-nine patients with a known intracranial lesion or with clinical suspicion underwent the gadolinium-enhanced magnetic resonance (MR) imaging using 1.5T. Postcontrast axial, coronal, and sagittal T1 fat-saturated, axial FLAIR images were acquired after administration of gadobenate dimeglumine. The MR imaging parameters for the postcontrast T2-FLAIR images were 6000–9000/90–110/1845–2030 ms/150 (repetition time/echo time/inversion time/flip angle), and the acquisition time was 2 min 12 s. All images were acquired with a section thickness of 5 mm, an intersection gap of 2 mm, and a field of view of 256 mm × 144 mm. The images were transferred to a workstation and reviewed. Results: We found that postcontrast FLAIR images are useful by showing better meningeal involvement in various pathologies and enhancement of the solid component in intra-axial lesions. However, it was not much helpful in extra-axial lesions and lesions with mild postcontrast enhancement and lesions with perilesional edema. Conclusion: Postcontrast FLAIR is a useful adjunct to postcontrast T1W images in equivocal cases and for additional information.
postcontrast fluid-attenuated inversion recovery
Trend of cancer incidence in an oncology center in Nigeria
Background: Globally, 32.5 million people diagnosed with cancer within the 5 years previously were alive at the end of 2012. 8.2 million deaths and 14.1 million new cases are recorded annually, but 70% will be in developing countries. Lung, breast, and colorectal cancers are commonly diagnosed. Aim and Objectives: The aim and objectives of this study is to review the trend of cancer incidence in Lagos University Teaching Hospital (LUTH) from January 2004 to December 2013. Materials and Methods: This is a retrospective study of histologically confirmed malignancies seen at Radiotherapy Department, LUTH from January 2004 to December 2013. Case files were retrieved through the record department, and the information required was extracted with the aid of a data extraction form. Results: A total of 3,314 new cases of cancer were recorded in LUTH during the study period. The mean age of cancer presentation is 48.52 (±16.44). The median age is 49.00 years with an age range of 1–100 years. The peak age incidence for males was 50–54 years accounting for 10% of all male presentation while females had a peak age incidence of 40–44 years accounting for 14% of female cases. The male-to-female ratio was 1:3. Breast (38.1%), cervical (17.0%), and colorectal cancers (3.3%) are the common ones recorded. In males, the most common cancer was prostate cancer (12.8%) followed by colorectal cancer (4.5%). Conclusion: In general, cancer incidence in Nigeria appears low compared to developed countries which may not truly reflect the burden of the disease. This could be due to poor population-based statistics and poor health patronage of orthodox medical care.
Routine addition of diffusion‑weighted imaging to pediatric brain imaging with acute presentation: An initial experience
Context: A number of disorders affecting the pediatric brain pose a diagnostic challenge. Magnetic resonance imaging (MRI) is widely accepted as a sensitive technique for the diagnosis of ischemia, encephalitis, and leukodystrophies. Conventional MR sequences used in routine practice include T1-weighted (T1-W), T2-weighted, and fluid-attenuation inversion recovery (FLAIR) sequences. However usually, the presentation in small children is confusing and presents a diagnostic challenge even after the use of these various MR sequences requiring repeated MRI examinations. Detecting pathological changes occurring at microenvironment level is vital for early diagnosis, effective treatment, and obviating the need of repeated MRI. Aims: The purpose of our study was to assess the additional role of diffusion-weighted imaging (DWI) in better detection of these various pathologies of brain. Settings and Design: This was a prospective study. Subjects and Methods: Thirty children of ages ranging from neonate to 12 years of age with various complaints of central nervous system involvement were evaluated with MRI brain within 72 h of initial clinical presentation. T1 and T2 spin-echo sequences FLAIR and postcontrast T1-W imaging were done. DWI was performed with echoplanar imaging using depth-resolved surface coil spectroscopy sequence. The lesions were evaluated on DWI and conventional sequences. The final diagnosis was established on the basis of clinical evaluation, electroencephalographic findings, imaging, cerebrospinal fluid analysis, serologic tests, and fatty acid evaluation in plasma assay. Statistical Analysis Used: This was a descriptive study. Results: The patients were divided into three groups. Group A included patients in whom DWI detected