Detecting white matter injury in sickle cell disease using voxel-based morphometry.
OBJECTIVE
Sickle cell disease (SCD) is associated with cerebrovascular disease, cerebral infarction, and cognitive dysfunction. This study aimed to detect the presence and extent of white matter abnormalities in individuals with SCD using voxel-based morphometry (VBM).


METHODS
Thirty-six children and adolescents with SCD (age range, 9-24 years) and 31 controls (8-25 years) underwent magnetic resonance investigations using T1- and T2-weighted protocols. White and gray matter density maps were obtained from three-dimensional magnetic resonance imaging (MRI) data sets. Using VBM, we compared the maps between controls and SCD individuals with silent white matter infarct lesions (SCD+L; n = 16), and those without visible abnormality (SCD-L; n = 20).


RESULTS
In comparison with controls, intelligence quotients (IQs) were lower in both SCD groups irrespective of presence of visible lesions. VBM showed widespread bilateral white matter abnormalities in the SCD+L group, extending beyond the regions of focal infarction in the deep anterior and posterior white matter borderzones. Bilateral white matter abnormalities were also observed in the SCD-L group, in locations similar to those in the SCD+L group.


CONCLUSIONS
VBM is sensitive to detection of widespread white matter injury in SCD patients in borderzones between arterial territories even in the absence of evidence of infarction. Those changes may contribute to cognitive deficits in this population.
Baldeweg
Torsten
T
Developmental Cognitive Neuroscience Unit, Institute of Child Health, University College, London, United Kingdom. t.baldeweg@ich.ucl.ac.uk
Hogan
Alexandra M
AM
Saunders
Dawn E
DE
Telfer
Paul
P
Gadian
David G
DG
Vargha-Khadem
Faraneh
F
Kirkham
Fenella J
FJ
D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000145:classification / Q000150:complications / Q000473:pathology*; D001921:Brain / Q000002:abnormalities / Q000473:pathology; D001930:Brain Injuries / Q000209:etiology / Q000473:pathology*; D001931:Brain Mapping; D002648:Child; D005260:Female; D007839:Functional Laterality; D049690:History, Ancient; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies