Africa-Press – Liberia. Brain tumours are a notable source of neurological morbidity and death in resource poor health systems where delays in receiving a diagnosis are common. Neuroimaging is a crucial part of the diagnosis and treatment of intracranial tumours, and the role of higher imaging modalities will differ from setting to setting. Although magnetic resonance imaging (MRI) remains the preferred modality of choice in assessment of brain tumours in high-income countries, implementation in Liberia is limited due to infrastructural, financial and workforce limitations. This narrative review focuses on the drawbacks of MRI as compared with computed tomography (CT) in the assessment of brain tumours in the Liberian healthcare context. A search of the literature was targeted using PubMed, Google Scholar and relevant global health/radiology reports and the search focused on neuroimaging in sub-Saharan Africa and in low-resource environments. The review shows that the benefits of MRI in terms of soft tissue contrast and tumour characterization are outweighed in Liberia by high acquisition and maintenance costs, scan time, need for stable electricity, limited technical expertise, and limited access to populations in rural areas. In contrast, the advantages of CT include mostly universal availability in the community, faster CT time, a lower cost per exam, and better utilization of emergency and referral-based clients, for the sake of lower tissue resolution and the use of ionizing radiation. These factors make CT a more practical first-line imaging modality for evaluation of brain tumour in Liberia. The review emphasises the need for context sensitive diagnostic strategy prioritising for optimisation of CT-based pathways, selective and sustainable utilisation of MRI and health system investments for improved equitable access to neuro-oncological care.
1. INTRODUCTION
Brain tumours (both primary and metastatic) place a significant burden to the patient and health systems worldwide, with significant mortality and long-termneurological disability (Martucci et al., 2023; Smits, 2021). Although epidemiological data is more limited in relation to the health situation in Liberia, statistics from around the world indicate that more than 300,000 new cases and 250,000 deaths are registered each year as a result of primary brain and central nervous system tumours (Martucci et al., 2023). In sub–Saharan Africa, due to increasing numbers of non-communicable diseases, better survival from infectious diseases and population ageing, the absolute number of patients with brain neoplasms is likely to increase (Anazodoet al., 2022; Pulumati et al., 2023).
Neuroimaging is a key part of the holistic approach of diagnosis, characterisation, and management of brain tumours. CT and MRI are the current modalities dominating the worldwide. In high income settings, imaging with MRI has become the mainstay of brain tumour imaging at every stage of the care continuum ranging from initial diagnosis to treatment planning and follow up (Martucci et al., 2023; Smits, 2021). However, the industry paradigm is predicated on the assumption of reliable availability of high field MRI, as well as stable power and climate control, and a cadre of trained radiologists, technologists, and physicists, which are not fulfilled in many LMICs (Aderinto et al., 2023; Murali et al., 2023).
Liberia is typical of such constraints. Decades of civil conflict and the Ebola outbreak in 2014 and 2015 caused severe damage to the health system, including diagnostic, and it has only been in recent years that major efforts to renew laboratory and diagnostic governance have been initiated (Kohar et al., 2025; Shoman et al., 2017). While those reforms have prioritized infectious disease surveillance and basic laboratory capacity, high end imaging such as MRI is extremely limited with most advanced radiology concentrated in a small number of urban facilities, often in the private sector. CT on the other hand has gradually spread throughout public and private hospitals in the region and is widely acknowledged as the first line neuroimaging modality in Africa (Aderinto et al., 2023; Anazodo et al., 2022).
This review compiles the relative disadvantages of MRI as compared to CT in the assessment of brain tumours in a Liberian and similar low resource environment. Instead of rehashing the much-described technical superiority of the MRI, the emphasis lies on the inversion of the familiar hierarchy of modalities imposed by cost, infrastructure, workforce and health system realities. The point is to inform today’s clinicians, policymakers, and planners who have to make pragmatic decisions in the face of crippling resource limitations concerning investments in imaging and referral pathways.
1.1. Overview Of Brain Tumours
Brain tumours are a broad term which covers a range of primary and secondary tumours, from the very low grade and relatively indolent to extremely aggressive tumours such as glioblastoma, brain metastases from systemic malignancies (Martucci et al., 2023; Smits, 2021). Malignant brain tumours have poor prognoses with 5-year survival being around 35% on average for both primary CNS cancers worldwide (Martucci et al., 2023). Their impact is magnified in LMICs, where late presentation, limited neurosurgical capacity as well as restricted access to radiotherapy and chemotherapy are common (Pulumati et al., 2023).
