Feasibility and Validity of Ultra-Low-Field MRI for Measurement of Regional Infant Brain Volumes in Structures Associated With Antenatal Maternal Anemia

The availability of ultra-low-field (ULF) magnetic resonance imaging (MRI) has the potential to improve neuroimaging accessibility in low-resource settings. However, the utility of ULF MRI in detecting child brain changes associated with anemia is unknown. The aim of this study was to assess the comparability of 3T high-field (HF) and 64mT ULF volumes in infants for brain regions associated with antenatal maternal anemia. This neuroimaging substudy is nested within Khula South Africa, a population-based birth cohort. Pregnant women were enrolled antenatally and postnatally, and mother–child dyads (n = 394) were followed prospectively at approximately 3, 6, 12, and 18 months. A subgroup of infants was scanned on 3T and 64mT MRI systems across study visits and images were segmented using MiniMORPH. Correlations and concordance coefficients were used to cross-validate HF and ULF infant brain volumes for the caudate nucleus, putamen, and corpus callosum. Seventy-eight children (53.85% male) had paired HF (mean [SD] age = 9.64 [5.26] months) and ULF (mean [SD] age = 9.47 [5.32] months) datasets. Results indicated strong agreement between systems for intracranial volume (ICV; r = 0.96, ρ_ccc = 0.95) and brain regions of interest in anemia including the caudate nucleus (r = 0.89, ρ_ccc = 0.86), putamen (r = 0.97, ρ_ccc = 0.96) and corpus callosum (r = 0.87, ρ_ccc = 0.79). This cross-validation study demonstrates excellent correspondence between 3T and 64mT volumes for infant brain regions implicated in antenatal maternal anemia. Findings validate the use of ULF MRI for pediatric neuroimaging on anemia in Africa.