Context: Stroke is one of the leading causes of death globally and is a major cause of long-term disability. Aims of Study: (1) To identify hemorrhagic foci in patients with acute ischemic stroke by susceptibility-weighted imaging (SWI). (2) To compare the detection of hemorrhagic foci in patients with acute ischemic stroke by SWI versus conventional magnetic resonance imaging (MRI) (T1-weighted, T2-weighted, and fluid-attenuated inversion recovery [FLAIR]). Materials and Methods: Two-hundred and fifty patients, who clinically presented with neurological deficit, were evaluated using 1.5 Tesla MRI scanner from October 2011 to September 2013 with the above sequences. Detection of hemorrhage in acute infarct was evaluated and compared. Results: Of 250 patients evaluated in this study, 232 cases were arterial infarcts and 18 cases were venous infarcts. Hemorrhage was detected in 86 (34.4%) patients, of which 68 cases were from arterial infarcts and 18 were from venous infarcts. SWI was significantly sensitive and specific (P < 0.004) for the detection of hemorrhage in acute infarct compared to T1-weighted, T2-weighted, and FLAIR. Conclusion: SWI is a very sensitive sequence for the detection of hemorrhage in acute stroke patients. Therefore, its use is recommended in the protocol for evaluation of these patients.

Background: Low back pain (LBP) is a common debilitating disease affecting productivity worldwide. The excellent soft-tissue contrast, noninvasiveness, the absence of bone artifact and ionizing radiation has made magnetic resonance imaging (MRI) the gold standard for evaluating etiology of LBP. Aim: This study is to determine the frequency and pattern of occurrence of MRI findings in patients presenting with LBP as well as correlating it with sociodemographic factors and body mass index (BMI). Materials and Methods: A prospective study of 120 patients who had MRI of the lumbar spine was performed during a 12-month period in University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. Data recorded included: Sociodemographics, anthropometry, duration of pain, and MRI findings. Statistical analysis was performed with Statistical Package for Social Sciences (SPSS) Version 20. Pearson Chi-square test was used to compare age, sex, occupation, BMI with MRI findings. P < 0.05 was considered significant. Results: The age distribution of patients was from 18 to 80 years; mean age was 51.0 ± 13.2 years. Males were 66 (55%) and females 54 (45%). LBP was chronic in 98 (82%), and professionals had the highest frequency - 49 (40%). Intervertebral disc degeneration was the most common MRI finding and correlated significantly with age (r = 0.342, P = 0.002) and BMI (r = 0.433, P = 0.001) of patients. Conclusion: Intervertebral disc degeneration is a common cause of LBP in our environment. There is a significant association between its presence, extent and severity with the BMI and age of the patients.

Background: Pulmonary tuberculosis (PTB) has 95-98% of its mortality in developing countries. It is associated with marked weight loss which can be evident at the lateral soft-tissue thickness on chest radiographs. Objective: To determine the pattern of lateral soft-tissue thickness changes and gender predisposition on chest radiographs in PTB patients and after complete anti-TB treatment. Methodology: This prospective study was conducted over a 6 month period at the Radiology Department of Ahmadu Bello University Teaching Hospital, Zaria. Two hundred adults who were bacteriologically proven to have PTB were consecutively recruited into the study as cases, aged 18-70 years and followed up after 6 months of complete anti-TB treatment and found to be asymptomatic and bacteriologically sputum negative. Their lateral soft-tissue thickness on the chest radiographs was measured. Results: The mean and standard deviation of pretreated and posttreated PTB patients was 12.66 ± 2.63 mm and 21.13 ± 2.56 mm, respectively (P < 0.0001). However, significant increase is noted in lateral soft-tissue thickness after complete anti-TB treatment (P < 0.001) and female sex (P = 0.001). Conclusion: Lateral soft-tissue thickness reduction was seen in PTB patients and significant increase was observed after complete anti-TB treatment.