more lesions or showed a greater extent of lesions on apparent diffusion coefficient (ADC) map than conventional MRI. This group had 11 cases including 7 cases of ischemic encephalopathy, one case of adrenoleukodystrophy (ADL) showing increased extent of lesion with restricted diffusion at the advancing edge and 3 cases of viral encephalitis. In Group B, 12 cases had similar results in both DWI and conventional MRI imaging. Of these, 7 cases with no specific diagnosis and subsequent spontaneous recovery showed no lesion on both conventional and DWI; 5 cases showed equal extent and number of lesions on DWI; 1 case was diagnosed as ADL, 2 as viral encephalitis, and 2 as ischemic encephalopathy on final workup. In Group C, T2 and FLAIR showed more lesions than DWI and had 7 cases. 5 had normal ADC maps but 1–2 small hyperintense lesions on T2 and FLAIR imaging, while the remaining two diagnosed with ischemic encephalopathy had hyperintense areas on T2 and FLAIR sequences with associated ventricular enlargement
Role of multidetector computed tomography in differentiating benign and malignant common bile duct strictures
Objective: To evaluate the diagnostic features in differentiating malignant from benign common bile duct (CBD) strictures using contrast-enhanced multidetector computed tomography (MDCT). Patients and Methods: An ambispective study from January 1, 2008 to December 31, 2010, on fifty patients with liver function tests suggestive of obstructive jaundice and an ultrasound showing biliary obstruction were included. A nonenhanced computed tomography (CT) was done before the administration of the contrast medium and then scans were routinely obtained in four phases: early arterial , late arterial, portal venous, and delayed phases. The CT scans acquired were reviewed on a picture archiving and communication system workstation. CT findings were interpreted with regard to wall thickness, the location, length involved, enhancement pattern, presence of invasion, and margins of the stricture. These were compared with the attenuation of the normal CBD wall, the maximum CBD diameter proximal, and pancreatic duct dilatation. Results: The mean age ± standard deviation of patients was 62.84 ± 11.61 years (range: 38–82 years). Among the fifty patients included in the study, 31 (62%) had malignant CBD stricture. The involved segments of malignant CBD strictures were significantly longer with significantly larger maximum proximal CBD diameter, considerably thicker and irregular stricture wall and showing more enhancement during delayed phase. No significant differences were found between malignant and benign CBD strictures with respect to stricture location. Conclusions: Presence of irregular margins, invasion into neighboring tissues, long-segment involvement, more proximal CBD dilatation, and hyperenhancement in delayed and portal venous phases in contrast-enhanced MDCT helps in the differentiation of malignant from benign CBD strictures.
Role of computed tomography in identifying anatomical variations in chronic sinusitis: An observational study
Background/Aim: Clear visualization of bony wall, mucosal layer, sinus contents, and compartment by computed tomography (CT) helps to identify the anatomical variations in chronic sinusitis(CS). We describe the clinical and radiological features in CS. Materials and Methods: We included patients of both genders aged ≥15 years, with CS. Unenhanced CT images of the nasal cavity and paranasal region were taken in coronal, complemented by axial and sagittal reconstructions. Analysis of anatomical variants was performed using a soft tissue window and a bone window. Results: Headache (64%), nasal obstruction (53%), and nasal discharge (38%) were common complaints of 100 patients (male = 52) whose mean ± standard deviation age was 32.55 ± 10.9 years. Significant mucosal thickening in at least one of the paranasal sinuses (PNSs) was seen in all except four patients. All had a minimum of one anatomical variant, 72% had >1 variant. Maxillary antra were most commonly involved (62.0%), followed by ethmoid sinuses (36.0%). Deviated nasal septum (60%) was most common, followed by concha bullosa (38%); paradoxical middle turbinate (18%), ethmoidal bulla (20%), agger nasi cells(33%), Haller cells(21%), and onodi cells(10%) were other features. All had optic nerve involvement with Type I (84%) involvement being common. Kero’s classification Type I was noted in 71%. None had Type IV. Cribriform plate and carotid canal wall were normal in all while 2% had dehiscence of lamina papyracea. Conclusion: CT plays an important role in visualization of anatomical variations in PNSs, and anatomical variations particularly in the ostiomeatal complex are the key factors in the causation of CS.
