A variety of imaging modalities exist for the diagnosis of stroke. Several studies have been carried out to ascertain their contribution to the management of acute stroke and to compare the benefits and limitations of each modality. Diffusion-weighted imaging (DWI) has been described as the optimal imaging technique for diagnosing acute ischemic stroke, yet limited evidence is available on the value of DWI in the management of ischemic stroke with low-field magnetic resonance (MR) systems. Although high-field MR imaging (MRI) is desirable for DWI, low-field scanners provide an acceptable clinical compromise which is of importance to developing countries posed with the challenge of limited availability of high-field units. The purpose of this paper was to systematically review the literature on the usefulness of DWI in acute stroke management with low-field MRI scanners and present the experience in Nigeria.

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Aims: Incidence of cancer is on the increase and the greater proportion of that increase is from developing countries. About 50-60% of the cancer cases will require radiotherapy at least once during the course of the treatment. This paper is an effort to appraise the present radiotherapy capacity to treat cancer in Nigeria and to project its future challenges and development. Materials and Methods: The available radiotherapy centers in Nigeria were identified and information about the types and number of radiotherapy equipments, imaging systems, personnel, and training capacity were obtained. Results: In 2001, there were five radiotherapy centers with six megavoltage therapy machines in Nigeria comprising of five cobalt-60 and one linear accelerator. The population of the country then was 120 million, that is, one therapy machine for a population of about 20 million. By the end of 2010 the number of megavoltage therapy machines has reached eight with one therapy machine situated in each of eight radiotherapy centers, but the population has equally increased to more than 155 million giving only a marginal improvement in the radiotherapy service. Conclusion: There has been an increase of radiotherapy centers in Nigeria however, the number of available facilities is grossly inadequate and there is dearth of trained personnel. Careful and strategic planning is needed to develop manpower capabilities in all fields of specialization related to radiotherapy service in order to adequately care for the multitude of cancer patients.

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Background: Establishment and use of "diagnostic reference levels" (DRLs) is essential for proper use and audit of ionizing radiation in medicine and other radiation applications. Nigeria does not yet have a guideline for DRL. The European Commission reference dose levels were applied to routine computed tomography (CT) examinations in Nigeria's major hospitals. Aim: To determine the dose of CT examinations at the University College Hospital, Ibadan, Nigeria and provide a template for dose optimization. Materials and Methods: Data were obtained from a GE Brightspeed multidetector CT scanner. The dose characteristics and estimates were derived from computed tomography dose index (CTDI _vol ), and dose length product (DLP) with the effective dose (E) calculated using software developed by ImPACTscan group with the National Radiological Protection Board-S250 conversion coefficients data for a random sampling of 1 per 10 typical CT patients. Results: The mean values of CTDI _vol in mGy were 73.5 ± 4.2 (head), 22.7 ± 6.7 (chest), 37.9 ± 5.6 (abdomen), 28.2 ± 8.3 (abdomen-pelvis), 41.4 ± 13.2 (cervical spine), and 40.1 ± 4.2 (lumbar spine) examinations. The corresponding mean values of DLP in mGy.cm were 1898, 1189, 1902, 2548, 1372, and 1563, respectively. The calculated E values in mSv for the above examinations were 2.8, 11.8, 22.5, 39.6, 4.6, and 29.0, respectively. All values consistently exceeded recommended ECRDLs except the CTDI _vol for chest, cervical, and abdomen-pelvis examinations. Conclusion: CT doses were higher than EC recommended guidelines necessitating a need for optimization of CT practice and the requirement for a CT dose survey in Nigeria.

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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.

