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Cerebral hemodynamic assessment and neuroimaging across the lifespan in sickle cell disease
Lori C Jordan1, Michael R DeBaun2
11 Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
Insights
Sickle cell anemia (SCA) increases stroke risk. New MRI methods may help identify high-risk individuals for better stroke prevention and management in both children and adults.
Area of Science:
- Neurology
- Radiology
- Hematology
Background:
- Sickle cell anemia (SCA) patients face elevated stroke risks compared to peers.
- Transcranial Doppler identifies high-risk children but not adults for initial strokes.
- Current methods lack efficacy in identifying recurrent stroke or silent stroke risks in SCA patients.
Purpose of the Study:
- To review stroke epidemiology, mechanisms, and impact in SCA.
- To explore advanced neuroimaging strategies for stroke risk assessment in SCA.
- To identify individuals at high risk for initial and recurrent strokes.
Main Methods:
- Review of existing literature on stroke in SCA.
- Discussion of transcranial Doppler ultrasound limitations.
- Exploration of contrast-free MRI techniques for cerebral hemodynamics assessment.
Main Results:
- Stroke is a significant complication in both pediatric and adult SCA patients.
- Existing methods for stroke risk stratification in SCA are limited, especially for adults and recurrent events.
- Advanced MRI techniques offer promising alternatives for assessing cerebral hemodynamics without radiotracers.
Conclusions:
- Improved neuroimaging is crucial for identifying SCA patients at high risk of initial and recurrent strokes.
- Contrast-free MRI holds potential for feasible screening and longitudinal monitoring of cerebral hemodynamics in SCA.
- Enhanced risk identification can guide more aggressive, tailored therapies to prevent stroke complications.
Abstract:
Children and adults with sickle cell anemia (SCA) have a higher risk of strokes compared to age- and race-matched peers. Velocity in the middle cerebral or distal internal carotid artery as measured by transcranial Doppler ultrasound is a recognized method to identify children but not adults with SCA at high-risk for first stroke. For both children and adults with SCA that have had a stroke, no methods clearly identify individuals at highest risk of recurrent strokes or an initial silent stroke, the most common neurological injury. Methods to assess cerebral hemodynamics in SCA have been utilized for decades but often required radiotracers making them not feasible for screening and longitudinal follow-up. MRI approaches that do not require exogenous contrast have been introduced and are appealing in both clinical and research scenarios. Improved neuroimaging strategies hold promise for identifying individuals with SCA at increased risk of initial and recurrent infarcts, justifying more aggressive risk-based therapy. We review the epidemiology of stroke in SCA, the impact of strokes, stroke mechanisms, and potential imaging strategies including regional and global oxygen extraction fraction, cerebral blood flow, and vessel wall imaging to identify individuals at high-risk of stroke.
