MRI in SCD: spectrum of abnormality in SCD as illustrated by different imaging examples. Axial DWI (A) and apparent diffusion coefficient (ADC) (B) map of the brain demonstrating multiple foci of restricted diffusion along bifrontal regions (corresponding to the short arrows in A), along the internal watershed zone most consistent with acute strokes. (C) Axial fluid attenuation inversion recovery (FLAIR) image in a different patient with SCD demonstrate areas of old (silent) infarctions in a similar internal watershed distribution. (D) Axial T2 image shows a large area of right occipital cystic encephalomalacia resulting from prior infarction. (E) Axial T2 image from another patient shows diffuse volume loss, sulcal prominence, and an old right basal ganglia infarct from sickle cell-associated vasculopathy. (F) Maximum intensity projection image from the MRA shows nonvisualization of the left MCA with multiple collateral in the left lenticulostriate distribution (long arrow), consistent with moyamoya collaterals.