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ORIGINAL ARTICLES
Normal second and third trimester uterine and umbilical doppler indices among healthy singleton gestation Nigerian women
Ademola Joseph Adekanmi, Adebola Roberts, Abiodun Oludotun Adeyinka, Eric Okechukwu Umeh, Franklin Anor, Joseph Chidi Odo, Adeniyi Olorunfemi Fagbohun
January-June 2017, 24(1):1-7
DOI:10.4103/1115-3474.198078  
Background: Uterine and Umbilical artery Doppler ultrasound is an established and safe tool for quantitative analysis of the utero-placental and the feto-placental blood flow in pregnancy. Aim: To evaluate the Doppler indices in the uterine and umbilical arteries of healthy pregnant women. These will serve as baseline values in predicting impaired blood flow velocimetry in hypertensive disorders of pregnancy that leads to serious maternal and foetal health compromise. Methodology: This was a prospective longitudinal study in consenting singleton gestation women. The right and the left uterine arteries and the umbilical arteries were interrogated. Doppler parameters; Peak Systolic Velocity (PSV), End Diastolic Velocity (EDV), Resistive Index (RI), Pulsatility Index (PI) and the systolic to diastolic ratio(S/D) were obtained from each healthy pregnant indigenous Nigerian women. Pearson's correlation analysis of the relationship between these parameters and selected maternal demographic parameters was done. P < 0.05 was considered statistically significant. Results: The mean of the normal uterine and umbilical arteries values were different from most published reference values from other parts of the World. No correlation between these indices and maternal parameters were found in this study. Conclusion: Uterine and umbilical artery Doppler indices among normal indigenous pregnant African women are different from those from the developed World. Using other reference values may be inaccurate for pregnant women in our environment.
  33,370 18 -
Classification of midfacial fractures on computed tomography following head injury in a Nigerian population
Yvonne U Osuagwu, Abiodun O Adeyinka, Atinuke M Agunloye, Vicky N Okoje
July-December 2013, 20(2):74-83
DOI:10.4103/1115-1474.121098  
Background: Head injury is a global epidemic which results in fractures of the craniofacial region. Computed tomography (CT) is the gold standard in evaluating the head injured patient. The aim of this study was to assess the causes of head injury resulting in midfacial fractures and to characterize and classify the observed fracture patterns and associated findings on CT. Patients and Methods: Between 2006 and 2008, 300 consecutive patients with acute head injury were evaluated with a helical General Electric (GE CT/e) CT scan machine. Data reviewed included cause of injury, age and gender distribution, types of facial fractures sustained, and associated intracranial and soft tissue injuries. Results: The modal age group of the patients was the 30 to 39 year age group while the mean age was 32.78 years ± 18.51 standard deviation (SD) with a male: female ratio of 8:3. Abnormal CT scans were seen in 244 (81.4%) of the 300 patients studied. Of the 244 abnormal cases, 79 (32.4%) patients had midfacial fractures. The midfacial fractures were grouped according to the proposed classification. Most of the fractures involved the sinonasal complex (SNC; 47.3%), while the remainder was almost equally distributed in the zygomatico-maxillary complex (ZGMC; 24.4%) and orbital complex (OC; 28.3%). Subgroups were assigned depending on the associated CT findings including soft tissue swelling, cranial fractures, and intracranial abnormalities. Conclusion: Road traffic accidents (RTA) continue to be a major cause of head injury and midfacial fractures followed by falls and assault. We have described the CT findings in midfacial fractures following head injury in the study area and suggest a classification system for categorizing these fractures and associated findings.
