PT  - JOURNAL ARTICLE
AU  - Whitehead, M.T.
AU  - Smitthimedhin, A.
AU  - Webb, J.
AU  - Mahdi, E.S.
AU  - Khademian, Z.P.
AU  - Carpenter, J.L.
AU  - Abraham, A.
TI  - Cerebral Blood Flow and Marrow Diffusion Alterations in Children with Sickle Cell Anemia after Bone Marrow Transplantation and Transfusion
AID  - 10.3174/ajnr.A5830
DP  - 2018 Nov 01
TA  - American Journal of Neuroradiology
PG  - 2132--2139
VI  - 39
IP  - 11
4099  - http://www.ajnr.org/content/39/11/2132.short
4100  - http://www.ajnr.org/content/39/11/2132.full
SO  - Am. J. Neuroradiol.2018 Nov 01; 39
AB  - BACKGROUND AND PURPOSE: Hematopoietic marrow hyperplasia and hyperperfusion are compensatory mechanisms in sickle cell anemia. We have observed marrow diffusion and arterial spin-labeling perfusion changes in sickle cell anemia following bone marrow transplantation. We aimed to compare arterial spin-labeling perfusion and marrow diffusion/ADC values in patients with sickle cell anemia before and after bone marrow transplantation or transfusion.MATERIALS AND METHODS: We reviewed brain MRIs from patients with sickle cell anemia obtained during 6 consecutive years at a children's hospital. Quantitative marrow diffusion values were procured from the occipital and sphenoid bones. Pseudocontinuous arterial spin-labeling perfusion values (milliliters/100 g of tissue/min) of MCA, anterior cerebral artery, and posterior cerebral artery territories were determined. Territorial CBF, whole-brain average CBF, and marrow ADC values were compared for changes before and after either bone marrow transplantation or transfusion. Bone marrow transplantation and transfusion groups were compared. Two-tailed paired and unpaired Student t tests were used; P < .05 was considered significant.RESULTS: Fifty-three examinations from 17 patients with bone marrow transplantation and 29 examinations from 9 patients with transfusion were included. ADC values significantly increased in the sphenoid and occipital marrow following bone marrow transplantation in contrast to patients with transfusion (P > .83). Whole-brain mean CBF significantly decreased following bone marrow transplantation (77.39 ± 13.78 to 60.39 ± 13.62 ml/100 g tissue/min; P < .001), without significant change thereafter. CBF did not significantly change following the first (81.11 ± 12.23 to 80.25 ± 8.27 ml/100 g tissue/min; P = .47) or subsequent transfusions. There was no significant difference in mean CBF between groups before intervention (P = .22).CONCLUSIONS: Improved CBF and marrow diffusion eventuate following bone marrow transplantation in children with sickle cell anemia in contrast to transfusion therapy.ACAanterior cerebral arteryASLarterial spin-labelingBMTbone marrow transplantationPCAposterior cerebral arterySCAsickle cell anemiaT1relaxation time