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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 9  |  Issue : 2  |  Page : 112-114

Magnetic resonance imaging request pattern in a poor resource environment as a prerequisite for future planning


1 Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria
2 Department of Surgery, Federal Medical Centre, Birnin Kebbi, Nigeria

Date of Web Publication14-Dec-2017

Correspondence Address:
Dr. O N Salawu
Department of Surgery, Federal Medical Centre, Birnin Kebbi
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jotr.jotr_19_17

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  Abstract 


Introduction: Magnetic Resonance Imaging (MRI) is a non invasive imaging technique used for diagnosis of pathology in parts of the body, it is particularly useful in demonstrating soft tissue such as brain, spinal cord, nerve root, intervertebral disc, muscles etc. contrast can be used to enhance the MRI image. The aim of this study is to know the indications and pattern of MRI request in this environment. Methods: A two year retrospective study was carried out in a private diagnostic centre in the North – Central Nigeria from September 2014 – August 2016. A record of biodata, body regions and indications requested were analyzed with SPSS version 17. Results: total of 837 MRI were requested during the study period, there was a male preponderance with male to female ratio of 1.6: 1, the commonest age group was those greater than 60 years. MRI request was found to be highest in the spine region of the body, the commonest indication for MRI request was low back pain from disc prolapsed, this made MRI of the lumbar spine the most frequently requested MRI in the body. Conclusion: Soft tissue pathologies of the spine, brain, muscles and nerves are clearly demonstrated by MRI, this make it an indispensable equipment which should be available in all tertiary health centres in the country for early detection and treatment of different pathologies. There is also need for inclusion of MRI charges in national health insurance scheme because of the frequent indications for the procedure.

Keywords: Diagnostic, muscles, pathology


How to cite this article:
Babalola O M, Salawu O N, Ahmed B A, Ibraheem G H, Kolade O A, Olawepo A, Agaja S B. Magnetic resonance imaging request pattern in a poor resource environment as a prerequisite for future planning. J Orthop Traumatol Rehabil 2017;9:112-4

How to cite this URL:
Babalola O M, Salawu O N, Ahmed B A, Ibraheem G H, Kolade O A, Olawepo A, Agaja S B. Magnetic resonance imaging request pattern in a poor resource environment as a prerequisite for future planning. J Orthop Traumatol Rehabil [serial online] 2017 [cited 2019 May 26];9:112-4. Available from: http://www.jotr.in/text.asp?2017/9/2/112/220760




  Introduction Top


Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and physiological processes of the body in both health and diseases tissue. It was developed in 1960's and 1970's and has been in clinical use since the 1980's.[1] Its advent has revolutionized medical care toward optimal diagnosis in almost all regions of the body. Inaccessible body regions can easily be visualized and staged in disease states.[2] Its invention with the accurate diagnosis has encouraged subspecializations in almost all fields of medical practice especially neurology, cardiology, musculoskeletal system, liver and gastrointestinal system, oncology and breast lesions.[3],[4]

Even though there are about 25,000 scanners worldwide,[1] the high cost of the machine, installation and maintenance in Nigeria has made the procedure to be very expensive to patients. This has reduced the number of patients that accept to do the procedure among those that need it.[5] MRI machine is available in some tertiary institution and few private center in Nigeria, but high cost of the procedure remains the common problem to patients.

Questions have been asked on the cost-effectiveness of the use of MRI due to its cost on the health care.[5] Since the advent of MRI use in our practice in my center, it has been fraught with challenges of affordability, since most patients pay out of pocket, with the increasing poverty level in the country, significant percentage of patients will only concede to doing the investigation either at the extreme of life or disability, hence government should in cooperate this investigation in national insurance scheme so that the poor populace can also benefit from the use of MRI.

Most literature on MRI use in Nigeria has essentially focused on the outcome of its use in different specialization with none focusing on general request pattern.

The aim of this study is to know the general pattern of MRI request which may reflect the indispensable disease morbidity and disease burden pattern in this economically challenged environment. This can aid the government future planning for health in this environment.


