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   Table of Contents - Current issue
Coverpage
January-June 2022
Volume 29 | Issue 1
Page Nos. 1-78

Online since Tuesday, November 15, 2022

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ORIGINAL ARTICLES  

An observational study of the demographic, clinical, and diffusion-weighted magnetic resonance imaging characteristics of patients with musculoskeletal infections p. 1
Rishabh Yadav, Harneet Narula, Amit Mittal, Akshay Kumar, Sahil Mittal
DOI:10.4103/wajr.wajr_3_22  
Introduction: Musculoskeletal infections have been emerging nowadays. Its early diagnosis is warranted as it may lead to disabling sequelae. Recently, the use of diffusion-weighted magnetic resonance imaging (DWMRI) provided additional pulse sequences enabling better diagnosis and needs to be explored for diagnosing musculoskeletal infections. Thus, we conducted this study with an aim to discuss demographic, clinical, and DWMRI findings of the spectrum of musculoskeletal infections, emphasizing the apparent diffusion coefficient (ADC) map for this domain of infections. Methods: A retrospective observational study was carried out in the department of radiodiagnosis of a tertiary care hospital. The study was performed on 50 patients who were suspected cases of musculoskeletal infections. All the patients underwent basic investigations, ultrasound, magnetic resonance imaging, and diffusion-weighted imaging with ADC mapping. The data were entered into MS EXCEL spreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Results: Maximum patients were in the age group of 11–20 years (40%) with 58% males and 42% females. Lower limb infections were common, especially the involvement of the hip joint. Pain and swelling were the most common symptoms as seen in 96% and 88% of the patients respectively. DWMRI was able to diagnose and lay down significantly different ADC values for different musculoskeletal infections. The mean ADC values were higher for acute infections and lower for chronic infections. Conclusions: DWMRI holds an important role in the investigation profile for musculoskeletal infections and must be used wherever deemed necessary to avoid unnecessary referrals and treatments.
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Contrast radiographic anatomy of the gastrointestinal tract of white-bellied pangolin Highly accessed article p. 8
Adepeju T Ogunleye, Adenike O Olatunji-Akioye, Benjamin O Emikpe, Theophilus A Jarikre, Oladipo O Omotosho, A Morenikeji Olajumoke
DOI:10.4103/wajr.wajr_36_21  
Context: Pangolins are scaly ant-eating placental mammals threatened with extinction due to over-exploitation and poaching. Aggressive protection by conservationists is moderately successful due to scanty information regarding their physiology. Aims: Contrast radiography, a diagnostic technique for investigating gastrointestinal diseases may assist conservation efforts to improve the survival of these animals. Subjects and Methods: Eight rescued white-bellied pangolins of different ages, sexes, and weights were evaluated. Four live ones; with a mean weight of 1.52 ± 0.3 kg were radiographed and measurements taken by Digimizer. Four others had an opportunistic necropsy done and gross measurements of the gastrointestinal tract. Sedation with Ketamine caused uncurling, facilitated handling, and barium was administered orally. Serial dorso-ventral and lateral radiographs, physiological parameters, gastrointestinal dimensions, and contrast images were acquired. Results: The oral cavity was oval-shaped with no teeth; the long thin tongue runs beside the esophagus and contrast within the stomach 0 min postadmin lends credence to the length of the tongue just proximal to the stomach at the 8th thoracic rib. The plain radiograph revealed stones within the stomach at the 10th thoracic rib. The esophageal length, stomach length, and width radiographically, were 201.38 ± 1.70, 95.42 ± 1.9, and 53.02 ± 16.70 mm while the gross gastric length, diameter, and intestinal length were 7.1 ± 0.12, 13.3 ± 0.4, and 220.21 ± 4.03 cm, respectively. The mean contrast transit time was 1.34 ± 0.65 h-stomach, 0.48 ± 0.48 h-small intestines, and 10.00 ± 5.76 h-large intestines. Compared to mean transit times in dogs, it is longer but shorter when the transit times are compared to mean transit times in rats. Conclusion: Average transit time of the digestive tract is consistent with the reported average in dogs (3 ± 1.5 h). Implications for feeding and gut health in pangolins can assist in understanding critical care and boost conservation efforts.