Children and young adults can have different patterns of tumour type, location, and molecular characteristics compared with adults and brain tumours are the first leading cause of cancer-related death in children in many regions (Nikam et al., 2022). In both pediatric and adult populations, symptoms such as headache, seizures, focal deficits and cognitive or behavioural changes are non-specific, thus clinical diagnosis alone is unreliable (Smits, 2021). Early and accurate imaging is therefore important to distinguish between neoplastic and non-neoplastic pathology, narrow the differential diagnosis and direct referral for surgery or oncology.
Where neurological expertise and neurosurgical capacity is limited, the role of imaging for diagnosis is even more significant in Liberia. Misdiagnosis or delayed recognition of brain tumours might be worsened by the fact that the symptomatology is often similar to infectious, vascular and traumatic brain conditions very common in West Africa (Aderinto et al., 2023; Shoman et al., 2017). Under the circumstances, the choice of imaging modality has great implications on the timing and quality of care.
1.2. Brief Overview of MRI And CT
MRI utilizes powerful magnetic fields and radiofrequency pulses that alter the alignment of hydrogen nuclei and assess their relaxation properties so that they produce images reflecting tissue composition and underscoring the microenvironment (Aderinto et al., 2023). By using different pulse sequences, MRI can be used to emphasize different aspects of tissue structure, water content, and diffusion, which led to its great sensitivity to white matter integrity, edema and subtle changes in the parenchyma (Martucci et al., 2023). Functional sequences can be used to map blood flow, metabolism and sometimes also correlate with genetic features of tumours (Smits, 2021). However, the presence of costly superconducting magnets (for high field systems) and continuous cooling, shielding from radio frequency and high planning requirements of the MRI room, along with the expertise of trained operators and interpreters makes the use of MRI expensive (Murali et al., 2023).
CT, by contrast, is based on the use of revolving X ray beams and detectors to reconstruct cross sectional images based on tissue attenuation. It is relatively fast, robust and technically less difficult to install and maintain than MRI. CT scanners have the advantage of being less sensitive to power fluctuations, have shorter examination times and lower costs, when compared to other imaging modalities such as MRI, PET, etc. of being cheaper to purchase and also cheaper to operate, but the disadvantage is the exposure to ionizing radiation (Aderinto et al., 2023). CT has limitations in soft tissue contrast and functional imaging but in resource limited settings CT just has become the work horse of neuroimaging (Anazodo et al., 2022).
2. LITERATURE SEARCH STRATEGY
Electronic searches were performed in PubMed and Google Scholar of English language articles from 2015 – 2025 using combinations of the following terms: “brain tumour MRI CT”, “neuroimaging Africa”, “MRI access sub–Saharan Africa”, “computed tomography Africa”, “neuroimaging low- and middle-income countries”, “Liberia health system diagnostics”, and “cancer imaging LMICs”. Reference lists of select reviews were searched for additional sources. Global and regional reports were found from the WHO, IAEA, and related agencies supplemented with radiology and oncology reviews from the focus on LMIC cancer diagnostics.
2.1. Inclusion criteria were as follows: primary or review peer reviewed articles, and/or major institutional reports; specific to neuroimaging or brain tumours, and/or advanced imaging capacity of Africa and/or LMICs; and services organization, cost, infrastructure and workforce can be related to MRI and CT.
2.2. Exclusion criteria included: case reports without implications for health systems; highly technical papers of the physics without relation to clinical practice; and studies from high income countries without a clear discussion of transferability in relation to low resource settings.
No eligible studies were found which specifically analysed brain tumour imaging in Liberia, whereas evidence from sub–Saharan Africa and LMICs in general is used to extrapolate to an association with likely challenges in Liberia, acknowledging that this is a limitation of the study.
3. RATIONALE FOR FOCUSING ON LIBERIA
Liberia’s health system was severely weakened by the prolonged conflict and Ebola outbreak with profound repercussions to the workforce infrastructure and diagnostic capacity (Kohar et al., 2025; Shoman et al., 2017). A recent reform has been an increase in laboratory governance, workforce development and quality management systems, but these improvements are found amongst basic laboratory networks rather than high end imaging (Kohar et al., 2025). The experience of the country serves as an example of fragile systems having difficulty absorbing and sustaining complex technologies like MRI.