  10,375 27 -
Current status of radiation oncology facilities in Nigeria
Sunday Adeyemi Adewuyi, Oladapo Babatunde Campbell, Kingsley Kayode Ketiku, Francis Abayomi Duronsinmi-Etti, Josbat Thomas Kofi-Duncan, Philip Chinedu Okere
January-June 2013, 20(1):30-36
DOI:10.4103/1115-1474.117909  
Background: An analysis of the current radiation oncology facilities status in Nigeria was conducted to establish a comprehensive baseline. Nigeria is the most populated African country with a population of at least 160 million people based on 2006 population census and average annual growth rate of 3.1%. It is also one of the least developed countries as regards radiation oncology resources with inadequate radiotherapy facilities. Many of the patients have little or no access to safe and modern radiation therapy. Purpose: To obtain a better understanding of the status of radiation oncological practices in Nigeria and to help sensitize the Nigerian government and its developmental partners on the way forward. Materials and Methods: The data were obtained mainly through surveys on the availability of major items of equipment and personnel which were conducted in September 2011. The study included only commissioned and functioning public radiotherapy facilities which are 5 in the country. Data were related to number and types of megavoltage machines, trained manpower (Radiation Oncologists, Medical Physicists, Oncology Nurses, Radiotherapy technologists, maintenance engineers and mould room Technicians), treatment planning systems TPS, Brachytherapy equipment, CT Simulator and Conventional simulators. Results: Of over 50 Tertiary Health Institutions (Teaching Hospitals and Federal Medical Centers) in the country, only 5 has Radiation Therapy facilities with 1 megavoltage machine each, 2 located in the north, 2 in the south and 1 in the Federal Capital Territory. The population served by each megavoltage machine ranges from 20 to 40 million per machine based on 2006 census. Most patients have little or no access to radiation oncology services. Some differences in equipment and personnel amongst centers were demonstrated and the shortage of radiation therapy resources was grossly evident. There are 18 Radiation Oncologists, 8 Medical physicists, 18 Radiotherapy technologists, 26 Oncology Nurses, 3 linear accelerators, 2 Co-60 machines, 2 orthovoltage therapy machines, 2 conventional simulators, 2 CT simulators, 2 centers with 3D TPS, 3 LDR and 1 HDR brachytherapy machines and 2 mould rooms. Some centers were found to treat patients without simulators or treatment planning system. Conclusion: A large deficiency exists for radiation oncological services in Nigeria. There are significant deficiencies in the availability of all components of radiation therapy in the analysed centers. Cognisance should be taken of the specific short falls in each centre to ensure that there is expansion of existing centers and creation of new centers especially in every geopolitical zone and major teaching hospitals in the country.
  9,568 25 3
CASE REPORTS
Classical case of tuberculous Epididymo-orchitis and how to rule out differentials on sonography
Nirmala Chudasama, Roopkamal Sidhu, Nilay Shah
January-June 2016, 23(1):32-35
DOI:10.4103/1115-3474.162153  
Tuberculous infection of the scrotum is rare and occurs in approximately 7% of patients with tuberculosis. With the rise in the human immunodeficiency virus pandemic, the incidence of opportunistic extrapulmonary tuberculosis has correspondingly increased, the genitourinary system being the most common affected site. We present a classical case of tuberculous epididymo-orchitis with clinical, sonographic and histopathological (macro and microscopic) findings as well as the precise management plan incorporated. The sonographic imaging overlap with bacterial epididymo-orchitis, malignant testicular lesions and testicular torsion is discussed. Adequate knowledge of this entity is of utmost importance to ensure a meticulous diagnosis and treatment.
  9,152 16 -
ORIGINAL ARTICLES
Sonographic evaluation of gallbladder dimensions in healthy adults in Benin City, Nigeria
Ademola A Adeyekun, Ikechukwu O Ukadike
January-June 2013, 20(1):4-8
DOI:10.4103/1115-1474.117901  
Background: Several disease conditions can affect gallbladder (GB) size and wall thickness (WT). Imaging methods are superior to clinical evaluation in assessing GB dimensions. Ultrasonography is a relatively safe, inexpensive and reproducible imaging modality for assessing normal or diseased GB. There are few reports on normal GB dimensions in the Nigerian medical literature. This study therefore set out to contribute to data on GB dimensions among Nigerians. Materials and Methods: This was a prospective study. Three hundred and twenty-two healthy adult volunteers, consisting of 133 males and 189 females were assessed, by ultrasound, following over night fasting. GB length, width, height and WT were measured for each subject. GB-V was calculated by the ellipsoid formula. Data analysis included descriptive statistics and comparison of measurements with biometric parameters. Statistical significance between the variables was done with the Students t-test, with 'P' value set at ≤0.05. Results: One hundred and thirty-three males (41.3%) and one hundred and eighty-nine females (58.7%) were studied. The mean age of subjects was 31.92±11.7 years. The mean values of the length (L), height (H), and width (W) of the GB were 6.16±1.09 cm; 2.75±0.58 cm; and 2.98±0.59 cm respectively. Mean GB-V was 27.2±12.8 cm 3 and WT 0.25±0.04 cm. Age and gender did not significantly influence GB measurements. Conclusions: A normal range of GB dimensions for the Benin City locality has been established. The study confirmed the non-dependence of GB measurements on age and gender.
