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Updated: Jul 5, 2026
Scanning Dos and Don'ts: Using Magnetic Resonance Imaging in Awake Children Aged 3 to 5 Years to Assess Brain Structure and Function
Published on: March 10, 2026
MRI abnormalities of the brain in one-year-old children with sickle cell anemia
Winfred C Wang1, Steven G Pavlakis, Kathleen J Helton
1Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA. win.wang@stjude.org
Insights
Silent brain infarcts affect 13% of infants with sickle cell anemia (SCA) by age one. Early central nervous system (CNS) evaluation is crucial for timely intervention in children with SCA.
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Sickle cell anemia (SCA) can cause central nervous system (CNS) damage, but the onset age is unclear.
- Infants with SCA underwent brain MRI as part of the BABY HUG trial.
Purpose of the Study:
- To determine the age of onset of CNS damage in infants with SCA.
- To identify early indicators of neurological complications in SCA.
Main Methods:
- Utilized a standardized MRI/MRA protocol across eight centers for infant participants.
- Correlated imaging findings with clinical data, including age, HbF levels, and transcranial Doppler (TCD) velocity.
Main Results:
- 13% of infants (23 subjects, average age 13.7 months) had silent brain infarcts on MRI.
- Infarcts correlated with increased right-sided TCD velocity and lower HbF levels.
Conclusions:
- Silent brain infarcts are present in infants with SCA as early as one year of age.
- Early and thorough CNS evaluation is essential for developing timely interventions in pediatric SCA.
Background:
Sickle cell anemia (SCA) frequently results in damage to the central nervous system (CNS), but the age of onset of these effects is uncertain. We performed MRI examinations of the brain in infants with SCA, who were evaluated as part of the multicenter randomized double-blinded Pediatric Hydroxyurea Phase III Clinical Trial (BABY HUG).
Methods:
Determination of eligibility for enrollment in the trial originally required baseline MRI and magnetic resonance angiography (MRA) of the brain. A standardized imaging protocol was utilized across eight clinical centers. MRI/MRA exams were reviewed by a panel of three neurology/neuroradiology readers and interpretations reported to the coordinating center. Results were correlated with patient age, gender, history, WBC count, platelet count, hemoglobin (Hb), HbF level, score on the Bayley Scales of Infant Development, and velocity on transcranial Doppler ultrasonography (TCD).
Results:
Twenty-three subjects with HbSS were examined at average age 13.7 months (range 10-18 months); 13 were male. Three (13%, CI: 3-34%) had silent infarcts on MRI, two in the right frontal area and one bilaterally. None had MRA abnormalities. The lesions were correlated with increased right-sided TCD velocity and low HbF level, but not with age, history, Hb level, developmental score, or left-sided velocity.
Conclusions:
Silent brain infarcts occur in a small but significant number of infants with SCA as early as a year of age. This finding indicates a need for thorough evaluation of the CNS very early in life in children with SCA in order to develop timely intervention strategies.
