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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticlePediatric Neuroimaging

MRI-Based Brain Volume Scoring in Cerebral Malaria Is Externally Valid and Applicable to Lower-Resolution Images

Manu S. Goyal, Lorenna Vidal, Karen Chetcuti, Cowles Chilingulo, Khalid Ibrahim, Jeffrey Zhang, Dylan S. Small, Karl B. Seydel, Nicole O’Brien, Terrie E. Taylor and Douglas G. Postels
American Journal of Neuroradiology February 2024, 45 (2) 205-210; DOI: https://doi.org/10.3174/ajnr.A8098
Manu S. Goyal
aFrom the Mallinckrodt Institute of Radiology (M.S.G.), Washington University School of Medicine, St. Louis, Missouri
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Lorenna Vidal
bChildren’s Hospital of Philadelphia (L.V.), Philadelphia, Pennsylvania
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Karen Chetcuti
cDepartment of Radiology (K.C.), Kamuzu University of Health Sciences, Blantyre, Malawi
dDepartment of Radiology (K.C., C.C.), Queen Elizabeth Central Hospital, Blantyre, Malawi
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Cowles Chilingulo
dDepartment of Radiology (K.C., C.C.), Queen Elizabeth Central Hospital, Blantyre, Malawi
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Khalid Ibrahim
fCollege of Osteopathic Medicine (K.B.S., T.E.T., K.I.), Michigan State University, East Lansing, Michigan
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Jeffrey Zhang
eDepartment of Statistics and Data Science (J.Z., D.S.S.), The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
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Dylan S. Small
eDepartment of Statistics and Data Science (J.Z., D.S.S.), The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
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Karl B. Seydel
fCollege of Osteopathic Medicine (K.B.S., T.E.T., K.I.), Michigan State University, East Lansing, Michigan
gBlantyre Malaria Project, (K.B.S., N.O., T.E.T., D.G.P.) Kamuzu University of Health Sciences, Blantyre, Malawi
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Nicole O’Brien
gBlantyre Malaria Project, (K.B.S., N.O., T.E.T., D.G.P.) Kamuzu University of Health Sciences, Blantyre, Malawi
hNationwide Children’s Hospital (N.O.), Division of Pediatric Critical Care, Columbus, Ohio
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Terrie E. Taylor
fCollege of Osteopathic Medicine (K.B.S., T.E.T., K.I.), Michigan State University, East Lansing, Michigan
gBlantyre Malaria Project, (K.B.S., N.O., T.E.T., D.G.P.) Kamuzu University of Health Sciences, Blantyre, Malawi
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Douglas G. Postels
gBlantyre Malaria Project, (K.B.S., N.O., T.E.T., D.G.P.) Kamuzu University of Health Sciences, Blantyre, Malawi
iDivision of Neurology (D.G.P.), The George Washington University, Children’s National Medical Center, Washington, DC
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    FIG 1.

    Outcomes of children by the initial consensus BVS. Proportional outcomes of consensus BVS are demonstrated when trichotomized into 3 categories, ≤5, 6 or 6.5, and 7 or 8.

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    FIG 2.

    Sample T2w original and simulated MRIs from children with CM. The original brain MRIs were obtained on a Signa Ovation 0.35 T magnet (upper row) and corresponding axial images were obtained after image degradation to simulate the resolution of a very-low-field scanner (lower row). A, A BVS of 8 was assigned to the original scan as well as to the degraded images by all 3 radiologists. B, A BVS of 6 was assigned to the original scan, and 6 or 7, to the degraded images. C, A BVS of 4 was assigned to the original scan, and 5 or 3, to the degraded images.

Tables

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    Table 1:

    MRI criteria for assignment of brain volume scores

    BVSBrief DescriptionFeatures
    1Severe atrophyMarkedly atypical for age with diffuse prominence of the cisternae, ventricles, and sulci
    2Mild atrophySubtle prominence of the cisternae, ventricles, and sulci for age
    3NormalTypical for age
    4Mild increased volumeMildly increased brain volume for age, but with normal cisternae, ventricles, and sulci
    5Mild swellingSome localized or regional loss of cisternae, ventricles, and sulci
    6Moderate swellingDiffuse involvement with incomplete effacement of the cisternae, ventricles, and sulci
    6.5aModerate-to-severe swellingFeatures between 6 and 7, eg, near-complete effacement of the sulci without cisternal/ventricular effacement or significant cisternal/ventricular effacement with partial loss of the sulci
    7Severe swellingLoss of all sulci with cisternal and ventricular effacement and decreased gray/white matter delineation
    8Severe swelling with herniationLoss of all sulci with cisternal and ventricular effacement with herniation
    • ↵a Score of 6.5 was not included in the original BVS.

    • View popup
    Table 2:

    ORs for mortality at a BVS threshold of 7 or 6

    Fisher TestOR95% CIP Value
    7–8 vs ≤6.516.174.3–69.7<.001
    6–8 vs ≤511.501.6–503.7.005
    Seydel et al7 (7–8 vs ≤6)13.75a4.3–58.6a<.001
    • ↵a The OR and CI reported in Seydel et al7 used logistic regression and was 14.0 (4.5–43.4). Here we use Fisher exact test instead because of its increased accuracy for sample sizes in this study, which was then also applied to Seydel et al7 to make these results comparable. Accordingly, the recalculated OR and CI are slightly different than that reported in Seydel et al7.

    • View popup
    Table 3:

    BVS assigned to degraded MRIs compared with original criterion standard BVS assigned to nondegraded scans

    Test StatisticR1R2R3Median
    Intraclass coefficient (95% CI)0.901 (0.830–0.944)0.878 (0.777–0.932)0.867 (0.762–0.926)0.928 (0.874–0.959)
    Mean bias+0.170–0.340+0.319+0.128
    Mean absolute deviation0.5530.5960.6170.468
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American Journal of Neuroradiology: 45 (2)
American Journal of Neuroradiology
Vol. 45, Issue 2
1 Feb 2024
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MRI-Based Brain Volume Scoring in Cerebral Malaria
Manu S. Goyal, Lorenna Vidal, Karen Chetcuti, Cowles Chilingulo, Khalid Ibrahim, Jeffrey Zhang, Dylan S. Small, Karl B. Seydel, Nicole O’Brien, Terrie E. Taylor, Douglas G. Postels
American Journal of Neuroradiology Feb 2024, 45 (2) 205-210; DOI: 10.3174/ajnr.A8098
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Manu S. Goyal, Lorenna Vidal, Karen Chetcuti, Cowles Chilingulo, Khalid Ibrahim, Jeffrey Zhang, Dylan S. Small, Karl B. Seydel, Nicole O’Brien, Terrie E. Taylor, Douglas G. Postels
MRI-Based Brain Volume Scoring in Cerebral Malaria Is Externally Valid and Applicable to Lower-Resolution Images
American Journal of Neuroradiology Feb 2024, 45 (2) 205-210; DOI: 10.3174/ajnr.A8098

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