  9,060 19 -
Analysis and economic implications of X-ray film repeat/reject in selected hospitals in Ghana
Eric Kwasi Ofori, William Kwadwo Antwi, Lawrence Arthur, Cofie Afua Yeboah, Klenam Dzefi-Tettey
January-June 2013, 20(1):14-18
DOI:10.4103/1115-1474.117903  
Background/Aims: Repeat of X-ray examinations contributes to the radiation burden of patient and waste of resources in most developing countries. This study determined the economic implications of repeated X-ray examinations in 10 selected hospitals in Ghana. Materials and Methods: The study was carried out in July, 2011 using a total of 2785 radiographs from 1685 patients (85.9% adult and 14.1% pediatrics). Of these, 944 (56.0%) were female and 741 (44.0%) male. Reject films were compiled and classified according to the reasons for the reject. Time and cost analyses due to the repeat examinations were also carried out. Results: Out of 2785 radiographs included in the study, 540 representing 19.4% were rejected. The overall reject rate for the individual hospitals ranged from 14.6% to 20.8%. The minimum time wasted by the radiographers in repeating examinations during the 1 month study was estimated to be approximately 135 h representing 17 working days in Ghana. The loss of revenue per month due to 540 rejected/repeated radiographs amounts to approximately $6021 equating to approximately $72,256/annum. Exposure error and poor patient positioning constituted between 52.0% and 23.0% respectively of the overall causes of film rejection and were evenly distributed across the hospitals. Conclusion: Consistent training in radiographic techniques and standardization of protocols as well as quality assurance measures in the hospitals could help overcome the reported exposure error and poor patient positioning and improve revenue savings.
  8,083 32 1
ARAWA 2012 PROCEEDINGS
ARAWA 2012 Proceedings

January-June 2013, 20(1):50-64
  7,943 21 -
CASE REPORTS
Imaging clues for exophytic liver lesions
Sheo Kumar, Basant Kumar, Rama N Sundarayan, Aneesh M Malal
January-June 2013, 20(1):41-44
DOI:10.4103/1115-1474.117905  
Preoperative diagnosis of the organ of origin in cases of exophytic lesions of liver is difficult and a challenge for the radiologist and clinicians. It needs careful examination and interpretation of radiological findings for correct diagnosis. We present our experience with exophytic liver lesions in four patients diagnosed with hepatocellular adenoma, hepatocellular carcinoma (HCC), cavernous hemangioma, and hydatid cyst, and highlighted these issues.
  7,492 21 -
Right renal pelvic calculus mimicking an extrarenal pelvis
Olalekan Ibukun Oyinloye, Mutiu Oladapo Atobatele, Mohammed Saliu Ibrahim
July-December 2014, 21(2):99-101
DOI:10.4103/1115-1474.134623  
A 57-year-old man presented with recurrent intermittent colicky right flank pain of 1-year duration. Intravenous urogram (IVU) on two separate occasions suggested a right-sided, extrarenal pelvis. However, when pain became recurrent and persistent, he had a non-contrast computed tomography (CT) examination, which revealed a calculus in the renal pelvis. Diagnosis was missed in the initial imaging modalities because apart from the dilated pelvis, there was no evidence of hydronephrosis or calculus seen, hence a diagnosis of extrarenal pelvis. This case report highlights the superior utility of CT in imaging of suspected urolithiasis, especially when the patient remains symptomatic. Radiologists should be wary, especially in symptomatic patients with features of extrarenal pelvis on IVU.