Postmortem forensic imaging: An essential tool in contentious cases
Background: Traditional autopsy (TA) is employed towards determining the cause and manner of death. Over the last decade, virtual autopsy (VA), involving the application of forensic imaging techniques have gained prominence and, with great precision in developed countries. Aim: This is to compare the findings at post-mortem using forensic imaging techniques and, those of TA. Materials and Methods: Post-mortem CT-Scan and MRI techniques were employed in the present case and for the first time in Nigeria, to identify the fatal injuries and determine their causation. The examination was done prior to the TA; the latter was done by a team of pathologists without the prior knowledge of the imaging findings. The results, using both methods, were subsequently compared. Results: Most of the VA and TA findings were the same except for the areas that were not readily accessible to the pathology team because of prior embalmment of the body. The inexperience of the radiologist in the area of post-mortem forensic imaging also contributed to the few discrepancies. Conclusion: This is the first virtopsy to be conducted in Nigeria and, with impressive results. The findings compare favourably with those of TA and, have the added advantage of identifying minor injuries that might easily be missed using TA method. Success is however hinged on the expertise of the forensic radiologist and forensic pathologist. While VA can be employed to solve the problems of religious opposition to TA, the cost of the former is astronomical.
Postirradiation white blood cell recovery in rats: Following single and double (repeated) X‑ray exposure
Purpose: This study aims at determining the effect of radiation on peripheral white blood cells (WBCs) and the time for their full recovery in Albino Wister Rats following single and double (repeated) X-ray exposure so that a safe period for repeated irradiation can conveniently be recommended for any radiographic examination. Materials and Methods: Twenty one healthy albino Wister Rats of aged between 2–4 month and weighing about 140–200 g were used for this study. They were divided into three Groups A, B, and C. Group B and C were irradiated with X-ray from a diagnostic X-ray machine. Group C was immediately irradiated again with the same exposure factors at about 3–4 min interval. Blood samples from both control and experimental groups (after irradiation) were collected through a period of 30 min to 7 days and subjected to standard hematologic examination to determine the WBC count and differential leukocytes count. Results: A sharp fall in WBC was observed in the single-exposed group 30 min following irradiation. This is however more pronounced in the double-exposed group. This fall persisted till 48 h after irradiation. The WBC count returned to normal on the 3rd and 4th day following irradiation for both experimental groups. The maximum repair and recovery recorded were 98.6% for single exposure and 95.9% for double exposure of the normal count. Conclusion: This study has presented that the recovery of an irradiated peripheral WBC is not 100% and that the effect is more remarkable in cells with double (repeated) irradiation. A safe period of at least 3–7 days should be allowed for the cells to recover from previous irradiation before an examination is repeated. This will serve as a guide to radiographers/radiologist in the management of patients who need follow-up examinations.
Occupational hazards among medical radiation workers
Objectives: The objective of the study was to determine the prevalence of occupational hazards among medical radiation workers in Northern Nigeria and to assess the adequacy of existing occupational safety measures in the region. Materials and Methods: A prospective cross-sectional study of 139 medical radiation workers in six tertiary health-care institutions in northern Nigeria. Structured questionnaires were used to obtain vital information about the occurrence of occupational hazards, prevention and control measures. Data were analyzed using descriptive and inferential statistics using the computer software SPSS. Results: Out of 159 questionnaires distributed 139 were retrieved giving a response rate 87.4%. Stress, direct contact with bodily fluids, and contrast media splashes were the three most prevalent hazards reported by 121 (87.1%), 78 (56.1%), and 72 (51.8%), respectively. Conclusion: Medical radiation workers in Northern Nigeria face a wide range of occupational hazards, and therefore concerted efforts must be channeled toward mitigating these hazards.
