Radiology

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Computed to Myography Pattern of Bone Fracture and outcome of Road Traffic Accident in Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia.
(Addis Ababa University, 2017-10) Bekele Sisay; Admassie Daniel
Background:Road traffic accident (RTA) is defined as a collision between two or more, between vehicle and pedestrians, between vehicles and fixed animals obstacles. Of all the transportation systems that people use, road transport is the most widely used, complex and dangerous because it is highly associated with the rise in road traffic collisions. Road traffic accidents have become a huge global public health and development problem with highest burden in developing country, especially highest cause of mortality and disability in Africa. Ethiopia, one of developing country in Africa suffering one the most frequent car accidents and mortality.Aim:Aimed at determining the pattern of bone fractures in TASH and assess outcome of RTA. Methods:The study is a retrospective cross sectional study involves all patients sustained road traffic accident coming to department of radiology and having CT from February to August. The CT scan will be examine by senior radiology residents and revised by radiologist. The chart of the patient will be revised for pertinent clinical information and to assess the outcome the accident. Results:A total of 131RTA victims were included in the study of which 95 (72.5%) were male and majority of them are from urban 81(61.8%). The most affected people were passengers (45%) followed by pedestrians (35.1%) and those found in between 20-29 years of age (33.6%). The fracture occurred were in lower limb (22.3%), spine (21.8%), upper limb (19%), pelvic bone(16.6) and head (15.2%) and the most fractured body region was head and neck(23.2%). Over all fracture of vertebral bone, skull and pelvic bone was the top leading frequently fractures. Majority of patients have either neurologic or movement impairment (61.1%) and others cured (22.1%) and died (7.6%) Conclusions:In this study, RTA commonly affects males and those productive age groups (20-49yr). Of all fracture of lower limb was the leading followed by fracture of spine and pelvic bone fractures respectively. With specific bone fracture vertebral bone fracture is the commonest. The outcome of the patient at the time of their discharge or on their follow up, most of them had some degree of neurologic or movement impairments.
Computed Tomography and X-Ray Patterns of Pelvic Fracture in Tikur Anbessa Specialized Hospital in Adults, Addis Abeba University, Addis Abeba ,Ethiopia.
(Addis Abeba University, 2019-07) Hagos Haile; Admassie Daniel; Gezahegn Hiwot; Zenebe Moges
Background :Trauma is a public health burden resulting in increased morbidity, mortality and disability for thesurvivors. Musculoskeletal injury results in dramatic, destructing and life-threatening injuries.Of these pelvic fracture accounts approximately to 3% of the overall injuries and is one of the majorcauses of morbidity and mortality.Classification of pelvic fracture is useful in describing injuryand also helps in guiding both the initial treatment and definitive fixation. But pelvic fractureshave presented a great challenge to orthopedic surgeons and radiologists over the years in that multiple classification system exists to attempt to standardize care and no consensus exists in theclassification method of such fractures. The classification scheme of Young and Burgess andTiles described the severity of injury by the mechanistic process involved and by grading thestability of the injury respectively. However, the most current classification method is that developed by the AO and OTA and is a composite of these two earlier methods. In addition, anunderstanding of the mechanism of injury that leads to pelvic fractures is useful to guidetreatment and understand patterns of injury and cause of mortality. Objective :The objective of the study is determining the CT and X-ray pattern of pelvic fracture in TASH. Method :The study is a hospital based retrospective cross sectional study done on 80 patients who havepelvic ring fracture who have CT scan and Pelvic X-ray (AP, Inlet and outlet views) in thedepartment of radiology. The CT scan was examined by senior radiology residents and revised by radiologist, with these finding the Tiles classification of pelvic ring fracture was assessed bythe principal investigator initially by X-ray alone and later by CT scan alone blindly. vii Result :A total of 80 patients with pelvic ring fracture were included in the study of which 58 (72.5%)were males and 22 (27.5%) were females. Road terrific accident was the major cause of pelvicfracture accounting for 76.3% of cases followed by fall from a height. Of those involved in RTAthe most affected people were both passengers and pedestrians (30%) each followed bydrivers(16.3%).The most commonly affected age group was those found in between 15-25years of age (43.8%) and followed by those in between 26-35 years (35%). The most commonpattern of pelvic ring fracture was Tiles B2 (25%) followed by C1 (22.5%) and B3 (20%). Over allTiles B accounts 45% and Tiles C accounts 38.8%. Conclusion :In this study trauma commonly affects males and RTA is the most common type of trauma causing pelvic ring fracture affecting males in the productive age groups between 15-35 years.Tiles B pattern of pelvic ring fracture is the most common pattern followed by Tiles C pattern.Further study is recommended in the value of CT and X-ray in the evaluation of pelvic fracture.