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Epidemiological profile of congenital anomalies detected during antenatal ultrasound in three imaging centers in the city of Ouagadougou p. 15
Benilde Marie-Ange Tiemtore-Kambou, N. A. Nde-Ouedraogo, P. D. Lamien, I. F. N. Sieba, L. Kere-Nidjergou, D. Bayala, A. Koama, A. M. Napon, O. Diallo, R. Cisse
DOI:10.4103/wajr.wajr_33_21  
Objectives: To study congenital anomalies discovered during antenatal care in three medical imaging centers in the city of Ouagadougou. Specifically, the aim was to determine the prevalence of antenatal malformations on ultrasound, to identify the different types of malformations detected and to determine the average gestational age (GA) of discovery of CAMs in our context. Materials and Methods: This was a retrospective and prospective multicenter cross-sectional study conducted in the imaging departments of the following three health facilities: the University Hospital of Bogodogo (CHUB), the Nina Polyclinic, and the Yati Medical Clinic. The study was carried out from January 1, 2016, to October 31, 2019. It included all women who had a fetal malformation during obstetrical ultrasound performed during the study period. Results: Fetal malformations represented 1.10% of all obstetric ultrasounds performed in the three medical imaging centers in the city of Ouagadougou. The mean GA of discovery of CAMs was 27 weeks 2 days. The most common malformations were (in decreasing order) the central nervous system (67.10%), the urogenital system (18.62%), the abdomen (14.72%), the digestive system (13.85%), the skeleton (13.42%), the cardiovascular system (8.23%), and the respiratory system (5.19%). An abnormality of the amniotic fluid was associated with 35.50% of the malformations detected. Conclusion: The prevalence of congenital anomaly in our study is similar to that of other studies and obstetric ultrasound plays a key role in its early antenatal diagnosis”.
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Vertebral end-plate changes: Are they clinically significant for postoperative low back pain? p. 22
Emre Kacar, Rukan Karaca, Demet Gunduz, Ender Korfali
DOI:10.4103/wajr.wajr_31_21  
Background: Our aim was to assess the relationship between postoperative recurrent low back pain and vertebral body end-plate signal intensity changes on magnetic resonance imaging in disc herniation patients. Materials and Methods: The preoperative magnetic resonance images of 748 patients were retrospectively reviewed. End-plate changes were separated into three groups according to the Modic classification. The postoperative clinical improvement was defined according to the Kawabata criteria. The localization and type of end-plate degeneration and improvement after the operation were analyzed with Pearson's Chi-square test. Results: End-plate degeneration was found in 394 of 748 patients. Single-level and multiple-level end-plate changes were present in 70.4% and 29.6% of the patients, respectively. Type 2 (85.5%), type 1 (10.7%), and type 3 (3.8%) degenerations were encountered in order of frequency. The severities of the end-plate changes were mild, moderate, and severe in 63.2%, 32.7%, and 4.1% of the patients. Type 1 and type 2 degenerations correlated with clinical course in the postoperative period (P < 0.05). Conclusions: Type 1 and type 2 degenerative end-plate changes seen on preoperative magnetic resonance scans can influence the clinical course and be an indicator of postoperative back pain.
