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Detecting white matter injury in sickle cell disease using voxel-based morphometry
Torsten Baldeweg1, Alexandra M Hogan, Dawn E Saunders
1Developmental Cognitive Neuroscience Unit, Institute of Child Health, University College, London, United Kingdom. t.baldeweg@ich.ucl.ac.uk
Insights
Voxel-based morphometry (VBM) reveals widespread white matter abnormalities in children and adolescents with sickle cell disease (SCD), even without visible infarcts. These changes may explain cognitive deficits in SCD patients.
Area of Science:
- Neurology
- Radiology
- Pediatrics
Background:
- Sickle cell disease (SCD) is linked to neurological complications like stroke and cognitive impairment.
- Detecting subtle white matter changes is crucial for understanding SCD's impact on the brain.
Observation:
- This study utilized voxel-based morphometry (VBM) on MRI scans of 36 children and adolescents with SCD and 31 controls.
- White and gray matter density maps were analyzed to compare individuals with SCD (with and without visible lesions) to controls.
Findings:
- Individuals with SCD, regardless of visible lesions, exhibited lower intelligence quotients (IQs) compared to controls.
- VBM identified extensive bilateral white matter abnormalities in SCD patients, extending beyond infarcts and present even in those without visible lesions.
Implications:
- VBM is a sensitive tool for detecting white matter injury in SCD, even in areas without infarction.
- These subclinical white matter abnormalities may underlie cognitive dysfunction observed in individuals with SCD.
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.
Interpretation:
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.
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