Heroes in Proving the Value of Imaging: Part 3

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Gretchen Birbeck, MD

Heroes in Proving the Value of Imaging is an occasional series about advocates for the profession who are working to enhance radiology through research, governmental affairs, humanitarian efforts, and more. In Part 3, ImagingBiz speaks with Gretchen Birbeck, MD, on using MRI to study malaria in Malawi.

The list of breakthrough medical insights made possible, in part, through the use of donated imaging technology is gratifyingly long—and growing—thanks to the continuing generosity of the heroes of radiology: those with a passion for philanthropy. A prime example comes from the southern African nation of Malawi, where the Blantyre Malaria Project is underway. Researchers involved in that program have, over the past two decades, greatly enhanced science’s understanding of the malarial mechanisms responsible for killing 4 million people per year, worldwide, and leaving millions more in varying states of debilitation.

"MRI is opening up for us whole new avenues for investigating the mechanisms of injury that lead a child from being acutely ill to waking up and doing really well, versus waking up but not doing well neurologically, versus dying. MRI is transforming the questions that we can ask and increasing the speed at which we can answer them."
-Gretchen Birbeck, MD

Among that project’s most intriguing findings of late are those made by Gretchen Birbeck, MD, MPH, DTMH, associate professor and director of the International Neurologic and Psychiatric Epidemiology Program at Michigan State University (MSU) in East Lansing. “I’m currently involved in a study of Malawian children who are cerebral-malaria survivors, and imaging technology figures prominently in that effort,” she says.

Nearly one-third of the study’s children have a degree of long-term neurological impairment resulting from cerebral malaria. “Some of the young survivors exhibit severe developmental delay, deficits consistent with cerebral palsy that include motor-delay problems, loss of language function, and coordination and gait issues. In addition, there is a very high rate of behavioral problems, chiefly an attention-deficit/hyperactivity-disorder syndrome that occurs three to five months after recovery from cerebral malaria,” Birbeck reports.

These and other discoveries have led Birbeck to conclude that the next step should be to explore whether children being treated for malaria might benefit from concurrent treatment with neuroprotective agents. She says, “The question that needs to be answered is this: Are there existing drugs, now being used for other neurologic conditions, that could be put into play during the treatment for malaria itself in order to protect the brain from injury?”

Lost Without It

The answer, if there is one, is more than likely to be uncovered with help from the Ovation MRI scanner that GE Healthcare donated to the Blantyre Malaria Project through the auspices of MSU. Birbeck has been using the 0.35T unit regularly since its installation about a year ago at Queen Elizabeth Central Hospital in Blantyre, Malawi, where she works for six months of each year.

This gift has proven pivotal to Birbeck’s research. “Without it, I (and others studying cerebral malaria among Malawian children) would know much less about the impact of the disease on survivors than currently is the case,” she says. “Moreover, we would be at very high risk of going down false routes of investigation. Our MRI scanner is giving us a great deal of guidance in terms of comorbid conditions being encountered. It’s enabling us to step back and make sure that the deficits we’re seeing in survivors are indeed attributable to cerebral malaria, and not actually the result of some prior injury or previous insult.”

Birbeck continues, “MRI is also opening up for us whole new avenues for investigating the mechanisms of injury that lead a child from being acutely ill to waking up and doing really well, versus waking up but not doing well neurologically, versus dying. MRI is transforming the questions that we can ask and increasing the speed at which we can answer them.”

Related Study

Birbeck’s study cohort consists of 128 pediatric cerebral-malaria survivors plus 313 children who have never contracted the disease. The male–female ratio is about evenly split, and at the time of enrollment in the study, participants ranged in age from 9 months to 11 years. They are slated to be followed by Birbeck until February 2010.

MRI scans are also