CEREBROVASCULAR RESERVE IN SICKLE CELL DISEASE ASSESSED
WITH PERFUSION MAGNETIC RESONANCE IMAGING
L. VÁCLAVŮ1, HJMM MUSTSAERTS1, CBLM MAJOIE1, ET VAN BAVEL1, AJ NEDERVEEN1, BJ BIEMOND1
1 Academic Medical Center, Amsterdam, The Netherlands
Poster Ref: P372 Abstract identifier: EHA-3939.
CONCLUSION
Low CVR in SCD patients is in line with literature suggesting that maximum vasodilation has
been reached in SCD1
Sickle hemoglobin in less able to carry oxygen due to this mutation.
Reduced oxygen delivery causes elevated cerebral blood flow (CBF).
Chronic high blood flow impairs the ability of the vessels to dilate further1.
Since this was observed in SCD patients in a steady-state disease course, it is very imaginable
that the CVR will become exhausted during times of increased metabolic demand (e.g. fever,
infection)
Impaired vessels are thought to induce Silent strokes due to local perfusion deficits.
Perfusion is flow through the capillary network to deliver oxygen to the tissue.
Perfusion measurements can provide local hemodynamic information
CBF was significantly dependent on hematocrit
CBF was significantly higher in patients with Sickle
Cell Disease compared with healthy controls
OBJECTIVES
ACKNOWLEDGEMENTS
REFERENCES
1.
2.
3.
4.
Nur E et al. Blood:114:3473 - 3478
Alsop D et al. 2015 MRM:73:102-116
Petersen ET et al. 2012 ISMRM 20:472
Václavů L et al. AJNR 2016 In Press
Table 1. Subject characteristics
Healthy controls
Sickle Cell Disease
Patients
n
9
25
Mean age ± SD
33 ± 14y
33 ± 12y
Males/Females 5/4
16/9
Ethnicity
Dutch Antilles and
Africa
Dutch Antilles and
Africa
Haemoglobin
HbAA/HbAS
HbSS or HbSß0
Haematocrit
39 ± 4 %
25 ± 5 %
CONTACT INFORMATION
Lena Václavů
Department of Radiology, Academic Medical Center
Meibergdreef 9 , 1105 AZ, Amsterdam, The Netherlands
[email protected]
Lena Vaclavu
Cerebral blood flow was significantly higher in patients with Sickle Cell Disease, and was
dependent on blood hematocrit. Thus, severity of anemia was a strong indicator of
resting CBF. Moreover, The higher the baseline CBF, the lower the cerebrovascular reserve
(CVR) in response to vasodilation. The CVR in patients was approximately one-third of
that in controls.
John C Wood, Children’s Hospital Los Angeles, LA, USA
Red blood cells and iron - Clinical 1
CBF increases due to vasodilation induced by
acetazolamide were significantly lower in patients
compared to control, indicated by red arrows
Esben Thade Petersen, Danish Research Centre for Magnetic Resonance, Hvidore Hospital
372-P
Baseline cerebral blood flow was a significant
predictor of cerebrovascular reserve
Procedure
• IRB approved study
• All participants underwent MRI at 3T (Ingenia, Philips Healthcare, Best, The Netherlands)
• Sequences included: T2-weighted and FLAIR anatomical scans, Arterial Spin Labelling (ASL)
perfusion MRI2, and T1blood for improved quantification of CBF3,4
Data processing
• Registration of perfusion images to population-based average
• CBF quantification
• CVR calculated from increase in CBF induced by acetazolamide (vasodilator)
CVR could potentially be a cerebrovascular biomarker in SCD for treatment stratification in the
future
MRI-based cerebral perfusion measurements with acetazolamide show robust CVR results and
indicate that cerebral hemodynamics may be impaired in SCD
Our aim was to gain understanding of cerebral hemodynamics in SCD by using perfusion MRI.
Our objective was to investigate the acute response of cerebral blood flow by inducing
vasodilation in patients with SCD. This is called cerebrovascular reserve (CVR).
We hypothesised that patients would have impaired vascular reactivity due to pre-existing
increased vasodilation and elevated resting CBF.
METHODS
DOI: 10.3252/pso.eu.21EHA.2016
Sickle Cell Disease (SCD) is an inherited chronic form of anaemia, caused by a
hemoglobin mutation.
Poster presented
at EHA 21 on:
10th June 2016
RESULTS
21eha
INTRODUCTION
Academic Medical Center