Ethiopian Journal of Health Sciences

Yibeltal Siraneh — 2024-10-25

TABLE OF CONTENTS

Artificial Intelligence in Radiology for Ethiopia

Kumlachew Abate Mekonen — 2024-10-25

Letter to the Editor

Review of St. Paul’s Hospital Millennium Medical College Radiology Program: Stakeholders’ Viewpoints

Kumlachew Abate Mekonen — 2024-10-25

BACKGROUND: St. Paul’s Hospital Millennium Medical College (SPHMMC) has offered radiology specialty training for a decade. To mark its 10th anniversary and assess the program's status, this study aimed to gather stakeholders’ perspectives on its functioning.

METHODS: The assessment was conducted from June 15 to July 5, 2024, using a stratified cross-sectional study design. A total of 211 participants were recruited through exhaustive sampling from alumni, faculty, students, referring physicians, and patients. Data were collected via web-based and paper-based questionnaires, where stakeholders rated the core functions of the SPHMMC radiology program (curriculum, teaching, research, and imaging practices) on a 5-point scale and provided additional feedback.

RESULTS: Overall, 78% of stakeholders regarded the program’s curriculum as highly relevant. However, teaching quality and research were viewed negatively, with only 19% and 11% of radiologists rating these aspects positively. Referring physicians considered radiology reports relevant (68%) but often found them incomplete and untimely (73%), with only 2% deemed timely. Over 80% of patients expressed dissatisfaction with the imaging services and were unwilling to recommend them.

CONCLUSIONS: While positive perceptions of the curriculum and imaging services suggest program strengths, the negative feedback on teaching and research quality indicates the need for improvements to maintain SPHMMC’s commitment to quality education and services.

Tracer Study of St. Paul’s Hospital Millennium Medical College Radiology Graduates: Career and Curriculum Insights

Alemayehu Bedane — 2024-10-25

BACKGROUND: Saint Paul’s Hospital Millennium Medical College (SPHMMC) is one of Ethiopia's premier radiology training institutions. This study aimed to trace graduates of SPHMMC’s radiology program and examined their career outcomes and perspectives on the training received.

METHODS: A cross-sectional study design was employed, recruiting 78 participants. Data on employment status, career outcomes, job satisfaction, and perceptions regarding the program's strengths, weaknesses, and curriculum relevance were collected through a web-based questionnaire from May 31 to June 8, 2024. SPSS version 26 was used for data processing and analysis.

RESULTS: The study revealed a high employment rate among SPHMMC radiology graduates, with 97% employed and 75% securing jobs within one month of graduation. Most graduates held permanent positions (86%) as radiology specialists, sub-specialists, and academicians. There was notable regional variation, with 65% working in Addis Ababa. Job satisfaction levels were 79% for radiology careers and 53% for current jobs. Satisfaction with the program overall and curriculum relevance was 69% and 96%, respectively.

CONCLUSIONS: High employment rates, and career and curriculum satisfaction levels might be reflective of the high market demand for radiologists in Ethiopia and the effectiveness of SPHMMC’s radiology program in preparing graduates for professional careers. The regional disparity in radiologist distribution suggests underlying systemic issues that require further investigation.

Comparative Analysis of Clinical and Radiologic Staging of Cervical Cancer: A Cross-Sectional Study in Ethiopia

Fami Zekeriya Yusuf — 2024-10-25

BACKGROUND: Cervical cancer remains a significant challenge in developing countries, with many patients diagnosed at advanced stages. The clinical staging of cervical cancer is guided by the International Federation of Obstetrics and Gynecology (FIGO) guidelines, while computed tomography (CT) and magnetic resonance imaging (MRI) offer valuable supplemental information. This study aimed to evaluate the initial clinical and imaging stages of cervical cancer and to assess the agreement between these staging methods.

METHODS: A cross-sectional study was conducted involving 115 newly diagnosed cervical cancer patients at Tikur-Anbessa Specialized Hospital from September 1, 2022, to February 30, 2023. Clinical staging was performed for all patients, with CT staging for 107 and MRI staging for 34. Data were extracted from the hospital’s central databases and analyzed using SPSS version 27. Descriptive and reliability analyses were conducted, with statistical significance set at a p-value of <0.05 and a 95% confidence interval.

RESULTS: At diagnosis, 61 patients (53%) presented with advanced clinical stages (III-IV). CT imaging indicated advanced stages in 85 patients (73.9%), while MRI was performed on 34 patients. Agreement between clinical and CT-based staging was poor (weighted Cohen’s kappa = 0.171, p = 0.016), while agreement between clinical and MRI-based staging was moderate (weighted Cohen’s kappa = 0.418, p = 0.007).

CONCLUSION: Newly diagnosed cervical cancer patients exhibit a high prevalence of advanced-stage disease. There is poor agreement between clinical and CT-based cervical cancer staging, contrasted with moderate agreement between clinical and MRI-based staging.