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Background: Diagnostic reference levels (DRLs) were first conceptualized in 1996 by the International Commission on Radiological Protection as a result of wide variations in patient dose levels for the same examination. Current works on computed tomography (CT) doses in Nigeria produced significant variations. These observed variations, coupled with unavailable national or regional DRLs have presented the need for the establishment of standards through a dose survey. Objective: The aim of this study is to establish DRLs for CT of the head in adult populations of Anambra State of Nigeria. Materials and Methods: The retrospective survey was carried out from February to June 2016 in the four busiest CT centers. The digital CT population considered was those of subjects examined in 2015, and who were aged ≥18 years. Two hundred folders, comprising fifty from each center were included. The on-screen volume computed tomography dose index (CTDI_vol) and dose-length product (DLP) for the subjects were recorded. The 75^th percentile was then calculated for each center to establish center-specific DRLs. Finally, a combined 75^th percentile of the CTDI_voland DLP for all centers was calculated to establish the DRLs for the state. Data were analyzed using SPSS version 20.0 (SPSS Incorporated, Chicago, Illinois, USA). Results: The digital folders of 104 male and 96 female subjects with age range of 18–93 years were analyzed. The specific 75^th percentile of the CTDI_vol and the DLP of the centers ranged from 46 to 86 milligray (mGy) and 794 to 1785 mGy centimeters (mGy-cm), respectively. The DRLs for the State are 66 mGy and 1444 mGy-cm, respectively. Conclusion: The DRLs for head CT in Anambra State has been derived. Although the CTDI_volis comparable to the recommendations of the European Commission, the DLP is significantly higher. Further training on dose optimization may help to bring the radiation dose in the locality at par with foreign values.

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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.

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Background/Aim: Radiology residency was initiated nearly 30 years ago in the West African subregion, but accompanying formal subspecialty training has been developed within the 30 year time span. In contrast, subspecialization has evolved over the past 25 years in developed countries. The aim of this study was to determine residents' perspective about radiology subspecialization training in West Africa. Materials and Methods: Semi-structured, self-administered electronic questionnaires were sent to residents at different levels of training via E-mail and during update courses. Data analysis was performed using SPSS version 15.0 (IBM) package. Quantitative variables were expressed using summary statistics including means and medians. Descriptive analysis was performed for the qualitative variables using frequencies, proportions, and charts. Statistical significance was set at the 5% level using two tailed P values. Results: There were 117 respondents 85 (72.6%) males and 32 (27.4%) females. A total of 110 (94%) were aware of the various subspecialties in radiology with neuroradiology being identified by all as separate subspecialty. Interventional radiology topped the choice of subspecialty with 61 (52.1%) respondents, and 67 (57.3%) would prefer that subspecialties be introduced in phases. Ultrasound, basic X-ray, mamography equipment, and computed tomography scanners are available in many of the training centers. 116 (99.1%) of the residents believed that there is a need for subspecialization in the subregion. Conclusion: Our study demonstrates the need for subspecialization in West Africa. To achieve this goal, collaboration and support from well-established radiology residency and fellowship training programs based in developed countries is necessary.

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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.

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Background: An analysis of the current radiation oncology facilities status in Nigeria was conducted to establish a comprehensive baseline. Nigeria is the most populated African country with a population of at least 160 million people based on 2006 population census and average annual growth rate of 3.1%. It is also one of the least developed countries as regards radiation oncology resources with inadequate radiotherapy facilities. Many of the patients have little or no access to safe and modern radiation therapy. Purpose: To obtain a better understanding of the status of radiation oncological practices in Nigeria and to help sensitize the Nigerian government and its developmental partners on the way forward. Materials and Methods: The data were obtained mainly through surveys on the availability of major items of equipment and personnel which were conducted in September 2011. The study included only commissioned and functioning public radiotherapy facilities which are 5 in the country. Data were related to number and types of megavoltage machines, trained manpower (Radiation Oncologists, Medical Physicists, Oncology Nurses, Radiotherapy technologists, maintenance engineers and mould room Technicians), treatment planning systems TPS, Brachytherapy equipment, CT Simulator and Conventional simulators. Results: Of over 50 Tertiary Health Institutions (Teaching Hospitals and Federal Medical Centers) in the country, only 5 has Radiation Therapy facilities with 1 megavoltage machine each, 2 located in the north, 2 in the south and 1 in the Federal Capital Territory. The population served by each megavoltage machine ranges from 20 to 40 million per machine based on 2006 census. Most patients have little or no access to radiation oncology services. Some differences in equipment and personnel amongst centers were demonstrated and the shortage of radiation therapy resources was grossly evident. There are 18 Radiation Oncologists, 8 Medical physicists, 18 Radiotherapy technologists, 26 Oncology Nurses, 3 linear accelerators, 2 Co-60 machines, 2 orthovoltage therapy machines, 2 conventional simulators, 2 CT simulators, 2 centers with 3D TPS, 3 LDR and 1 HDR brachytherapy machines and 2 mould rooms. Some centers were found to treat patients without simulators or treatment planning system. Conclusion: A large deficiency exists for radiation oncological services in Nigeria. There are significant deficiencies in the availability of all components of radiation therapy in the analysed centers. Cognisance should be taken of the specific short falls in each centre to ensure that there is expansion of existing centers and creation of new centers especially in every geopolitical zone and major teaching hospitals in the country.

