Faculty of Radiology

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ULTRASONOGRAPHIC FINDINGS OF THE ACHILLES TENDON IN ASYMPTOMATIC VOLUNTEERS AT THE KORLE BU TEACHING HOSPITAL, ACCRA.
(Ghana College of Physicians and Surgeons, 2022-02-01) NIXON, HAROLD RICKETTS
Introduction: The Achilles tendon (AT) is the thickest and strongest tendon in the human body. It is the conjoint tendon of the gastrocnemius and soleus muscles in the posterior compartment of the leg. It is one of the most commonly injured tendons and is frequently affected by a wide range of inflammatory and degenerative processes. However, AT pathology is often oligosymptomatic and under-evaluated; because symptoms and signs of tendon pathology are open to variable interpretation. Traditional methods of investigating the AT have been magnetic resonance imaging (MRI) and computed tomography (CT) and most of the existing data was obtained from non-African individuals. Noting that genetic differences between the races can result in phenotypic variability, it is likely that the existing data does not fully represent the asymptomatic African AT. Ultrasonography (USG) is a reliable, safe and inexpensive imaging modality for evaluating the AT. In our local setting; USG is the least expensive and most readily available of the available imaging modalities for evaluating the AT. However, there is no definitive work outlining the normal USG features of the AT in our region. This knowledge gap in the USG imaging findings of the AT causes delays in the diagnosis and cost-efficient management of AT pathology. This study sought to determine the USG characteristics of the AT in the asymptomatic population of an African country; thence defining the ‘normal’ USG characteristics of the AT. Objective: To determine the ultrasonographic imaging findings of the Achilles tendon in asymptomatic volunteers at the Korle Bu Teaching Hospital, Accra. Materials and Methods: This was a hospital-based, cross-sectional study at the Radiology department of the Korle Bu Teaching Hospital. The participants (all asymptomatic volunteers above the age of 10 years) were selected with use of standardized questionnaires before inclusion into this study. USG examinations were carried out using a Toshiba Aplio 300 ultrasound machine (Toshiba medical systems corporation, Japan); equipped with a Linear Array 4.8-11 MHz transducer. In all patients, both ATs were scanned. Analysis: Captured data was analyzed in Statistical Package for Social Science (SPSS Inc., Chicago, IL, USA) version 25.0. The main outcome parameters being the echogenicity and thickness of the AT. Ankle dominance and other variables such as age, sex, height and BMI were expressed as percentages and/or graphs. Results: 342 subjects (including 162 males and 180 females) were recruited into the study and underwent bilateral ultrasound examination of their AT. 100% of the ATs reviewed were homogeneously hyperechoic - with mean thickness of 4.84 ± 0.92 mm. Males had thicker AT than females in all groups. 87.7% of dominant AT were thicker than non-dominant AT. Body height had a significant positive correlation with AT thickness. Conclusions: The asymptomatic AT is homogeneously hyperechoic and has mean thickness of 4.84 ± 0.92 mm on USG examination. Departures from these measurements should alert a radiologist to possible pathology when scanning a patient. The results of this study differ from other studies done on non-African populations; suggesting the need for further study on our indigenous population.