  6,857 20 -
ORIGINAL ARTICLES
Pattern of urinary bladder sonographic findings in patients evaluated for urinary schistosomiasis
Sadisu Mohammed Ma'aji, Bappa Adamu
July-December 2015, 22(2):92-96
DOI:10.4103/1115-3474.164865  
Background: Urinary schistosomiasis is one of the neglected tropical diseases. Of the 239 million people with active Schistosoma infections in 2009, 85% lived in sub-Saharan Africa. The urinary bladder is the main site of pathologic damage in patients with urinary schistosomiasis. Objectives: The objectives were to study the prevalence and pattern of sonographic bladder abnormalities in patients evaluated for urinary schistosomiasis. Materials and Methods: All consecutive patients being evaluated for urinary schistosomiasis at the Usmanu Danfodiyo University, Teaching Hospital Sokoto and Federal Medical Centre Birnin Kebbi were prospectively scanned at radiology departments of the two centers. All the patients were scanned with Apogee 800 plus (Japan 2002) and Concept D (Dynamic Imaging Scotland) ultrasound scanners with a variable frequency probes at 3.5–5 MHz. Doppler was used to assess the vascularity of urinary bladder masses, and to differentiate between masses and blood clots which is a diagnostic challenge when using brightness mode (B-mode) sonography alone. The gain was set correctly to allow good visualization of the bladder and adjacent structures. Transverse images are obtained in the true axial plane and angled caudal to show the bladder base. Longitudinal and oblique sagittal images are obtained to complete the examination. All the ultrasound findings and images were recorded as hard copies, and the films were reviewed by a qualified radiologist. The results were analyzed using statistical software SPSS 17.0 for windows. Results: We evaluated a total of 107 patients. The mean age of the patients was 42.9 ± standard deviation 16.8 years, with a range between 7 and 86 years. There were 84 males accounting for 78.5% and 23 females accounting for 21.5%. Abnormal sonographic findings were seen in 101 (94.4%) of patients evaluated. Urinary bladder stone with wall thickening was the most common finding accounting for 37 (36.4%), followed by bladder wall thickening with internal echoes accounting for 32 (21.5%) of the patients. The incidence of irregular bladder mass was 15 (14.0%) while polypoidal mass accounted for 4 (3.7%). Contracted bladder with wall calcification was seen in 7 (6.5%) while no abnormalities were seen in the urinary bladder in 6 (5.6%) of the patients. Conclusion: Abnormal bladder sonographic findings are common in patients evaluated for signs and symptoms of urinary schistosomiasis in North-Western Nigeria, with a prevalence of 94.4% in this current study. Urinary bladder stone with wall thickening followed by bladder wall thickening with internal echoes were the most common findings accounting for 58% of the findings. These sonographic abnormalities should raise the suspicion of urinary schistosomiasis in an endemic region.
  6,837 12 -
Radiotherapy in Nigeria: Current status and future challenges
Kenneth Chima Nwankwo, David A Dawotola, Vinay Sharma
July-December 2013, 20(2):84-88
DOI:10.4103/1115-1474.121099  
Aims: Incidence of cancer is on the increase and the greater proportion of that increase is from developing countries. About 50-60% of the cancer cases will require radiotherapy at least once during the course of the treatment. This paper is an effort to appraise the present radiotherapy capacity to treat cancer in Nigeria and to project its future challenges and development. Materials and Methods: The available radiotherapy centers in Nigeria were identified and information about the types and number of radiotherapy equipments, imaging systems, personnel, and training capacity were obtained. Results: In 2001, there were five radiotherapy centers with six megavoltage therapy machines in Nigeria comprising of five cobalt-60 and one linear accelerator. The population of the country then was 120 million, that is, one therapy machine for a population of about 20 million. By the end of 2010 the number of megavoltage therapy machines has reached eight with one therapy machine situated in each of eight radiotherapy centers, but the population has equally increased to more than 155 million giving only a marginal improvement in the radiotherapy service. Conclusion: There has been an increase of radiotherapy centers in Nigeria however, the number of available facilities is grossly inadequate and there is dearth of trained personnel. Careful and strategic planning is needed to develop manpower capabilities in all fields of specialization related to radiotherapy service in order to adequately care for the multitude of cancer patients.
  6,812 25 6
Intracranial cystic tumors with a mural nodule: Conventional, diffusion tensor and perfusion magnetic resonance imaging findings
Mboka Jacob, Seung-Koo Lee
January-June 2016, 23(1):1-6
DOI:10.4103/1115-3474.164866  
Introduction: Intracranial cystic tumors with mural nodule have been extensively studied. None of these studies have established the role of conventional, fractional anisotropy diffusion tensor imaging (FADTI) and dynamic susceptibility contrast magnetic resonance imaging (MRI) in the assessment of grade and type of cystic brain tumors with a mural nodule. Materials and Methods: This was a retrospective cross-sectional study, which was conducted at Severance Hospital. Brain MRI of 15 consecutive patients with a cystic brain tumor with a mural nodule was analyzed. Results: Among the 15 studied patients 11 were females. The age ranged from 12 to 54 years. Six of the patients had high-grade tumors. Most five of the high-grade tumors showed cystic wall contrast enhancement while none was found among the low-grade group. All high-grade tumors showed increased regional cerebral blood volume (rCBV) compared to three of low-grade tumors. Hemangioblastomas, glioblastoma multiforme (GBM) and the primitive neuroectodermal tumor showed increased rCBV while pilocytic astrocytoma, ependymoma, and ganglioglioma showed decreased rCBV. There were no difference in fractional anisotropy (FA) values between tumor grades and types. Conclusion: Postcontrast T1-weighted image and perfusion MRI showed in this study to be very useful in differentiating high- and low-grade cystic tumors with the mural nodule. FA values added no benefit to tumor differentiation. Hemangioblastoma was the only tumor with increased rCBV among low-grade tumors. GBM, which is a malignant tumor, can present as a cystic lesion with a mural nodule.
