MRI TRAINING IN AFRICA.

Introduction: This article presents an overview of MRI training in Africa, emphasizing its current status and the obstacles it encounters, with a report from a recent MRI workshop held in Uganda in September 2022. Africa's medical imaging sector faces unique challenges due to limited access to advanced technology, skilled professionals, and educational resources. While some regions have made notable strides in establishing MRI training programs, others struggle with a shortage of qualified MRI technicians and radiologists. These disparities underscore the urgent need for a more equitable distribution of resources and expertise across the continent. The aim of the MRI workshop was to initiate actions to address these challenges. This workshop leveraged the expertise of MRI clinicians and scientists to devise strategies for enhancing MRI training in Africa. The report outlines the key outcomes, recommendations, and initiatives resulting from this collaborative endeavor. Conclusion: This report offers a crucial overview of MRI training in Africa, highlighting its challenges and disparities. It emphasizes the necessity of coordinated efforts to improve MRI education, ultimately contributing to enhanced healthcare outcomes for Africa's population.

RETROSPECTIVE EVALUATION OF MRI PATTERN OF GLIOBLASTOMA IN A TERTIARY HOSPITAL IN NIGERIA.

Introduction: Malignant gliomas, especially glioblastomas, are among the most aggressive and devastating of cancers, commonly producing profound progressive disability and leading to death in most cases. Conventional magnetic resonance (MR) imaging with gadolinium-based contrast agents is the most widely established and most useful tool in the characterization of cerebral tumors including Glioblastomas. This study aims to describe the imaging characteristics of Glioblastoma in African patients using conventional MR imaging. Methodology: This was a retrospective cross-sectional study carried out at a Nigerian tertiary hospital. The demographic data, MR images and reports of patients with imaging and histological diagnosis of Glioblastoma between January 2003 and September 2017 were retrieved and reviewed. All the recorded data were analyzed using simple proportion and descriptive statistics with the Statistical Package for Social Sciences (SPSS) version 20.0 software for Windows. Results: One hundred and twenty-two (122) patients had brain tumors during the review period, out of which 14 (11.5%) had histologically confirmed glioblastoma. The male- to -female ratio was 2.5 to 1.0. The age ranged between 14 and 72 years with a mean age of 49.6 years SD ±16.3. Twelve (85.7%) patients had solitary tumors and 2 (14.3%) had multiple tumors. Six (42.9%) were found on the right hemisphere only, 5 (35.7%) were found on the left hemisphere while 3 (21.4%) traversed both hemispheres. All tumors showed inhomogeneous enhancement and significant midline shift to the contra-lateral side of greater than 3mm. Only 1 (7.1%) tumor showed evidence of intra-tumoral bleed detected on T2* sequence. Conclusion: Glioblastoma is a known aggressive brain tumor with unique MR imaging characteristics. While midline shift is typical, intra-tumoral bleeding may be an uncommon finding at presentation in our center.

DELAYED DIAGNOSIS OF AVM PRESENTING WITH STROKE AND SEIZURES IN A YOUNG NIGERIAN: A CASE REPORT.

Background: Brain arteriovenous malformations (BAVM) are a cause of intracerebral haemorrhage (ICH) and seizures especially in young patients. ICH due to BAVMs seem to have relatively better neurologic outcomes compared to other causes of spontaneous ICH as patients often recover fully. In this report we highlight a case of delayed diagnosis of BAVM in a young man who presented with seizures and stroke. Case summary: A 36-year-old man was referred on account of focal, secondarily generalized tonic clonic convulsions. He had suffered a right ICH 3 years before the index presentation. His general physical and neurologic examination were normal. Electroencephalography revealed right sided focal epileptiform discharges and brain MRI revealed a right parieto-occipital AVM. The seizures were controlled with carbamazepine and he was referred for neurosurgical evaluation. Conclusion: BAVMs are an important cause of intracerebral haemorrhage and attendant neurologic morbidity especially in young individuals. Neuroimaging plays a central role in BAVM diagnosis and MRI is of great value where facilities and expertise for conventional angiography do not exist. In some instances, delayed presentation of BAVM cases may be due to relatively better neurologic outcomes in BAVM-related ICH.