Computed Tomography Radiation Exposure among Urinary Tract Stone Patients at Tikuranbessa Specialized Hospital: A Retrospective Study
(Addis Abeba University, 2021-08) Nebiyou Tensae; Teferi Seife; Admassie Daniel
Background: Urinary tract stone is increasing dramatically in recent years so is the diagnosticcapability especially after the employment of abdominopelvic CT. The wide use of abdominopelvic CT in the diagnosis, treatment planning, and follow-up of these patients raisedthe issue of radiation exposure. For this reason, CT protocols that decrease the radiation dosewithout decreasing the sensitivity and specificity of depicting stone have been implemented. Thecommon of these protocols is low dose CT despite its wide advocation there is wide variation inCT protocols in different institutions. The CT protocol used in our country is not known and thereis no national guideline or recommendation for these types of patients, therefore, a wide variety ofprotocols in different institutions is expected of which some may expose patients to unnecessary radiation. Objectives: To study the amount of radiation dose patients at tikuranbessa specialized hospitalpatients with urinary tract stone disease receive in being evaluated by abdomen/pelvic CT Methods: a retrospective cross-sectional was done February 1to august 31, 2021, at TASH in patients who had their scan for urolithiasis or symptoms related to urolithiasis 1/07/202031/10/2020G.Careincluded until the sample size isattained.Datawerecollectedbytheprincipalinvestigator with a structured questioner that evaluates the number of CT they had The CTcharacteristics like DLP CTDvol, date, and place the CT was taken. These data were analyzed bystatistical software SPSS version 22 Results: None of our patients have exposure more than 50msv per year or 100msv over 5 years.3.6% of our patients have radiation exposure of more than 4msv, which is the standard for lowdoseCT.Themedianradiationexposureis1.27mSvperscan.Exposurefactorsliketubecurrent,tube current product, dose length product, scan range all have similar values with almost null interquartile range.Tube current product was found to have a statistically significant positive correlation with effective dose.All the scans that overpassed the low dose threshold(4msv) were done outside TASH. Conclusion: Our study showed that TASH’s low dose CT protocol for patients with urolithiasisis well optimized and patients are not being overexposed but even with the limited data we have non-TASH institutions are likely using non-optimized CT scans and patients may be a victim ofradiation overexposure for either diagnosis or follow of urolithiasis.
Computer Tomographic Pattern of Bone Metastasis at Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia.