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Aim: To evaluate the renal sizes and echogenicity pattern in patients with human immunodeficiency virus (HIV)-associated nephropathy and to correlate renal echogenicity with serum creatinine levels and proteinuria. Materials and Methods: A cross-sectional study of 100 consecutively confirmed HIV- seropositive patients aged between 19 and 65 years (Mean ± SD: 35 ± 10.79) comprising 32 males and 68 females with clinical and laboratory features of HIV-associated nephropathy (HIVAN) was conducted at the Infectious Diseases Clinic of the University of Maiduguri Teaching Hospital, between April 2011 and September 2012. The subjects were evaluated with renal ultrasound scan and the observed abnormalities were recorded. Serum creatinine levels and CD4 + lymphocyte counts were also obtained for all the patients. Proteinuria was established by dipstick method. Results: Of the 100 cases studied, ultrasound showed enlarged kidneys in 28 patients (28%) and abnormal echogenicity was present in 192 kidneys (96%). 100 kidneys (50%) were globular, 160 kidneys (80%) had decreased corticomedullary definition, 90 kidneys (45%) had decreased renal sinus fat and 80 kidneys (40%) had heterogenous renal parenchymal patterns. A high serum creatinine level, increased degree of proteinuria, lower CD4 counts, reproductive age group and black race were associated with HIVAN. Conclusion: The severity of HIVAN as indicated by raised serum creatinine level and proteinuria correlated positively with the degree of renal echogenicity.

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Context: Left ventricular function in HIV/AIDS patients from South-East Nigeria has not been reported. Aims: We sought to determine the prevalence and spectrum of left ventricular function abnormalities in patients with HIV infection in the University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria. Settings and Design: This was a descriptive, cross-sectional study of patients with HIV/AIDS at UNTH, Enugu from September 2006 to July 2007. Methods and Material: Sixty-six HIV-infected patients being managed at the antiretroviral therapy clinic and who had no other cardiovascular risk factor other than HIV infection were consecutively recruited. They were matched for sex, and age with seronegative healthy controls. Clinical and echocardiographic evaluation was carried out to assess the left ventricular function. Statistical Analysis Used: The findings were analyzed with statistical package for social sciences (SPSS) version 10.0. Results: The patients consisted of 29 males and 37 females aged between 23 and 62 years. Left ventricular systolic dysfunction was identified in 9 (13.6%) of 66 HIV-infected patients and 1 (4.3%) of 23 controls (P = 0.201) while left ventricular diastolic dysfunction (reversed fi lling pattern) was identifi ed in 19 (28.8%) and 3 (13.0%) of the HIV-infected patients and controls, respectively (0.021). Left ventricular hypertrophy was seen in 2 (3.0%) patients but in only 1 (4.3%) control (P = 0.647), while left ventricular dilatation was absent in all the patients and controls. Conclusions: Systolic function does not vary significantly between our patients with HIV/AIDS and sero-negative controls. This calls for further investigation of cardiac function in Nigerian HIV/AIDS patients.

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Aims: The present clinico-radiological study was done to evaluate the morphological variants of soft palate in oral submucous fibrosis (OSMF) patients using digital lateral cephalometry. Different variations in the morphology of soft palate were compared with stages of OSMF. Further, soft palate morphology in OSMF patients was compared radiographically with that of normal population. Materials and Methods: A total number of 100 patients who were a part of this study were divided in two equal Groups. Group 1 comprised of 50 patients clinically diagnosed with OSMF and Group 2 included 50 routine patients. Results: Six different morphological variants of soft palate were found. Among the study Groups, type 1soft palate was most commonly seen (56%) whereas type 5 was the least common variant. Majority of patients belonged to stage II OSMF and type 1soft palate was commonly seen in this stage of disease whereas butt shaped soft palate (type 3) was more common in stage III OSMF. Conclusion: In OSMF, type 1 and 2 are commonly seen but as the diseases advances, these are replaced by type 3 and 6 variants. In OSMF patients, there in reduction in the anterio-posterior dimension of soft palate.