Sub Saharan Africa as a whole has less than one MRI scanner per million inhabitants on average with almost 40% of the available machines classified as obsolete low field machines still in force out of necessity (Anazodo et al., 2022). Many MRI units are located in small, private, urban centres with often little linkages to national training and research institutions and with underutilisation due to high cost and challenges in operation (Murali et al., 2023). These patterns are consistent with the context in Liberia, where private diagnostic centres have developed in Monrovia, although most of Liberia’s rural populations are not having access to even basic imaging.
Focusing specifically on Liberia enables discussing the influence of system level constraints, such as limited power reliability, workforce shortages, broken referral networks, and financial barriers, in increasing the subsidy of MRI over CT. Insights from Liberia are applicable also to other post conflict and fragile states in Africa with similar dilemmas in how to prioritize diagnostic investments.
4. COMPARATIVE ROLE OF MRI AND CT IN BRAIN TUMOUR ASSESSMENT
4.1. Diagnostic Accuracy
In high resource settings, MRI has been shown to be superior to CT in the detection of small intra axial tumours, nature of tumour heterogeneity and defining peritumoral oedema (Nikam et al., 2022; Martucci et al., 2023; Smits, 2021). Its better contrast resolution and multiplanar capabilities enable the accurate volumetric assessment and better detection of non-enhancing infiltrative components, in particular gliomas (Smits, 2021). CT is less sensitive especially for small and isodense lesions and posterior fossa tumours and is less able to differentiate edema from infiltrative tumour (Martucci et al., 2023).
However, diagnostic accuracy in practice depends not only upon modality performance in itself, but on quality and consistency of implementation. In sub–Saharan Africa, there may be frequent power interruptions, maintenance issues and a lack of protocol optimization may degrade the performance of MRI below its theoretical potential (Anazodo et al., 2022; Murali et al., 2023). If existing MRI systems are low field strength with old coils and software, or if the sequence set obtained is small and routine, has relatively low case to case gain that reduces over time, the marginal gain over a modern multislice CT is likely to be smaller than anticipated.
Moreover, recent developments in radiomics and machine learning for image processing have been applied to CT images to enhance the ability of CT based tools to divide brain metastases and help with radiotherapy planning, especially when MRI is not available (Wang et al., 2025). Such approaches highlight the importance of assessing diagnostic pathways as they exist within a context and not considering MRI to be superior.
4.2. Tumour Characterization
MRI is unquestionably supreme for the detailed characterization of tumour, in order to evaluate: the internal architecture (necrosis and cystic components, haemorrhage), like tension between the solid tumour and the tissue edema, the identification of satellite lesions, and the assessment of the infiltration along white matter tracts (Martucci et al., 2023; Smits, 2021). There are advanced sequences involving in the grading and response of treatment (Nikam et al., 2022). CT is able to detect gross morphology and calcification; however, subtle infiltrative phenotypes and non-enhancing components of a tumour often go undetected (Aderinto et al., 2023).
In Liberia the question is not whether MRI is diagnostically superior – it clearly is – but whether the health system will be able to consistently deliver the health benefits of MRI to the majority of patients with suspected brain tumours. If MRI is only available on an intermittent basis with long waiting times and high out of pocket costs, then for many patients CT will be the only realistic modality informing diagnosis and management.
4.3. Emergency vs. Elective Imaging
CT is the modality of choice in people who are acutely ill because of its rapidity, tolerance of unstable or ventilated patients, and the few contraindications. It rapidly identifies haemorrhage, mass effect and hydrocephalus, that may co-exist with brain tumours or be caused by tumour related complications (Aderinto et al., 2023). In African hospitals with emergency departments and trauma services constituting the major entry points into the health system, CT scanners are often placed close to the casualty units and will be part of the acute care protocols (Anazodo et al., 2022).
MRI by contrast requires longer acquisition times, is more sensitive to patient motion, and requires more complicated patient monitoring and safety measures. These features restrict its use among unstable patients, as well as access after-hours. In Liberia, where auditory care and anaesthesia facilities are scarce and where critically ill patients will be ruddled with life-saving anaesthesia is not an easy feat, MRI is less appropriate in the emergency evaluation of tumours than CT, and its drawbacks in this field are further compounded.
5. DISADVANTAGES OF MRI COMPARED WITH CT IN LIBERIA AND SIMILAR SETTINGS
5.1. High Cost and Maintenance Challenges
MRI systems cost a great deal of money, sometimes several times the price of a CT scanner, and call for repeated expenditures on maintenance, service contracts, and specialized consumables. In sub–Saharan Africa an average MRI was about US$200 – almost half a monthly salary, so inaccessible to the everyday people (Anazodo et al., 2022). These costs are associated with underutilization, and few scanners are found to perform 15 or more exams daily compromising financial sustainability (Anazodo et al., 2022).
