Bridging the neuroimaging access gap: Clinical integration of mobile 64 mT MRI for paediatric care at a low-resource referral hospital in Malawi

Vokhiwa, Maclean, Chetcuti, Karen, Chikwana, Jessica, Banda, Saidon, Lange, Frederik, Williams, Steve, Jones, Derek K. ORCID: https://orcid.org/0000-0003-4409-8049, Deoni, Sean C.L., Phiri, Kamija S. and Umar, Eric 2026. Bridging the neuroimaging access gap: Clinical integration of mobile 64 mT MRI for paediatric care at a low-resource referral hospital in Malawi. Journal of Magnetic Resonance Open , 100230. 10.1016/j.jmro.2026.100230

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Abstract

Inequitable access to neuroimaging limits paediatric neurological care across sub-Saharan Africa, where fewer than one MRI scanner exists per million people. Low-field magnetic resonance imaging (MRI) may expand access, but evidence supporting its integration into paediatric clinical workflows in low-resource hospitals remains scarce. We evaluated the feasibility, diagnostic adequacy, and proof-of-concept clinical utility of mobile 64 mT MRI system at a referral hospital in southern Malawi without on-site conventional brain imaging. In this pilot single-case observational study, a 9-year-old female with progressive neurological decline and suspected white matter disease underwent triplanar T2-weighted and diffusion-weighted imaging using a Hyperfine Swoop 64 mT system. Workflow, image quality, artefacts, diagnostic adequacy, and radiologist diagnostic confidence were assessed, with cloud-enabled remote radiological review. The workflow from referral to consensus working diagnosis was completed within 22 hours without sedation or adverse events. All six planned sequences were acquired with whole-brain coverage with diagnostically adequate image quality (overall confidence: 4/5, T2: 4/5; DWI: 3/5). T2-weighted imaging demonstrated bilateral frontal and parietal white matter hyperintensity, a periventricular rim, and supratentorial ventricular dilatation; diffusion-weighted imaging and ADC maps showed no restricted diffusion. Integrated with the clinical history, findings supported a working diagnosis of probable juvenile-onset Alexander disease and informed discontinuation of a planned tertiary referral and transition to palliative and rehabilitation services. Mobile 64 mT MRI with remote radiological review was feasible within this resource-constrained paediatric clinical workflow and provided clinically useful neuroimaging where conventional imaging was unavailable. Larger studies are needed to establish reproducibility and inform equitable scale-up across similar settings.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Schools > Psychology Research Institutes & Centres > Cardiff University Brain Research Imaging Centre (CUBRIC)
Publisher:	Elsevier
ISSN:	2666-4410
Date of First Compliant Deposit:	5 October 2026
Date of Acceptance:	30 September 2026
Last Modified:	05 Oct 2026 14:30
URI:	https://orca.cardiff.ac.uk/id/eprint/190006

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