  5,710 18 -
Cross-sectional study on incidental spinal findings in magnetic resonance imaging lumbar spine of patients with low back pain
Binoj Varghese, Arun C Babu, Ashok Kumar, PS Priya, Jaison S John, Mohammed Noufal, KM Sivasubramaniyan
January-June 2017, 24(1):38-44
DOI:10.4103/1115-3474.198091  
Background: Incidental finding is an observation, not related to the current medical problem. Various incidental findings can be seen in the lumbar spine (LS) magnetic resonance imaging (MRI) taken for evaluation of low back pain. Aims: To evaluate and analyze the spinal incidental findings in MRI LS of patients with low backache. Settings and Design: A retrospective, cross-sectional analytical study. Materials and Methods: All patients (n = 1269, males: 578, females: 691; mean age: 45 ± 15 years) with low backache, who underwent MRI of the LS at a tertiary care hospital in South India, during a period from January 2011 to August 2015. Two radiologists evaluated these examinations for the presence of incidental findings in consensus. We included fatty vertebral hemangioma (FVH), fatty filum terminale (FFT), extraspinal synovial cyst (SC), Tarlov cyst (TC), enostosis, and limbus vertebrae. Statistical Analysis Used: Calculated the prevalence of incidental findings and analyzed the relationship of these incidental findings with patient demographics. Results: Overall, incidental spinal findings were present in 390 patients (30.7%). FVH was the most common incidental finding (n = 205 patients, 16.16%), followed by extraspinal SC (n = 130 patients, 10.2%), and FFT (114 patients, 9%). A pattern of increasing frequency with age noted in the FVH (P = 0.001), TC (P = 0.017), and enostosis (P = 0.008). There was no significant sex predilection for the incidental findings. Conclusion: Incidental findings are common in LS MRI. Understanding on the nature and prevalence of these lesions is essential for the radiologist, for optimal reporting and for the clinician in appropriate interpretation of radiological reports.
  5,653 18 -
CASE REPORTS
Avascular necrosis of both femoral heads following short-term high-dose steroid treatment for acute severe asthma - A rare presentation: Case report and review of literature
Philip Oluleke Ibinaiye, Abubakar Mohammed Musa, Samuel Olorunfemi David, Philip Chinedu Okere
July-December 2013, 20(2):104-106
DOI:10.4103/1115-1474.121103  
A 50-year-old patient who had acute severe asthma presented with avascular necrosis (AVN) of both femoral heads 6 months after short-term high-dose steroid therapy. The use of steroids on a long-term basis can cause AVN of the bone which also occurs in various diseases. A variety of traumatic and nontraumatic factors contribute to the etiology of AVN although long-term exogenous steroid administration and alcoholism are among the most common nontraumatic causes. AVN of both femoral heads presenting after short-term high-dose steroid treatment for acute severe asthma is rare in medical literature; thus, prompting the present case report.