Maintenance and repair are chronic problems. Belittling access to trained biomedical engineers and vendor support, expensive and often imported spare parts, and maintenance schedules are hard to keep up to date (Murali et al., 2023). As a consequence, a number of high field magnetic resonance imaging (MRI) systems spend long periods out of service, while older low field units continue to perform longer than their recommended lifespan (Anazodo et al., 2022). CT scanners in addition to requiring maintenance are usually more robust than MRI scanners, less sensitive to environmental factors, and less expensive to maintain.
For Liberia, where health financing is still limited and where donor support is often committed to communicable diseases programmes (Kohar et al., 2025; Shoman et al., 2017), investing in MRI is a significant opportunity cost. High fixed costs and recurring expenditures on a limited number of scanners used by mostly urban, insured, or wealthier patients can have the effect of further widening the diagnostic inequity.
5.2. Limited Availability in Liberia
MRI density across sub–Saharan African is below one scanner per million people with marked concentration in few middle-income countries and private facilities (Anazodo et al., 2022; Murali et al., 2023). The CAMERA needs assessment survey emphasised the fact that the most common indications for MRI scans were neurological and musculoskeletal, but absolute scan numbers were low, and many scanners were underutilised (Anazodo et al, 2022). In many countries, there is no access to MRI in whole regions.
Although there is a lack of specific information about Liberia’s stock of MRIs, post conflict economic conditions in the country and the overall paucity of the private health sector mean that the availability of MRI is extremely limited and likely confined to one or few MRI facilities in the capital city. In comparison, CT has continued to diffuse more widely throughout sub–Saharan Africa, extending even into secondary hospitals and/or mixed public-private facilities, where its role in the diagnosis of stroke and trauma has been reported several times (Aderinto et al., 2023). This disparity means that for the majority of Liberian patients, the option of MRI in the evaluation of their brain tumours is only theoretical and not practical.
5.3. Long Acquisition Time
MRI examinations usually take 20-45 minutes for a standard brain tumour examination (much longer if advanced examination sequences are incorporated). Patients need to lie still in a narrow bore, which is challenging for children, patients with a cognitive impairment or in a great deal of pain. Motion artefact may reduce images to the point that they are not diagnostic, which is a waste of precious scanner time.
CT head examinations, on the other hand, typically take only minutes from start to finish, including positioning of patients and administration of contrast drugs. High throughput enables both emergency and elective caseloads in CT scanners, which is important in settings where imaging resources are limited and demand is high (Aderinto et al., 2023; Anazodo et al., 2022). In hospitals with low resources, where there are large patient numbers but few trained personnel, the slower process of MRI is a disadvantage, meaning that the number of patients that can be scanned a day is reduced along with waiting times.
5.4. Need for Patient Cooperation and Sedation
Because MRI is very sensitive to motion, cooperative patients are very important, particularly for advanced functional or diffusion sequences. Children and recalcitrant adults are often in need of sedation or general anaesthesia that in turn relies on the availability of anaesthetists, monitoring equipment, and pre-existing protocols for maintaining an airway in the MRI environment.
In many African hospitals the anaesthesia workforces are seriously understaffed and workforces operating theatres are competing for their time. Sedation outside of the OR may be thought not safe or practical. Low field / open MRI-equipment may reduce claustrophobia and enhance access but is both uncommon and often delivers worse image quality (Anazodoet al., 2022; Rowand et al., 2025).
CT by virtue of its speed may be accomplished in uncooperative patients with minimal or no sedation; often a little restraint and caregiver presence are adequate. This difference is particularly important in Liberia where the services of paediatric neurology are limited along with anaesthesia and intensive care services. The need for sedation then becomes a unique operational drawback for MRI.
5.5. Contraindications and Patient Safety Concerns
MRI is absolutely contraindicated or carries significant risk in patients with certain metallic implants or pacemakers and foreign bodies containing metallic materials, also in some patients with severe claustrophobia. Implant screening can prove difficult in LMIC environment where the reporting of devices is poor and previous surgical notes are not available. In addition, poor ferromagnetic screening or poor staff training related safety events are more probable where MRI governance is poor (Anazodo et al., 2022; Murali et al., 2023).
CT has far fewer contra-indications and is safe with patients with most implants and is therefore more universally applicable. While the advantage of MRI’s lack of ionizing radiation is non-disputable, in the context of LMIC the difficulties of managing the safety risks (and exclusions) associated with MRI may outweigh this benefit, particularly with radiation doses from modern CT protocols optimized (Aderinto et al, 2023 Pulumati et al, 2023).
