Brain magnetic resonance imaging abnormalities in adult patients with sickle cell disease: correlation with transcranial Doppler findings.
OBJECTIVE
Brain imaging abnormalities were reported in up to 44% of children with sickle cell disease (SCD). The prevalence of neuroimaging abnormalities in adult patients with SCD and their relationship to transcranial Doppler is still unclear. Our objectives were to study the frequency of MRI and MR angiography abnormalities in adults with SCD and to define what transcranial Doppler velocities are associated with intracranial stenoses detected by MR angiography.


METHODS
We examined all adult patients (>16 years) with SCD followed in the hematology outpatient clinic at our university hospital with MRI, MR angiography, and transcranial Doppler.


RESULTS
We evaluated 50 patients. The overall prevalence of MRI abnormalities was 60%. Abnormal MRI findings were more frequent when vessel tortuosity or stenoses were present on MR angiography (P<0.01). Patients with intracranial stenoses had significantly higher time-averaged maximum mean velocities (P=0.01). A time-averaged maximum mean velocity of 123.5 cm/s allowed the diagnosis of middle cerebral artery or internal carotid artery intracranial stenosis with sensitivity of 100% and specificity of 73% with an area under the receiver operator characteristic curve of 0.91 (CI, 0.79 to 1.00).


CONCLUSIONS
The frequency of brain imaging abnormalities detected by MRI/MR angiography in adults with SCD was higher than that described for children. Transcranial Doppler velocities in adult patients with intracranial stenoses were lower than those described for the pediatric population with SCD.
Silva
Gisele Sampaio
GS
Department of Neurology, Universidade Federal de São Paulo, São Paulo, Brazil. giselesampaio@hotmail.com
Vicari
Perla
P
Figueiredo
Maria Stella
MS
Carrete
Henrique
H
Idagawa
Marcos Hideki
MH
Massaro
Ayrton Roberto
AR
D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000000981:diagnostic imaging* / Q000473:pathology*; D001921:Brain / Q000002:abnormalities* / Q000473:pathology*; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000000981:diagnostic imaging; D004453:Echoencephalography; D005260:Female; D006801:Humans; D020765:Intracranial Arterial Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D017585:Ultrasonography, Doppler, Transcranial; D055815:Young Adult