Preoperative diagnosis of the organ of origin in cases of exophytic lesions of liver is difficult and a challenge for the radiologist and clinicians. It needs careful examination and interpretation of radiological findings for correct diagnosis. We present our experience with exophytic liver lesions in four patients diagnosed with hepatocellular adenoma, hepatocellular carcinoma (HCC), cavernous hemangioma, and hydatid cyst, and highlighted these issues.

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Background: Several disease conditions can affect gallbladder (GB) size and wall thickness (WT). Imaging methods are superior to clinical evaluation in assessing GB dimensions. Ultrasonography is a relatively safe, inexpensive and reproducible imaging modality for assessing normal or diseased GB. There are few reports on normal GB dimensions in the Nigerian medical literature. This study therefore set out to contribute to data on GB dimensions among Nigerians. Materials and Methods: This was a prospective study. Three hundred and twenty-two healthy adult volunteers, consisting of 133 males and 189 females were assessed, by ultrasound, following over night fasting. GB length, width, height and WT were measured for each subject. GB-V was calculated by the ellipsoid formula. Data analysis included descriptive statistics and comparison of measurements with biometric parameters. Statistical significance between the variables was done with the Students t-test, with 'P' value set at ≤0.05. Results: One hundred and thirty-three males (41.3%) and one hundred and eighty-nine females (58.7%) were studied. The mean age of subjects was 31.92±11.7 years. The mean values of the length (L), height (H), and width (W) of the GB were 6.16±1.09 cm; 2.75±0.58 cm; and 2.98±0.59 cm respectively. Mean GB-V was 27.2±12.8 cm ³ and WT 0.25±0.04 cm. Age and gender did not significantly influence GB measurements. Conclusions: A normal range of GB dimensions for the Benin City locality has been established. The study confirmed the non-dependence of GB measurements on age and gender.

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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: 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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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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Aneurysmal malformations of the vein of Galen (VGAM) are a rare congenital intracranial vascular disorder. It is known to occur in two main forms. We present two children with classic demonstrations of broadly recognized categories. It typically results in high-output congestive heart failure or may present with developmental delay, hydrocephalus and seizures. Our aim is to demonstrate the challenges of imaging and management in an African setting of a rare congenital intracranial vascular disorder presenting in older African children with infrequently recognized associations using limited imaging techniques. Computed tomography (CT) showed extensive gyriform hyperdensities at the grey-white matter junction, dilatation of a portion of the superior sagittal sinus with erosion of the inner table of the calvarium, multiple abnormal tortuous vessels in the suprasellar region, and a markedly dilated vein of Galen and ventricular system. Magnetic resonance imaging (MRI) showed a tortuous dilated pontomesencephalic vein in the quadrigeminal cistern, dilated vein of Galen and straight sinus. A network of vessels in the quadrigeminal cistern draining into dilated vein of Galen thinning of the corpus callosum is seen. Chest radiograph and electrocardiographic chart showed evidence of cardiomegaly and cardiac failure in one patient. We review the literature and discuss the challenges of imaging and management in our African setting. The VGAM is a recognized rare anomaly, however, knowing the true prevalence and improving its management in our African environment is limited due to the challenges of available imaging technology, lack of personnel in interventional neuroradiology, and inaccessibility to care of a large poor population.

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Background: With the widespread use of ultrasound scan in pregnancy, there is a growing concern about the ability and accuracy of sonographic determination of the fetal gender. Aim: This study aims to find out how accurate this is in a health facility in Port Harcourt, South Nigeria. Materials and Methods: A retrospective cohort study was carried out over a 2-year period. The birth gender of 750 women who were scanned during the index pregnancy and the fetal sex noted on routine ultrasound were compared to find out how accurate the gender was determined by ultrasound. The data obtained were subjected to statistical analysis. Results: During the study period out of the 945 women who attended the antenatal clinic of the health facility during the study period, 750 (79%) had relevant scan reports from various imaging centers in Port Harcourt. The study showed that all sonographic sex determinations were made later than 19 weeks gestation and overall accuracy throughout pregnancy was 98.4%. Conclusions: Gender determination by ultrasound which has a high accuracy in this environment also has a degree of failure. Thus the expectant mother and referring physician should be aware of its limitations and accuracy in our environment.