5.6. Volatility of Power Supply and Technical Downtime
Stable, high-quality electricity is a prerequisite in order for an MRI to work. Power fluctuation, surges, and outages may damage equipment, interrupt the scans, and increase downtime. Many African MRI centres report notable difficulty with power supply infrastructure resulting in reliance on backup generators and voltage regulation systems (Anazodo et al, 2022; Murali et al, 2023). Climate management is no less important; the ambient temperature and humidity associated with high temperatures will require high-performance air conditioning in order to safeguard the sensitive electronics and maintain magnet stability (Anazodoet al., 2022).
In the developing Republic of Liberia, where the national infrastructure for power networks is still being built and many health facilities rely on unreliable grids or diesel generators, these requirements are impeding sustainable MRI services to a great extent. Technical downtime for power related failure or lack of maintenance can make MRI intermittently nonavailable rendering referral pathways unreliable. CT scanners while they are still susceptible to power problems are generally more tolerant and less likely to be irreparably damaged by short outages.
5.7. Limited Trained Personnel and Expertise
MRI requires specialist expertise in site planning, optimal protocols, artefact management and safety supervision. The CAMERA survey described there are significant gaps in MRI training in sub–Saharan Africa with many technologists and radiologists having no opportunities for continuous education or exposure to advanced techniques (Anazodo et al., 2022). In these conditions, it might happen that, not obtaining optimal operating conditions, the quality of imaging and its diagnostic value decrease, despite the large capital investment in implementing the MRI systems.
Radiologists who are experienced in the interpretation of neuro oncological MRI are also hard to find, especially outside of the major academic centres. In contrast, interpretation of CT scans is more widely known by general radiologists and even non radiologist physicians with well-established emergency imaging patterns for stroke, trauma and mass lesions (Aderinto et al., 2023). While teleradiology can help overcome workforce shortages for both modalities, it does not eliminate the need for on-site technical expertise and system maintenance (Murali et al., 2023).
In Liberia, where overall health workforce density is low and postgraduate radiology training short, it can be said that the human resource requirements of MRI are a significant disadvantage in comparison with CT, which can be integrated more easily into existing staff skill sets.
5.8. Accessibility Barriers towards Rural Populations
MRI units in sub–Saharan Africa are overwhelmingly found in the large urban centres and in private facilities (Murali et al., 2023). Patients from rural areas also face the cost of travel (long distances to the facility), transportation costs, accommodation costs, and opportunity costs (loss of income) to obtain MRI in addition to examination fees. These barriers resulted in some quite effective exclusion of many patients from MRI based assessment of brain tumours reinforcing urban rural disparities.
CT, although concentrated in urban hospitals, its footprint is spread out in secondary and regional hospitals making it more likely that a symptomatic patient can at least access a CT head within a reasonable distance (Aderinto et al., 2023). In Liberia, where the development of road infrastructure and transport is underdeveloped in many counties, the geographic centralization of MRI is a real disadvantage.
6. HEALTH SYSTEM AND INFRASTRUCTURE CHALLENGES IN LIBERIA
6.1. Imaging Infrastructure
Liberia’s diagnostic infrastructure has been historically founded upon basic laboratory services and x ray imaging with very limited capacity for advanced forms of imaging (Kohar et al., 2025; Shoman et al., 2017). National laboratory policy reforms have initiated advancing the standardisation of quality management, as well as incorporating private labs into surveillance networks; however, such for radiology activities are less developed (Kohar et al., 2025). Against this background, investment in and maintenance of MRI services is exceptionally difficult.
Sub Saharan evidence indicates that the capacity of MRI is greatly skewed towards private urban centres with business-oriented models, while public hospitals rely more on CT and basic imaging (Aderinto et al., 2023; Anazodo et al., 2022; Murali et al., 2023). Without a coordinated national imaging strategy, Liberia runs the risk of acquiring MRI units ad hoc, leaving little room for appropriate planning for upkeep, workforce and access for the benefit of support for diagnostic service fragmentation.
6.2. Workforce Limitations
Shortages of health workers, such as radiologists, technologists and biomedical engineers, are a characterizing feature of health systems in West Africa and contributed to the delayed Ebola response (Kohar et al., 2025; Shoman et al., 2017). MRI adds to these workforce strains as it requires dedicated technologists who are trained in the complexity of sequence design as well as safety protocols and managing emergencies unique to the magnet environment (Anazodo et al., 2022; Murali et al., 2023). Lack of local physics support, and service engineers, add further to system reliability issues.
