Mri-Based Brain Volume Scoring In Cerebral Malaria Is Externally Valid and Applicable To Lower Resolution Images

Introduction: Children with cerebral malaria have a high risk of mortality and neurological morbidity. Both mortality and morbidity are associated with initially increased brain volume on magnetic resonance imaging (MRI), 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. Methods: To assess the independent reproducibility of the Brain Volume Scoring, radiologists not associated with the initial validation study were trained to score MRI scans from a new cohort of cerebral malaria patients. These scores were then compared to their survival and neurological outcomes. To assess applicability to lower resolution MRI, we assigned Brain Volume Scores to brain MRIs degraded to simulate a very low field (64 mT) portable scanner (Hyperfine), and compared these to the original scores assigned to the original non-degraded MRIs. Results: Brain Volume Scores on the new cohort of cerebral malaria patients were highly associated with outcomes (odds ratio for mortality = 16, p < 0.001). 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 > 0.87). 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. Disclosure: Supported by NIH R01 AI034969 and U01 AI126610