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Background: Doppler velocimetry of fetal arterial blood flow in pregnancy induced hypertension (PIH) determines fetal hemodynamic adjustment. Objective: This study was aimed to determine the pattern of fetal arterial blood flow of selected vessels in patients with PIH. Materials and Methods: A total of 34 pregnant women with PIH at a gestational age of 24-37 weeks were prospectively examined with Doppler ultrasound of the fetal middle cerebral artery (MCA), umbilical artery and placental blood flow (uterine artery). Results: The mean peak systolic velocity (PSV) of the fetal MCA was 8.23±3.96, resistance index (RI) was 0.763±0.07 and systolic diastolic (S/D) ratio was 4.558±1.36. The mean PSV of umbilical artery was 72.28±26.585, RI was 0.62±0.19 and S/D was 2.63±0.75. The mean placental blood flow (uterine artery) PSV was 141.34±70.58, RI was 0.59 and S/D was 2.42±1.07. Uterine artery PSV was normal in only six patients. Uterine artery was also not sonographically demonstrated in two patients. Conclusion: Doppler velocimetry of arterial blood vessels in pregnancy complicated with PIH reveals abnormal pattern; its application in PIH would be useful for further management.

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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.

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Background: Gastrointestinal (GI) transit time is a useful diagnostic technique routinely done around the world in human medicine. In veterinary medicine, however, this has only been done in few species in developed nations. With veterinary science, still developing in many parts of Africa, this technique is not routinely done. Our aim was to determine GI transit (GIT) time in Pelusios castaneus, a small sized group of freshwater pleurodira turtles that inhabit the tropics of West Africa. Materials and Methods: The study group comprised four males and four females with a mean weight of 0.81 ± 0.37 kg. Using a routine feeding technique, 10 ml of dilute barium sulfate suspension was administered orally and the GIT time of the contrast observed and monitored through radiography. The transit time was recorded in hours as it traveled through each section of the GIT. The time for complete contrast excretion was recorded for each turtle. Results: The contrast mean transit time from the mouth through the esophagus to the stomach was 1.06 ± 0.20 h and the mean onset of gastroduodenal transit was 4.05 ± 0.09 h while mean intestinal transit time was 245.90 ± 53 h. The mean total contrast excretion time was 10.8 ± 2.4 days. The female excretion time was shorter than the males (males: 13.7 ± 3.33 days; females: 7.8 ± 3.27 days), but this was not statistically significant. Our findings were at variance with results obtained among freshwater turtle species that inhabit temperate climates. Conclusion: These findings suggest an influence of turtles' natural habitat climatic conditions on their GIT time and possibly digestion.

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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.

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The characteristic appearance of Candida esophagitis on barium studies is that of diffuse discrete mucosal plaques, which may become confluent to form 'cobblestone or shaggy' esophagus. Many authors have also reported different radiographic findings such as a foamy appearance in florid esophageal candidiasis in immunocompromised patients. This report discusses a “feathery” appearance seen in barium esophagography of a 74-year-old woman who presented with dysphagia. The barium swallow showed fine out- pouching giving a “feathery” appearance, which is similar to what is described as pseudo-diverticulosis in patients with esophagitis complicating gastro-esophageal reflux disease. A diagnosis of esophagitis presumably due to candidiasis was made. This was confirmed by fungal studies on biopsy specimen following flexible esophagoscopy. Radiologists should be aware of this rare manifestation as a new sign of Candida esophagitis in order to avoid unnecessary delay in diagnosis and treatment.

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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.