CT while also requiring trained staff, is less demanding in terms of physics expertise and site safety. A radiographer or radiologist already working as a radiographer can usually be upskilled and worked with CT with targeted training and general radiologists can interpret CT neuroimaging using shorter learning curves compared to advanced MRI (Aderintoet al, 2023). Thus, from a workforce perspective, MRI’s requirements are a large disadvantage in Liberia.
6.3. Referral and Diagnostics Delays
Fragmented health systems and poor referral systems were major factors in poor outcomes during the Ebola outbreak and remain a problem in non-communicable disease care (Kohar et al., 2025; Shoman et al., 2017). For brain tumours, people can pass through many layers of health care (primary care, traditional healers, general hospitals) before ultimately being referred to a facility with CT and only a subset of these will ever reach an MRI facilitated centre.
Where MRI is not so readily available and appointment availability is a constraint waiting times may be quite long, particularly in cases of non-emergency indications. Transport logistics, cost barriers and scheduling difficulties combine to delay MRI examination, despite the fact that it is clinically indicated. By contrast, CT access, albeit imperfect, is more commonly and rapidly achieved at tertiary or regional hospitals facilitating earlier detection of the presence of mass lesions and even preliminary diagnosis (Aderinto et al., 2023; Anazodo et al., 2022). The low availability and logistical difficulty of MRI is therefore a direct factor in diagnostic delay in Liberia.
7. CLINICAL AND PUBLIC HEALTH IMPLICATIONS
7.1. Impact on Early Diagnosis
Delayed/missed diagnosis of brain tumours is a major issue in LMICs, where overlapping symptomatology with infectious and vascular diseases and the lack of imaging have a part to play. In these settings, overreliance on MRI as a diagnostic test has the potential to make early detection worse than it would be otherwise if CT is not widely used or valued. Given the realities of Liberia’s system, looking at CT as a first line modality and only using MRI in selected cases may give more timely diagnoses to a larger proportion of the population.
While it is possible that MRI’s enhanced ability to detect lesions will translate into a better early diagnosis, that requires MRI to be available, cheap, and reliable. Current experience in Africa would seem to suggest that these conditions are rare (Aderinto et al., 2023; Anazodo et al., 2022; Murali et al., 2023). MRI’s disadvantages of cost, lack of availability and fragility of use therefore indirectly prevent population level improvements in brain tumour detection.
7.2. Treatment Planning Limitations
From a neurosurgical and radiotherapy perspective, detailed MRI is of very valuable use in preoperative planning, functional mapping and delineation of radiation targets (Martucci et al., 2023; Smits, 2021). Co registration of MRI with CT has been shown to change target volumes for radiotherapy significantly for brain tumours, and MR-only radiotherapy planning is feasible using electron density surrogation’s (synthetic CT) (Nikam et al., 2022). In high income settings, these capabilities are inherent in precision oncology.
In Liberia and any similar setting, however, there is such a lack of availability of MRIs that such advanced planning remains restricted to a minority of patients. Most brain tumour patients who have any form of treatment may be mostly dependent on CT based planning which is less precise but operationally feasible. The disadvantage of MRI here is not its inherent capability but the mismatch of the health system in place; the high-end modality whose benefits cannot be widely deployed, potentially taking resources away from strengthening CT based workflows and basic oncology services.
7.3. Equity and Access to Care
The remodelled–and sometimes higher–out of pocket cost of MRI within African health systems, coupled with the low density of MRI facilities in private urban centres, means there are vast inequalities within African health systems (Anazodoet al., 2022; Murali et al., 2023). Wealthier, urban patients may have access to state-of-the-art MRI and advanced oncologic care where rural and poor patients may have access to CT or no imaging at all. In Liberia, a relatively rural country with a struggling public health sector, the inequitable distribution of MRI is likely to reflect or surpass such regional distribution.
CT, though not free from inequities, has a broader striking footprint on the public and lower per scan costs, making it a better candidate as the ‘equaliser’ in access to basic neuroimaging. When considering which modality options are best for assessing brain tumours, appropriate consideration must be given to the risk that investment in MRI may favour a minority of the elite at the expense of the majority, who may be left dependent on under resourced CT services.