RADIOLOGICAL ANATOMY OF THE ARTERIAL SUPPLY OF THE PROSTATE GLAND
(BABATUNDE BASHIRU JIMAH, 2022-03-01) BABATUNDE, BASHIRU JIMAH
Background: In West Africa and Ghana, prostate arterial embolization (PAE) is a novel procedure. To ensure effective prostatic arterial embolization and selective intervention, a thorough understanding of prostate artery anatomy and its relationship to prostate size is required. Aim: The purpose of this study is to describe the anatomy of adult male prostate arterial supply and correlate them with prostate gland size and artery diameter on Computed Tomography of patients presenting to Euracare Advanced Diagnostic and Heart Centre. Methodology: A prospective cross-sectional study was conducted, at Euracare Advanced Diagnostics and Heart Centre. Patients who presented for Computed Tomography Angiography of the pelvis were included in the study. A total of 104 pelvic halves (52 males) were studied, and pertinent conclusions were reached. The diameter of the prostate artery and the volume of the prostate gland were measured. The Pearson Correlation coefficient was used to calculate the correlation between prostate artery diameter and prostate gland volume. The branching pattern of the prostate artery was classified using the de Assis et al (2015) classification, which serves as the foundation for most classifications. Result: According to the data, 37 (71.15 %) of the patients had enlarged prostate gland with a volume greater than 30ml. All of the patients aged 60 and above had an enlarged prostate gland and were mostly married. A higher proportion of patients with enlarged prostate (18, 94.74 %) had a history of prostate disease. In each pelvic half, one prostate artery was discovered. There were three types of prostate arterial branching. The majority of the pelvic halves (61, 58.7 %) had type 1, followed by type III and type II. In 50% of the pelvic halves, the origin was symmetrical type I. The mean prostate artery diameter was 1.28mm + 0.16 on the right and 1.26mm + 0.18 on the left, which was higher among those over 60. The average prostate gland volume was 42.58+14.17ml. The mean volume was higher in those over 60 (54.22+2.52 ml) compared to those under 60 (32.60+5.11ml), p =0.0000. The prostate gland volume and the diameter of the right (r=0.4771, p=0.0003) and left (r=0.5131, p=0.0001) arteries showed a significant positive correlation. Similar findings were made with those who had enlarged prostate glands with the right (r-0.3559, p=0.0306) and left (r = 0.4176, p=0.0101) prostate arteries.. Conclusion: The prostate arteries in the study population had type I, III, and II origins. The mean prostate artery diameter increases with increasing age and increasing prostate volume.
ENDOMETRIAL CANCER – A 10-YEAR REVIEW OF CLINICOPATHOLOGICAL FEATURES AND TREATMENT OUTCOME
(DADZIE, MARY – ANN, 2022-03-01) DADZIE, MARY – ANN
Although recently there have been significant advances in the understanding of endometrial cancer biology, the role of lymphadenectomy, adjuvant radiation, and chemotherapy is still not well defined. As a result, variability in the management of endometrial cancer across oncology centres is common and may have an impact on outcomes. There is limited literature on the current incidence of endometrial cancer, its detailed clinicopathological pattern, prognosis and practices in the management of endometrial cancer from Ghana. Lack of such information hampers the development of strategies to improve the outcome. Aim: To assess the treatment outcomes and factors affecting recurrence and survival in endometrial cancer patients treated with curative intent at the Korle Bu Teaching Hospital from January 2009 to December 2018. Methodology: In this retrospective study, data on patients with histological diagnosis of endometrial carcinoma seen at the National Radiotherapy, Oncology and Nuclear Medicine Centre treated between 1st January 2009 and 31st December 2018 were retrieved from the database. All patients had total abdominal hysterectomy with or without pelvic +/- para-aortic lymphadenectomy/sampling. Adjuvant therapy included external beam radiotherapy (EBRT) on cobalt- 60 machine +/-vaginal brachytherapy either with low or high dose rate +/- chemotherapy depending on risk stratification. Information regarding the demographic, clinical and pathological status of patients, type and sequence of treatment and follow-up of the patient after treatment was retrieved from the patients’ medical records. Patients that met the inclusion criteria were assessed. They were then categorized into risks groups based on the PORTEC definition and analyzed for the following endpoints: loco-regional and distant recurrence rates, the overall and disease–free survival rates, and factors affecting recurrence, disease-free and overall survival. Results: A total of 146 out of 269 patients were eligible for the study. The mean age was 61.3 years with majority being postmenopausal (77%) and a high prevalence of hypertension (42%) and diabetes (20%). The commonest presentation was abnormal vaginal bleeding (79%) and major histological type was endometrioid adenocarcinoma (78%). All patients had total abdominal hysterectomy with bilateral salpingo-oophrectomy with a lymph node dissection rate of 11% and a lymph node positivity rate of 62.5%. Less than half (47%) were FIGO stage 1. The 5year overall survival was 87.5%, 69%. 