(Addis Abeba University, 2019-08) Tolasa Fikadu; Admassie Daniel; Gezzehagn Hiwot ; Zenebe Moges
Background:Skeletal metastases account for 70% of all malignant bone lesions and are seen in vast number of primary cancers. Lung cancer, breast cancer, renal carcinoma and prostate cancer account for approximately 80% of all skeletal metastases.CT scan imaging has an important role in the detection, diagnosis, prognosis treatment, planning and follow up monitoring of bone metastases.Substantial proportion of patient with advanced cancer and bone develop skeletal related events including pathologic fracture, spinal cord compression,myelosuppression and hypercalcemia which usually associated with moderate or severepain. Objectives:To determine pattern and distribution of skeletal metastases in patient with known and unknown primary cancer by using CT scan at Tikur Anbessa teaching referral hospital. Method:Prospective cross-sectional descriptive study of all patient with skeletal metastases diagnosed byCT scan followed by using data collection sheet (questionnaires) and medical records during study period at Black Lion Hospital from October 2018 to July 2019. Result:A total of 140 patients with known or unknown primary tumor with bone metastasis wereincluded in the study from October 2018 to July 2019 GC. 81 0f them were female and 59 weremale.The mean age at presentation was 52 years +/- 14.75(age range of 37.25-66.75years) andmajority of the patients were found in age group of 40-60(42.9%)years.Among the involved bone the most common affected was spine (62.1%), followed by pelvis (41.2%).The mostcommonly known primary cancers metastasis to bone were breast (30.7%) followed by lung(29%) and prostate (15.7%) tumors.Lytic type (51%) of the bone lesion is the frequent morphologic type followed by mixed (34%) and sclerotic (17%).Among the studied patients(65%) patients had bone pain symptom while (19.3%)had pathological fracture and(15.7%)patients had spinal cord compression symptom. Discussion:Majority of patients during the study period were female and the mean age of prestation was 52years +/-14.75. Among the primary tumors breast, lung, prostate, renal and thyroid cancer were the common tumors identified in our study. In this study spine was the most common boneinvolved followed by pelvis and ribs and sternum. When we see the morphology of bone lesionidentified on CT scan lytic is the most common followed by mixed andscelrosis.Pain was the most common clinical pentation of the studied patient.
Cross Sectional Study of the Patterns of Knee Joint Abnormalities Detected by Knee MRI in Patients Evaluated at Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia From April–September 2017.
(Addis Ababa University, 2017-09) Gizaw Elias ; Admassie Daniel
Introduction: The knee joint, the largest joint in the body, has several functions which are essential for human beings to walk, run and jump. Primarily, it enablesflexion-extension of the lower limb in the sagittal plane. Joint stability duringmovement is attained by the shape of the articular surfaces, the collateral andcruciate ligaments, the menisci and tendons and muscles crossing the knee joint.(1) The vulnerability of the knee, the largest joint in the body, to direct traumamakes knee injuries very common throughout life. (2)MRI visualizes most components of the knee joint, including articular cartilage,menisci, intra-articular ligaments, synovium, bone marrow, subchondral cysts, andother periarticular and intra-articular lesions that are not detectable by radiography.(4).The patterns of abnormalities of these different joint components as detected byMRI has been studied in different centers. Such types of studies, to date, have notbeen done in our country to our knowledge. The aim of this paper is to studyfrequency and the patterns of these abnormalities in the knee joint detected by kneeMRI. Objective: To assess the patterns of abnormalities in the knee joint detected by knee MRI. Methods: Hospital based prospective cross sectional study was conducted on 49patients who had knee MRI at Tikur Anbessa Specialized Hospital for a period of 7months from January 1 to August 2016. Patients included here are those who had knee MRI and no history of knee surgery. Results: A total of 49 patients were included in the study out of which 26(53.1%)were male and 23 (46.9%) were female, with a mean age of 43 years (range 17 to68 years). The three most common pathologies were joint effusion seen in32(65.3%), bone marrow edema in 22(45.8%) and osteophytes in 22(44.9%). ACLtear was the commonest ligament abnormality occurring in 5 (10.4%) patients. Ten(20.8%) patients had meniscal tear, all involving the medial meniscus with theposterior horn being involved in 8(80%) of these patients. Conclusion: The mean age of our study population was higher than most referenced papers suggestive of possible delay in health seeking. The commonestknee pathologies were similar to other studies. Features of osteoarthritis were seen in higher frequency in our study population. Even though the higher mean age could be the possible cause, further study is recommended to look into the causes.Bone fracture, tendon abnormality and ligament abnormality showed statistically significant association with trauma. These abnormalities which were seen with higher frequency in those with a history of trauma were also observed in higher frequency in the male population.