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Size and shape of sella turcica among Down syndrome individuals in a Nigerian population p. 27
Osaronse Anthony Aghimien
DOI:10.4103/wajr.wajr_29_21  
Background/Aims: This study was conducted to determine the size and shape of sella turcica (ST) among Down syndrome (DS). Materials and Methods: The size of the ST was determined among 29 DS (mean age 13.76 ± 2.41 years), while the shape of the ST was among 25 DS individuals (mean of 13.84 ± 2.41 years) who met the inclusion criteria. Statistical significance of linear measurement in relation to gender was evaluated using an independent t-test, while Chi-square test was used to analyze the occurrence and significance of the shape. A statistically significant level was set at P < 0.05. Results: ST length (STL), depth (STD), and anterior–posterior diameter (STAPD) were 9.00 ± 3.23 mm, 7.61 ± 1.51 mm, and 10.45 ± 2.79 mm, respectively. Female DS had a larger value for STD and STAPD than males (P > 0.05). The pyramidal shape of the dorsum sella accounted for the largest deviation (28.3%) in shape. A change in shape of the ST tend to affect the depth (F = 1.669, P = 0.204) and diameter (F = 1.425, P = 0.263) than its effects the length. Conclusion: The depth and diameter of ST were observed to be larger than normal individuals within the same age range documented in the literature. Abnormal deviation in the shape of sell turcica may have contributed to the variation in the length, depth, and diameter. A deviation in the size and shape of ST could be considered etiological factor in the development of malocclusion among Down syndrome individuals.
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Multiparametric differentiation of intracranial central nervous system lymphoma and high-grade glioma using diffusion-, perfusion-, susceptibility-weighted magnetic resonance imaging, and spectroscopy p. 33
Santosh Rai, Fathima Raeesa, Mayur Kamath, Sharada Rai, Muralidhar K Pai, Sonali D Prabhu
DOI:10.4103/wajr.wajr_16_21  
Aims and Objectives: To observe the characteristics of primary central nervous system lymphoma (PCNSL) and high-grade glioma (HGG) in diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), susceptibility-weighted imaging (SWI) and spectroscopy, and differentiate them based on these parameters. Materials and Methods: A total of 45 patients diagnosed with the central nervous system (CNS) neoplasm on magnetic resonance imaging (MRI) using 1.5 Tesla MRI Siemens Magnetom Avanto (Siemens, Germany) and with subsequent histopathological evidence as glioblastoma or CNS lymphoma were included. The study was completed over a period of 2 years. Results: It was found that DWI is effective in the differentiation of HGGs and PCNSLs. A total of 20 (57.1%) HGGs showed diffusion restriction, whereas 9 (90%) of the PCNSLs showed diffusion restriction. The mean apparent diffusion coefficient (ADC) (×10–6 mm2/s) in PCNSLs was 646 whereas, in HGGs, it was found to be 824.3. Thirty-one (88.6%) of the HGGs showed increased perfusion. The mean value of rCBVmean in HGG was found to be 4.06 and the mean value of rCBVmax was 3.63. None of the PCNSLs showed increased perfusion. The mean value of rCBVmean in PCNSLs was 0.097 and rCBVmax was 0.133. 30 (85.7%) of HGGs showed significant areas of blooming on SWI (in the form of intratumoral susceptibility signals [ITSS]). None of the PCNSLs showed blooming. All HGGs and PCNSLs showed increased choline and decreased N acetyl aspartate (NAA) on spectroscopy. Mean Choline/Creatine (Cho/Cr) in HGGs was found to be 3.06, whereas in PCNSLs, it was 1.84. Conclusion: It is important to make a distinction between HGG and PCNSL as the treatment modalities are different for both. Multiparametric evaluation of ADC, ITSS, and rCBVmean allows the differentiation of PCNSLs and solid glioblastoma which supports the integration of advanced MR imaging techniques including DSC-PWI, DWI, and SWI for the routine diagnostic workup of these tumors.
