NeuroInterp: A method for facilitating neuroimaging research on cerebral malaria

Abstract

Radiologic data are increasingly important in clinical care guidelines for neurologic disorders and in the conduct of clinical trials assessing novel therapies. The infrastructure and expertise for neuroradiologic evaluations remain scarce in resource-limited settings, but where available, MRI and CT capacity can offer new insights into common, globally devastating diseases. In vivo data for frequently fatal tropical conditions such as cerebral malaria have been largely limited to autopsy studies, which only provide information on nonsurvivors at a single point in time. New imaging facilities in sub-Saharan Africa offer opportunities for expanded research on tropical neurologic disorders.1 However, data management challenges hamper the research utility of radiologic evaluations.Traditional methods of capturing radiographic data from neuroradiologic evaluations provided for clinical purposes rely on unstructured narrative descriptions. Narratives are unsuitable for research analysis for several reasons: the text data are not structured for statistical analysis; reports are rarely standardized among radiologists or among institutions; determining whether an unmentioned feature is absent or inadvertently disregarded in the narrative is frequently impossible; searching for unambiguous words in text reports to develop a database (e.g., swelling vs edema) is haphazard; and, as with many physician-driven technologies, clinical interpretations may have considerable inter-and intrareader variability.To improve the utility of MRI in clinical research of cerebral malaria, we devised a data entry application and workflow instrument, NeuroInterp. As an instrument, NeuroInterp prompts radiologists to systematically glean data from their evaluations. As a workflow instrument, NeuroInterp ensures that serial readings are evaluated by multiple readers with discordant data identified and adjudication addressed. This methodologic approach to developing a data management instrument for MRI data could also be applied to other tropical conditions whose radiographic correlates have not been well-characterized.The NeuroInterp instrument. Development of the NeuroInterp instrument began in 2008, when, as part of a long-standing NIH-funded study of pediatric cerebral malaria, brain MRI acquisition became part of the standard evaluation of comatose patients admitted to the pediatric research ward at Queen Elizabeth Central Hospital in Blantyre, Malawi. 1CT and autopsy studies of cerebral malaria suggested a number of likely radiographic findings, including acute edema, chronic atrophy, inflammatory lesions, and ischemia.2,3 To develop appropriate items for inclusion in the NeuroInterp platform for pediatric cerebral malaria findings, 2 years of narrative-based findings were summarized and distilled into discrete items for structured entry. Two fellowship-trained radiologists, one in neuroradiology (M.J.P.) and one in MRI (S.D.K.), read all studies. The radiologists reviewed all MRIs from the research ward and collaboratively developed a sy...

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