Context: The purpose of this study was to assess the role of diffusion-weighted-magnetic resonance imaging (DW-MRI) and apparent diffusion coefficient (ADC) values in the evaluation of different benign and malignant brain mass lesions with histopathological correlation. Aims: To assess the role of DW-MRI in the evaluation of different mass lesions of the brain with histopathological correlation. To evaluate the role of ADC values in characterization and differentiation of benign and malignant mass lesions of the brain. Settings and Design: The study design was a cross-sectional study and it was done in patients who were referred to Victoria Hospital attached to Bangalore Medical College and Research Institute (BMC and RI), Bengaluru between December 2012 and November 2014. The sample size of the study was 50. Subjects and Methods: We retrospectively reviewed 50 MR examinations of patients who were referred to Department of Radio Diagnosis, BMC, and RI, Bengaluru for intracranial mass lesion evaluation with MRI. All of them had undergone conventional MRI examination with Siemens AVANTO 1.5T scanner, and we determined ADC values and signal intensities on DW images (DWIs). In all patients with contrast-enhanced tumors, region of interests (ROIs) were placed in the enhanced region. In patients with nonenhancing tumors, ROIs were placed in the solid part of the lesion. We also evaluated the correlation between ADC values and cellularity in the mass lesions. Additional clinical details and histopathological findings were correlated with the DWI and ADC findings for radiologic-pathologic concordance. Statistical Analysis: Brain MRI results of 50 patients with histologically verified or clinically diagnosed brain mass lesions were subjected to analysis. They ranged in age from 2 to 72 years (mean, 43.5 years). The examinations were performed with a 1.5T scanner, an 8-channel surface head coil. The examination protocol included the following sequences and images: Turbo spin-echo (SE) T2-weighted images (3920/102/1), fluid-attenuated inversion recovery (2500/9000/111/1) ([inversion time/repetition time (TR)/echo time (TE)/excitations], and SE T1-weighted images [488/10/1] [TR/TE/excitations]), carried out in three planes, before and after contrast medium administration (in a standard dose). Results: A positive correlation was found in the comparison of mean ADC values for high-grade gliomas (1.19 × 10⁻³ mm ² /s ± 0.2) and metastasis (0.833 × 10⁻³ mm ² /s ± 0.2), low-grade gliomas (1.34 × 10⁻³ mm ² /s ± 0.2), and medulloblastomas (0.68 × 10⁻³ mm΂/s ± 0.075), as well as for in epidermoid cyst and necrotic areas in malignant tumors. Conclusion: ADC is useful in the differentiation of various brain mass lesions, in grading brain tumors, and differentiation of benign cystic and malignant necrotic areas. The combination of routine image interpretation and ADC had a higher predictive value. The ADCs of glioma, metastasis, and meningioma are related to tumor cellularity. We believe that DWIs and ADCs can provide information useful to diagnose brain mass lesions that cannot be obtained with conventional MRI alone.

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.

Background: Routine lateral cephalometric radiographs can determine upper and lower pharyngeal airway constriction or patency depending on the dentofacial skeletal discrepancy. Appropriate orthodontic treatment that would maintain or improve the airway patency can be considered if the width of the airway in the various skeletal classes is determined. Aim: The aim of this study was to evaluate the upper and lower pharyngeal widths in skeletal Class I, II, and III untreated orthodontic patients in Benin City, Nigeria. Materials and Methods: In this study, 188 lateral cephalometric radiographs comprising three groups based on the ANB angle: Class I (ANB 2-4°), Class II (ANB >4), and Class III (ANB < 2) were analyzed using the method described by McNamara. The vertical facial pattern (the Sella-Nasion-GoGn angle) and palatal length were also determined. The differences between groups and correlations between variables were determined with the Students t-test and the Spearman correlation coefficient, respectively. Results: The mean upper and lower pharyngeal width for skeletal Classes I were 10.56 ± 3.67 mm and 11.14 ± 3.79 mm, respectively. Skeletal Class II had the narrowest upper airway width, whereas skeletal Class III had the narrowest lower airway widths, respectively. The palatal length was 9.04 mm in males and 8.6 mm in females, and there was a highly statistically significant difference P < 0.05 between hyperdivergent facial pattern and the upper pharyngeal width. There was a significant difference between skeletal pattern II and the upper pharyngeal width. Conclusion: Pharyngeal dimensions should be taken into consideration when managing patients with skeletal patterns II and III and the hyperdivergent facial patterns.