Magnetic Resonance Imaging pattern of congenital brain anomalies in the neurosurgery department of a teaching hospital in Nigeria: An initial experience
Context: Congenital brain anomalies are of diverse types however few are seen in clinical practice. They are associated with high morbidity and mortality; prompt diagnosis and management aid in mitigating some of their adverse effects. Magnetic resonance imaging (MRI) is ideal for imaging these conditions, especially in pediatric cases due to its lack of ionizing radiation and excellent soft-tissue delineation. Not much literature exists for Nigeria due to challenges with statistics and record keeping. Aim: The aim of this study is to document the common congenital brain anomalies encountered using MRI in our environment. Settings and Design: A 5-year retrospective study of all pediatric brain MRI conducted and reviewed in Lagos University Teaching Hospital. 73 pediatric brain MRI scans were reviewed. Materials and Methods: Morphologic evaluation of all pediatric brain MRI conducted in the last 5 years (March 2012–February 2016) was reviewed, retrospectively, by three independent radiologists. Clinical presentations were also documented. Statistical Analysis Used: Descriptive statistics was done using SPSS: PASW Statistics for Windows, Version 18.0 Results: Seventy-three pediatric brain MRI scans were conducted in the last 5 years with congenital brain anomalies seen in 19 (26.0%) of the cases. Their ages ranged from 3 months to 17 years with a mean age of 6.7 ± 6.1 years. There were 9 (47.4%) males and 10 (52.6%) females. The common anomalies are congenital hydrocephalus 7 (35%), of which aqueductal stenosis was 6 (32%), arteriovenous malformations 3 (16%), cerebral atrophy 3 (16%), and arachnoid cysts 2 (11%). Predominant clinical features were delayed developmental milestones, macrocephaly, seizures, headaches, and vomiting. Conclusion: The common congenital brain anomalies in our environment are congenital hydrocephalus, aqueductal stenosis, arteriovenous malformations, cerebral atrophy and arachnoid cysts. MRI is useful in evaluating these anomalies; early diagnosis and prompt intervention can be offered to mitigate adverse effects.
Interdisciplinary investigation of occurrence of diverticular disease among patients referred for barium enema and colonoscopy studies at Dr. George Mukhari Academic Hospital, Ga‑Rankuwa, Pretoria, South Africa
Background: Diverticular disease (DD) is believed to be a disease which is prevalent in developed countries. Contrary to this belief, DD has been reported with an increasing trend in prevalence in Africa for the past four decades. Objectives: The objective of this study was to highlight the increasing trend of DD and to corroborate barium enema findings obtained from Diagnostic Radiology Department, with colonoscopy results from the Surgery Department at Dr. George Mukhari Academic Hospital. Methods: Results for barium enema and colonoscopy investigations of all the patients referred over a 1-year period were retrospectively reviewed by two independent research groups; each of these groups was unaware of the research carried out in the Departments of Diagnostic Radiology and Surgery. Data from the records were analyzed with the Statistical Package for the Social Sciences(IBM SPSS, version 22.0), New York, USA, version 22.0. Results: Barium enema results of 166 patients were evaluated for DD, and out of these, 129 patients (77.7%) were negative, while 37 patients(22.3%) (95% confidence interval = 19.07–25.50) were positive. A review of 384 colonoscopy results also revealed positive evidence for 47 patients (13.5%) (95% confidence interval = 10.30–17.50) for DD and 337 patients (86.5%) were negative. The findings of barium enema and colonoscopy investigative studies were similar for female preponderance, diffuse pattern of distribution of DD and the mean age of patients. Conclusion: The two studies corroborate each other and have produced the highest number of diagnostic yield for DD in one year, in Africa.
