Silent infarcts in sickle cell disease occur in the border zone region and are associated with low cerebral blood flow. Blood 2018 Oct 18;132(16):1714-1723
Date
08/01/2018Pubmed ID
30061156Pubmed Central ID
PMC6194388DOI
10.1182/blood-2018-04-841247Scopus ID
2-s2.0-85055079713 (requires institutional sign-in at Scopus site) 77 CitationsAbstract
Silent cerebral infarcts (SCIs) are associated with cognitive impairment in sickle cell anemia (SCA). SCI risk factors include low hemoglobin and elevated systolic blood pressure; however, mechanisms underlying their development are unclear. Using the largest prospective study evaluating SCIs in pediatric SCA, we identified brain regions with increased SCI density. We tested the hypothesis that infarct density is greatest within regions in which cerebral blood flow is lowest, further restricting cerebral oxygen delivery in the setting of chronic anemia. Neuroradiology and neurology committees reached a consensus of SCIs in 286 children in the Silent Infarct Transfusion (SIT) Trial. Each infarct was outlined and coregistered to a brain atlas to create an infarct density map. To evaluate cerebral blood flow as a function of infarct density, pseudocontinuous arterial spin labeling was performed in an independent pediatric SCA cohort. Blood flow maps were aligned to the SIT Trial infarct density map. Mean blood flow within low, moderate, and high infarct density regions from the SIT Trial were compared. Logistic regression evaluated clinical and imaging predictors of overt stroke at 3-year follow-up. The SIT Trial infarct density map revealed increased SCI density in the deep white matter of the frontal and parietal lobes. A relatively small region, measuring 5.6% of brain volume, encompassed SCIs from 90% of children. Cerebral blood flow was lowest in the region of highest infarct density (P < .001). Baseline infarct volume and reticulocyte count predicted overt stroke. In pediatric SCA, SCIs are symmetrically located in the deep white matter where minimum cerebral blood flow occurs.
Author List
Ford AL, Ragan DK, Fellah S, Binkley MM, Fields ME, Guilliams KP, An H, Jordan LC, McKinstry RC, Lee JM, DeBaun MRAuthor
Dustin K. Ragan PhD Assistant Professor in the Radiology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAnemia, Sickle Cell
Brain
Cerebral Infarction
Cerebrovascular Circulation
Child
Child, Preschool
Female
Humans
Magnetic Resonance Imaging
Male
Prospective Studies
Risk Factors
