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   Table of Contents - Current issue
Coverpage
January-June 2022
Volume 3 | Issue 1
Page Nos. 1-38

Online since Thursday, July 7, 2022

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REVIEW ARTICLE  

Current status of bone single-photon emission computed tomography combined with computed tomography in evaluation of foot and ankle pain p. 1
Hardik Veerwal, Anjali Meena, Vandana Kumar Dhingra
DOI:10.4103/jrmt.jrmt_25_21  
The complex anatomy of the foot and ankle makes it a clinical challenge to reach a final diagnosis in patients with foot and ankle pain. Conventional imaging modalities such as radiography, computed tomography (CT), and magnetic resonance imaging (MRI) play a vital role in making a diagnosis in patients with foot and ankle pain. MRI is considered to be the go-to modality for foot and ankle pathologies, but it has limitations in patients with metallic implants and claustrophobia. With wider availability and excellent imaging quality of new-age gamma cameras, bone single-photon emission computed tomography combined with CT (SPECT/CT) with technetium-99m (99mTc) labeled bisphosphonates has come into forefront for diagnosis of foot and ankle pathologies. SPECT is known to have high sensitivity to detect lesions but with low specificity. This low specificity was overcome by the introduction of SPECT/CT, a hybrid imaging modality that involves anatomical correlation of CT with the functional imaging of SPECT. SPECT/CT is extremely useful for evaluating the common but challenging causes of foot and ankle pain such as osteoarthritis, impingement syndrome, infection, inflammation for detecting optimal sites for intraarticular injection, and evaluation of diabetic foot. This review article aims to discuss various imaging modalities available for foot and ankle evaluation and the current status of SPECT/CT in diagnosing various foot and ankle pathologies.
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ORIGINAL ARTICLES Top

Estimating renal insufficiency in breast cancer patients using ultrasound determined resistive index: A cross-sectional study of a Nigerian Cohort p. 8
Oluwagbemiga Oluwole Ayoola, Olusegun A Alatise, Olalekan Olasehinde, Tewogbade A Adedeji, Adewale O Adisa, Bukola B Olagbaju, Olurotimi O Komolafe, Fatiu A Arogundade
DOI:10.4103/jrmt.jrmt_27_21  
Purpose: The purpose of this study was to investigate if the renal arterial resistive index (RRI) is impaired in women with breast cancer and correlate these values with estimated glomerular filtration rate (eGFR) as determined by the Chronic Kidney Disease Epidemiology Collaboration equation. Materials and Methods: This was an observational study of fifty chemotherapy-naïve women with histologically confirmed breast carcinoma recruited consecutively over a 1-year period. All women had a Doppler ultrasonography done to determine their RRI and eGFR. Results: Fifty women with breast cancer were evaluated. Their ages ranged from 28 to 85 years, with a mean age of 48.6 ± 13.8 years. The mean RRI in the study was 0.7 ± 0.07. There were thirty subjects (60%) with abnormal resistive index (RI) (>0.7), whereas twenty subjects (40%) had normal RRI. The mean eGFR in the study cohort was 62.6 ± 17. eGFR was abnormal in 96% of the women. About half (n = 24, 48%) had severe renal insufficiency (stages 3 and 4). The majority had advanced breast disease (stages 3 and 4), with 23 patients (46%) presenting with stage 3 disease and 17 (34%) stage 4 disease. Pearson's correlation done between RRI and eGFR showed a mild but statistically significant correlation between RI and eGFR (r = −0.28, P = 0.04). Conclusions: Renal artery RI is raised in most subjects with breast cancer and correlates significantly with the eGFR as determined by cystatin C alone.
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Fetal doppler velocimetry of the middle cerebral artery in hypertensive disorders of pregnancy, in Kano, Nigeria p. 13
Abdullahi Dahiru, Yahuza Mansur Adamu, Kabiru Isyaku, Anas Ismail, Yusuf Lawal, Murtala Yusuf
DOI:10.4103/jrmt.jrmt_22_21  
Background: Hypertension is one of the leading causes of maternal and fetal mortality and morbidity. The middle cerebral artery (MCA) is the major supplier of blood to the brain. Doppler velocimetry has made it possible to identify and insonate the fetal MCA and is used in fetal surveillance in high-risk pregnancies and has been efficacious in antenatal fetal monitoring. Materials and Methods: Sixty-five patients with hypertensive disorders of pregnancy and 65 normotensive pregnant controls between 20 and 39 weeks of gestational age were recruited for this study. Obstetric ultrasound scan was done to determine the gestational age, estimated fetal weight, and amniotic fluid indices. Fetal MCA Doppler velocimetric indices (peak systolic velocity [PSV], end-diastolic velocity [EDV], (RI) Resistivity index RI-resistivity index, pulsatility index [PI], and systolic/diastolic ratio [S/D ratio]) were also measured and documented. Results: The mean PSV of the study group (32.1 ± 10.1 cm/s) was lower than that of the control group (38.6 ± 9.3 cm/s). This difference was not statistically significant (P = 0.416). However, the mean EDV of the study group (9.09 ± 2.9 cm/s) was higher than that of the control group (8.6 ± 2.0 cm/s) which was also not statistically significant (P = 0.074). There was a statistically significant difference (P ≤ 0.001) between the mean RI of the study group (0.70 ± 0.10) and that of the control group (0.77 ± 0.05). The mean PI of the study group (1.35 ± 0.5) was also lower than that of the control group (1.49 ± 0.3), which was statistically significant (P ≤ 0.001). There was also a statistically significant difference (P = 0.003) between the mean S/D ratio of the study group (3.64 ± 1.4) and that of the control group (4.5 ± 1.1). Conclusion: There was a significant statistical difference in the fetal MCA Doppler velocimetric indices between hypertensive and normotensive groups indicating that fetal MCA Doppler ultrasound is a useful tool in monitoring the hemodynamic changes in the cerebral circulation of fetuses of mothers with hypertension in pregnancy.
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Safety and efficacy of percutaneous ultrasound-guided needle aspiration of liver abscesses in a resource-scarce environment: The experience of a private diagnostic service center in kaduna over an 8-year period p. 21
Tokan Silas Baduku
DOI:10.4103/jrmt.jrmt_9_21  
Background: Liver abscess is a condition found in both the developed and the developing countries (including Nigeria), which was normally treated with drugs alone. Refractory patients who were initially treated by open abdominal surgery are now successfully treated with minimally invasive approach from increased availability and access to ultrasound in low-resource settings where the burden of liver abscess is still significant. To our knowledge, not much data are available in our environment on a large series of patients with liver abscess managed solely with percutaneous needle aspiration under ultrasound guidance in combination with systemic and local abscess sac antibiotic treatment. We, therefore, report our experience in the management of liver abscess in Goshen Diagnostic Services, Kaduna, Nigeria (a private diagnostic center). Aim: The aim of this study was to describe our experience in the ultrasound-guided percutaneous management of liver abscesses over a period of 8 years in a private diagnostic center and to review the literature. Materials and Methods: This prospective study was conducted over an 8-year period at Goshen Diagnostic Services (a privately owned diagnostic outfit with only outpatient facility), Kaduna, Nigeria, from June 2012 to May 2020, involving 77 adult patients (62 male and 15 female) with liver abscess who were referred from various medical facilities within the city just for drainage purposes. Results: A total of 77 patients were eligible for the study consisting of 62 males and 15 females (male-to-female ratio of 4:1). Fifty-eight (75.3%) of them were referred from government/public hospitals, whereas 19 (24.7%) were from privately owned medical centers. Fifty-three (68.8%) patients were referred when still on admission in the various hospitals, whereas 24 (31.2%) came as outpatients. Twenty-eight percent of them required only a single aspiration, whereas 38.9% and 24.7% had to go for a second and third episode, respectively. The success rate was 100% after 6 months of follow-up. Conclusion: Liver abscess management used to be a surgical dilemma with substantial morbidity and mortality but has currently become minimally invasive. At present, morbidity and mortality have markedly diminished, with reduced cost to the patient. The direct infiltration of drugs into the abscess sac has improved the success rate.
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CASE REPORTS Top

