Bridging the Neuroimaging Access Gap: Clinical Integration of Mobile 64 mT MRI for Paediatric Care at a Low-Resource Referral Hospital in Malawi

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.