Brain Imaginig in SCD Adults Patients: Correlation to TCD Image and Atoxic Contrast ( Microbubbles).

The purposes of this study were to evaluate the intracranial lesions in adults patients with sickle cell disease (SCD) using magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). The patients were selected from the main hematological hospital of Rio de Janeiro state (HEMORIO). About 187 patients underwent neurological examination and Transcranial Doppler image (TCDi) with microbubbles. Eighty patients were chosen by an aleatory way to perform MRI and MRA, including those symptomatic and asymptomatic ones. MRI and the MRA were evaluated by two different neuroradiologists, in a blind way about the clinical aspects and TCD results. The middle age was 29 years and 81.3% of the patients had the homozygous form of the SCD. In the MRI, 50% of the patients showed intraparenchymatous lesions. Leukoencephalopathy was the most frequent abnormality in 47.5%, encephalomalacia in 16%, lacunar infarctation in 12.5% and atrophy in 12.5%. Of the encephalomalacia cases, the frontal and parietal lobes were the most affected in 85%. In the MRA study, 34% of the patients presented abnormalities, 26% with vascular stenosis and 19% with vascular occlusions. The anterior circulation was the most compromised in the stenotic cases and the carotid was the main affected artery in the occlusions cases. The silent lesions were observed in 45% of the MRI and 24% of the MRA. The prevalence of parenchymatous lesions and vascular stenosis in cases with genotype SS was significant. There was significant statistic relation between the leukoencefalophalopathy and the vascular stenosis with the medium basal hematocrit.

The use of both methods (MRI and TCD image) demonstrated a powerful tool to study vascular lesions in SCD adults patients. The prevalence of silent infarcts in SCD adults patients was higher than previously estimated in literature (55%). This finding reinforces the prophylactic intervention study with TCD Imagining and prophylactic transfusion therapy in early stage of life.

No relevant conflicts of interest to declare.