Pattern and outcome of prenatally diagnosed major congenital anomalies at a Nigerian Tertiary Hospital.

INTRODUCTION: The prevalence of major congenital anomalies (CAs) shows wide variations depending on geographical location and may range from <1% to 8% and it causes between 20% and 30% of perinatal deaths. In Nigeria, the prevalence of CAs may be underestimated with the general reliance on mostly livebirths ranging between 0.5% and 2.8% exempting cases of miscarriage and abortions. The purpose of this study was to determine the epidemiologic pattern and outcome of major CAs detected prenatally at the University College Hospital, Ibadan, Nigeria, over a 4-year period. METHODS: This hospital-based descriptive study highlights the prevalence and pattern of prenatally diagnosed fetal anomalies among the pregnant women who presented for routine prenatal ultrasound screening within the study period. Demographic details, associated risk factors, and fetal anomaly type in the fetuses were recorded using a prepared pro forma and were analyzed. RESULTS: Prenatal ultrasound screening for fetal anomalies was performed on 989 fetuses (including 15 sets of twins and 1 set of triplets) during the study period, out of which 62 (6.3%) had CAs. Of the 62 with CAs, 37 (59.7%) were major and 25 (40.3%) were minor. Majority of the fetuses with major anomalies were found among women aged 30-34 years and most were detected during the routine 18-22 weeks' anomaly scan. The major anomalies were most common in central nervous system. Nine (14.5%) pregnancies were terminated before term and 8 (29.6%) babies had different postnatal surgical interventions. Eleven (17.7%) of the fetuses with anomalies died in the perinatal period. CONCLUSION: CAs remain a major contributor to perinatal morbidity and mortality in Nigeria. Since most are idiopathic, early prenatal detection with ultrasound may facilitate improved diagnosis and the reduction of overall perinatal morbidity and mortality in the Nigerian setting.

Routine prenatal ultrasound anomaly screening program in a Nigerian university hospital: Redefining obstetrics practice in a developing African country.

BACKGROUND: Congenital anomalies are among the leading causes of fetal and infant morbidity and mortality worldwide. Prenatal ultrasound (US) screening has become an essential part of antenatal care in the developed world. Such practice is just evolving in the developing countries such as Nigeria. The aim of this article is to present our initial experience and demonstrate the effectiveness of a prenatal US screening program in detecting congenital malformation in a developing country. MATERIALS AND METHODS: This was a prospective evaluation of the prenatal US screenings conducted at a major referral hospital in Southwestern Nigeria. All pregnant women referred to the antenatal clinic for mid-trimester screening during the period of study were assessed. RESULTS: Two hundred and eighty-seven pregnant women (5 with twin gestations) were presented for fetal anomaly scan during the study period. Twenty-nine anomalies (9.9%) were detected among the scanned population. Sixteen of the anomalies were followed to delivery/termination with a specificity of 93.5%. The commonest malformations were demonstrated in the genitourinary tract (34.5%) followed by malformations within the central nervous system (27.6%). Six (20.6%) of the anomalies were lethal. Five of the anomalies were surgically correctable. CONCLUSION: Institutions and hospitals across Nigeria and other low- and middle-income countries need to develop policies and programs that would incorporate a standardized routine screening prenatal US in order to improve feto-maternal well-being and reduce the high perinatal mortality and morbidity in developing nations.

TIME OF PRESENTATION OF STROKE PATIENTS FOR CT IMAGING IN A NIGERIAN TERTIARY HOSPITAL.

