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(Stroke. 2009;40:2408.)
© 2009 American Heart Association, Inc.

Original Contributions

Brain Magnetic Resonance Imaging Abnormalities in Adult Patients With Sickle Cell Disease

Correlation With Transcranial Doppler Findings

Gisele Sampaio Silva, MD, PhD; Perla Vicari, MD, PhD; Maria Stella Figueiredo, MD, PhD; Henrique Carrete, Junior, MD, PhD; Marcos Hideki Idagawa, MD Ayrton Roberto Massaro, MD, PhD

From the Departments of Neurology (G.S.S.), Hematology (P.V., M.S.F.), and Radiology (H.C.J., M.H.I.), Universidade Federal de São Paulo, São Paulo, Brazil; and Centro Diagnostico Fleury (A.R.M.), São Paulo, Brazil.

Correspondence to Gisele Sampaio Silva, MD, PhD, 6 Whittier Place Unit 7K, Boston, MA 02114. E-mail giselesampaio{at}hotmail.com

Background and Purpose— Brain imaging abnormalities were reported in up to 44% of children with sickle cell disease (SCD). The prevalence of neuroimaging abnormalities in adult patients with SCD and their relationship to transcranial Doppler is still unclear. Our objectives were to study the frequency of MRI and MR angiography abnormalities in adults with SCD and to define what transcranial Doppler velocities are associated with intracranial stenoses detected by MR angiography.

Methods— We examined all adult patients (>16 years) with SCD followed in the hematology outpatient clinic at our university hospital with MRI, MR angiography, and transcranial Doppler.

Results— We evaluated 50 patients. The overall prevalence of MRI abnormalities was 60%. Abnormal MRI findings were more frequent when vessel tortuosity or stenoses were present on MR angiography (P<0.01). Patients with intracranial stenoses had significantly higher time-averaged maximum mean velocities (P=0.01). A time-averaged maximum mean velocity of 123.5 cm/s allowed the diagnosis of middle cerebral artery or internal carotid artery intracranial stenosis with sensitivity of 100% and specificity of 73% with an area under the receiver operator characteristic curve of 0.91 (CI, 0.79 to 1.00).

Conclusions— The frequency of brain imaging abnormalities detected by MRI/MR angiography in adults with SCD was higher than that described for children. Transcranial Doppler velocities in adult patients with intracranial stenoses were lower than those described for the pediatric population with SCD.

Key Words: magnetic resonance imaging • sickle cell anemia • stroke • transcranial Doppler ultrasonography