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Transcranial Doppler Screening in 50 Patients With Sickle Cell Hemoglobinopathies in Iran
Susan Zamani1, Afshin Borhan Haghighi, Sezaneh Haghpanah
1*Pediatric Department †Clinical Neurology Research Center ‡Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Insights
Transcranial Doppler (TCD) screening did not show significant correlation with silent brain ischemia in sickle cell disease (SCD) patients. Further research is needed to confirm TCD
Area of Science:
- Neurology
- Hematology
- Pediatrics
Background:
- Sickle cell disease (SCD) is associated with increased risk of cerebrovascular complications.
- Previous studies on the correlation between transcranial Doppler (TCD) and brain MRI findings in SCD patients have yielded inconsistent results.
Purpose of the Study:
- To investigate the correlation between transcranial Doppler (TCD) values and the presence of silent brain ischemia detected by MRI in patients with sickle cell disease (SCD).
Main Methods:
- A cross-sectional study included 50 patients diagnosed with sickle cell hemoglobinopathies.
- Data collected included demographics, clinical history, laboratory results, brain MRI, and TCD measurements.
- Statistical analysis compared TCD values and clinical/laboratory data between patients with and without ischemic brain damage.
Main Results:
- Only 6% of patients showed evidence of ischemia on brain MRI.
- No significant differences in TCD values were observed between patients with and without ischemic brain damage.
- Platelet count was significantly higher in the ischemic group (P=0.002).
- Pain crises were associated with mean velocity values in specific cerebral arteries (P<0.05).
Conclusions:
- Transcranial Doppler (TCD) mean velocity values did not significantly correlate with the presence of silent brain ischemia on MRI in this cohort of SCD patients.
- The observed frequency of silent ischemia was lower than anticipated.
- Larger studies are required to determine the predictive value of abnormal TCD in identifying silent ischemia in specific ethnic groups within the SCD population.
Background:
As previous studies had discordant results with regard to the correlation of transcranial Doppler (TCD) screening and brain MRI, the aim of this study was to find the correlation between TCD values and silent ischemia in sickle cell disease (SCD) patients.
Method And Materials:
In this cross-sectional study, 50 patients with proven diagnosis of sickle cell hemoglobinopathies based on their hemoglobin electrophoresis were included. Demographic data, their physical exam, information with regard to crises history, and their laboratory data were recorded. Brain MRI and TCD were requested for all patients.
Results:
The mean age of the patients was 10.2±5.8 years. Only 3 patients (6%) showed evidence of ischemia on brain MRI. Normal and ischemic patients were not significantly different with respect to TCD values, sex, splenomegaly, aplastic crisis, and laboratory test results (P-value >0.05). Only platelet count was significantly higher in the ischemic group compared with that in the normal group (P=0.002). The pain crisis was significantly associated with the mean velocity values of RMCA, LMCA, RV, and LV arteries (P-value <0.05).
Conclusion:
On the basis of our results, there was no significant difference in the mean velocity TCD values between patients with and without evidence of ischemic brain damage in brain MRI. The frequency of silent ischemia was much lower than expected. Further studies with larger sample sizes are needed to elucidate the positive predictive value of abnormal TCD in the prediction of silent ischemia in patients with sickle hemoglobinopathy in certain ethnic groups.
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