BACKGROUND: Neuroimaging is the cornerstone for guiding thrombolytic and interventional therapy for stroke. Beneficial outcome can only be obtained within a rather short time of less than 3-4.5 hours of symptom onset. Challenges in developing countries like Nigeria often lead to delayed presentation of stroke patients in hospitals. We sought to study the time and pattern of presentation of stroke patients for CT imaging in a Nigerian tertiary hospital. METHODS: Of the 271 stroke patients who had cranial CT between 2008 and 2010, eighty-three (30.6%) with full retrievable CT records, were included in this study. They were categorized into six time groups cross-tabulated with their CT findings. RESULTS: Forty-two patients (50.6%) had cerebral infarction while 23 (27.7%) had haemorrhagic stroke. However, 18 (21.7%) patients had apparently normal CT findings. The mean presentation time for CT imaging was 70 hours (SD ±94 hours). Only 31% of all stroke patients presented for CT imaging within 12 hours, and none, within 3 hours. Forty-six percent did not present within 24 hours of symptom onset. Significantly more patients with ischemic stroke (72.3%) than hemorrhagic stroke (27.7%) presented after 12 hours of ictus (X(2) = 4.027 d=1, P =0.045). Age (X(2)=0.008, P =0.931) and gender (X(2)1.742, d=1,P =0.187) had no statistically significant relationship with the time of presentation for CT imaging. CONCLUSION: None of our patients met the time criteria for thrombolytic therapy. Ischemic stroke patients presented for imaging later than patients with intracerebral haemorrhage. There is a need to increase the awareness regarding early recognition, presentation and diagnosis of stroke for timely intervention in Nigeria.

Computed tomography measurement of extra-ocular muscle diameters in a population of normal patients in a tertiary hospital in Nigeria.

BACKGROUND: Measurements of extraocular muscle diameter may be useful in diagnosis and as an outcome indicator in the assessment of treatment options in thyroid-associated ophthalmopathy. Racial differences are known to account for craniofacial variations and orbital sizes. OBJECTIVE: To determine the normal diameters of extra-ocular muscles using computed tomography in a homogeneous, group of hospital patients in a tertiary hospital in Nigeria. MATERIAL AND METHOD: The maximum diameters of extra-ocular muscles were measured for 182 normal patients on thin slice reconstructed coronal computed tomography images. The effects of age and sex were determined. RESULT: Normal ranges for the diameters (mean + 2 SDs) of extraocular muscles were 4.5 + 1.2 mm for medial rectus, 4.9 + 2.1 mm for lateral rectus, 4.8 + 1.6 mm for inferior rectus and 4.0 + 1.5 mm for the superior group. The mean diameter of the extra-ocular muscles of male patients was not significantly larger than that of female patients (p > 0.05). There was a small but positive correlation between age and diameter of each extra-ocular muscle except in the left medial rectus and right lateral rectus muscles (P < 0.05). CONCLUSION: These normative values may serve as radiological reference values in the assessment of changes in size and suspected enlargement of the extraocular muscles in Nigerian patients. They may also be extrapolated to other Black African patients, until population studies become available.

CT-guided percutaneous transthoracic lung biopsy: first experience in Ibadan, Nigeria.

Percutaneous lung biopsy had been described in the nineteenth century by Leyden, but image- guided needle chest biopsy only gained widespread acceptance in the 1970s. Currently, tissue sampling of a thoracic lesion is indicated when the diagnosis cannot be obtained by the non-invasive techniques and cytological diagnosis will modify the stage of the disease or influence the therapeutic strategy. Cytology obtained by small-gauge needle aspiration biopsy confirms the nature of the lesion in 80 - 95% of cases and carry a low incidence of major complications. The purpose of this report was to provide information on our first experience with CT-guided biopsy and show that with some innovativeness much can be achieve with limited resources and good team work. We performed a CT of the thorax using appropriately placed improvised metal markers, which determined the optimal cutaneous entry point. We then re-checked the location of the lesion scanning intermittently at 5mm slice thickness; we marked the entry point with a pen and cleaned the surface with methylated spirit. A local anaesthetic was subcutaneously injected around marked area. We used a 21G aspiration needle to obtain cytology sample then 18G Trucut biopsy needle to obtain histology specimen. The length of the needle was chosen based on predetermined distance of the target lesion from the skin estimated from the CT images. Our patient was a 51-year-old Nigerian female with a peripherally located nodule in the posterior aspect of the right lung. She had CT-guided biopsy of the nodule. The procedure was well tolerated with no complication of pneumothorax. The histology report provided the basis for treatment regimen. Our experience indicates that percutaneous transthoracic CT-guided needle biopsy is feasible and a safe procedure in our hospital for evaluation of undetermined lung lesions.

