Painful sickle cell crisis: bone marrow patterns observed with MR imaging

Area of Science:

• Radiology
• Hematology
• Medical Imaging

Background:

• Sickle cell anemia (SCA) is a genetic blood disorder characterized by abnormal hemoglobin.
• Painful crises are a common and debilitating manifestation of SCA, often involving bone marrow infarction.
• Accurate differentiation between acute and chronic infarcts is crucial for effective patient management.

Purpose of the Study:

• To evaluate the utility of magnetic resonance (MR) imaging in distinguishing acute from chronic bone marrow infarcts in patients with SCA.
• To assess MR imaging findings in the context of painful crises in SCA.

Main Methods:

• Eleven patients with homozygous sickle cell anemia (SCA) underwent MR imaging during painful crises.
• Signal intensity changes in bone marrow were analyzed on short and long repetition time (TR)/echo time (TE) sequences.
• Isotope marrow scans were performed in five patients for confirmation.

Main Results:

• Diffuse decrease in bone marrow signal intensity suggested hematopoietic hyperplasia.
• Focal areas of decreased signal intensity were observed in painful and painless joints.
• In painful joints, these areas showed high signal on long TR/TE images, indicating acute infarction (edema).
• In painless joints, low signal persisted on long TR/TE images, suggesting chronic infarcts or fibrosis.

Conclusions:

• MR imaging can differentiate between acute and chronic bone marrow infarcts in SCA patients.
• The findings suggest MR imaging is a valuable tool for monitoring SCA complications and directing therapeutic interventions.