  Methodology Top


A retrospective study of the indications and request pattern from a privately owned diagnostic center in a suburban region in North-central Nigeria for a 2 years duration from September 2014 to August 2016 was done. A private diagnostic center allows for none disruption of service for the duration of review and allows easy access to the patient from all the surrounding states which have no MRI facility. A record of biodata, body region(s) requested, and indications were collated and analyzed using SPSS (SPSS version 17. Inc., Chicago, IL, USA) software. The study limitation to this study was that the facility either has a breakdown or unavailable coil for abdominal MRI.


  Result Top


A total of 837 MRI procedures were done during the period with an average of 35 procedures per month. Males were 514 and females 323 with a ratio of 1.6:1. The most common age group who had the procedure was in the age >60 years (n = 247), and the least age group with the procedure was 11–20 years (n = 46), as shown in [Table 1].
Table 1: Age distribution pattern

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The request pattern showed that the highest request was in the spine 481 (57.5%), followed by the brain 328 (39.2%) while MRI done in other parts of the body where biopsy cannot be done, e.g., eye was 2 (0.2%), or where biopsy will increase the chance of tumor spread were pelvic tumor which was 5 (0.6%), arms and forearms tumors which was 7 (0.8%), thighs and legs tumors which was 4 (0.5%), knee joint meniscal tear was 8 (1%), tumor around the shoulder joint was 1 (0.1%), and shoulder joint rotator cuff tear was 1 (0.1%) as shown in [Table 2].
Table 2: Indications for medical resonance imaging

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For the spine lesion, low back pain was the most common symptoms seen in 243 (29%) of cases; paraplegia was the symptoms in 238 (28%) of cases. For the low back pain, prolapsed intervertebra was the cause in 238 (28%) patients, tumor was the cause in 2 (0.2%) patients, and nonspecific cause was seen in 3 (0.4%) patients [Table 2].

The causes of paraplegia were trauma in 172 (20%) patients, tuberculosis in 27 (3.2%) patients, tumor in 5 (0.6%) patients, Guillain-Barre syndrome 3 (0.4%) patients, transverse myelitis 2 (0.2%) patients, and congenital lesion in 29 (3.5%) patients [Table 2].

The indications for brain MRI were tumor in 128 (15.3%) patients, stroke in 110 (13.1%) patients, trauma in 51 (6.1%) of patients, and congenital lesion in 39 (4.7%) patients [Table 2].

A breakdown of the MRI request for spine showed that the most commonly requested spine segment was the lumbar regions 282 (58.6%), which also constitute a third of all MRI request in the facility; this was followed by cervical region which was 118 (24.6%), thoracic region 28 (5.8%), and 53 (11.0) patients did MRI of multiple regions of spine, as shown in [Table 3].
Table 3: Magnetic resonance imaging request of different spine regions

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  Discussions Top


The use of MRI has revolutionized health care, not only because it has made almost all regions of the body visible but it also has no hazard of radiations, compared to another radiological test. Its versality has made its use possible in all specialties of medical care.[3],[4]

Despite its advantage, the high cost of procurement, installation, and maintenance has been a challenge in the developing countries like Nigeria limiting its accessibility and affordability. Most health centers in Nigeria does not have MRI machine.[6] Since health economics demands what is affordable within a community, pattern of request may reflect the health burden and its need for specialization in our subregion.

In this study, MRI request was highest among patients whose age was above 60-year-old; this is because diseases such as spine degenerative disease, sprain, and tumors are common in this age group.

Spine MRI was the most common procedure in the study, and lumbar segment was the highest segment of spine necessitating MRI. The most common indication for the spine MRI was low back pain from slipped intervertebral disc. This may be due to the fact that majority of the people in this environment engages in menial job that required lifting heavy object, even at old age, this has made them susceptible to frequent prolapsed intervertebral disc. The second most common indication for the spine MRI was traumatic paraplegia; this is due to increasing road traffic injury in this part of the world, majority of the drivers do not obey the traffic rules, passengers may not use seat belt, there are lots of bad roads in the country, substandard spare parts of vehicles, e.g., tires, and all these are contributing factors to traumatic paraplegia from road traffic injury in the country.