MR Imaging Findings of the Shoulder in Patients with Shoulder Pain
(Addis Abeba University, 2019) Gezahegne Hiwot; Admassie Daniel
Background: Shoulder pain is the third commonest cause of pain of all musculoskeletal relatedcomplaints. The diagnosis of shoulder pathologies is based primarily upon the results of clinicaltests and imaging findings. Of the imaging modalities Magnetic Resonance Imaging (MRI) isintroduction of MR in this country, no data has been made available about the MR imaging findings of patients presenting with shoulder pain. Objective: The aim of the present study is to determine the imaging pattern of various shoulderpathologies, as seen on MRI, in patients presenting with shoulder pain at St Paul’s HospitalMillennium Medical College, which is one of the tertiary and teaching hospitals in Addis Ababa. Method: This is an institutional based descriptive cross sectional study in which a total of 101patients satisfying the inclusion criteria over a period of sixteen months were included. The MRimages were read using structured reporting. Statistical analysis of the findings was then doneusing the software SPSS version 25. Result: There were 54 (53.5%) male and 47 (46.6%) female patients. The age ranged fromtwenty to seventy years. The mean age was 43.81years.The most common indication to have anMRI was chronic pain accounting for 70 (69.2%) of the cases and the right shoulder was imagedmore than the left with the ratio of 2.15:1. Rotator cuff disease is the most common pathology of glenohumeral joint, for which MRI was done. Involvement of supraspinatus tendon was 64.3%in all the pathologies. Of the 41 patients diagnosed with supraspinatus tear, partial tear was seenin 34 patients (82.9%) and complete tear was seen in 7 (17%) patients. Degenerative disease ofthe AC joint was the second most common pathology detected and it was associated with supraspinatus tendon pathology and sub acromial sub deltoid bursitis. 15.8% of the cases had anormal MR finding in this study. Conclusion: Rotator cuff pathology and AC joint arthritis were the two commonest pathologies detected on MR, and supraspinatus tendon was the most common involved tendon with pathology. Though MRI is the preferred test for evaluating rotator cuff pathology andimpingement syndrome, the cost and burden of ordering MR is significant. Proper indications and the relevance of the findings should be well evaluated and guide lines should be prepared forthe imaging of patients with shoulder pain.
MRI imaging Pattern of Ankle Joint Pathology (Retrospective Study, from 2018-2020 at Tikur Anbessa Specialized Hospital and Saint Paulos Millennium Medical College Hospital, Addis Ababa, Ethiopia)
(Addis Abeba University, 2020-08) Gedeno Gelebo; Gezehagne Hiwot; Admassie Daniel
Background: The ankle joint (Talocrural articulation) is a hinge-type synovial joint. It is one of the frequently injured joints and as such ligament injury is a more common pathology. The most common ankle injuries are sprains and fractures, which involve ligaments and bones in the ankle. Ankle joint can also be affected by inflammatory, infectious and tumoral lesions. Magnetic resonance (MR) imaging has opened new horizons in the diagnosis and treatment of many diseases affecting the ankle and foot. Objectives: This study was designed to assess the Magnetic Resonance imaging findings/patterns of ankle joint pathologies in patients who apresented with ankle joint compliant. Method: Hospital based retrospective descriptive cross-sectional study was conducted at Tikur Anbessa Specialized Hospital and Saint Pauls Millennium Medical Collage Hospital within a period of 30 months from January 2018 to June 2020G.C to address the specific objectives stated.Data was collected using structured questionnaires from picture archiving and communication system (PACS) system, from both manual and electronic patient