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Seizures in children: Spectrum of findings on brain magnetic resonance imaging at the Korle Bu Teaching Hospital, Ghana p. 42
Klenam Dzefi-Tettey, Emmanuel Kobina Mesi Edzie, Edmund Kwakye Brakohiapa, Kafui Kossi Kekessie, Albert Dayor Piersson, Franklin Acheampong, Philip Narteh Gorleku, Harold Ricketts Nixon, Abdul Raman Asemah, Henry Kusodzi
DOI:10.4103/wajr.wajr_11_22  
Background: The current imaging modality of choice in the evaluation of patients with seizures is magnetic resonance imaging (MRI). MRI with a specific seizure protocol considerably has a positive impact on patients' management. This study determined the spectrum of brain findings in children with seizures. Materials and Methods: The study subjects were 191 children aged 1–16 years who presented with seizures within January 2017–August 2021. Socio-demographics and MRI examinations were retrospectively studied. Brain MRI images of patients with their respective reports were analyzed by experienced radiologists. Data from these reports were collected and coded into Statistical Package for Social Sciences (SPSS) version-20.0 for analysis. Results: One hundred and ninety-one children were included in the study comprising 99 (51.8%) males and 92 (48.2%) females. Abnormal brain images were noted in 89 (46.6%) of the study population. The most common abnormalities were cerebral atrophy 41 (21.5%), white matter T2 Fluid-attenuated inversion recovery hyperintensities 22 (11.5%), and temporal lobe atrophy 9 (4.7%). Twenty-six (29.2%) of the children presented with multiple lesions and these were more common in children <5 years of age. Conclusion: MRI is extremely useful in the early detection and diagnosis of the causes of seizures in children in low socio-economic setting like ours. The majority of the children with brain lesions were under five years, and in a setting like ours, all efforts should be made to image them since they are sometimes denied MRI due to the relatively high cost of the procedure.
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Validity of sonographic prediction of birth weight: A study of three algorithms in a cohort of healthy pregnant women of Yoruba descent in a suburb of Lagos state, Southwest Nigeria p. 50
Cletus Uche Eze, Kingsley Chibuike Cosmas, Joshua Ifeanyichukwu Nwamba, Ernest Ruto Upeh
DOI:10.4103/wajr.wajr_6_22  
Background: Accurate estimation of fetal birth weight is critical in determining the delivery route and management of the neonate. Purpose of Study: The purpose is to determine the accuracy of Hadlock IV, Campbell, and Shepard's algorithm as predictors of birth weight in a cohort of fetuses of Yoruba descent. Materials and Methods: Fetal weight (FW) was estimated in a sample of 384 fetuses using Hadlock IV, Campbell, and Shepard's algorithm while actual birth weight (ABW) was measured. Receiver operating characteristic curves were plotted and used to determine the accuracy and sensitivity of each algorithm. Results: Most babies (84.6%) had normal estimated fetal weight (EFW) and ABW; mean FW = 3.2 ± 0.5 kg); 10% had low weight while 5.5% were macrosomic. While EFW correlated positively and strongly with ABW, the Hadlock IV algorithm had the strongest correlation (r = 0.978). The Hadlock IV, Campbell, and Shepard's algorithms had 92%, 72%, and 56% accuracy within the tenth centile, respectively. At 95% confidence interval, Hadlock IV was the most accurate predictor of normal birth and low birth weight (area under the curve [AUC] =0.91 and 0.94, respectively). Campbell was the most accurate predictor of macrosomia (AUC = 0.89). Conclusion: While Hadlock IV and Campbell algorithm are valid predictors, the Shepard model is a doubtful birth weight predictor among fetuses of Yoruba origin. When there is a need for absolute birth weight values, the Hadlock IV algorithm is preferred for suspected normal and low-weight babies while the Campbell model is preferred for fetuses weighing >4 kg among Yoruba fetuses.
