MRI-Based Brain Volume Scoring in Cerebral Malaria Is Externally Valid and Applicable to Lower-Resolution Images
Manu S Goyal1, Lorenna Vidal2, Karen Chetcuti3,4
1From the Mallinckrodt Institute of Radiology (M.S.G.), Washington University School of Medicine, St. Louis, Missouri goyalm@wustl.edu.
Background And Purpose:
Children with cerebral malaria have an elevated risk of mortality and neurologic morbidity. Both mortality and morbidity are associated with initially increased brain volume on MR imaging, as graded by the Brain Volume Score, a subjective ordinal rating scale created specifically for brain MRIs in children with cerebral malaria. For the Brain Volume Score to be more widely clinically useful, we aimed to determine its independent reproducibility and whether it can be applicable to lower-resolution MRIs.
Materials And Methods:
To assess the independent reproducibility of the Brain Volume Score, radiologists not associated with the initial study were trained to score MRIs from a new cohort of patients with cerebral malaria. These scores were then compared with survival and neurologic outcomes. To assess the applicability to lower-resolution MRI, we assigned Brain Volume Scores to brain MRIs degraded to simulate a very-low-field (64 mT) portable scanner and compared these with the original scores assigned to the original nondegraded MRIs.
Results:
Brain Volume Scores on the new cohort of patients with cerebral malaria were highly associated with outcomes (OR for mortality = 16, P < .001). Scoring of the simulated degraded images remained consistent with the Brain Volume Scores assigned to the original higher-quality (0.35 T) images (intraclass coefficients > 0.86).
Conclusions:
Our findings demonstrate that the Brain Volume Score is externally valid in reproducibly predicting outcomes and can be reliably assigned to lower-resolution images.
Insights
The Brain Volume Score reliably predicts outcomes in children with cerebral malaria and can be used with lower-resolution MRI scans, improving its clinical utility for this serious condition.
Area of Science:
- Pediatric Neurology
- Medical Imaging
- Infectious Diseases
Background:
- Cerebral malaria in children carries significant risks of mortality and neurological complications.
- Increased brain volume on MRI, assessed by the Brain Volume Score, is linked to these adverse outcomes.
- The Brain Volume Score is a subjective rating scale for brain MRIs in pediatric cerebral malaria.
Purpose of the Study:
- To determine the independent reproducibility of the Brain Volume Score.
- To assess the applicability of the Brain Volume Score to lower-resolution MRI scans.
- To enhance the clinical utility of the Brain Volume Score for pediatric cerebral malaria.
Main Methods:
- Radiologists independently scored MRIs from a new cohort of children with cerebral malaria.
- Scores were compared with patient survival and neurological outcomes.
- Brain Volume Scores were assigned to simulated low-resolution MRIs and compared to original scores.
Main Results:
- Brain Volume Scores in the new cohort strongly correlated with mortality (OR=16, P<.001).
- Scoring consistency was high between original and simulated lower-resolution MRIs (ICC > 0.86).
Conclusions:
- The Brain Volume Score demonstrates external validity and reproducibility in predicting outcomes.
- The Brain Volume Score can be reliably applied to lower-resolution MRI images.
- This enhances the potential for wider clinical use of the Brain Volume Score in managing pediatric cerebral malaria.