Positive Predictive Value of High-Grade Prostate Imaging and Reporting Data System V2.1 Magnetic Resonance Imaging Findings for Prostate Cancer

Abdudin Heru Mehammed — 2024-10-25

BACKGROUND: Prostate cancer is a leading cause of cancer-related mortality among men, second only to lung cancer. Prostate magnetic resonance imaging (MRI) utilizing the Prostate Imaging and Reporting Data System (PI-RADS) v2.1 scoring system effectively stratifies patients by risk and correlates significantly with histopathological outcomes. This study aimed to assess the positive predictive value (PPV) of high-grade PI-RADS v2.1 MRI findings and their correlation with histopathological results from biopsies in patients visiting the interventional radiology unit at St. Paul’s Hospital Millennium Medical College (SPHMMC).

METHODS: A facility-based cross-sectional study was conducted involving patients referred to the SPHMMC interventional radiology unit with high-grade PI-RADS v2.1 MRI findings who underwent TRUS-guided prostate biopsy between January 2023 and April 2024.

RESULTS: Among 105 patients, the PPV was 94.5% for a PI-RADS v2.1 score of 5 and 51.5% for a score of 4. These findings underscore the predictive power of high-grade PI-RADS scores, particularly for score 5 lesions, aiding clinicians in decision-making for further investigations and treatment. Significant correlations were observed between MRI characteristics—such as ill-defined margins, larger size, and extraprostatic extension—and high-grade PI-RADS scores in the peripheral zone (p<0.01).

CONCLUSION: High-grade PI-RADS v2.1 scores exhibit strong positive predictive value for detecting prostate cancer, emphasizing the essential role of multiparametric MRI in diagnosis. Integrating multiparametric MRI findings with clinical and laboratory data can further enhance patient care and outcomes.

Clinical and Radiological Features of Perianal Fistula: An MRIBased Study in Addis Ababa, Ethiopia

Semira Abrar Issa — 2024-10-25

BACKGROUND: Perianal fistula refers to an abnormal connection between the anal canal and the perianal skin or perineum. Magnetic Resonance Imaging (MRI) plays a crucial role in accurately characterizing perianal fistulas, which informs surgical strategies and helps minimize recurrence.

METHODS: This cross-sectional study was conducted at a single diagnostic imaging center in Addis Ababa, utilizing retrospectively collected data from May 2023 to June 2024. All patients referred for suspected perianal fistulas were included. MRI scans were reviewed by a radiologist in body imaging fellowship and a body imaging subspecialist. Findings, along with sociodemographic data, were documented in a structured questionnaire and analyzed using SPSS.

RESULTS: The study encompassed 304 primary fistula tracts in 276 patients, with 233 (84.4%) being male. Complex fistulas were identified in 83 patients (30.1%), 43 (15.6%) had secondary extensions, and 64 (27.1%) presented with abscess collections. The most common type of fistula, according to the Parks classification, was intersphincteric, observed in 263 cases (86.5%). The St. James University Hospital grades 1 and 2 were predominant, representing 176 (57.9%) and 62 (20.4%) of the cases, respectively. A significant association was found between complex fistulas, higher Parks grades, and the total length of the fistula tract.

CONCLUSION: This study elucidates MRI patterns of perianal fistulas, revealing that over one-third of patients had complex fistulas. This underscores the importance of preoperative MRI for effective surgical planning and reducing recurrence rates.

Retinoblastoma in Ethiopian Children: Imaging Findings and Staging

Abebe Mekonnen Woldeyohannes — 2024-10-25

BACKGROUND: Retinoblastoma is the most prevalent intraocular retinal malignancy in children worldwide. Accurate staging is critical for treatment planning and relies heavily on radiologic imaging and clinical findings. This study aims to evaluate imaging patterns and staging of retinoblastoma in children at Tikur Anbessa Specialized Hospital (TASH).

MATERIALS AND METHODS: This cross-sectional study analyzed retrospective data from TASH between September 2018 and September 2021. It focused on patients diagnosed with retinoblastoma who underwent Computed Tomography (CT) scans or Magnetic Resonant Imaging (MRI) and had pathology results available. Two radiologists, each with over 10 years of experience, independently reviewed the scans. Supplementary data were gathered from the pediatric oncology unit registry using structured questionnaires. The International Retinoblastoma Staging System (IRSS) was used to stage extraocular disease based on cross-sectional imaging and the International Intraocular Retinoblastoma Classification (IIRC) for intraocular disease classification.

RESULTS: Eighty-three patients were included, with 42 (50.6%) males and 41 (49.4%) females. The mean age at presentation was 3.4 ± 2 years. The most common clinical symptoms were proptosis (42 patients, 50.6%) and leukocoria (37 patients, 44.6%). Clinical staging revealed 63 (75.9%) patients in Group E, 19 (22.9%) in Group D, and 1 (1.2%) in Group C according to IIRC. Stage IV disease was predominant, with 33 (39.2%) in Stage IVA and 18 (21.4%) in Stage IVB according to IRSS.

CONCLUSION: Most patients presented with advanced retinoblastoma, particularly Stage IV. This underscores the need for community awareness of early signs and symptoms of retinoblastoma, promoting timely medical consultation.