Introduction: Numeric variation in presacral vertebral segments and lumbosacral transitions has been reported in different studies with wide range of prevalence (4-36%). There is no standard method for numbering of lumbar vertebrae. In typical regional sequences for lumbar spine magnetic resonance imaging (MRI), vertebral and disc morphology, intervertebral angle, and various local anatomical structures are used as landmarks for numbering. Aim: (a) To document the prevalence in variation of presacral mobile vertebral count and lumbosacral vertebral transition using whole spine MRI. (b) To evaluate the accuracy in the location of the proximal right renal artery (RRA), aortic bifurcation, and conus termination as a landmark for vertebral numbering. Materials and Methods: This prospective observational study includes 317 patients, referred for MRI of the lumbosacral spine. Vertebrae were counted manually using sagittal whole spine localizer images (Mobi View). Short tau inversion recovery (STIR) coronal images were included for classification of lumbosacral transitional vertebrae (LSTV). Prevalence and types of LSTV and level of proximal RRA, aortic bifurcation, and conus termination were documented. Results: About 25.5% of patients showed LSTV and 7.8% of patients showed variation in presacral vertebral count without LSTV. Castellvi Type IIIb LSTV was most prevalent followed by Type IIb. There was significant variation in the level of aortic bifurcation, RRA, and conus termination in patients with normal count and with LSTV. Conclusions: Spinal and paraspinal structures, such as aortic bifurcation, RRA, and conus termination, cannot be considered as landmark for numbering of vertebrae. Counting of vertebrae manually from C2 is recommended for confident documentation of numerical variation in vertebrae. The inclusion of STIR coronal image helps in better identification and characterization of the LSTV.

Context: Neuroinfections are one of the most common complications in human immunodeficiency virus (HIV)-infected patients. The neurological complications arise from the HIV infection itself or from secondary opportunistic infections and neoplasm. Neurological manifestations cause significant morbidity and mortality in HIV-infected patients. Aims: The aims of the study were to assess the magnetic resonance imaging (MRI) features of the central nervous system infections in patients with HIV and to correlate the imaging features with biochemical markers of various neuroinfections in HIV patients to get a better diagnostic probability wherever possible. Settings and Design: HIV patients with suspected neuroinfections were included in the study. The CD4 count, the cerebrospinal fluid analysis reports and other serological investigations were taken. The various MRI sequences were then taken and assessed. Materials and Methods: All HIV-infected patients who were suspected to have neuroinfection who were referred for MRI imaging to the Department of Radio-diagnosis, Bangalore Medical College and Research Institute, from the attached hospitals were assessed. Statistical Analysis Used: Documented observations were compiled using  SPSS-16.5 software (IBM). Univariate analysis was carried out for data interpretation. Multiple variables were assessed with Pearson's method. Results: In this study, majority were men with a male to female ratio of 5:1 and most falling in the age group of 20-40 years. Out of 50 patients in our study, 48 patients were proven to have some or the other neuroinfections, either purely biochemically or by considering the radiological and clinical criterion and only in 2 patients the exact diagnosis could not be made and were empirically treated with antitubercular treatment. Conclusion: This study tried to correlate the various neuroinfections in HIV-infected patients with their respective biochemical markers and CD4 counts. Neuroinfections are common complications in HIV-infected patients with the distribution of infection related to the CD4 count.