3‑Tesla Magnetic Resonance Imaging evaluation of intraspinal extramedullary nonosseous neoplastic lesions with their postsurgical and histopathological correlation
Aims: This study aimed to evaluate the diagnostic ability of 3-Tesla magnetic resonance imaging (MRI) in detection and characterization of intraspinal extramedullary nonosseous neoplastic lesions and their histopathological correlation. Settings and Design: It was a prospective study involving fifty patients who presented with low backache and lower limb weakness with MRI findings suggestive of a neoplastic extramedullary intraspinal lesion. Patients and Methods: A 3-Tesla 16-channel MRI scanner was used for imaging. Multiplanar imaging was done using T1, T2, short-tau inversion recovery sequences and T1 fat-saturated sequences. All patients then underwent postgadolinium MRI. The findings of MRI were then reviewed. An analysis of correlation between MRI findings and surgical and histopathological findings was done. Results: Out of the fifty patients evaluated, intradural lesions were noted in forty patients and extradural lesions in ten patients. Schwannoma was the most common tumor, followed by meningioma in the intradural category. Two rare cases of intradural lipoma and malignant peripheral nerve sheath tumors were also detected. In extradural category, metastasis was the most common lesion along with two rare lesions of epidural meningioma and leukemia-associated granulocytic sarcoma. Conclusions: MRI is an indispensable tool in the evaluation of spinal neoplasms. Its multiplanar capability, high-quality soft-tissue resolution, and depiction of various anatomic landmarks help the neurosurgeon to make a road map for the surgery. In most of the cases, MRI can give information regarding the histopathology of the lesion. However, in some cases, differential diagnosis needs to be included, especially in cases of extradural meningiomas and malignant peripheral nerve sheath tumors, because of their rare incidence.
Herlyn‑Werner‑Wunderlich syndrome: A rare cause of pain in the left iliac fossa
Alterations of the Müllerian ducts are rare but often treatable causes of infertility. Uterus didelphys is caused by a complete or almost complete lack of fusion of the Müllerian ducts during embryological development. As a result, two separate symmetrical uterine cavities develop with two cervices and no communication between these cavities; this is often associated with a vaginal septum, which can have a transverse wall that blocks one of the hemivaginas. Symptoms begin to develop in menarche, and complications related to a retrograde menstrual flow arise, along with pelvic adhesions and endometriosis. Some kidney abnormalities may occur. Magnetic resonance imaging can be used to diagnose and distinguish surgically correctable forms of Müllerian duct alterations. The surgical approach depends on the imaging findings. The objective of this article is to describe the radiological characteristics of the Herlyn-Werner-Wunderlich syndrome.
obstructed hemivagina and ipsilateral Renal Anomaly syndrome
A case of renal artery embolization for Grade 5 renal injury, usually reserved for surgery
Kidney trauma occurs in approximately 1%–5% of all traumas with the male preponderance. The consequences of blunt renal trauma range from a simple contusion or renal hematoma to complete shattering of the organ or avulsion of the vascular pedicle. Recently, there is more focus on conservative management as newer techniques evolve and its currently the preferred approach to most renal injuries; however, surgery is the main treatment modality for avulsion of the renal pelvis, injuries to the vascular pedicle, and life-threatening hemodynamic instability. Renal artery embolization is a minimally invasive procedure used in the management of many disease conditions and also to control hemorrhage. We report of a Grade 5 renal injury with hemodynamic instability managed with renal artery embolization which otherwise would have been managed with surgery. A 33-year-old presented with Grade 5 left renal injury and hemodynamic instability after a fall. Computed tomography of the abdomen after resuscitation showed shattered left kidney with disruption of the renal hilum and features suggestive of active bleeding. Due to the hypovolemic nature of the patient, embolization of the renal artery was requested. With anesthetic support and antibiotic cover, the right common femoral artery was punctured and a 5 French sheath inserted. Both left renal arteries were selectively catheterized and embolized to stasis with coils. An Angio-Seal device was deployed in the groin and no immediate complications seen. The patient was discharged few days after. This case report shows that Grade 5 renal artery can also be managed through a minimal invasive procedure to reduce the length of time at the hospital and also reduce the metabolic response of the patient.
