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Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Conventional and advanced brain MR imaging in patients with sickle cell anemia
Pratibha Issar1, Maya Nehra1, Gurmeet Singh2
1Department of Radiodiagnosis, J.L.N. Hospital and Research Centre, Bhilai, Chhattisgarh, India.
Background:
Sickle cell disease (SCD) is an autosomal recessive hemolytic disorder; its cerebrovascular complications include silent cerebral ischemia, infarct, and brain atrophy. Conventional magnetic resonance imaging (MRI) often underestimates the extent of injury. Diffusion tensor imaging (DTI) can demonstrate and quantify microstructural brain changes in SCD cases having normal routine MRI.
Objective:
To identify various neurological abnormalities in asymptomatic sickle cell patients using routine MRI and to evaluate the microstructure of various regions of the brain using DTI.
Materials And Methods:
A prospective, randomized case-control study was conducted over a period of 2 years. A total of 58 cases of SCD and 56 age- and sex-matched controls were included. Routine MRI and DTI were performed in both the groups following a standard protocol. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were calculated in certain pre-defined regions. Primary data were analyzed using MS excel version 17. Analysis of variance test was performed and statistical significance was set at P < 0.05.
Results:
Thirty regions of interest with 60 variables were included in the final analysis. Patients with SCD showed statistically significant reduced FA values, increased ADC values, or both, clustered in several brain areas, including pons, cerebral peduncle, corpus callosum, frontal, temporal, parietal white matter, centrum semiovale, periventricular areas, basal ganglia, and left thalamus (P < 0.05).
Conclusion:
DTI is a promising method for characterizing microstructural changes, when conventional MRI is normal.
Insights
Diffusion tensor imaging (DTI) reveals subtle brain microstructural changes in sickle cell disease (SCD) patients, even when conventional MRI appears normal. This advanced technique quantifies these changes, aiding in understanding SCD
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Sickle cell disease (SCD) is an inherited blood disorder with potential cerebrovascular complications like silent ischemia and brain atrophy.
- Conventional MRI may not detect all neurological damage in SCD.
- Diffusion tensor imaging (DTI) offers a more sensitive method to assess microstructural brain integrity.
Purpose of the Study:
- To detect neurological abnormalities in asymptomatic SCD patients using routine MRI.
- To evaluate brain microstructure in SCD using DTI.
- To compare DTI metrics between SCD patients and healthy controls.
Main Methods:
- A prospective, randomized case-control study involving 58 SCD patients and 56 controls.
- Both groups underwent routine MRI and DTI.
- Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were calculated in predefined brain regions.
Main Results:
- SCD patients exhibited significantly reduced FA and/or increased ADC values in multiple brain areas.
- Affected regions included the pons, cerebral peduncle, corpus callosum, white matter, basal ganglia, and thalamus.
- These microstructural changes were statistically significant (P < 0.05).
Conclusions:
- DTI is a valuable tool for detecting and quantifying microstructural brain alterations in SCD.
- DTI can identify abnormalities not visible on conventional MRI.
- This imaging technique holds promise for better characterization of SCD-related neurological damage.
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