Detectability of white matter cerebral blood flow using arterial spin labeling MRI in patients with sickle cell disease: Relevance of flow territory, bolus arrival time, and hematocrit

Author:

Richerson Wesley T1ORCID,Aumann Megan1,Song Alexander K1,Eisma Jarrod J1,Davis Samantha2,Milner Lauren2,Garza Maria1,Taylor Davis L3,Martin Dann3,Jordan Lori C23ORCID,Donahue Manus J145

Affiliation:

1. Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA

2. Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA

3. Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA

4. Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA

5. Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA

Abstract

Sickle cell disease (SCD) is the most common genetic blood disorder, characterized by red cell hemolysis, anemia, and corresponding increased compensatory cerebral blood flow (CBF). SCD patients are at high risk for cerebral infarcts and CBF quantification is likely critical to assess infarct risk. Infarcts primarily localize to white matter (WM), yet arterial spin labeling (ASL) MRI, the most common non-invasive CBF approach, has poor WM CBF sensitivity owing to low WM CBF and long WM bolus arrival time (BAT). We hypothesize that anemia, and associated cerebral hyperemia, in SCD leads to improved WM detection with ASL. We performed 3-Tesla multi-delay pulsed ASL in SCD (n = 35; age = 30.5 ± 8.3 years) and control (n = 15; age = 28.7 ± 4.5 years) participants and applied t-tests at each inversion time within different flow territories, and determined which regions were significantly above noise floor (criteria: one-sided p < 0.05). Total WM CBF-weighted signal was primarily detectable outside of borderzone regions in SCD (CBF = 17.7 [range = 12.9–25.0] mL/100 g/min), but was largely unphysiological in control (CBF = 8.1 [range = 7.6–9.9)] mL/100 g/min) participants. WM BAT was reduced in SCD versus control participants (ΔBAT = 37 [range = 46–70] ms) and BAT directly correlated with hematocrit (Spearman’s-ρ = 0.62; p < 0.001). Findings support the feasibility of WM CBF quantification using ASL in SCD participants for appropriately parameterized protocols.

Publisher

SAGE Publications

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