57% and 30% respectively for low, intermediate, high Intermediate and high risk patients (P-value: 0.001) whiles that for disease-free survival was 67%, 59%, 64.5% and 54% (P- value: 0.74). Adjuvant radiotherapy resulted in significantly improved 2year disease-free survival compared to those who had no radiotherapy in intermediate (100% vs 54% p-value: 0.006), high intermediate (87.5% vs 63%, p-value:0.041) and high risk (70.5% vs 45.5% p-value :0.041) but not overall survival. There was no difference in disease free and overall survival between patients who had pelvic lymphadenectomy and those who did not. After a median follow up of 34.5 months, there were 51 (35%) recurrences, majority of which were pelvic. Lymphovascular space invasion was the only factor associated with recurrence(p-value:0.01) whiles FIGO stage (P-value: 0.05), grade(p-value:0.03) and histology(p-calue:0.02) were associated with survival. Marital status was the only sociodemographic factor associated with survival Conclusion: Overall survival outcome for patients with endometrial cancer is comparable to developed countries but not disease-free survival which was poorer due to high recurrence rate. Adjuvant radiotherapy significantly improved the disease-free survival notably in intermediate risk population. Novel molecular testing is needed to better risk stratify and select patients who will benefit from adjuvant therapy to mitigate the high pelvic recurrences observed in the study.
CORRELATION OF EMBOLIC BURDEN AND RIGHT HEART DYSFUNCTION PARAMETERS WITH SHORT-TERM MORTALITY IN ACUTE PULMONARY EMBOLISM USING COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAPHY
(ASAMOAH, NANA AKUA KONAMA, 2022-10-15) ASAMOAH, NANA AKUA KONAMA
Introduction: Various parameters, as identified on computed tomography pulmonary angiography (CTPA) in patients with acute pulmonary embolism (PE) are being used internationally to categorize patient into low or high risk to enhance choice of management by physicians. Data on Computed tomography (CT) pulmonary angiographic parameters as predictors of mortality in patients with acute pulmonary embolism and how they correlate with patient outcome in Ghana is minimal in comparison to developed countries. Aim: The main aim of the study was to identify the most significant parameter on CTPA that predicts short-term mortality in patients with acute PE. Material and Methods: The study was a prospective cross-sectional design assessing the right heart dysfunction parameters and clot/embolic burden as predictors of short term mortality in patients with Acute pulmonary embolism. 60 patients presenting to spectra health with CTPA findings consistent with acute PE were Conveniently sampled. Additionally, Student t-test and logistics regression were conducted to compare and predict the best radiological parameter for mortality. A chi-square test was used in addition to Fisher’s exact test at a 95% level of significance to test for the association of age and duration of death, age and outcome of patient. Results: Sixty patient (60) patients, comprising 26 (43.3%) males and 34 (56.67%) females were enrolled in the study with a mean age of 58 years which ranges from 29 years to 89 years. Out of the 60 patients, 20 (33.33%) died, 40 (66.66%) survived. Of all the parameters evaluated on CTPA, the Rv/Lv ratio (P-value 0.001), Rv diameter (P-value 0.003), and clot load score (P-value 0.001), were highly associated with short term mortality on bi-variate analysis. However, on multivariate analysis of Rv/Lv ratio (P-value 0.118), Rv diameter (P-value 0.381), and clot load (P-value 0.03), the clot load score was found to be the most significant parameter for predicting short term mortality. Conclusion: Right ventricular short axis diameter (Rv), Rv/Lv ratio (RV enlargement), and clot load score are significantly associated with short term mortality. The results of this present study, hopefully serve as a baseline upon which future studies build to improve outcomes in patients with acute PE.

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