Accuracy of Lung Ultrasound Compared to Chest Radiography for Diagnosing Pneumonia in Children: A Hospital-Based Cross-Sectional Study

Leul Adane Chemeda — 2024-10-25

BACKGROUND: Traditionally, pediatric pneumonia is diagnosed through clinical examination and chest radiography (CXR), with computed tomography (CT) reserved for complications. Lung ultrasound (LUS) has gained popularity due to its portability and absence of ionizing radiation. This study evaluates LUS's accuracy compared to CXR in diagnosing pneumonia in children.

METHODS: We conducted a cross-sectional study from April to September 2023 involving 108 children aged 14 or younger admitted with pneumonia. Each child underwent LUS using a 5-zone scanning protocol, followed by CXR, with the latter interpreted independently by two consultant radiologists. Agreement between LUS and CXR for diagnosing consolidation and interstitial pneumonia patterns was assessed using Cohen’s Kappa (k) with SPSS version 26.0.

RESULTS: Pneumonia was radiographically confirmed in 79 children (73.1%). LUS detected consolidation in 41.7% of cases, compared to 43.5% for CXR, demonstrating a sensitivity of 97.8%, specificity of 95.2%, positive predictive value (PPV) of 93.6%, and negative predictive value (NPV) of 98.4%. LUS showed higher accuracy for interstitial lung patterns (sensitivity 93.6%, specificity 97.4%). The agreement between LUS and CXR was excellent, with Cohen’s Kappa values of 0.908 for consolidation and 0.863 for interstitial pneumonia. LUS also identified more pleural effusions (11.1%) compared to CXR (6.5%).

CONCLUSION: LUS demonstrates comparable diagnostic accuracy to CXR for pneumonia, exhibiting high sensitivity and specificity for pneumonia-related features. It outperforms CXR in detecting small-volume consolidations and effusions, supporting its routine use in clinical settings.

The State of Radiology Research in Ethiopia: A Scoping Review

Ashenafi Aberra Buser — 2024-10-25

BACKGROUND: Radiology is an essential component of modern medicine and a rapidly evolving research field. The nature and dynamic of radiology research in Ethiopia remained largely unexplored. This bibliometric scoping review was done to explore the current state of radiology research in Ethiopia.

METHODS: Literature search was conducted using PubMed, Scopus, Embase, Web of Science, and Google Scholar from inception to June 15, 2024. Study screening, review, and selection were performed using EndNote Reference Manager. The key indicators assessed include publication trends, research themes, publication utility, contribution and collaboration of individuals and institutions, and journal metrics. Statistical analysis was done using R and VOS viewer software.

RESULTS: Though low in volume, radiology research publication is increasing in Ethiopia, with 241 publications from 1968 to 2024, accounting for 0.03% of the global radiology research output. Top contributing institutions were Addis Ababa University, Jimma University, and St. Paul’s Hospital Millennium Medical College. The studies were largely focused on case-reports, cross-sectional studies, and diagnostic imaging. Systematic reviews, meta-analyses, artificial intelligence and trials constituted only 3% of the studies. Most publications (96.7%) were done by academic institutions. Most frequently used journals were Ethiopian Medical Journal and Ethiopian Journal of Health Sciences, accounting for 29% and 15% of the total publications, respectively. Publications in Q1 journals was 12%. International collaboration was 7%, with the USA being the primary collaborator.

CONCLUSION: To elevate the quality and impact of radiology research in Ethiopia, it is crucial to adopt contemporary and robust research methodologies, align research topics with global trends and technological advancements, and foster enhanced collaboration and productivity within the research community.

Isolated Prostate Tuberculosis Mimicking Prostate Cancer

Tesfaye Kebede Legesse — 2024-10-25

BACKGROUND: Tuberculosis (TB) remains the deadliest infectious disease globally, with the kidneys being the most frequently affected organ in the genitourinary system. Isolated prostate involvement by tuberculosis is rare and may mimic prostate cancer. This case report aims to highlight the diagnostic challenges and therapeutic responses associated with isolated prostate tuberculosis, particularly in the context of significantly elevated prostate-specific antigen (PSA) levels in a TB-endemic region.

CASE PRESENTATION: A 69-year-old male was referred to Tikur Anbessa Specialized Hospital (TASH) with obstructive lower urinary tract symptoms (LUTS) lasting seven months. He had previously undergone transurethral resection of the prostate (TURP), with histopathological findings suggestive of benign prostatic hyperplasia (BPH). Further investigation revealed an extremely elevated PSA level of 1768 ng/ml. Magnetic Resonance Imaging (MRI} raised high suspicion for locally advanced prostate cancer; however, a repeat biopsy and histopathology ultimately diagnosed TB prostatitis. The patient responded successfully to anti-tuberculosis therapy.

CONCLUSION: Isolated prostate involvement by M. tuberculosis is rare, and extremely elevated PSA levels are unusual. Histopathological examination is a confirmatory test, but results can be falsely negative if a representative sample is not obtained. Therefore, a high degree of clinical suspicion, particularly in endemic areas, along with repeat biopsy, is crucial for accurate diagnosis.