8. FUTURE DIRECTIONS AND PRACTICAL RECOMMENDATIONS
8.1. Optimizing CT Use
For Liberia, the need of the hour should be to maximize clinical and public health value of existing CT infrastructure. This includes standardisation of CT head protocols when patients have suspected brain tumours, provision of availability and safe administration of contrast, education of clinicians to develop familiarity with diagnostic CT patterns of primary and metastatic lesions, and integration of CT and its findings into the multidisciplinary decision-making process where possible. Dose optimization and quality assurance processes should be covered, to reduce risks of radiation to the minimum during the diagnostic procedure, while maintaining diagnostic quality (Aderinto et al., 2023; Pulumati et al., 2023).
Emerging tools including AI assisted segmentation and radiomics from CT images to further improve tumour delineation for radiotherapy planning or surgical navigation in settings where MRI is not an option.9,10 Wang et al. Teleradiology connections can help overcome the interpretive shortfalls and enhance ongoing professional development.
8.2. Selective MRI Deployment
MRI should be deployed strategically where high yield settings with infrastructure and power reliability and workforce sufficient to support sustainable use should be there. For Liberia, this probably means a small number of tertiary centres, preferably fused with neurosurgical and oncology services. Total cost of ownership such as power systems, maintenance and training should be considered over and above purchase price when investing in investment planning (Anazodo et al., 2022; Murali et al., 2023).
Technological innovations like low field and portable MRI systems have potential to help lower costs, reduce issues related to site constraints and increase reach for paediatric populations in LMICs (Rowand et al., 2025; Shen et al., 2021). Qualitative work from multiple sites in Africa and Asia underpins, however, that even low field systems need care and attention to issues of power stability, internet connectivity, user training and human centred implementation (Rowand et al., 2025; Shen et al., 2021). Liberia could act as a pilot for such technologies working with and international communication networks, whilst looking carefully at feasibility and impact.
8.3. Training and Capacity Enhancement
Sustainable imaging services require effective human resources. Liberia’s wider activities to increase laboratory and public health training (Kohar et al., 2025) are to be accompanied by specific initiatives in radiology and biomedical engineering. Regional collaborations and initiatives like CAMERA have indicated how eager and interested there is in Africa for MRI education and research partnerships (Anazodo et al., 2022; Murali et al., 2023). These networks can have clinical and technological Liberian fellows, teach at distances and jointly work on research projects around workable and context appropriate imaging solutions.
For CT, continuous professional development training should focus on neuroimaging interpretation, radiation safety and optimization of protocols for evaluation of tumour. Introducing basic concepts in MRI into radiology curriculums can help prepare the workforce for gradual expansion of MRI without sacrificing priority of currently dominant modalities.
9. CONCLUSION
In principle, MRI provides unsurpassed soft tissue contrast and functional information for the evaluation of brain tumours and in high income settings, it is rightly regarded as the cornerstone of neuro oncologic imaging. In Liberia and other low resource settings, however, the drawbacks of MRI in comparison to CT are acute. High capital costs and maintenance costs, instability of power and climate control limited availability, long acquisition time and workflow time, requirement for patient cooperation and sedation, safety limitations and extreme shortages of trained personnel all limit MRI’s contribution in real world brain tumour care.
CT, despite the limitations associated with it and the radiation levels of exposure, is more readily accessible, less costly, faster, and more consistent with current emergency and inpatient workflows in African hospitals. For most of the Liberian patients, CT will be the main and often the only imaging modality to guide the diagnosis and treatment of brain tumours for the foreseeable future.
Policy and clinical approaches will therefore aim to focus on developing more robust CT based neuroimaging pathways, with MRI used on a limited basis in settings where it can be sustained and equably accessed. Investments made in MRI should be accompanied by concomitant investments in power infrastructure and maintenance, as well as workforce training and integration of effective neurosurgical and oncologic services, in order to ensure scarce resources, go to true health benefits and not showpieces of technology.
