MRI scanners: their use in the field, though it faces formidable obstacles, could provide the breakthrough needed in understanding cerebral malaria

Flickr\Just Us 3

Billions of dollars have been spent on magnetic resonance imaging (MRI) yet its potential for understanding cerebral malaria remains virtually untapped, say researchers.

MRI has flourished as a tool for understanding many diseases of the rich world but although this scanning technique could "transform our understanding" of cerebral malaria and lead to new therapies, it has barely been used for this purpose says a team writing in the American Journal of Tropical Medicine and Hygiene.

Cerebral malaria is the most severe form of the disease, affecting 20–50 per cent of those who contract malaria. It is caused by the parasite Plasmodium falciparum and results in coma, brain damage and organ failure. In 30–50 per cent of cases, it is fatal and one million deaths are reported each year.

According to the researchers, around one in four children in Sub-Saharan Africa who survive cerebral malaria experience persistent problems with memory, attention and other cognitive skills.

The underlying mechanisms of cerebral malaria are not well known and there is no specific treatment, say the US and Thai researchers. Scientists rely on brain tissue from dead patients for their studies but MRI offers a non-invasive means of gathering data as the disease progresses.

Yet despite immense progress in scanning technology over the past decade, there has only been one systematic MRI study based on malaria patients living in an area where the disease is prevalent — and this was more than a decade ago, say the researchers.

The team, led by Gary Brittenham from Columbia University College of Physicians and Surgeons in the United States, is currently using MRI to investigate malaria in Thailand.

Brittenham tells SciDev.Net that he hopes to extend his research to endemic areas but admits that adapting MRI scanners to probe how cerebral malaria unfolds in the field presents "an array of technical and logistic challenges". Scanning machines are now available, however, in a number of endemic areas, he adds.

Brittenham's work is welcomed by Terrie Taylor, a researcher at the Michigan State University, United States, and head of the Blantyre Malaria Project.

Taylor began assessing malaria damage with an MRI scanner in Malawi in 2008. Her team is studying the disease using a donated MRI scanner. The aim is to compare autopsy scans with brain scans from survivors.

Link to abstract in American Journal of Tropical Medicine and Hygiene