  5,640 24 -
ORIGINAL ARTICLES
Normative measurements of the ocular globe position in relation to interzygomatic line, using magnetic resonance imaging among adults in Zaria, Nigeria
Joshua Oluwafemi Aiyekomogbon, Nuhu D Chom, A Umdagas Hamidu, AL Rafindadi, Philip Oluleke Ibinaiye, Joseph Bako Igashi
July-December 2016, 23(2):118-123
DOI:10.4103/1115-3474.187970  
Introduction: Proptosis and enophthalmos are cardinal signs of many orbito-ocular and systemic diseases which are common in our environment. The need for an imaging parameter that will aid its early diagnosis is necessary as visual compromise is a major consequence if they are not diagnosed and managed early. Aim and Objectives: This prospective study was aimed at using magnetic resonance imaging (MRI), to determine interzygomatic distance, distance between the anterior and posterior borders of the globes and the interzygomatic line (IZL), and then using these parameters to determine the normal position of the ocular globes within the orbits. Methodology: The study was conducted within 6 months spanning November 29, 2011-May 28, 2012, at the Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria. The distance between anterior border of the globe (corneal apex) and IZL which is referred to as Hertel-index, distance between posterior border of the globe and IZL, and length of the IZL were measured at the level of the lens for 340 normal ocular globes of 170 patients on T1-weighted MRIs. Results: The normal ranges for the orbital measurements are as follows (mean ± standard deviation): The normal position of the posterior pole of the right globe was 6.34 ± 0.99 mm from IZL (ranged 5.40-7.33) while that of the left globe was 6.56 ± 0.93 mm (ranged 5.63-7.50). All measurements in male patients were significantly higher than those in female patients (P < 0.001) and the position of the right globe within the orbit was significantly different from that of the left for both sexes (P < 0.001). Conclusion: The results obtained from this study may help ophthalmologists, radiologists, and other clinicians to quantitatively evaluate patients with enophthalmos, exophthalmos, or other changes in the orbital morphology.
  5,323 19 -
CASE REPORTS
Acute calcific tendinitis of longus colli: An uncommon cause of acute neck pain
N Gopinath Thandre, Shaji Padinjatel, Krishnakiran Karanth, Jagdish Jagalpathy
January-June 2014, 21(1):38-41
DOI:10.4103/1115-1474.128087  
Acute calcific tendinitis of the longus colli muscle is an inflammatory condition associated with calcifications in longus colli muscle fibers which can present as acute neck pain. We present a case of a patient presenting with acute neck pain. MRI showed retropharyngeal effusion and edema of the left side longus colli muscle. CT showed amorphous calcifications in prevertebral region at C2 level which is a characteristic finding. Effusion in left lateral atlantoaxial joint is an uncommon associated finding in this condition which was seen in this case. It is important to recognize imaging features to prevent unnecessary investigations and surgical intervention.
  5,020 19 -
Neonatal intestinal obstruction: A case of jejunal and colonic atresia with micro colon
Suwaid Mohammad Abba, Anas Ismail, Dambatta Abdullahi Hamisu
January-December 2012, 19(1):14-16
DOI:10.4103/1115-1474.112519  
Congenital intestinal atresia is a common cause of neonatal intestinal obstruction. Intestinal obstruction from jejunal and colonic atresia is rare. The etiology of intestinal atresia is mainly from abnormal morphogenesis; mainly, from an intra-uterine vascular insult. This case underscored the value of imaging to allow for early detection, determine the extent of the lesion possible associated anomalies and come up with possible differential diagnoses. A 2-day-old baby presented with clinical signs of lower intestinal obstruction suspected to be hischsprungs disease. Barium enema, however, showed features of jejunal and colonic atresia with extensive micro colon, which were confirmed and corrected at surgery.
  4,964 21 -
MRI features of multiple system atrophy
Sumantro Mondal, Sumit Chakraborty, Atanu Chakraborty, Debanjali Sinha, Tony Ete, Arijit Nag
January-June 2014, 21(1):35-37
DOI:10.4103/1115-1474.128086  
Multiple system atrophy (MSA) is a synucleinopathy, characterized by combined manifestations of cerebellar, parkinsonian, and autonomic features. It is subdivided into two main types-parkinsonian MSA (MSA-P) and cerebellar MSA (MSA-C). Magnetic resonance imaging (MRI) of the brain is a valuable tool in diagnosing this condition as it shows many characteristic features, such as the 'hot cross bun' sign. This is a cruciform hyperintensity imaging feature, seen at the level of pons in axial T2-weighted MRI images. This sign is typically seen in patients with MSA-C. This reported case describes a patient with MSA-C with characteristics brain MRI features.