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Pattern of structural magnetic resonance imaging lesions in the patients with progressive cognitive decline: A single-center study in Southeast Nigeria p. 59
Birinus Adikaibe Ezeala-Adikaibe, B Bibiana Oti, Samuel C Ohaegbulam, Chika Anele Ndubuisi, Okwuonodulu Okwudili
DOI:10.4103/wajr.wajr_23_21  
Objectives: The aim of the index study was to describe the pattern and frequency of structural brain lesions in magnetic resonance imaging (MRI) of patients with dementia. Methods: This was a retrospective, descriptive study carried out in Memfys Hospital in Enugu, South East Nigeria, to review all MRIs of patients who presented with progressive cognitive decline. Results: Out of a total of 147 (86.5%) scan reviewed, 6 (6.8%) had normal brain scan, while 95 (64.6%) had brain atrophy, followed by white matter lesions 78 (49.7%). Strokes, including lacunar stroke, were seen in 44 (29.9%). Hydrocephalus (14.3%) and brain tumors (11.6%) were the most common surgical lesion found. Patients with atrophy (P < 0.01) and white matter lesions (P < 0.01) were significantly older compared to the average age of the cohort, while patients with normal brain scans and brain tumors were younger P < 0.01 and P = 0.02, respectively. Conclusion: Brain atrophy and white matter lesions were the most common MRI findings in patients presenting with cognitive decline in Enugu, South East Nigeria. Such patients also tended to be older than those with normal brain scans or brain tumors.
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Inner ear computed tomography findings among children with audiometry proven sensorineural hearing loss in a special needs school in South-West, Nigeria p. 67
Segun Samson Akindokun, Temitope Olugbenga Bello, Adedayo Olugbenga Olaosun, Olawale Ogundiran, Oluwagbemiga Oluyoola Ayoola, Victor Olufemi Oyedepo, Olayemi Atinuke Alagbe
DOI:10.4103/wajr.wajr_2_22  
Background: Hearing loss is a major problem in children because of its devastating effect on education and cognitive development. Clinicians rely on pure-tone audiometry (PTA) to determine the types and degrees of hearing loss; however, the test is subjective and cannot determine the cause of the hearing loss. Computed tomography (CT) of the temporal bone is important for evaluating hearing loss, due to its ability to identify bony ear malformations and to examine pathologies of the middle and the inner ear. The objective of this study was to determine bony labyrinthine anomalies in a group of children with profound and severe hearing loss. Materials and Methods: This was a descriptive cross-sectional study conducted among students from a school with special needs in Osogbo, Osun State, Nigeria. One hundred and twenty students with hearing loss selected by stratified systematic random sampling participated in this study. There were 66 (55%) males and 54 (45%) females. Demographic data were collected from the participants and from the school records. All the participants went through audiometry so as to determine and confirm their thresholds and a high-resolution CT scan of the temporal bone to determine bony labyrinthine abnormalities. Results: One hundred and twenty participants making 240 ears were studied, with a mean age of 12.1 ± 2.3 years. Ninety-five participants (79.2%) had prelingual hearing loss while 25 (20.8%) had acquired postlingual hearing loss. Nine participants (7.5%) had abnormalities of the bony labyrinth; seven of which had bilateral and two unilateral bony abnormalities, and thus 16 (6.7%) out of 240 ears had such abnormalities. The most common cochlear abnormality was hypoplasia 6 ears (37.5%), followed by type I incomplete cochlear partitions 3 ears (18.7%). Conclusion: This study found that the bony labyrinth was normal in 93.3% of ears, and the most common bony anomaly was cochlear hypoplasia.
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CASE REPORT Top

Cerebellar pilocytic astrocytoma: Unusual presentation in a 3-year-old girl with classical imaging features p. 74
Austine Abebe Osawe, Funmilola Olusola Showunmi, Ahmadu Shehu Mohammed, Alfred Aondoyima Tume
DOI:10.4103/wajr.wajr_41_21  
Pilocytic astrocytomas (PAs) are the most common pediatric primary brain tumor. They are World Health Organization Grade 1 tumors with an excellent prognosis. In children, the cerebellum, optic nerve chiasm, and hypothalamic region are the most common locations in that order. Clinically, cranial nerve palsies, symptoms of raised intracranial pressure, and ataxia are commonly seen. We present an unusual case of PA in a 3-year-old toddler with inability to walk. High index of suspicion is required for the diagnosis of posterior fossa tumors in this age group as they can deteriorate rapidly.
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