Early experience of percutaneous transhepatic sphincteroplasty with occlusion balloon evacuation of biliary stones in a Lagos, Nigeria Center p. 27
Hammed Ninalowo, Aderemi Oluyemi, Chidubem Ugwueze, Samuel Busayo Ogunlade
DOI:10.4103/jrmt.jrmt_26_21  
Untreated obstructive jaundice secondary to common bile duct stones can lead to serious metabolic and life threatening complications. Three options exist for CBD stone evacuation; endoscopic retrograde cholangiopancreatography (ERCP), surgical exploration, and percutaneous transhepatic biliary intervention. Open surgical exploration has been the mainstay of management of CBD stones in Nigeria due to limited access to less invasive approaches. The availability of percutaneous transhepatic intervention can serve as an alternative. For this case series, the first consecutive patients who were treated for choledocholithiasis with percutaneous sphincteroplasty between March 2020 and December 2020 at a center in Lagos are described. A total of 6 patients underwent stone evacuation over the study period. The technical success of sphincteroplasty and CBD stone evacuation was 100% in all patients (n = 6) at the first attempt. This series illustrates that percutaneous transhepatic sphincteroplasty for clearance of biliary stones is technically feasible and available to Nigerian patients.
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Ultrasonography and magnetic resonance imaging findings of an occult tibial plateau fracture p. 32
Adeniyi Sunday Aderibigbe, Oluwagbemiga Oluyoola Ayoola, Oludare Uriel Ashaolu, Olurotimi Olufunto Komolafe
DOI:10.4103/jrmt.jrmt_2_22  
We describe a case of posttraumatic lateral tibial plateau fracture that was not demonstrated by conventional radiography. Knee joint ultrasound showed mild lateral meniscal protrusion suggestive of an intra-articular injury, which was confirmed at magnetic resonance imaging to represent an occult lateral tibial plateau fracture. A high index of suspicion for occult fractures should be maintained in posttraumatic patients with ultrasound findings of meniscal protrusion, in spite of apparently normal X-ray findings.
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Congenital intracranial teratoma masquerading as encephalocele p. 35
Yahuza Mansur Adamu, Mustapha Shuaibu Hikima, Yusuf Lawal
DOI:10.4103/jrmt.jrmt_23_21  
Teratomas are rare tumors accounting for only 0.5% of all intracranial tumors. However, they are considered as the most common congenital brain tumors present at birth. Commonly, they are found in the sacrococcygeal region, head and neck, gonads, and the mediastinum, although they may be found in other parts of the body. An encephalocele on the other hand is an extracranial lesion with intracranial contents through a defect in the skull. The higher prevalence of encephaloceles often leads to misdiagnosis of other congenital diseases of the brain like tumors as encephalocele. We present a 29-day-old child who presented to the hospital on account of swelling on the skull which was noticed since birth and associated absence of hair over the swelling covered by intact skin with initial impression of encephalocele made. The role of imaging in these patients precisely computed tomographic scan and magnetic resonance imaging (MRI) cannot be overemphasized for appropriate diagnosis and surgical intervention. A radiological diagnosis of congenital intracranial teratoma was made and the patient had surgical excision of the tumor. Congenital intracranial teratoma are rare congenital malformations. The present report demonstrates the classic imaging features as seen on plain radiographs, computed tomography, and MRI which are indispensable for subsequent surgical intervention.
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