Brain MRI ranked second in the body region that requires the procedure, the most common indication for brain MRI was brain tumor, this does not agreed with the findings of Luxenberg et al. in Israel where brain MRI was the most common procedure done in their series.[7] This can be explained by the fact that there are fewer number of neurosurgeons in Nigeria to manage this brain tumor, majority of them present to spiritual homes and died there.

Stroke was the second most common indication for brain MRI in this study. This may be due to an increase in the prevalence of hypertension in Nigerian. The majority of these hypertensive patients are not regular with their medications, and hospital follow-up leading to an uncontrolled hypertension which serves as an increase risk for stroke in our environment especially in the young adults and the elderly.[8],[9]

The versatility of MRI can be demonstrated in the patients with orbital tumor where biopsy cannot be done without damaging the orbital structure, but diagnosis can be made with the aid of MRI, another area where its use is of great important is before epidural steroid injection for low back pain with radiculopathy, where it will show all the spine structure clearly, the level of nerve compression and the degree of the compression will be shown hence the point of the steroid injection can be determined easily. In sport medicine, MRI can be used to image muscles, tendons and ligaments to show the point of injury so as to aid treatment.[2],[3],[10] Furthermore, MRI is important in making accurate staging of tumor of the extremities, it is usually advisable to do MRI of a tumor before biopsy because biopsy can disrupt the actual staging of the tumor.


  Conclusion Top


Spine pathologies are the most common indication for MRI request in our environment, followed by pathologies of the brain. The majority of these spine pathologies are located in the low back area which makes lumber region to be the most common spine region for the investigation. All these soft tissue parthologies can be clearly demonstrated by MRI, hence it is an indispensable equipment which should be made available and affordable in all tertiary health center of the country for easy diagnosis and early treatment of these pathologies. There is also need for inclusion of MRI charges in national health insurance scheme because of the frequent indications for the investigative procedure.

Acknowledgment

We acknowledge the management staff of Ola-Olu Hospital, Ilorin, where the study was done.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Vaknin S, Shemer J, Luxenburg O. Medical resonance imaging (MRI) - The technology, the regulation and the utilization pattern in Israel. Harefuah 2012;151:306-9.  Back to cited text no. 1
    
2.
Fafowora OF, Cookey-gam AI, Obajimi MO. Radiological evaluation of orbital tumours in Ibadan, Nigeria. Afr J Med Med Sci 1996;25:361-4.  Back to cited text no. 2
    
3.
Featherstone T. Magnetic resonance imaging in sports medicine - An overview. Br J Sports Med 1994;28:84-9.  Back to cited text no. 3
    
4.
Oyinloye O, Nzeh D, Adesiyun O, Ibrahim M, Akande H, Sanya E. Neuroimaging of young adults with stroke in Ilorin Nigeria. Ann Afr Med 2015;14:82-8.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Eyesan SU, Obalum DC, Nnodu OE, Abdulkareem FB, Ladejobi AO. Challenges in the diagnosis and management of musculoskeletal tumours in Nigeria. Int Orthop 2009;33:211-3.  Back to cited text no. 5
    
6.
Ademola AA. An appraisal of the cost benefit of magnetic resonance imaging in Nigeria. Niger Postgrad Med J 2003;10:251-3.  Back to cited text no. 6
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7.
Luxenburg O, Vaknin S, Pollack G, Siebzehner M, Shemer J. Utilization patterns of CT and MRI in Israel. Harefuah 2003;142:810-4, 880.  Back to cited text no. 7
    
8.
Oghagbon EK, Okesina AB, Biliaminu SA. Prevalence of hypertension and associated variables in paid workers in Ilorin, Nigeria. Niger J Clin Pract 2008;11:342-6.  Back to cited text no. 8
[PUBMED]    
9.
Alkali NH, Bwala SA, Akano AO, Osi-Ogbu O, Alabi P, Ayeni OA. Stroke risk factors, subtypes, and 30-day case fatality in Abuja, Nigeria. Niger Med J 2013;54:129-35.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Kawu AA. Epidural steroid injection in patients with lumbosacral radiculopathy in Abuja, Nigeria. J Neurosci Rural Pract 2012;3:121-5.  Back to cited text no. 10
[PUBMED]  [Full text]  



 
 
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  [Table 1], [Table 2], [Table 3]



 

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Abstract
Introduction
Methodology
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