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Background/Aim: The maxillary sinus is the largest paranasal sinus and represents a complex anatomical structure with significant inter-individual variation. Computerized Tomography (CT) in the assessment of the maxillary sinus yields much more information. The aim of this study is to determine the prevalence, number and location of maxillary sinus septa using CT. Materials and Methods: One hundred and thirty subjects (79 males and 51 females), between 20–80 years, with normal maxillary sinus CT anatomy, from head CT scans carried out at the Radiology Department of the Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, over a period of 5 years, were studied. Head CT scans were obtained from the local data base of the CT machine and back up compact disc from the CT library. Images were taken with Neusoft Dual Slide Helical CT machine, and films were viewed on the computer monitor. Septa were identified as bony projections from the sinus walls into its cavity on axial and coronal slides. Results: In this study, septa were present in 14.23% (37 septa out of 158) males sinuses, while in females, 10.34% (27 out of 102) had septa. The overall prevalence of maxillary sinus septa was 24.62%. Conclusion: Maxillary sinus septa appear common and are capable of complicating sinus membrane surgeries. CT may be useful in surgical evaluation and planning.

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Background: Breast symptoms are not uncommon among Nigerian adult females. Most worrisome are symptoms associated with the possibility of breast cancer. Mammography is an imaging technique being introduced in third world practice as an aid for screening and diagnosis of patients with breast symptoms. Objective: To document the pattern of mammographic findings in symptomatic females referred for mammography. Methodology: Patients with breast symptoms of palpable lump, pain or nipple discharge referred to the mammography unit of the Radiology department were recruited into the study at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria between June, 2012 and May 2013. Two standard views (cranio-caudal-CC and medio-lateral oblique-MLO) were done on both breasts for each patient. Results: Study population comprised seventy-one patients aged 20 to 79 years with a mean age of 48.3 years ±9.5, and range of 20 - 70 years. Of these, forty (56.3%) presented with breast pain, twenty-five (35.2%) had palpable breast lump, while fourteen (19.7%) presented with nipple discharge. 74.65% percent of participants showed positive mammographic findings. These were a well circumscribed breast opacity (35.2%), asymmetric soft tissue density (39.4%), calcification (39.4%), breast asymmetry (8.5%), nipple retraction (7.0%), tissue retraction (4.2%), skin thickening (1.4%), and axillary nodes (9.9%). Mammography calcifications were noted in 28 cases. Four of these (14.3%) were micro-calcification, while 24 (85.7%) were various forms of macro-calcifications. Conclusion: Asymmetric soft tissue density, calcification and well circumscribed breast opacity were the commonest mammographic findings among symptomatic women in our environment. Follow-up imaging or minimally-invasive image-guided biopsy or cytology may be indicated for further evaluation.

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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.

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Background: Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive radiological investigation, performed rapidly, and does not expose the patients to ionized radiation or iodinated contrast material. The present study was conducted to evaluate the role of MRCP in detection of common bile duct (CBD) stones in patients with suspected choledocholithiasis. Materials and Methods: This prospective study included 30 patients with suspicion of choledocholithiasis based on clinical evaluation, biochemical, or radiological investigations. Ultrasonography and MRCP were performed in all patients. All patients underwent open surgery. CBD exploration was performed in all patients, either due to presence of palpable stones or due to the presence of dilated CBD (>7 mm). Demonstration of CBD stones intraoperatively was considered the "gold standard" for their presence, defined as stones visualized, and extracted or attempted for extraction during surgical CBD exploration. Results: Intraoperatively, 21 (70%) out of 30 patients had cholelithiasis. 26 (86.67%) out of 30 patients had dilated CBD intraoperatively. In 20 (66.67%) out of 30 patients, choledocholithiasis was detected intraoperatively. The sensitivity, specificity, positive, and negative predictive values of ultrasonography in detecting CBD stones in the present study were 65%, 60%, 76.47%, and 46.15%, respectively. The sensitivity, specificity, positive, and negative predictive values of MRCP in diagnosis of CBD stones in the present study were 95%, 90%, 95%, and 90%, respectively. Conclusions: MRCP is a noninvasive investigation without complications and has high sensitivity, specificity, positive, and negative predictive values in detecting CBD stones. MRCP should be done in all cases with suspicion of CBD stones, where facilities and expertise are available.

