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Cerebral blood flow abnormalities in children with sickle cell disease: a systematic review

Amir M Behpour1, Prakesh S Shah, David J Mikulis

  • 1Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.

Pediatric Neurology
|February 20, 2013
PubMed

Insights

Cerebral blood flow imaging can detect brain abnormalities in children with sickle cell disease, even when other scans appear normal. This tissue-level assessment offers valuable insights for identifying potential issues.

Area of Science:

  • Neurology
  • Pediatrics
  • Radiology

Background:

  • Sickle cell disease (SCD) is associated with an increased risk of cerebrovascular complications in children.
  • Standard neuroimaging like MRI and transcranial Doppler (TCD) may not detect all brain abnormalities.
  • Cerebral blood flow (CBF) assessment may offer a more sensitive method for identifying subclinical cerebrovascular changes.

Purpose of the Study:

  • To systematically review the utility of different cerebral blood flow imaging modalities in identifying brain abnormalities in children with sickle cell disease.
  • To compare the prevalence of CBF abnormalities with structural MRI and TCD abnormalities.
  • To assess the diagnostic accuracy of CBF imaging in detecting cerebrovascular disease in pediatric SCD patients.

Main Methods:

  • A systematic review of 11 studies was conducted.
  • Studies reporting CBF abnormalities alongside structural MRI or TCD abnormalities in pediatric SCD patients were included.
  • Bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool.
  • Subjects were categorized into those with and without stroke, and abnormality prevalence was calculated for each modality.

Main Results:

  • The prevalence of CBF abnormalities was equal to or lower than structural MRI abnormalities in patients with stroke.
  • CBF abnormalities were equal to or greater than structural MRI abnormalities in patients without stroke.
  • CBF abnormalities were more prevalent than TCD abnormalities in four studies of patients without stroke and one study of patients with stroke.

Conclusions:

  • Cerebral blood flow assessment shows potential value in detecting brain abnormalities at the tissue level in children with sickle cell disease.
  • CBF imaging may identify abnormalities not detected by conventional MRI or TCD.
  • Further research is warranted to fully establish the role of CBF imaging in managing pediatric SCD patients.

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