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Detecting white matter injury in sickle cell disease using voxel-based morphometry

Authors

  • Torsten Baldeweg MD,

    Corresponding author
    1. Developmental Cognitive Neuroscience Unit, Institute of Child Health, University College, London, United Kingdom
    2. Great Ormond Street Hospital for Children, London, United Kingdom
    • Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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  • Alexandra M. Hogan PhD,

    1. Developmental Cognitive Neuroscience Unit, Institute of Child Health, University College, London, United Kingdom
    2. Great Ormond Street Hospital for Children, London, United Kingdom
    Current affiliation:
    1. Developmental Brain-Behaviour Unit, University of Southampton, Southampton, United Kindgom
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  • Dawn E. Saunders MD,

    1. Department of Radiology, Great Ormond Street Hospital for Children, London, United Kingdom
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  • Paul Telfer MD,

    1. Department of Paediatric Haematology and Oncology, Queen Elizabeth Children's Service, The Royal London Hospital, London, United Kingdom
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  • David G. Gadian DPhil,

    1. Great Ormond Street Hospital for Children, London, United Kingdom
    2. Radiology and Physics Unit, Institute of Child Health, London, United Kingdom
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  • Faraneh Vargha-Khadem PhD,

    1. Developmental Cognitive Neuroscience Unit, Institute of Child Health, University College, London, United Kingdom
    2. Great Ormond Street Hospital for Children, London, United Kingdom
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  • Fenella J. Kirkham MBBChir

    1. Great Ormond Street Hospital for Children, London, United Kingdom
    2. Neurosciences Unit, Institute of Child Health, University College, London, United Kingdom
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Abstract

Objective

Sickle cell disease (SCD) is associated with cerebrovascular disease, cerebral infarction, and cognitive dysfunction. This study aimed to detect the presence and extent of white matter abnormalities in individuals with SCD using voxel-based morphometry (VBM).

Methods

Thirty-six children and adolescents with SCD (age range, 9–24 years) and 31 controls (8–25 years) underwent magnetic resonance investigations using T1- and T2-weighted protocols. White and gray matter density maps were obtained from three-dimensional magnetic resonance imaging (MRI) data sets. Using VBM, we compared the maps between controls and SCD individuals with silent white matter infarct lesions (SCD+L; n = 16), and those without visible abnormality (SCD−L; n = 20).

Results

In comparison with controls, intelligence quotients (IQs) were lower in both SCD groups irrespective of presence of visible lesions. VBM showed widespread bilateral white matter abnormalities in the SCD+L group, extending beyond the regions of focal infarction in the deep anterior and posterior white matter borderzones. Bilateral white matter abnormalities were also observed in the SCD−L group, in locations similar to those in the SCD+L group.

Interpretation

VBM is sensitive to detection of widespread white matter injury in SCD patients in borderzones between arterial territories even in the absence of evidence of infarction. Those changes may contribute to cognitive deficits in this population. Ann Neurol 2006

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