White Matter Integrity in Tanzanian Children With Sickle Cell Anemia: A Diffusion Tensor Imaging Study

BACKGROUND AND PURPOSE—Widespread reductions in white matter integrity are associated with cognitive dysfunction in sickle cell anemia. Silent cerebral infarction (SCI), vasculopathy (VSC), and low hemoglobin concentration (Hb) are implicated; we aimed to determine independent contributions to micro...

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Bibliographic Details
Published in:Stroke (1970) 2020-04, Vol.51 (4), p.1166-1173
Main Authors: Jacob, Mboka, Stotesbury, Hanne, Kawadler, Jamie M, Lapadaire, Winok, Saunders, Dawn E, Sangeda, Raphael Z, Chamba, Clara, Kazema, Ramadhan, Makani, Julie, Kirkham, Fenella J, Clark, Chris A
Format: Article
Language:English
Subjects:
Adolescent
Anemia, Sickle Cell - diagnostic imaging
Anemia, Sickle Cell - epidemiology
Brain - diagnostic imaging
Child
Diffusion Tensor Imaging - trends
Female
Humans
Magnetic Resonance Angiography - trends
Male
Prospective Studies
Tanzania - epidemiology
White Matter - diagnostic imaging
Young Adult
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Summary:BACKGROUND AND PURPOSE—Widespread reductions in white matter integrity are associated with cognitive dysfunction in sickle cell anemia. Silent cerebral infarction (SCI), vasculopathy (VSC), and low hemoglobin concentration (Hb) are implicated; we aimed to determine independent contributions to microstructural white matter injury and whether white matter integrity differs across arterial territories. METHODS—Sixty two children with sickle cell anemia aged 6 to 19 years were prospectively studied at Muhimbili National Hospital, Tanzania. SCI± and VSC± were identified on magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) scans by 2 neuroradiologists. Tract-based spatial statistics tested for voxel-wise differences in diffusion tensor imaging metrics (ie, fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity) between SCI± and VSC± groups, with correlations between diffusion tensor imaging metrics and Hb. In tract-based spatial statistics analyses, potentially mediating factors (ie, age, sex, as well as Hb, SCI, and/or vasculopathy) were covariates. Differences in mean diffusion tensor imaging metrics across regions of interest in arterial territories were explored. RESULTS—Compared with SCI− patients (n=45), SCI+ patients (n=17) exhibited increased radial diffusivity in multiple regions; negative relationships were observed between mean diffusivity, axial diffusivity, and Hb (P
ISSN:0039-2499
1524-4628
DOI:10.1161/STROKEAHA.119.027097