title: Brain positron emission tomography in splenectomized adults with β-thalassemia intermedia: uncovering yet another covert abnormality.
abstract: Covert brain infarction is an emerging concern in patients with β-thalassemia intermedia (TI). We have recently observed a high prevalence (60%) of silent brain infarction on brain magnetic resonance imaging (MRI) in 30 splenectomized adults with TI. In this work, we further evaluate cerebral involvement in the same 30 patients using fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scanning. The median age was 32 years (range, 18-54 years) with a male to female ratio of 13:17. Nineteen patients (63.3%) had evidence of decreased neuronal function on PET-CT. Involvement was mostly left sided, multiple, and most commonly in the temporal and parietal lobes. Elevated liver iron concentration, beyond 15 mg Fe/g dry weight, characterized patients with decreased neuronal function. The concordance rate between brain MRI and PET-CT for the detection of brain abnormality was only 36.7% (Kappa 0.056, P = 0.757), highlighting that both modalities reveal different types of brain pathology. Decreased neuronal function is a common finding in patients with TI and is associated with iron overload. Moreover, the addition of PET-CT to MRI identifies a greater proportion of TI patients with silent neuroimaging abnormalities.
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad El-Solh, 1107 2020, Beirut, Lebanon.
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Musallam
authors.forename: Wassim
authors.initials: W
authors.lastname: Nasreddine
authors.forename: Ahmad
authors.initials: A
authors.lastname: Beydoun
authors.forename: Roula
authors.initials: R
authors.lastname: Hourani
authors.forename: Ahmed
authors.initials: A
authors.lastname: Hankir
authors.forename: Suzanne
authors.initials: S
authors.lastname: Koussa
authors.forename: Mohamad
authors.initials: M
authors.lastname: Haidar
authors.forename: Ali T
authors.initials: AT
authors.lastname: Taher
mesh_terms: D000293:Adolescent; D000328:Adult; D020520:Brain Infarction / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D019190:Iron Overload / Q000175:diagnosis / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D012307:Risk Factors; D013156:Splenectomy / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D017086:beta-Thalassemia / Q000150:complications / Q000473:pathology* / Q000601:surgery*
chemical_list: D019788:Fluorodeoxyglucose F18