White matter cerebral blood flow is lowest in regions of highest infarct density. Resting cerebral blood flow maps from an independent cohort of children with SCA were aligned to the infarct density map of the SIT Trial participants. (A) Mean cerebral blood flow was measured within 3 regions of low, moderate, and high infarct density. White matter cerebral blood flow was lowest in the region of highest infarct density (Friedman Test, P < .001). *Pairwise tests for low- vs moderate-infarct-density, moderate- vs high-infarct-density, and low- vs high-infarct-density tiers, were significant after adjustment for multiple comparisons (P < .05). These data confirm that a nadir in resting cerebral blood flow may contribute to elevated and symmetric infarct densities in the border zone regions in pediatric SCA. (B) Nadir cerebral blood flow map (defined as average cerebral blood flow <45 mL/100 g/min) from the independent pediatric SCA cohort overlaid onto the infarct density map of the SIT Trial participants thresholded to include SCIs from 90% of the SIT Trial cohort. A high degree of overlap is found between nadir cerebral blood flow in the border zone region and regions of peak infarct density. CBF, cerebral blood flow.