Introduction: Breast diseases in men are not as common as those in women and though male breast cancer is seen rarely, thus the lack of screening guidelines worldwide, benign breast diseases such as gynecomastia present fairly commonly in both primary and tertiary care setting. There is a paucity of information about the pattern, protocols, and imaging features of male breast diseases in Nigeria. Objective: To review the variety of presentations and radiological features of male breast diseases encountered in Aminu Kano Teaching Hospital (AKTH) and University of Maiduguri Teaching Hospital (UMTH). We wish to discuss the departmental protocols and highlight the role of mammography and sonomammography in the evaluation of male breast diseases. Materials and Methods: A 5-year retrospective review was performed on the imaging findings of a total number of 27 male patients who presented with symptoms of breast disease to the radiology departments of AKTH (12) and UMTH (15) in Nigeria. All patients had mammography and sonomammography or sonomammography alone performed by a senior radiology resident and consultant radiologist. Selected cases had ultrasound guided biopsy and histology. Results: Twenty-seven male patients were reviewed from both centers with an age range of 0.06-69 years (mean of 33.11 ± 18.10 years). The majority of patients (88.9%) presented with breast enlargement only. Concerning laterality of disease, bilateral involvement was more common (59.3%). In unilateral disease, 33.3% of patients presented with left-sided lesions while only 7.4% had right-sided involvement. Gynecomastia was seen in twenty (20) patients and was the most common breast disease seen in male patients presenting for imaging in both centers. Breast abscesses were the second most common. We saw one case of bilateral male breast cancer. Overall, bilateral disease was far more common than unilateral. Conclusion: Mammography is the most important first-line imaging modality employed in the diagnosis of male breast diseases in our environment; sonomammography is an important and radiological modality of investigation used to differentiate gynecomastia from male breast cancer and breast abscess. Gynecomastia remains the most common occurring male breast disease in our study.

Background: The number of computed tomography (CT) centers and examinations in Nigeria has shown a steady increase. This will increase the collective dose and may potentially result in an increased incidence of cancer, hereditary diseases, and the possibility of mild deterministic effects. Objective: To determine radiation dose output and its relationship with anthropotechnical parameters. Methodology: A retrospective analyses of digital CT files. Effective dose was derived from the dose-length product and factor for examination of head CT (0.0023 mSv/mGy-cm). SPSS version 20.0 (SPSS Inc., Chicago, IL, USA) was used to analyze the data. Results: Files of 43 male and 42 female (n = 85) adult patients were analyzed. The mean (and 75 ^th percentile) of the CT dose index (CTDI), dose-length product (DLP), and effective dose in noncontrast examinations were 48 (59) mGy, 874 (1301) mGy-cm, and 1.8 (2.7) mSv, respectively. Contrast examinations yielded 54 (61) mGy, 1476 (2044) mGy-cm, and 3.1 (4.3) mSv, respectively. DLP showed a weak relationship with BPD (r = −0.220), age (r = 0.211), cephalic index (r = −0.186), height (r = 0.158), and gantry tilt (r = 0.154). There was no relationship with weight (r = 0.076), range (r = −0.073), occipitofrontal diameter (r = 0.037), and body mass index (r = −0.018). The correlations were neither statistically nor clinically significant. Conclusion: The CTDI is comparable with local values while the DLP is lower by a range of 5-31% but higher than foreign values by a range of 19-35%. Further optimization of CT radiation dose should be explored to eliminate the gulf between local and foreign dose outputs.

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.

Background and Objectives: Recognition of the causes of infertility, appropriate timely evaluation, and treatment with good outcome is the goal of the treating physician. Saline infused sonohysterography (SIS) is a cost-effective, safe, noninvasive, and a rapid procedure to visualize the female pelvic organs in the evaluation of infertility. The purpose of this study is to compare the diagnostic accuracy and the advantages of saline infused sonohysterography (SIS) over conventional hysterosalpingography (HSG). Materials and Methods: Thirty-five women who presented to the gynecology department between November 2005 and September 2007 for evaluation of infertility were included in the study. After taking informed consent, all the women were subjected to SIS, followed by conventional HSG on the next day. The study was conducted between 7 ^th and 11 ^th day of the menstrual cycle. Results of the two procedures were compared. Results: The sensitivity, specificity, positive predictive value, and negative predictive value of SIS in detecting tubal patency was 94.28%, 75%, 97.05%, and 50%, respectively. SIS was found to be superior to conventional HSG in the evaluation of uterine and ovarian factors of female infertility in the present study. SIS was also found to be cost-effective and less time-consuming than conventional HSG. Interpretation and Conclusion: SIS can be used as a simple, noninvasive, cost-effective primary diagnostic tool in the evaluation of female infertility and should be used in conjunction with conventional HSG in the evaluation of tubal, cervical, uterine, and ovarian factors of infertility to avoid unnecessary invasive diagnostic procedures.

