Inverse correlation between cerebral blood flow measured by continuous arterial spin-labeling (CASL) MRI and neurocognitive function in children with sickle cell anemia (SCA).
Overt stroke, clinically "silent" cerebral infarct, and neurocognitive impairment are frequent complications of sickle cell anemia (SCA). Current imaging techniques have limited sensitivity and specificity to identify children at risk for neurocognitive impairment. We prospectively evaluated 24 children with SCA with a neurologic exam, complete blood count, transcranial Doppler ultrasound (TCD), measurement of intelligence quotient (IQ), and magnetic resonance imaging (MRI) with measurement of cerebral blood flow (CBF) using continuous arterial spin-labeling (CASL) MRI. Average CBF to gray matter was 112 +/- 36 mL/100 g/min. We identified a strong inverse relationship between performance IQ and CBF (-1.5 points per 10 mL/100 g/min increase in CBF, P = .013). Elevated steady-state white blood cell count (> or = 14 x 10(9)/L [14,000/microL]) was associated with lower full scale IQ (86 +/- 9 vs 99 +/- 10, P = .005). CASL MRI may identify children with neurocognitive impairment, before damage is evident by structural MRI or TCD.
Strouse
John J
JJ
Division of Pediatric Hematology, Department of Pediatrics, the Neurocirculatory Physiology Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. jstrous1@jhmi.edu
Cox
Christiane S
CS
Melhem
Elias R
ER
Lu
Hanzhang
H
Kraut
Michael A
MA
Razumovsky
Alexander
A
Yohay
Kaleb
K
van Zijl
Peter C
PC
Casella
James F
JF
D000755:Anemia, Sickle Cell / Q000503:physiopathology*; D001783:Blood Flow Velocity; D002536:Cerebral Arteries; D002560:Cerebrovascular Circulation; D002648:Child; D003072:Cognition Disorders / Q000503:physiopathology*; D003627:Data Interpretation, Statistical; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000706:statistics & numerical data; D009483:Neuropsychological Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013113:Spin Labels
D013113:Spin Labels