  4,953 19 -
ORIGINAL ARTICLES
Normal pediatric lumbar lordosis: Measurement of magnitude and age of maximum development using three radiographic techniques
Francis Osita Okpala
July-December 2016, 23(2):82-88
DOI:10.4103/1115-3474.172093  
Background: A retrospective measurement of lumbar lordosis (LL) in normal supine lateral lumbosacral spine radiographs of 27 children aged 0.04-14.00 years. Measurement of the LL may aid in the early diagnosis and management of some pediatric conditions before irreversible neurologic change occurs. They include spondylolisthesis (congenital or acquired); achondroplasia and muscular dystrophies are less common. The sagittal radiographic lumbar lordotic angle is poorly documented in normal pediatric population. Objective: To evaluate the magnitude and age of maximum development of the normal pediatric LL using three different radiographic techniques. Methods: Ferguson (for lumbosacral angle [LSA]), Cobb (for Cobb angle) and tangential radiologic assessment of LL (for TRALL angle) were the methods used. Data were analyzed with SPSS statistics version 20.0 (Chicago, IL, USA). P < 0.05 was considered significant. Results: LSA varied from 15° to 62°, Cobb angle 15-65° and TRALL angle 20-46°. The mean (standard deviation) of LSA, Cobb, and TRALL angles were 35.8 (10.3)°, 35.6 (13.7)°, and 32.3 (7.3),° respectively; the 0.95 confidence interval for the LSA was 27.6-44.5°, Cobb angle 27.2-50.7°, and TRALL angle 26.8-40.1°. Each angle showed no significant gender difference. The major part of estimated adult LL was gained during the first 5 years of life; the second peak occurred in the 11-14 years age-group. Conclusion: In children under 15 years, poor management of pathologies affecting LL can cause irreversible neurologic damage arising from spinal deformity.
  4,806 37 -
CASE REPORTS
An unusual case of rib anomalies in number and morphology with association of vertebral and sternum anomalies: Computed tomography diagnosis
Dharmraj Meena
July-December 2015, 22(2):101-104
DOI:10.4103/1115-3474.162159  
A significantly less number of ribs with multiple developmental anomalies in ribs, spine, and sternum is very rare anomaly. We report a case of a 50-year-old man with 15 number of ribs, absent first, second, fourth, seventh and eleventh ribs on the left and absent first, third, eight and tenth ribs on the right side, along with a bifid anterior end of the left sixth rib, fused posterior ends of right fifth and sixth ribs, and bilateral hypoplastic 12th ribs. These anomalies were also associated with thoracolumbar block and hemivertebrae as well as a small sternum. All findings were identified incidentally on computed tomography. No similar type of rib anomalies was found in previous literature. We discuss the details of this case, and suggest a perspective of morphology and developmental biology.
  4,816 13 -
ORIGINAL ARTICLES
The role of ultrasound and magnetic resonance imaging in the evaluation of musculotendinous pathologies of the shoulder joint
Shoubhi Bhatnagar, Rajesh Kuber, Digish Shah
July-December 2014, 21(2):68-74
DOI:10.4103/1115-1474.134611  
Aim: To evaluate and characterize the musculotendinous pathologies of shoulder joint using ultrasound (USG) and magnetic resonance imaging (MRI). Background and Objectives: The glenohumeral joint, being the most mobile and unstable of all the joints, is often prone to injuries. To compensate for its unstable bony anatomy, the shoulder is protected anteriorly, posteriorly, and superiorly by a capsule and tendons that form the rotator cuff. Sonography is often considered the first-line imaging modality in the assessment of cuff as well as in nonrotator cuff disorders. MRI is of value in cases of extensive abnormality that is often incompletely characterized by the initial sonographic examination, as in case of sonographically inaccessible areas. However, musculoskeletal imaging is truly a multimodality approach and in order to identify and characterize the lesion, a combination of modalities should be used. Materials and Methods: A prospective study was carried out on 75 patients in the Department of Radiodiagnosis, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune over a period of 2 years from July 2011 to September 2013. Patients from all age groups including both men and women with shoulder pain, suspected to be arising from the musculotendinous tissues of the shoulder joint, were taken up for study. Results: In our study, USG showed a sensitivity of 95.2%, specificity of 88.8%, and positive predictive value of 80% for demonstrating full-thickness tears. In case of partial-thickness tears, USG showed overall sensitivity of 94.7%, specificity of 85.7%, and positive predictive value of 90%. Overall accuracy of USG in detecting full-thickness as well as partial-thickness tears was 91%. Conclusion: In patients with shoulder complaints, USG is a reliable dynamic diagnostic tool. It reveals high diagnostic accuracy in detecting rotator cuff pathologies including cuff tears and tendinopathy. However, MRI has always been successful in overall assessment of joint structure. Its ability to evaluate labrum and various glenohumeral ligaments cannot be superseded by USG.
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CASE REPORTS
Endovascular treatment of celiac artery aneurysm using detachable vascular plugs
Arun Gupta, Ajit Kumar Yadav, Hirenkumar Kamleshkumar Panwala, Abhishek Agarwal, Buxi TBS, KK Saxena
July-December 2013, 20(2):110-112
DOI:10.4103/1115-1474.121105  
Aneurysm of the celiac trunk is one of the rarest forms of splanchnic artery aneurysm. Untreated lesions enlarge progressively and may rupture spontaneously. Treatment of the celiac artery aneurysm is usually done by surgery or percutaneously by coil embolization. Presented is a case of 85-year-old man who sought care for a celiac trunk aneurysm detected on Doppler examination and confirmed by computed tomographic angiography. Patient underwent successful embolization using detachable vascular plugs.
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ORIGINAL ARTICLES
Sonographic evaluation of acute appendicitis and its complications
Soniya Daga, Sushil Kachewar, Dilip L Lakhkar, Kalyani Jethlia, Abhijeet Itai
July-December 2017, 24(2):152-156
DOI:10.4103/wajr.wajr_41_16  
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.
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First trimester sonographic dating formula for the Nigerian obstetric population
Victor Oyenkekaibe Oboro, Temitope Olugbenga Bello, Ayodeji Olaolu Oyeniran
January-December 2012, 19(1):1-4
DOI:10.4103/1115-1474.112515  
Objective: The main purpose of this study is to derive a dating formula for the Nigerian obstetric population, quantify its prediction error, and compare its performance with existing published formulae. Materials and Methods: The crown-rump length (CRL) of 322 fetuses without risk for fetal growth restriction were plotted against menstrual age to obtain a scatter plot from which we derived the best-fit fractional polynomial regression model for estimating gestational age (GA). The accuracy of the formula was compared with that of existing formula in another data set of 88 fetuses. Results: The scatter plot yielded a best-fit equation for the estimation of GA (in weeks) from CRL (in mm) as GA=−0.0008 (CRL2) + 0.168 CRL + 5.397, (R2=0.8017). The mean prediction error was 0.13 for our formula, and 0.16 and 0.20 for Nelson's, and Robinson's formulae, respectively. Conclusion: Our dating formula locally derived was more favorably applicable for the Nigerian population. This has implication for prenatal diagnosis in Nigeria.
  4,523 19 -
Secondary lumbar spondylosis in University of Uyo Teaching Hospital, Uyo, Nigeria: Radiographic correlation with incidence and concomitant discovertebral pathologies
Felix Uduma Uduma, Dianabasi U Eduwem, Philip Chinedu Okere
July-December 2013, 20(2):96-100
DOI:10.4103/1115-1474.121101  
Introduction: Lumbar spondylosis is an age-related degenerative disk disease of the lumbar spine. It could be preceded by known discovertebral lesions resulting in secondary lumbar spondylosis. Objectives: To determine the incidence of secondary lumbar spondylosis using lumbosacral radiographic evaluations. Study Designs/Settings: A cross-sectional prospective study. Radiology Department, University of Uyo teaching hospital, Uyo, Nigeria. Patient Sample: Two hundred and sixty-two patients. Outcome Measured: Pathologies are evaluated based on features seen on twin lumbosacral radiographs that demonstrate secondary spondylosis. Materials and Methods: Anterior-posterior and lateral plain radiographs of patients were done under standardized conditions. Studied period was 1 st May, 2011 to 12 th July, 2012. Results were analyzed using SSPS 13. computer package. Results: A total of 262 patients aged 10-89 years with mean age of 48.9 and standard deviation of 25.4 were studied. Males were 138 and females were 124. 173 patients constituting 66.03% of the studied population had lumbar spondylosis. A total of 57 patients (female to male ratio − 1.36:1) had secondary lumbar spondylosis. This constituites 32.95% of population with spondylosis. Secondary lumbar spondylosis was commonest in the 4 th to 6 th decade. A total of 17.54% of patients with secondary spondylosis were younger than 40 years. The commonest associated pathology was spondylolisthesis, n=25 cases (43.86%) with female predominance. The least were septic spondylitis and trauma (1.75% each). Other conditions were osteoporosis, metastasis, lumbarization, spina bifida, and Pott's disease. Conclusions: The commonest coexistence with lumbar spondylosis in Uyo, Nigeria is lumbar spondylolisthesis.
  4,205 18 -
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