Low field MR imaging of sellar and parasellar lesions: experience in a developing country hospital.

BACKGROUND: Magnetic resonance imaging (MRI), an advancement which followed computed tomography (CT) is expensive and inaccessible in most developing countries. However it is the procedure of choice in evaluating sellar and parasellar lesions. Its major advantages are its superior soft tissue contrast differentiation, its capacity for multiplanar imaging and nonexistence of ionising radiation. Its use is relatively new in Nigeria, a developing economy in Africa. Since its introduction in 2005, it has been utilised extensively for neuroimaging at the University College Hospital (UCH), Ibadan; a large hospital in south-western Nigeria. OBJECTIVE: To review the role and pattern of low field MR Imaging in sellar and parasellar lesions presenting to a tertiary care centre in Nigeria. METHODS: All 62 patients with clinically suspected sellar and parasellar masses, referred to the Department of Radiology, UCH Ibadan for MRI between December 2006 and January 2010 were retrospectively analysed. The examinations were performed using an open 0.2T permanent magnet MR unit. T1W, T2W, T2/FLAIR, TOF and T1W post gadolinium DTPA sequences of the sellar region were obtained. RESULTS: Of the 62 patients, there were 27 males and 35 females. The modal age group was 40-49 years with a mean age of 39.94 years (±16.65 years). Twenty-four cases (38.7%) had histological diagnosis, of which 20 (83.3%) were consistent with initial MRI diagnosis. Pituitary adenomas were the commonest (58.06%) lesions of the sellar and parasellar regions. Others include parasellar meningiomas, cranipharyngiomas, and giant aneurysms. Headache and visual impairment were the major presenting features and showed no significant correlation with tumour size. CONCLUSION: The use of low field MRI in the diagnostic evaluation of patients with suspected sellar or parasellar lesions in developing countries of low economic resource is commendable as it provides beneficial outcomes in management.

Experience with three-dimensional computed tomographic angiography in Ibadan, Nigeria.

INTRODUCTION: The latest versions of spiral CT scanners have provided the radiologist with unparalleled capabilities for vascular imaging. Computed Tomographic Angiography (CTA) has the potential of revolutionizing vascular imaging and with evolving improvements may replace conventional angiography in the near future OBJECTIVE: To report our initial experience with CTA in Nigeria; highlighting its usefulness as a non invasive modality and its clinical applications in diagnosis of vascular abnormalities of various parts of the body. MATERIALS AND METHODS: We reviewed 62 patients who had CTA between December 2003 and September 2005.. The studies were performed using a spiral technique with GE CT/e single-slice scanner (General Electric Medical Systems) having a gantry rotation period of one second. Details of techniques of data acquisition, methods of 3-D reconstruction and clinical applications are discussed. RESULTS: Vascular abnormalities were demonstrated in 26 (42%) patients including 5 cranial arteriovenous malformations (AVMs), 3 intracranial aneurysms, 1 spinal AVM, 3 aortic aneurysms, 5 carotid artery stenosis, and 2 traumatic peripheral aneurysms. CONCLUSION: Correlations between CTA and surgical findings were good. CT angiography has enhanced our practice of vascular radiology in Ibadan as it has done in the west and other parts of the world.

Radiation dose in paediatric computed tomography: risks and benefits.