recordings. Magnetic Resonance Images were evaluated for result correspondence. Computerized Data analysis was conducted by using Statistical Package for the Social Science (SPSS) version 25 software Result: A total of 114 patients were imaged with Magnetic Resonance Images in the two hospitals over the last 30 months and among them 75(56.8%) were females and 39(34.25) were males. The commonest age involved was between 31-40 and 21-30 years with age range from 787years.Bone marrow signal change (35.1%) is the commonest pathology detected with MRI followed by tendon pathology (28.9%) and joint effusion (26.3%). Tenosynovitis is the commonest tendon lesion detected followed by tendinopathy which is more common in Achilles tendon, the commonly involved tendon among tendons at ankle joint. Anterior Talofibular ligament is the commonly injured ligament in 72.7% of the cases with ligament lesions. Study showed 11 different types of tumor lesions (Giant cell tumor was more common), 5 cases with Haglund syndrome and 2 cases of Madura foot. Conclusion: Magnetic Resonance Image has a special quality in detecting bone, tendon, ligament and soft tissue pathologies irrespective of the etiology and our study confirmed this quality of detecting wide array of pathologies. Magnetic Resonance Image is an irreplaceable imaging modality in Musculoskeletal system imaging and its accessibility has led to increased detection of pathologies of the ankle joint which otherwise wouldn’t have been detected. Detection of minor fractures, bone contusion, small soft tissue lesions in detail made MRI gold standard imaging modality in Ankle joint.
Prospective Cross sectional study of Radio-Pathologic Correlation of Soft Tissue Tumors in Patients Evaluated at Tikur Anbessa Specialized Hospital and St Paul Millennium Medical College, Addis Ababa University, Addis Ababa, Ethiopia, 2019
(Addis Abeba University, 2019-08) Tadesse Samuel; Admassie Daniel ; Zeneb Moges; Gezahegn Hiwot
Introduction: Soft tissue is the supportive tissue of various organs and the non-epithelial, extra skeletal structures exclusive of lympho-hematopoietic tissues. It includes fibrous connectivetissue, adipose tissue, skeletal muscle, blood/lymph vessels, and the peripheral nervous system.Most soft tissue tumors are classified as ether benign and malignant there are also intermediategroups implying aggressive local behavior with low to moderate probability for metastasis. Softtissue tumors are classified histologically on the basis of the adult tissue they resemble. Objective: Assessment of radio-pathologic correlation of soft tissue tumors in patients evaluatedat Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia 2019. Method: The study was conducted at TASH from May 2018-January 2019. Hospital based prospective cross sectional study was conducted at TASH to address the specific objective during study period. The Study was conducted among patients being evaluated at Tikur Anbessa Specialized Hospital oncology department who have both MRI and pathology result during study period. Data was collected by evaluating the MRI report and biopsy result from oncology department and also using structured questionnaires. The data was checked for clarity and completeness. Computerized data analysis was conducted by using SPSS version 25 software. Result: Total of 73 cases evaluated with 60% malignant. The sensitive MRI parameters formalignancy are size >5cm (91%), necrosis (82%), bone involvement (80%). The specific MRI parameters include age>25yr (86%), necrosis (78%), heterogeneous enhancement (75%). From all the MRI parameters only necrosis had significant correlation with malignancy on imaging in ourstudy. Conclusion: The most sensitive and specific MRI parameter to predictmalignancy in our studyare size > 5cm, necrosis, heterogeneousenhancement. Necrosis had significant correlation for malignancy.
