Radiological imaging of the brain is central to the evaluation of neurological disorders, enabling non-invasive assessment of cerebral anatomy, pathophysiology, and pathology. Advances in computed tomography (CT) and magnetic resonance imaging (MRI) have improved diagnostic accuracy and clinical decision-making globally; however, evidence from low- and middle-income countries remains fragmented. This systematic review examined the role of radiological imaging modalities in the assessment of brain anatomy and in the identification and characterization of major neurological conditions, with particular focus on Nigeria.

The review was conducted in accordance with PRISMA 2021 guidelines. A comprehensive search of electronic databases and region-specific journals identified peer-reviewed studies published between 2015 and 2025 that investigated brain imaging using CT or MRI in Nigerian populations. Five eligible observational studies were included, comprising three CT-based and two MRI-based investigations conducted in tertiary or population settings. Data were synthesised narratively and thematically.

Findings showed that non-contrast CT remains the primary imaging modality for acute neurological presentations, particularly traumatic head injury and intracranial haemorrhage, due to its accessibility, speed, and sensitivity to acute blood products. CT was effective in identifying gross structural abnormalities but demonstrated limited ability to detect subtle or microstructural brain injury. In contrast, MRI provided superior anatomical detail and microstructural assessment, enabling improved characterization of non- acute, degenerative, and complex neurological conditions. Overall, CT and MRI play complementary roles in neuroimaging practice in Nigeria. Strengthening imaging infrastructure, expanding MRI availability, and optimizing referral pathways are essential to improve diagnostic accuracy, support evidence-based management, and advance neurological research in resource-limited settings.