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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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Background: Vaso-occlusion in the kidney is a capillary phenomenon. Renal medullary hyperosmolalrity and low oxygen tension encourage the maximum formation of sickled red cells. In addition, the glomerular loops constitute an aggregating point for the sickled red cells with subsequent obstruction to the blood flow. These factors, together with the large volume of blood flowing through the kidneys make renal complications inevitable in sickle cell anemia (SCA). Aim: The purpose of this prospective study was to report the renal sonographic findings of a sample of patients with hemoglobin electrophoretic pattern consistent with sickle cell anemia Materials and Methods: A cross-sectional prospective study of 74 patients with the diagnosis of SCA, as documented by electrophoresis and who attended the adult sickle cell clinic, Hematology Department of the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria and 20 age-matched controls with a normal hemoglobin (HbAA) phenotype and with no history of renal disease, was carried out between April and December, 2010. None of the patients had any clinical evidence of acute sickle episode (crisis) at the time of ultrasonographic examination. B-mode ultrasonography with Aloka SSD-3500 was used to assess the kidneys. The hematological parameters were determined by multiparameter analyzer Sysmex XT 2000i, whereas creatinine and urea of the patients were also analyzed using the Selectra XL chemistry autoanalyzer. Results: Renal size of the study group was compared with that of the control group and it showed a significant increase in the adult patients with SCA (P<0.05). The mean right renal length in the study group and control group was 10.65±0.97 cm and 9.95±0.80 cm (P<0.001), respectively, whereas the mean left renal length in the study group and control group was 10.70±1.02 cm and 10.00±0.66 cm (P<0.001), respectively. Statistical relationships between renal length and some hematological indices (packed cell volume (PCV), red blood cell count, and reticulocyte count) showed no correlation but renal length was positively correlated with reticulocyte count, especially high reticulocyte count. Other findings documented and discussed include echogenicity of renal parenchyma, hydronephrosis, and papillary necrosis. Conclusion: Renal ultrasound imaging of patients with SCA showed a high incidence of renal abnormalities.

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Background: Medical imaging using ionizing radiation is an essential tool for diagnosis. Ionizing radiation has adverse biological effects on living organisms and the risk of adverse effects increases with higher doses of radiation. It is the duty of the requesting doctor to balance the risks and benefits of imaging tests involving the use of ionizing radiation. However, previous studies reveal that doctors' knowledge regarding the radiation doses incurred during diagnostic radiological procedure is inadequate. Aims: To assess doctors' knowledge about the guiding principle of radiation protection (As Low as Reasonably Possible (ALARA)) and their knowledge of the radiation doses their patients receive during some common radiological procedures. Materials and Methods: We adapted the questionnaire used in a previous study and circulated it among 120 doctors from different specialties and cadres. There were questions about cadre, years in medical practice, specialty, and attendance at any training on radiation protection. We asked about nonmedical sources of radiation, the full meaning of ALARA, and the effective doses of ionizing radiation that patients receive during common radiological investigations proportional to chest X-ray. Responses were scored out of a total of 10 marks. Results: One hundred and twenty doctors participated in the study; 27 radiologists and 93 nonradiologists. The total scores ranged from 1 to 7 marks (mean score=3.38, median score=3.0). Overall, the doctor's total scores were significantly affected by their specialty and exposure to previous training on radiation protection, with P=0.001 and P=0.001, respectively. Scores were not significantly affected by number of years post qualification. Conclusion: Level of awareness about the basic principle of radiation protection and patients' exposure is poor among our study population

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