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.

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.

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 and cortical atrophy while DWI revealed them to be T2 shine through areas with increased ADC value focally. The 5 cases with hyperintensity on T2 and FLAIR, but normal ADC maps were labeled as nonspecific white matter hyperintensities. These children showed neither any progress of lesion nor any further clinical symptoms during the duration of study. Conclusions: We concluded that DWI was more sensitive than the other MR sequences in detecting early pathological changes even in cases of viral encephalitis and leukodystrophy apart from ischemia. It was also helpful in delineating the area more accurately at the microscopic level. We were also able to rule out actual pathology from nonspecific hyperintensities on T2 and FLAIR in some cases on DWI.

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.

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.

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.

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 3^rd and 4^th 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.

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.

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.

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.

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.

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.

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.

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.