REFERENCES
1. Nikam, R., Yue, X., Kaur, G., Kandula, V., Khair, A., Kecskemethy, H., Averill, L., & Langhans, S. (2022). Advanced Neuroimaging Approaches to Pediatric Brain Tumors. Cancers, 14. https://doi.org/10.3390/cancers14143401
2. Aderinto, N., Olatunji, D., Abdulbasit, M., & Edun, M. (2023). The essential role of neuroimaging in diagnosing and managing cerebrovascular disease in Africa: a review. Annals of Medicine, 55. https://doi.org/10.1080/07853890.2023.2251490
3. Martucci, M., Russo, R., Schimperna, F., D’Apolito, G., Panfili, M., Grimaldi, A., Perna, A., Ferranti, A., Varcasia, G., Giordano, C., & Gaudino, S. (2023). Magnetic Resonance Imaging of Primary Adult Brain Tumors: State of the Art and Future Perspectives. Biomedicines, 11. https://doi.org/10.3390/biomedicines11020364
4. Anazodo, U., Ng, J., Ehiogu, B., Obungoloch, J., Fatade, A., Mutsaerts, H., Secca, M., Diop, M., Opadele, A., Alexander, D., Dada, M., Ogbole, G., Nunes, R., Figueiredo, P., Figini, M., Aribisala, B., Awojoyogbe, B., Aduluwa, H., Sprenger, C., Wagner, R., Olakunle, A., Romeo, D., Sun, Y., Fezeu, F., Orunmuyi, A., Geethanath, S., Gulani, V., Nganga, E., Adeleke, S., Ntobeuko, N., Minja, F., Webb, A., Asllani, I., & Dako, F. (2022). A framework for advancing sustainable magnetic resonance imaging access in Africa. NMR in Biomedicine, 36. https://doi.org/10.1002/nbm.4846
5. Murali, S., Ding, H., Adedeji, F., Qin, C., Obungoloch, J., Asllani, I., Anazodo, U., Ntusi, N., Mammen, R., Niendorf, T., & Adeleke, S. (2023). Bringing MRI to low‐ and middle‐income countries: Directions, challenges and potential solutions. NMR in Biomedicine, 37. https://doi.org/10.1002/nbm.4992
6. Rowand, E., Owusu, R., Sibole, A., Abu-Haydar, E., & Delarosa, J. (2025). Feasibility and Usability of Low-Field Magnetic Resonance Imaging for Pediatric Neuroimaging in Low- and Middle-Income Countries: A Qualitative Study. Medical Devices (Auckland, N.Z.), 18, 107 – 121. https://doi.org/10.2147/mder.s478864
7. Kohar, T., Munemo, E., Kpaka, J., Marles, N., Akwiwu-Ibe, O., Dahourou, A., & Louis, F. (2025). Strengthening governance and leadership of the national laboratory system in Liberia: achievements and challenges. Frontiers in Public Health, 13. https://doi.org/10.3389/fpubh.2025.1504451
8. Pulumati, A., Pulumati, A., Dwarakanath, B., Verma, A., & Papineni, R. (2023). Technological advancements in cancer diagnostics: Improvements and limitations. Cancer Reports, 6. https://doi.org/10.1002/cnr2.1764
9. Shoman, H., Karafillakis, E., & Rawaf, S. (2017). The link between the West African Ebola outbreak and health systems in Guinea, Liberia and Sierra Leone: a systematic review. Globalization and Health, 13. https://doi.org/10.1186/s12992-016-0224-2
10. Wang, Y., Wen, Z., Bao, S., Huang, D., Wang, Y., Yang, B., Li, Y., Zhou, P., Zhang, H., & Pang, H. (2025). Diffusion-CSPAM U-Net: A U-Net model integrated hybrid attention mechanism and diffusion model for segmentation of computed tomography images of brain metastases. Radiation Oncology (London, England), 20. https://doi.org/10.1186/s13014-025-02622-x
11. Smits, M. (2021). Update on neuroimaging in brain tumours. Current Opinion in Neurology, 34, 497 – 504. https://doi.org/10.1097/wco.0000000000000950
12. Shen, F., Wolf, S., Bhavnani, S., Deoni, S., Elison, J., Fair, D., Garwood, M., Gee, M., Geethanath, S., Kay, K., Lim, K., Lockwood-Estrin, G., Luciana, M., Péloquin, D., Rommelfanger, K., Schiess, N., Siddiqui, K., Torres, E., & Vaughan, J. (2021). Emerging ethical issues raised by highly portable MRI research in remote and resource-limited international settings. NeuroImage, 238, 118210 – 118210. https://doi.org/10.1016/j.neuroimage.2021.118210
About the author
Layeevarfee O Kamara is a 6th-semester B.Sc. Medical Radiology and Imaging Technology student at Rayat Bahra University, India, expected to graduate in 2027. A Liberian national, his academic interests focus on diagnostic imaging, particularly computed tomography (CT) and magnetic resonance imaging (MRI). His work emphasizes improving radiological practices and diagnostic accuracy in resource-limited healthcare settings, especially in Liberia. He aspires to pursue a career in radiology and contribute to advancements in medical imaging.
For More News And Analysis About Liberia Follow Africa-Press
