Magnetic Resonance Imaging Research in Sub-Saharan Africa: Challenges and Satellite-Based Networking Implementation

Abstract

As part of an NIH-funded study of malaria pathogenesis, a magnetic resonance (MR) imaging research facility was established in Blantyre, Malaŵi to enhance the clinical characterization of pediatric patients with cerebral malaria through application of neurological MR methods. The research program requires daily transmission of MR studies to Michigan State University (MSU) for clinical research interpretation and quantitative post-processing. An intercontinental satellite-based network was implemented for transmission of MR image data in Digital Imaging and Communications in Medicine (DICOM) format, research data collection, project communications, and remote systems administration. Satellite Internet service costs limited the bandwidth to symmetrical 384 kbit/s. DICOM routers deployed at both the Malaŵi MRI facility and MSU manage the end-to-end encrypted compressed data transmission. Network performance between DICOM routers was measured while transmitting both mixed clinical MR studies and synthetic studies. Effective network latency averaged 715 ms. Within a mix of clinical MR studies, the average transmission time for a 256 × 256 image was ~2.25 and ~6.25 s for a 512 × 512 image. Using synthetic studies of 1,000 duplicate images, the interquartile range for 256 × 256 images was [2.30, 2.36] s and [5.94, 6.05] s for 512 × 512 images. Transmission of clinical MRI studies between the DICOM routers averaged 9.35 images per minute, representing an effective channel utilization of ~137% of the 384-kbit/s satellite service as computed using uncompressed image file sizes (including the effects of image compression, protocol overhead, channel latency, etc.). Power unreliability was the primary cause of interrupted operations in the first year, including an outage exceeding 10 days.

Lung endothelial cell antigen cross-presentation to CD8+T cells drives malaria-associated lung injury

“…1g), concurrently with vascular leakage. Of note, the only published data on MRI findings relate to patients with cerebral malaria 32,33 , pediatric cerebral malaria patients 34 , and ECM-susceptible and resistant mice infected with PbA 35,36 . Our data indicate that this technique may complement or replace traditional X-ray imaging of lung edema.…”

Imaging Plasmodium immunobiology in the liver, brain, and lung

“…edema, herniation, ventricular changes) and the extent of ‘recovery’ following a CM episode [137]. Recently, magnetic resonance imaging (MRI) of pediatric cerebral malaria patients has become available in Blantyre, Malawi [138] and has provided some insights into macroscopic neuronal changes associated with pathology [137]. Although a wide range of changes was reported, some were correlated to retinopathy with involvement of the basal ganglia being the most common finding, followed by increased brain volume with herniation, as well as diffuse and focal cortical abnormalities, alterations of the deep gray matter and involvement of the corpus callosum.…”

Survey of magnetic resonance imaging availability in West Africa

“…A number of the West African countries have no MRI machine or not more than 1 MRI unit per million of their population. On the basis of regional assessment of MRI utilization in Africa, countries in the Northern sub-region of Africa appear to have a relatively good MRI availability and presence, and show better MRI utilization per million compared to other parts of the continent [1, 5, 9-11]. MRI utilization in Africa is quite low when compared to the leading industrial nations in the world e.g Japan, United States, France and Spain.…”