Emerging ethical issues raised by highly portable MRI research in remote and resource-limited international settings

Shen, Francis X.; Wolf, Susan M.; Bhavnani, Supriya; Deoni, Sean; Elison, Jed T.; Fair, Damien A.; Gee, Michael S.; Geethanath, Sairam; Kay, Kendrick; Lim, Kelvin O.; Estrin, Georgia Lockwood; Luciana, Mónica; Peloquin, David; Rommelfanger, Karen S.; Schiess, Nicoline; Siddiqui, Khan M.; Torres, Efraín; Vaughan, J. Thomas

doi:10.1016/j.neuroimage.2021.118210

Cited by 42 publications

(35 citation statements)

References 122 publications

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“…Even this large MRI dataset was biased towards European and North American populations and European ancestry groups within those populations. This bias is unfortunately common in many clinical and scientific references, including anthropometric growth charts and benchmark genetic datasets, representing an inequity that must be addressed by the global scientific community 68 . In the particular case of brain charts, further increasing ethnic, socioeconomic and demographic diversity in MRI research will enable more population-representative normative trajectories 69 , 70 that can be expected to improve the accuracy and strengthen the interpretation of centile scores in relation to appropriate norms 26 .…”

Section: Discussionmentioning

confidence: 99%

Brain charts for the human lifespan

Bethlehem

Seidlitz

White

et al. 2022

Nature

917

498

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Over the past few decades, neuroimaging has become a ubiquitous tool in basic research and clinical studies of the human brain. However, no reference standards currently exist to quantify individual differences in neuroimaging metrics over time, in contrast to growth charts for anthropometric traits such as height and weight1. Here we assemble an interactive open resource to benchmark brain morphology derived from any current or future sample of MRI data (http://www.brainchart.io/). With the goal of basing these reference charts on the largest and most inclusive dataset available, acknowledging limitations due to known biases of MRI studies relative to the diversity of the global population, we aggregated 123,984 MRI scans, across more than 100 primary studies, from 101,457 human participants between 115 days post-conception to 100 years of age. MRI metrics were quantified by centile scores, relative to non-linear trajectories2 of brain structural changes, and rates of change, over the lifespan. Brain charts identified previously unreported neurodevelopmental milestones3, showed high stability of individuals across longitudinal assessments, and demonstrated robustness to technical and methodological differences between primary studies. Centile scores showed increased heritability compared with non-centiled MRI phenotypes, and provided a standardized measure of atypical brain structure that revealed patterns of neuroanatomical variation across neurological and psychiatric disorders. In summary, brain charts are an essential step towards robust quantification of individual variation benchmarked to normative trajectories in multiple, commonly used neuroimaging phenotypes.

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Section: Discussionmentioning

confidence: 99%

Brain charts for the human lifespan

Bethlehem

Seidlitz

White

et al. 2022

Nature

917

498

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“…Additionally, most MS patients will experience mobility impairment, which can impact quality of care (34). Mobile MRI units could bring imaging to patients, providing otherwise unavailable service to sparsely populated areas and individuals who cannot travel (35,36).…”

Section: Discussionmentioning

confidence: 99%

Portable, Low-Field Magnetic Resonance Imaging Sensitively Detects and Accurately Quantifies Multiple Sclerosis Lesions

Arnold

Okar

et al. 2022

Preprint

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Magnetic resonance imaging is a fundamental tool in the diagnosis and management of neurological diseases such as multiple sclerosis (MS). New portable, low–field MRI scanners could potentially lower financial and technical barriers to neuroimaging and reach underserved or disabled populations. However, the sensitivity of low–field MRI for MS lesions is unknown. We sought to determine if white matter lesions can be detected on a 64mT low–field MRI, compare automated lesion segmentations and total lesion burden between paired 3T and 64mT scans, and identify features that contribute to lesion detection accuracy. In this prospective, cross-sectional study, same–day brain MRI (FLAIR, T1, and T2) scans were collected from 36 adults (32 women; mean age, 50 ± 14 years) with known or suspected MS using 3T (Siemens) and 64mT (Hyperfine) scanners at two centers. Images were reviewed by neuroradiologists. MS lesions were measured manually and segmented using an automated algorithm. Statistical analyses assessed accuracy and variability of segmentations across scanners and systematic scanner biases in automated volumetric measurements. Lesions were identified on 64mT scans in 94% (31/33) of patients with confirmed MS. The smallest lesions manually detected were 5.7 ± 1.3 mm in maximum diameter at 64mT vs 2.1 ± 0.6 mm at 3T. Automated lesion burden estimates were highly correlated between 3T and 64mT scans (r = 0.89, p < 0.001). Bland-Altman analysis identified bias in 64mT segmentations (mean = 1.6 ml, standard error = 5.2 ml, limits of agreement = 19.0–15.9 ml), which over-estimated low lesion burden and under-estimated high burden (r = 0.74, p < 0.001). Visual inspection revealed over–segmentation was driven by flow–related hyperintensities in veins on 64mT FLAIR. Lesion size drove segmentation accuracy, with 93% of lesions >1.0 ml and all lesions >1.5 ml being detected. These results demonstrate that in established MS, a portable 64mT MRI scanner can identify white matter lesions, and disease burden estimates are consistent with 3T scans.

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“…This cost is much higher in a high-income country context and consequently may not accurately reflect the true cost that would be incurred in the context in which a displaced person is treated. Furthermore, this finding could also suggest that more cost-effective ways of implementing these procedures for displaced people-- such as the provision of portable MRIs currently being piloted in low-income contexts-- should be explored to ensure that a minimum viable procedure is in place for displaced persons, if the status quo is too expensive to execute 24 – 26 .…”

Section: Discussionmentioning

confidence: 99%

Practical needs and considerations for refugees and other forcibly displaced persons with neurological disorders: Recommendations using a modified Delphi approach

et al. 2021

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Background: There are >70 million forcibly displaced people worldwide, including refugees, internally displaced persons, and asylum seekers. While the health needs of forcibly displaced people have been characterized in the literature, more still needs to be done globally to translate this knowledge into effective policies and actions, particularly in neurology. Methods: In 2020, a global network of published experts on neurological disease and refugees was convened. Nine physician experts from nine countries (2 low, 1 lower-middle income, 5 upper-middle, 1 high income) with experience treating displaced people originating from 18 countries participated in three survey and two discussion rounds in accordance with the Delphi method. Results: A consensus list of priority interventions for treating neurological conditions in displaced people was created, agnostic to cost considerations, with the ten highest ranking tests or treatments ranked as: computerized tomography scans, magnetic resonance imaging scans, levetiracetam, acetylsalicylic acid, carbamazepine, paracetamol, sodium valproate, basic blood tests, steroids and anti-tuberculous medication. The most important contextual considerations (100% consensus) were all economic and political, including the economic status of the displaced person’s country of origin, the host country, and the stage in the asylum seeking process. The annual cost to purchase the ten priority neurological interventions for the entire displaced population was estimated to be 220 million USD for medications and 4.2 billion USD for imaging and tests. Conclusions: A need for neuroimaging and anti-seizure medications for forcibly displaced people was emphasized. These recommendations could guide future research and investment in neurological care for forcibly displaced people.

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Emerging ethical issues raised by highly portable MRI research in remote and resource-limited international settings

Cited by 42 publications

References 122 publications

Brain charts for the human lifespan

Brain charts for the human lifespan

Portable, Low-Field Magnetic Resonance Imaging Sensitively Detects and Accurately Quantifies Multiple Sclerosis Lesions

Practical needs and considerations for refugees and other forcibly displaced persons with neurological disorders: Recommendations using a modified Delphi approach

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