A “three‑eyed” infant: A case of partial facial duplication (diprosopus monocephalus triophthalmos)
Craniofacial duplication known as diprosopus is a rare congenital disorder whereby parts or all of the face are duplicated on the head. This is a case of a 1-year-old boy referred to our hospital with an extra eye (third eye) on the left side of the head and an abnormally shaped head, which were noticed since birth. Pregnancy and delivery were uneventful. Apart from routine antenatal medication, there was no history suggestive of ingestion of traditional or other medication during pregnancy. No history of smoking during pregnancy and no history of exposure to radiation. The child was born in a rural area to a “nonconsanguineous marriage.” Examination revealed posterior plagiocephaly, a depressed anterior fontanelle, and a bulging posterior fontanelle. There was an extra eye (third eye) in the left temporal region. Radiologic findings showed the presence of two normally situated bony orbits and two extra orbits in the left temporal region. Well-formed globes were seen in the normal orbits while only one of the extra orbits contained a globe. The importance of prenatal diagnosis is emphasized.
Hybrid single‑photon emission computed tomography‑computed tomography: A review of literature
The use of hybrid imaging consisting of single-photon emission computed tomography (SPECT) and X-ray transmission computed tomography (CT) scan has the advantage of providing functional and morphologic information for a given lesion or pathology in a single session. Internet search of PubMed and Google Scholar databases was undertaken. Key phrases searched were SPECT-CT and lesion categorization or characterization. Studies considered for review include a comparison of SPECT-CT versus SPECT scintigraphy, SPECT-CT versus SPECT versus planar scintigraphy, and SPECT-CT in patients with indeterminate lesions on conventional scintigraphy either for benign or malignant conditions. Fusion of functional information obtained from radionuclide imaging with morphologic information obtained from X-ray CT has improved lesion localization, characterization, and observer confidence. It has been shown to change patient management.
single-photon emission computed tomography-computed tomography
Ultrasound as screening modality in management of fever cases in dengue epidemic: Study of 202 cases
Aims and Background: Ultrasound is a screening procedure in suspected dengue fevers (DFs) and other febrile illness in epidemic areas with limited laboratory resources to help in prioritizing patients for emergency critical care. DF has become epidemic in India. Symptomatic dengue infection with any of the four serotypes of dengue virus can produce systemic and dynamic disease with a broad spectrum of illness with severe and nonsevere clinical manifestations. Subjects and Methods: A retrospective record-based study of 202 cases of suspected DFs were evaluated by ultrasound for a period of 18 months during epidemic in Radiology Department. All age groups were included in the study. Ultrasound of abdomen and chest performed in between 3rd and 10th day of fever. The data compiled by incorporating sonographic findings, clinical findings, and laboratory results. Laboratory data include serology and platelet count. Results: Ultrasound findings were analyzed, in comparison with clinical detection and laboratory results. Eighty-five percent were pediatric age group. The triad of ultrasound findings is stratified gallbladder wall thickening, 85.2%; ascites, 78%; and pleural effusions, 67.8%. Others are pericardial effusion 2.5%, hepatomegaly 9.1%, and splenomegaly 6.1%. Nearly 18.8% of severe dengue cases were observed. Detection of capillary leakage was 100% on ultrasound and 39.70% on thrombocytopenia. Eighty-six serology positive, 107 with no serology, and 6 seronegative cases were positive for ultrasound. Fifty-five percent isolated gallbladder edema is seen before thrombocytopenia. Conclusion: Ultrasound can be utilized as the mainstay of investigation in epidemic regions with infrastructure shortage. Early demonstration of serosal collection helps to grade DF to severe dengue and prioritize patients for critical care.
Sonographic evaluation of acute appendicitis and its complications
Objectives: The objectives of the study were to evaluate various sonographic findings in patients with clinically suspected acute appendicitis and its complications; to follow up and confirm sonographic findings by histopathological examination following surgery; and to determine the role of color Doppler sonography in acute appendicitis. Materials and Methods: One hundred patients clinically suspected to have acute appendicitis underwent ultrasound examination using high-resolution transducers; linear array transducers of 7.5–10 MHz and curvilinear transducer of 3.5–5 MHz. The presence of aperistaltic, noncompressible, blind-ended tubular structure with a diameter ≥6 mm in the right iliac fossa was the primary criterion for the diagnosis of acute appendicitis. Other findings such as the presence of appendicoliths, gas within the lumen of appendix, loculated collections, and appendicular phlegmon were also considered. Results: Out of 100 cases recruited for the study, 95 cases underwent surgical intervention in the form of immediate appendicectomy (89 patients), interval appendicectomy (four patients), or drainage of abscess(two patients). On histopathological/surgical correlation, true positive was 85, false positive – 1, true negative – 6, and false negative – 3. The observed sensitivity, specificity, positive predictive value, and negative predictive value of ultrasonography (US) in the diagnosis of acute appendicitis were 96.5%, 85.7%, 98.8%, and 66.7%, respectively, with an overall accuracy of 95.7%. In our study, 75% patients of appendicitis showed hyperemic color Doppler flow. Furthermore, the use of color and power Doppler sonography was more helpful in those patients where it was difficult technically to visualize the entire appendix. Conclusion: Grayscale US should be the first primary evaluation for patient suspicious of acute appendicitis, and color Doppler is an additional modality to increase sensitivity and more accuracy.
