Nassanga Rita, Nakasujja Noeline, Kaddumukasa Mark, Jones Stephen E, Sajatovic Martha, Kawooya Michael Grace
Department of Radiology, College of Health Sciences, Makerere University, Kampala, Uganda.
Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda.
PLoS One. 2025 Jan 17;20(1):e0305788. doi: 10.1371/journal.pone.0305788. eCollection 2025.
Diagnosing dementia remains challenging in low-income settings due to limited diagnostic options and the absence of definitive biomarkers. The use of brain MRI in the diagnosis of dementia is infrequent in Uganda, and even when it is used, subtle findings like mild regional atrophy are often overlooked, despite being crucial for imaging diagnosis.
The purpose of this study was to explore the perceptions and practices of imaging personnel and physicians regarding the use of brain MRI as a diagnostic approach for dementia in Uganda.
This was an exploratory qualitative study involving radiologists, technologists, senior house officers and psychiatrists. The participants were 25 in total. Data was collected through key informant interviews and focus group discussions and analyzed thematically using an inductive approach.
The study revealed three key themes: Brain MRI Practices for Diagnosing Dementia, Facilitators of Appropriate MRI Use, and Barriers to Appropriate Use of Brain MRI. Sub-themes under these themes included cost considerations, poor and good MRI practices, MRI as a standard operating procedure, positive attitudes towards brain MRI, and barriers such as structural, financial, operational, technical, and patient-related issues. Participants acknowledged the high accuracy and superiority of brain MRI for diagnosing dementia and recognized it as the standard of care. However, its use in Uganda is limited due to high costs, restricted access, mechanical failures, patient claustrophobia, myths and misconceptions, and interpretation difficulties by radiologists and inappropriate protocols by technologists.
The study identifies barriers to effective brain MRI use for dementia diagnosis in Uganda, including limited training, high costs, and uneven equipment distribution. Despite this, providers are positive about MRI adoption. Enhancing training, awareness, and phased rollouts can improve outcomes. Future research should focus on similar low-resource settings for validation.
由于诊断选择有限且缺乏明确的生物标志物，在低收入环境中诊断痴呆症仍然具有挑战性。在乌干达，脑磁共振成像（MRI）在痴呆症诊断中的应用并不常见，即使使用了，像轻度区域萎缩这样的细微发现也常常被忽视，尽管这些发现对影像学诊断至关重要。
本研究的目的是探讨乌干达成像人员和医生对使用脑MRI作为痴呆症诊断方法的看法和实践。
这是一项探索性定性研究，涉及放射科医生、技术人员、高级住院医生和精神科医生。参与者共有25人。通过关键信息访谈和焦点小组讨论收集数据，并采用归纳法进行主题分析。
该研究揭示了三个关键主题：用于诊断痴呆症的脑MRI实践、适当使用MRI的促进因素以及适当使用脑MRI的障碍。这些主题下的子主题包括成本考虑、不良和良好的MRI实践、MRI作为标准操作程序、对脑MRI的积极态度以及诸如结构、财务、操作、技术和患者相关问题等障碍。参与者承认脑MRI在诊断痴呆症方面具有很高的准确性和优越性，并将其视为护理标准。然而，由于成本高昂、获取受限、机械故障、患者幽闭恐惧症、误解和错误观念以及放射科医生的解读困难和技术人员的不当操作流程，其在乌干达的使用受到限制。
该研究确定了乌干达在有效使用脑MRI进行痴呆症诊断方面的障碍，包括培训有限、成本高昂和设备分配不均。尽管如此，提供者对采用MRI持积极态度。加强培训、提高认识和分阶段推广可以改善结果。未来的研究应关注类似的资源匮乏环境以进行验证。
