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Manara R, Ponticorvo S, Contieri M, Canna A, Russo AG, Fedele MC, Rocco MC, Borriello A, Valeggia S, Pennisi M, De Angelis M, Roberti D, Cirillo M, di Salle F, Perrotta S, Esposito F, Tartaglione I. Brain perfusion changes in beta-thalassemia. Orphanet J Rare Dis 2024; 19:212. [PMID: 38773534 PMCID: PMC11110312 DOI: 10.1186/s13023-024-03194-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/19/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Brain injury in hereditary hemoglobinopathies is commonly attributed to anemia-related relative hypoperfusion in terms of impaired oxygen blood supply. Supratentorial and infratentorial vascular watershed regions seem to be especially vulnerable, but data are very scarce. AIMS We investigated a large beta-thalassemia sample with arterial spin labeling in order to characterize regional perfusion changes and their correlation with phenotype and anemia severity. METHODS We performed a multicenter single-scanner cross-sectional 3T-MRI study analyzing non-invasively the brain perfusion in 54 transfusion-dependent thalassemia (TDT), 23 non-transfusion-dependent thalassemia (NTDT) patients and 56 Healthy Controls (HC). Age, hemoglobin levels, and cognitive functioning were recorded. RESULTS Both TDT and NTDT patients showed globally increased brain perfusion values compared to healthy controls, while no difference was found between patient subgroups. Using age and sex as covariates and scaling the perfusion maps for the global cerebral blood flow, beta-thalassemia patients showed relative hyperperfusion in supratentorial/infratentorial watershed regions. Perfusion changes correlated with hemoglobin levels (p = 0.013) and were not observed in the less severely anemic patients (hemoglobin level > 9.5 g/dL). In the hyperperfused regions, white matter density was significantly decreased (p = 0.0003) in both patient subgroups vs. HC. In NTDT, white matter density changes correlated inversely with full-scale Intelligence Quotient (p = 0.007) while in TDT no correlation was found. CONCLUSION Relative hyperperfusion of watershed territories represents a hemodynamic hallmark of beta-thalassemia anemia challenging previous hypotheses of brain injury in hereditary anemias. A careful management of anemia severity might be crucial for preventing structural white matter changes and subsequent long-term cognitive impairment.
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Affiliation(s)
- Renzo Manara
- Neuroradiology, Department of Neuroscience, University of Padua, Padua, Italy
| | - Sara Ponticorvo
- Dipartimento di Medicina e Chirurgia, Scuola Medica Salernitana, Università di Salerno, Fisciano, Italy
- Center for Magnetic Resonance Research (CMRR), Department of Radiology, University of Minnesota, 2021 6th St. SE, Minneapolis, MN, 55455, USA
| | - Marcella Contieri
- Dipartimento della Donna, del Bambino e di Chirurgia generale e specialistica, Universit? degli Studi della Campania "Luigi Vanvitelli", Via Luigi de Crecchio 4, Napoli, 80138, Italy
| | - Antonietta Canna
- Dipartimento di Medicina e Chirurgia, Scuola Medica Salernitana, Università di Salerno, Fisciano, Italy
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, USA
| | - Andrea Gerardo Russo
- Dipartimento di Medicina e Chirurgia, Scuola Medica Salernitana, Università di Salerno, Fisciano, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Maria Cristina Fedele
- Dipartimento della Donna, del Bambino e di Chirurgia generale e specialistica, Universit? degli Studi della Campania "Luigi Vanvitelli", Via Luigi de Crecchio 4, Napoli, 80138, Italy
| | - Maria Chiara Rocco
- Pediatrics and Residency Program of Pediatrics, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, 84081, Italy
| | - Adriana Borriello
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Via Luigi de Crecchio 7, Naples, Italy
| | - Silvia Valeggia
- Neuroradiology, Department of Neuroscience, University of Padua, Padua, Italy
| | - Maria Pennisi
- Dipartimento della Donna, del Bambino e di Chirurgia generale e specialistica, Universit? degli Studi della Campania "Luigi Vanvitelli", Via Luigi de Crecchio 4, Napoli, 80138, Italy
| | - Marianna De Angelis
- Dipartimento della Donna, del Bambino e di Chirurgia generale e specialistica, Universit? degli Studi della Campania "Luigi Vanvitelli", Via Luigi de Crecchio 4, Napoli, 80138, Italy
| | - Domenico Roberti
- Dipartimento della Donna, del Bambino e di Chirurgia generale e specialistica, Universit? degli Studi della Campania "Luigi Vanvitelli", Via Luigi de Crecchio 4, Napoli, 80138, Italy
| | - Mario Cirillo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Francesco di Salle
- Dipartimento di Medicina e Chirurgia, Scuola Medica Salernitana, Università di Salerno, Fisciano, Italy
| | - Silverio Perrotta
- Dipartimento della Donna, del Bambino e di Chirurgia generale e specialistica, Universit? degli Studi della Campania "Luigi Vanvitelli", Via Luigi de Crecchio 4, Napoli, 80138, Italy.
| | - Fabrizio Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Immacolata Tartaglione
- Dipartimento della Donna, del Bambino e di Chirurgia generale e specialistica, Universit? degli Studi della Campania "Luigi Vanvitelli", Via Luigi de Crecchio 4, Napoli, 80138, Italy
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Choi S, Leahy RM, Wood JC. Lower white matter volume in beta-thalassemia associated with anemia and cognitive performance. Am J Hematol 2020; 95:E144-E146. [PMID: 32180241 DOI: 10.1002/ajh.25787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Soyoung Choi
- Neuroscience Graduate ProgramUniversity of Southern California Los Angeles California USA
- Signal and Image Processing InstituteUniversity of Southern California Los Angeles California USA
- Division of Hematology, Oncology and Blood and Marrow TransplantationChildren's Hospital Los Angeles Los Angeles California USA
| | - Richard M. Leahy
- Neuroscience Graduate ProgramUniversity of Southern California Los Angeles California USA
- Signal and Image Processing InstituteUniversity of Southern California Los Angeles California USA
| | - John C. Wood
- Division of Hematology, Oncology and Blood and Marrow TransplantationChildren's Hospital Los Angeles Los Angeles California USA
- Department of Pediatrics, Keck School of MedicineUniversity of Southern California Los Angeles California USA
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