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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2018; 28(03): 305-311
DOI: 10.4103/ijri.IJRI_166_17
Neuroradiology & Head and Neck Imaging

Conventional and advanced brain MR imaging in patients with sickle cell anemia

Pratibha Issar
Department of Radiodiagnosis, J.L.N. Hospital and Research Centre, Bhilai, Chhattisgarh, India
,
Maya Nehra
Department of Radiodiagnosis, J.L.N. Hospital and Research Centre, Bhilai, Chhattisgarh, India
,
Gurmeet Singh
Department of Hematology, J.L.N. Hospital and Research Centre, Bhilai, Chhattisgarh, India
,
SK Issar
Department of Gastroenterology, J.L.N. Hospital and Research Centre, Bhilai, Chhattisgarh, India
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Abstract

Background: Sickle cell disease (SCD) is an autosomal recessive hemolytic disorder; its cerebrovascular complications include silent cerebral ischemia, infarct, and brain atrophy. Conventional magnetic resonance imaging (MRI) often underestimates the extent of injury. Diffusion tensor imaging (DTI) can demonstrate and quantify microstructural brain changes in SCD cases having normal routine MRI. Objective: To identify various neurological abnormalities in asymptomatic sickle cell patients using routine MRI and to evaluate the microstructure of various regions of the brain using DTI. Materials and Methods: A prospective, randomized case–control study was conducted over a period of 2 years. A total of 58 cases of SCD and 56 age- and sex-matched controls were included. Routine MRI and DTI were performed in both the groups following a standard protocol. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were calculated in certain pre-defined regions. Primary data were analyzed using MS excel version 17. Analysis of variance test was performed and statistical significance was set at P < 0.05. Results: Thirty regions of interest with 60 variables were included in the final analysis. Patients with SCD showed statistically significant reduced FA values, increased ADC values, or both, clustered in several brain areas, including pons, cerebral peduncle, corpus callosum, frontal, temporal, parietal white matter, centrum semiovale, periventricular areas, basal ganglia, and left thalamus (P < 0.05). Conclusion: DTI is a promising method for characterizing microstructural changes, when conventional MRI is normal.

Keywords

Apparent diffusion coefficient - diffusion tensor imaging - fractional anisotropy - sickle cell disease - sickle cell anemia - sickle cell trait


Publication History

Article published online:
26 July 2021

© 2018. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Darghouth D, Koehl B, Madalinski G, Heilier J-F, Bovee P, Xu Y. et al. Pathophysiology of sickle cell disease is mirrored by the red blood cell metabolism. Blood J 2011; 117: 1-4
    CrossrefPubMedGoogle Scholar
  • 2 Abboud MR, Cure J, Granger S, Gallagher D, Hsu L, Wang W. et al. Magnetic resonance angiography in children with sickle cell disease and abnormal transcranial Doppler ultrasonography findings enrolled in the STOP study. Blood 2014; 103: 2822-6
    CrossrefPubMedGoogle Scholar
  • 3 Panigrahi S, Patra PK, Khodiar PK. The screening and morbidity pattern of sickle cell anemia in Chhattisgarh. Indian J Hematol Blood Transfus 2015; 31: 104-9
    CrossrefPubMedGoogle Scholar
  • 4 Moser FG, Miller ST, Bello JA, Pegelow CH, Zimmerman RA, Wang WC. et al. The spectrum of brain MR abnormalities in sickle-cell disease: A report from the Cooperative Study of Sickle Cell Disease. Am J Neuroradiol 1996; 17: 965-72
    PubMedGoogle Scholar
  • 5 Kotb MM, Tantawi WH, Elsayed AA, Damanhouri GA, Malibary HM. Brain MRI and CT findings in sickle cell disease patients from Western Saudi Arabia Neuroscience. 2006;11:28-36.
  • 6 Haacke EM, Mittal S, Wu Z, Neelavalli J, Cheng YCN. Susceptibility-weighted imaging: Technical aspects and clinical applications, part 1. Am J Neuroradiol 2009; 30: 19-30
    CrossrefPubMedGoogle Scholar
  • 7 Balci A, Karazincir S, Beyoglu Y, Cingiz C, Davran R, Gali E. et al. Quantitative brain diffusion-tensor MRI findings in patients with sickle cell disease. Am J Roentgenol 2012; 198: 1167-74
    CrossrefPubMedGoogle Scholar
  • 8 Sun B, Brown RC, Hayes L, Burns TG, Huamani J, Bearden DJ. et al. White matter damage in asymptomatic patients with sickle cell anemia: Screening with diffusion tensor imaging. Am J Neuroradiol 2012; 33: 20439
    Google Scholar
  • 9 Wakana S, Jiang H, agae-Poetscher LM, van ZijlPCM, Mori S. Fiber tract-based atlas of human white matter anatomy. Radiology 2004; 230: 77-87
    CrossrefPubMedGoogle Scholar
  • 10 Thust SC, Burke C, Siddiqui A. Neuroimaging findings in sickle cell disease. Br J Radiol 2014; 87: 20130699 (1-8)
    CrossrefPubMedGoogle Scholar
  • 11 Kawadler JM, Kirkham FJ, Clayden JD, Hollocks MJ, Seymour EL, Edey R. et al. White matter damage relates to oxygen saturation in children with sickle cell anemia without silent cerebral infarcts. Stroke 2015; 46: 1793-9
    CrossrefPubMedGoogle Scholar
  • 12 Steen RG, Emudianughe T, Hankins GM, Wynn LW, Wang WC, Xiong X. et al. Brain imaging findings in pediatric patients with sickle cell disease. Radiology 2003; 228: 216-25
    CrossrefPubMedGoogle Scholar
  • 13 Winchell AM, Taylor BA, Song R, Loeffler RB, Grundlehner P, Hankins JS. et al. Evaluation of SWI in children with sickle cell disease. Am J Neuroradiol 2014; 35: 1016-21
    CrossrefPubMedGoogle Scholar
  • 14 Jellison BJ, Field AS, Medow J, Lazar M, Salamat MS, Alexander AL. Diffusion tensor imaging of cerebral white matter: A pictorial review of physics, fiber tract anatomy and tumor imaging patterns. Am J Neuroradiol 2004; 25: 356-69
    PubMedGoogle Scholar
  • 15 Pagelow CH, Macklin EA, Moser FG, Wang WC, Bello JA, Miller ST. et al. Longitudinal changes in brain magnetic resonance imaging findings in children with sickle cell disease. Blood 2002; 99: 3014-8
    CrossrefPubMedGoogle Scholar
  • 16 Chen R, Arkuszewski M, Krejza J, Zimmerman RA, Herskovits EH, Melhem ER. A prospective longitudinal brain morphometry study of children with sickle cell disease. Am J Neuroradiol 2015; 36: 403-10
    CrossrefPubMedGoogle Scholar
  • 17 Beaulieu C. The basis of anisotropic water diffusion in the nervous system: a technical review. NMR Biomed 2002; 15: 43555
    CrossrefPubMedGoogle Scholar