A 29-year-old male patient reported with diastemata in the maxillary and mandibular arches since childhood. On general physical examination, a cleft was seen in place of the middle finger which was missing on both right and left hand. On intra-oral examination, multiple teeth were missing. Further, the orthopantomograph and the wrist radiograph revealed multiple missing teeth with the absence of a middle finger. There are many syndromes associated with partial anodontia and ectrodactyly, but the isolated occurrence of these two entities is not reported in the literature. Here, we present a case of a rare association of ectrodactyly and partial anodontia.

The most common causes of penetrating arterial injuries are stab and gunshot-related injuries. Any penetrating trauma to the vessel wall that causes damage to the arterial wall will result in a pseudoaneurysm. The time from initial injury to detection of the pseudoaneurysm has been reported to vary from hours to years, depending on the site of formation and clinical symptoms. Enlarging swelling, the presence of pulsatile mass, palpable thrill, edema, and paresthesia of the involved area can be present based on location. Ultrasonography (US) and color Doppler US have been the preferred initial imaging technique to evaluate the vascular structures, especially under emergency conditions. The detection of a turbulent flow that appears as a classic "yin-yang" sign is a characteristic feature of pseudoaneurysms on the color Doppler US. In addition, the identification of a "to and fro" spectral waveform in the neck is considered pathognomonic for a pseudoaneurysm. As per the literature, the color Doppler US demonstrated high sensitivity (94%) and specificity (97%) for the diagnosis of a pseudoaneurysm. Therefore, it is a noninvasive, inexpensive, easy, and very tolerable first choice method for the diagnosis of a pseudoaneurysm. Here, we report on a delayed posttraumatic distal superficial femoral artery pseudoaneurysm in a young patient with color Doppler US findings.

A 5-year-old child presented with progressive right calf swelling for 4 years and a year history of pain at the same site. There was no skin discoloration. Doppler ultrasound scan and venography of the affected leg showed soft-tissue gigantism and anomalous venous drainage of the right leg with multiple tortuous varicose veins and venous aneurysm. The deep right calf veins were anomalous but ipsilateral popliteal and femoral veins were preserved. The arterial system of the right lower limb was preserved; no arteriovenous malformation was seen, and no limb length discrepancy or evidence of bone involvement was observed. The diagnosis of Klippel-Trenaunay syndrome was made based on the above clinical and radiological features. After due consultations with the pediatrician and orthopedic surgeon, she was commenced on analgesic and application of graded compression stockings, and she's doing well.

Male breast cancer is rare. It accounts for 0.2% of all cancers and 1% of all breast cancers. Most patients present with advanced stage and studies indicate overall survival ranging from 6 months to 3 years. Here we report a case of bilateral male breast cancer who has survived more than 25 years posttreatment.

Multiple ectopia of the thyroid gland is a term which refers to presence of multiple thyroid tissue in absence or presence of orthotopic thyroid gland. The prevalence of ectopic thyroid is approximately one per 100,000 to 300,000 persons and is reported to occur in one in 4,000 to 8,000 patients with thyroid disease. Multiple ectopia of thyroid is extremely rare entity. We present a case with multiple thyroid ectopia in absence of orthotopic thyroid gland. CT and MRI play an important role in locating ectopic thyroid tissue.

The common causes of secondary primary postpartum hemorrhage are usually retained products of conception and endometritis with vascular anomaly being a rarer cause. Pseudoaneurysm of the uterine artery or its branches usually develops as a complication of myomectomy, dilatation and curettage (D and C), and caesarean section. We present a case series of uterine artery pseudoaneurysms which occurred as complications of caesarean section and D and C, presenting with vaginal bleeding.

Bladder extrophy is an uncommon congenital anomaly of lower abdominal wall which is detected and managed at birth. As the bladder is open there is usually no upper tract involvement in these cases. Upper tract dilatation may be seen after successful bladder neck repair due to associated anatomical vesicoureteric reflux. In this case report we present an unusual association of bladder extrophy with bilateral upper tract involvement prior to bladder neck repair.