Prospective Study of Clinical Application of Justification and Optimization Principles of Alara in Pediatric Ct Imaging, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia
(Addis Ababa University, 2018-10) Ayalew Bezawit; Admassie Daniel
Background : Despite the improvements in the diagnosis and treatment of numerous medical conditions in pediatric patients by medical imaging, radiation exposure, particularly with CT imaging, continues to be worrisome for children who are more vulnerable than adults from radiation associated cancer development. Recent studies indicate that a cumulative dose of 50mGy triples the risk of leukemia and a dose of 60mGytriples the risk of brain tumors in children. Objective: To assess the clinical application of Justification and Optimization principles of ALARA in pediatric CT imaging in Tikur Anbesa Specialized Hospital. Method: An institution based prospective cross sectional study was conducted from December 2017 to July 2018 G.C in TASH Addis Ababa. Data was collected by using a standardized CT request form with preset form fields which will have to be completed manually by the physician requesting the CT. All pediatric patients who came for CT imaging in the study period was included in the study. The collected data was entered and analyzed using SPSS version 25. Result: Among the total of 429 CT requests received during the study period (8 months), 246 (57.3%) were male and 183(42.7%) were female. When we see the age distribution 52(12.1%) were less than 1 year, 153(35.7%) were 1 year to less than 5 years, 113(26.3%) were 5 year to less than 10 years and 111(2.9%) were 10 years to 14 years old. Out of the total 429 requests 28(6.5%) were rejected during the study period based on ALARA justification principle. From the rejected requests, for 11(39.2%) MRI was suggested instead of CT, for 6(21.42%) US were suggested instead of CT, additionally review of previous CT scan helped to reject 4(14.28%). Review of prior chest radiography helped in rejecting 2(7.14%) CT requests. For 5 (17.8%), other imaging modalities like Endoscopy, Echo, IVP and barium study were suggested. Nineteen (4.4%) Ct requests from 429 CT requests were optimized by applying principles optimization and thus received reduced radiation from CT imaging.X Conclusion: In general in this study 47(11%) patients were protected from unnecessary radiation exposure by applying optimization and justification principle of ALARA which indicates that applying ALARA principle has significant advantage in decreasing radiation exposure to children. The use of other alternating imaging modalities like US or MRI with no radiation exposure ha major role in replacing CT especially in pediatric patients who are more radiosensitive and have longer time to manifest radiation induced injury.
Prospective study of Computer Tomographic Pattern of Bone Metastasis in Breast Cancer Patients, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia, August 2018 GC.
(Addis Ababa University, 2018-08) Dessalegn Chala; Admassie Daniel
Introduction Bone metastasis is the most common site to which the breast cancer metastasis. Between 30%and 55% of the patients with breast cancers will develop bone metastasis during the course of the disease. Bone is also representing the first site of metastasis for 26% to 50%of patients with metastatic breast cancer. Imaging is essentials parts of the management of bone metastasis in breast cancer; however no consensus has been reached as to the optimal imaging modality. CT using the bone window offers superior skeletal detail, because of its ability to distinguish among materials of different density. Objective To assess the CT pattern of bone metastasis in breast cancer patients at Tikur Anbessa teaching referral hospital. Method Hospital based prospective cross-sectional study at Tikur Anbessa Specialized Hospital with breast cancer patient who have bone metastasis being evaluated at radiology department and who have CT imaging during the study period. Convenience sampling technique was used. Result A total of 100 breast cancer patients with bone metastasis were included in the study from September 2017 to August 2018 GC. 91 of them are female and 9 of them are male. The minimum age is 21 years and the maximum age is 71 years with mean age of 42.5 years.Ductal carcinoma (87%) is the most common type of breast cancer followed by Adenocarcinoma (5%) and malignant epithelial tumor (5%).Lytic type (51%) of bone lesion is the frequent morphologic type followed by mixed (28%) and sclerotic (21%) respectively. In 87% of the patients had vertebral bone involvement followed by Pelvic bone (34% of patients) and ribs (30% of patients). There are five patients with skull bone involvement. Conclusion Majority of patients are female in our study with female to male ratio of 9:1 which is lower than most studies done at different countries. When seen on computed tomography, lytic lesion is the most common feature of bone lesion followed by mixed (sclerotic and lytic) and sclerotic, which is in line with most of the studies. When we come to the anatomic distribution of the affected bones from breast metastasis, vertebral bone is the most commonly affected bone followed by pelvic bone and ribs.

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