Computed tomography (CT) is a powerful tool for the accurate and effective diagnosis and treatment of a variety of conditions because it allows high-resolution three-dimensional images to be acquired very quickly. However as the number of CT procedures performed globally have continued to increase; with growing concerns about patient protection. Currently, no system is in place to track patient doses and the lifetime cumulative dose from medical sources. The widespread use of CT even in developing countries has raised questions regarding the possible threat to public health especially in children. The best available risk estimates suggest that paediatric CT will result in significantly increased lifetime radiation risk over adult CT. Studies have shown that lower milliampere-second (mAs) settings can be used for children without significant loss of information. Although the risk-benefit balance is still strongly tilted toward benefit, there is still need for caution. Furthermore since the frequency of paediatric CT examinations is rapidly increasing, and estimates suggest that quantitative lifetime radiation risks for children are not negligible, efforts should be made toward more active reduction of CT exposure settings in paediatric patients. This article hopes to address this concerns and draw attention to the fact that children are not 'small adults ' and should therefore be treated differently.

Radiation Dose in Paediatric Computed Tomography: Risks and Benefits

Computed tomography (CT) is a powerful tool for the accurate and effective diagnosis and treatment of a variety of conditions because it allows high-resolution three-dimensional images to be acquired very quickly. However as the number of CT procedures performed globally have continued to increase; with growing concerns about patient protection. Currently; no system is in place to track patient doses and the lifetime cumulative dose from medical sources. The widespread use of CT even in developing countries has raised questions regarding the possible threat to public health especially in children. The best available risk estimates suggest that paediatric CT will result in significantly increased lifetime radiation risk over adult CT. Studies have shown that lower milliampere-second (mAs) settings can be used for children without significant loss of information. Although the risk-benefit balance is still strongly tilted toward benefit; there is still need for caution. Furthermore since the frequency of paediatric CT examinations is rapidly increasing; and estimates suggest that quantitative lifetime radiation risks for children are not negligible; efforts should be made toward more active reduction of CT exposure settings in paediatric patients. This article hopes to address this concerns and draw attention to the fact that children are not 'small adults ' and should therefore be treated differently

Intrapartum rupture of the uterus diagnosed by ultrasound.

BACKGROUND: Spontaneous uterine rupture is a life threatening obstetrical emergency encountered infrequently in the emergency department. Its diagnosis is often missed or delayed, leading to maternal and fetal mortality. METHOD: We present a case of ruptured uterus diagnosed by ultrasound in a 33-year-old gravid female with two previous cesarean sections. OBJECTIVE: To show the role of ultrasound in uterine rupture RESULT: Ultrasound demonstrates uterine laceration and intra-abdominal dislocation of placenta and foetus CONCLUSION: Because of the severity of the complication and the great variation of symptoms in connection with it, the authors encourage the use of ultrasound screening in the detection of this rare, but often catastrophic complication.

Helical CT myelogram: the Ibadan initial experience.

To evaluate our initial experience with Helical Computed Tomography (CT) Myelogram in the investigation of spinal abnormalities. As late as 1980, CT was still regarded as unreliable compared with myelography however, the advent of slip-ring technology in the 1990s, in association with the use of more powerful computers and higher energy x-ray tubes allowed a process known as Helical CT. This revolutionized CT scanning allowing achievement of thinner slices in a single breath-hold. Helical CT myelogram is one of the recent applications with the potential of improving clinical diagnosis in patients with spinal disorders. This is a descriptive study of 56 patients who had a CT myelogram in the first 15 months of operation of a helical CT scanner at Ibadan (January 2004-March 2005). Axial scans were done after a lumbar puncture with injection of 8-10 mls of contrast (iopamidol). Demographic, clinical data and CT findings were analyzed. Patient ages ranged from 3 to 75 years. The highest age frequency was seen in the 4th and 5th decade. 37 (66%) of these patients were males and 19 (34%) were females. The majority of scans, 22 (39.2%) were in the thoracic and thoraco-lumbar regions. Low back pain was the most common indication 26 (32.1%) followed by paraplegia 24 (29.6%). Spinal cord compression and spondylosis represented 34% and 20% of the CT findings respectively. Helical CT myelogram is a valuable investigative tool which demonstrates spinal abnormalities well by providing a good silhouette image of the spinal cord.