Normal ultrasound dimensions of newborn kidneys in Southwest Nigeria
Background/Aim: Accurate classification of renal size as normal and abnormal depends on precise knowledge of acceptable normal range for the population. Ultrasound (US) is an excellent tool for defining the norm and imaging neonates suspected with renal pathology because it is cheap, easy to perform, and harmless. Since the kidneys of neonates are distinct from those of older children and there is a paucity of data on normal renal size in neonatal population in sub-Saharan Africa, this study is to determine the normal range of renal size in a large cohort of Nigerian neonates. Materials and Methods: In a cross-sectional study of 528 apparently healthy neonates from two large hospitals in Ibadan, Nigeria, clinical examination and renal US scans were performed in the first 28 days of life. Renal length and width were correlated with somatometric parameters and chronological age of neonates. Nomograms with point-wise 95% reference ranges were also constructed. Results: Mean renal length and width were 4.31 ± 0.50 and 2.03 ± 0.28 and 4.33 ± 0.52 and 2.01 ± 0.31 on the right and left, respectively. Only the mean renal lengths were significantly different between males and females (P < 0.01) and there was no significant difference between the renal dimensions by sidedness. Body weight, chronological age, and to a minor extent, length were found to correlate positively with all renal dimensions. Conclusions: This study of a large neonatal population has provided the normal range of US renal dimensions for neonates in the study area, using the age and weight in plotting the 95% reference ranges for the renal nomogram.
Head computed tomography protocol audit and correction in two tertiary health institutions in Anambra State of Nigeria
Background and Objective: The optimization of patient protection in computed tomography (CT) requires the application of examination-specific protocols to ensure that the dose to each patient is as low as reasonably achievable. Appropriateness of a protocol reflects in the output of the volume CT dose index (CTDIvol) and dose-length product (DLP). This work aims to review and correct the likely weaknesses in default head CT protocols as a quality control measure. Materials and Methods: Departmental and Ethical Committee approvals were obtained. This retrospective study was undertaken between March and April 2016. The 75th percentile of the CTDIvol and DLP was calculated for 50 consecutive patients of both genders who were ≥18 years of age. On the CT console, radiographer (s)’ manipulation of each of the ten common components of default protocols was scrutinized and compared with predetermined standard values from literature. Observed deviations necessitated appropriate interventional measures. A second calculation of the 75th percentile of CTDIvol and DLP was done for another group of 50 patients. Both pre- and post-interventional values were compared with the 60 mGy (CTDIvol) and 1050 mGy-cm (DLP) recommended by the European Commission. Results: The pre - interventional CTDIvol and DLP outputs were 65 mGy/1634 mGy-cm (Center A) and 86 mGy/1786 mGy-cm (Center B) whereas the post - interventional values were 58 mGy/986 mGy-cm (Center A) and 60 mGy/1030 mGy-cm (Center B), respectively. Weaknesses noted in protocols were excessive scan range (≥15 cm), <1 helical pitch, >1 s gantry rotation time, absence of gap, erratic manual mA manipulation, and neglect of prospective dose chart. Some posteroanterior scanograms were also wrongly acquired at an azimuth of 0° (anteroposterior). Conclusion: CT dose output in our locality could be compared to the values of the European Commission if meticulous and regular dose audit and correction is implemented.
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