Hémosidérose du système nerveux central: apport diagnostique de l'Imagerie par Résonnace Magnétique / Hemosiderosis of the central nervous system: diagnostic contribution of Magnetic Resonnace Imagery

Introduction. L'hémosidérose du système nerveux central est une pathologie rare liée au dépôt d'hémosidérine à la surface du cerveau, des nerfs crâniens et de la moelle épinière secondaire à un saignement chronique. Nous rapportons un cas d'hémosidérose du système nerveux central chez une patiente jeune dans un tableau de méningite. A travers notre observation nous voulons décrire l'apport diagnostique de l'Imagerie par Resonnace Magnétique dans cette pathologie. Observation. Patiente de 39ans, sans antécédents particuliers, avait consulté au service des urgences pour des céphalées d'apparition brutale associées à des nausées. Le scanner cérébral objectivait un discret effacement des sillons corticaux et une sinusite sphénoïdale. L'Imagerie par Resonnace Magnétique cérébrale et médullaire objectivait un dépôt d'hémosidérine en hyposignal T2 Echo de gradient au niveau du cortex cérébral et de la moelle épinière. Le bilan étiologie du saignement chronique était négatif à l'angio-Imagerie par Resonnace Magnétique du polygone de Willis. La glycorachie était à 1,5g/l pour une glycémie à 5,6g/l (hypoglycorachie), la protéinorachie était à 2,43g/l sans bactériémie mais présence de 590 éléments dont 72% de lymphocytes et 27% de polynucléaires neutrophiles. Conclusion. L'Imagerie par Resonnace Magnétique est une technique indispensable au diagnostic de l'hémosidérose cérébro-méningée.

Magnetic resonance imaging of fibroadenoma-like lesions and correlation with Breast Imaging-Reporting and Data System and Kaiser scoring system

Background: Multiple breast lesions resembling fibroadenomas are a common imaging finding in patients presenting to the mammography unit at Dr George Mukhari Academic Hospital in the North-West district of Tshwane, South Africa. Patients often present with multiple lesions, up to 20 lesions per breast. These lesions often have atypical features on ultrasound and/or a clinical history of growth is commonly given. Phyllodes tumours may be indistinguishable from fibroadenomas and breast cancers may on occasion present with benign features, which can lead to misdiagnosis. Breast magnetic resonance imaging (bMRI) evaluation of lesions resembling fibroadenomas may improve accurate assessment and identification of lesions requiring biopsy. Objectives: To assess the reliability of bMRI to characterise lesions resembling fibroadenomas on ultrasound, using the Breast Imaging-Reporting and Data System (BI-RADS) and Kaiser scoring systems with histopathological correlation. Method: A quantitative, prospective, investigative study was performed with a sample size of 100 breast lesions among a total of 35 patients at Dr George Mukhari Academic Hospital. Patients were recruited after a breast ultrasound investigation revealed lesions resembling fibroadenomas, but with an indication for ultrasound-guided biopsy, for example, very large size, atypical features on ultrasound or a history of recent growth. The bMRI was performed prior to the ultrasound-guided breast biopsies. Three investigators independently evaluated the bMRI and applied BI-RADS descriptors to each lesion. The Kaiser score was then calculated for each lesion. Statistics were calculated using Pearson's and Spearman's coefficients for inter-reader variability, kappa scores for BI-RADS and Kaiser score correlation with histology. Results: Evaluation with bMRI, BI-RADS and the Kaiser scoring system showed statistically significant correlation with each other and with histopathology results for each lesion. There was statistically significant agreement among the investigators regarding the interpretation of the lesions and allocation of appropriate BI-RADS scores. Conclusion: Multiple lesions resembling fibroadenomas can be evaluated with bMRI when multiple breast biopsies would not be feasible. With a good imaging protocol and technique, adequate interpretation skills by the radiologist and the use of the Kaiser scoring system, an accurate diagnosis can be achieved

Multiple Sclerosis in a Nigerian Alcoholic Male: A Case Report from Enugu; South East Nigeria

Background: Multiple sclerosis is a rare neurological disorder in black Africans. In Nigeria it had been difficult to confirm suspected cases due to the paucity of diagnostic facilities. The availability of magnetic resonance imaging has enabled an increased confidence in making the diagnosis. Method: This is a case report of a 40- year old Nigerian farmer of the Igbo ethnic group living in a rural community in Enugu who presented with clinical features suggestive of multiple sclerosis. Though the patient had a significant history of alcohol consumption; he had clinical and magnetic resonance imaging features diagnostic of multiple sclerosis. Results: A 40-year old male farmer presented to the Neurology Clinic of the University of Nigeria Teaching Hospital Enugu in January 2010 with a 10-year history of recurrent episodes of weakness of the legs. Each episode was sudden; affected either limb alternately; was associated with paraesthesiae and would resolve spontaneously after a few days or weeks without any intervention. Over the years he became unable to walk. The sphincters and vision were unaffected. A week prior to presentation he developed tremors of the hands with disorientation. The patient exhibited confabulation and had flaccid quadriparesis with glove and stocking sensory loss. Spinal fluid protein was raised and there were classic periventricular and intracerebral white matter hyper-intensities on magnetic resonance imaging. Conclusion: This report of a case of multiple sclerosis suggests a need for clinicians in Africa to increase their index of suspicion in probable clinical scenario especially where magnetic resonance imaging exists

Accuracy of MRCP Compared to ERCP in the Diagnosis of Bile Duct Disorders

AIM: To determine the accuracy of Magnetic Resonance Cholangiopancreatography compared to the gold standard Endoscopic Retrograde Cholangiopancreatography in the diagnosis of bile duct disorders at our institution. PATIENTS AND METHODS: 52 patients with suspected pancreatobiliary pathology were included in this prospective observational study. MRCP was performed in the 24-hour period prior to the ERCP. RESULTS: MRCP had sensitivity; specificity; positive and negative predictive values of 87; 80; 83.3and 84.2respectively for choledocholitiasis which correlates well with results obtained in other parts of the world. CONCLUSION: At our institution; MRCP has high diagnostic accuracy for bile duct calculi. Due to a small study population; results for other biliary pathology were inconclusive