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Background/Aims: Repeat of X-ray examinations contributes to the radiation burden of patient and waste of resources in most developing countries. This study determined the economic implications of repeated X-ray examinations in 10 selected hospitals in Ghana. Materials and Methods: The study was carried out in July, 2011 using a total of 2785 radiographs from 1685 patients (85.9% adult and 14.1% pediatrics). Of these, 944 (56.0%) were female and 741 (44.0%) male. Reject films were compiled and classified according to the reasons for the reject. Time and cost analyses due to the repeat examinations were also carried out. Results: Out of 2785 radiographs included in the study, 540 representing 19.4% were rejected. The overall reject rate for the individual hospitals ranged from 14.6% to 20.8%. The minimum time wasted by the radiographers in repeating examinations during the 1 month study was estimated to be approximately 135 h representing 17 working days in Ghana. The loss of revenue per month due to 540 rejected/repeated radiographs amounts to approximately $6021 equating to approximately $72,256/annum. Exposure error and poor patient positioning constituted between 52.0% and 23.0% respectively of the overall causes of film rejection and were evenly distributed across the hospitals. Conclusion: Consistent training in radiographic techniques and standardization of protocols as well as quality assurance measures in the hospitals could help overcome the reported exposure error and poor patient positioning and improve revenue savings.

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Background: Paragonimiasis is one of the re-emerging public health diseases. Most of the presenting symptoms of pulmonary paragonimiasis are similar to those of tuberculosis (TB), which is also another major public health issue. Unfortunately both infections occur in the same environment of low socioeconomic status. Clinical and radiological differentiation between pulmonary paragonimiasis and tuberculosis can be difficult. Aim: This study was therefore designed to identify the chest radiological features that could be consistently used to differentiate between pulmonary TB and paragonimiasis in children. Materials and Methods: Two hundred and forty children aged five to eighteen years, were selected by stratified random samplings from a public primary and a secondary school in Ewang village, Mbo local government area of Akwa Ibom State, Nigeria. These children were screened for pulmonary paragonimiasis and pulmonary tuberculosis using sputum microscopy and Ziehl Neilson staining, respectively. Thereafter, the chest radiographs of children who were sputa-positive for paragonimus egg and acid fast bacilli were taken on full inspiration. Statistical Analysis: The data was analyzed with the STATA 10 software, produced by Stata Corp, Texas, USA. The results were expressed as means, standard deviations (SD), as well as percentages. A P < 0.05 was considered statistically significant. Results: A total of 204 children were examined; 91 (44.6%) were males and 113 (55.4%) were females. Ten (4.9%) of the subjects were sputum-positive for the paragonimus egg, while four (1.96%) of the subjects were sputum-positive for tuberculosis. The signs and symptoms of both diseases were similar. Radiologically, subcutaneous tissue wasting was an important differentiating feature between both diseases (P = 0.002). Conclusion: The study has shown that paragonimiasis and tuberculosis in children coexist in this locality. The clinical features of both conditions were similar hence differentiation on clinical grounds was difficult. Thus in a child being investigated for tuberculosis, the absence of subcutaneous tissue wasting radiologically should prompt further investigation for paragonimiasis.

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Background: Computerized Tomography (CT) findings of Cerebrovascular Accidents (CVA) in patients in Calabar, Nigeria, have not been previously reported. The aim is to document the CT findings and the pattern and demographic features of the condition. Materials and Methods: We prospectively studied 87 consecutive patients, presenting over a 12-month period with diagnosis of stroke. The sociodemographic and clinical data as well as the CT findings were collected. Statistical analysis was done using the computer software STATA 10 corp., Texas, USA. Results: There were 49 males and 37 females with a median age of 56 years (45.75-67). The ischemic type of CVA predominated, (81.4%), with no significant gender difference (P = 0.99). The peak age of stroke was in those less than 50 years (33.7%). The individuals with hemorrhagic stroke were younger than those with ischemic stroke (median of 48 and 59 years, respectively). Conclusion: Stroke incidence in Calabar has evolved so much, as to affect a much younger age group and the female to male ratio is fast approaching equality. The hemorrhagic type tends to affect younger males. It is recommended that young people presenting with stroke in the Calabar area, particularly where a CT scan is not available, must be suspected to have a hemorrhagic stroke.

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