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Iacobellis F, Di Serafino M, Russo C, Ronza R, Caruso M, Dell’Aversano Orabona G, Camillo C, Sabatino V, Grimaldi D, Rinaldo C, Barbuto L, Verde F, Giacobbe G, Schillirò ML, Scarano E, Romano L. Safe and Informed Use of Gadolinium-Based Contrast Agent in Body Magnetic Resonance Imaging: Where We Were and Where We Are. J Clin Med 2024; 13:2193. [PMID: 38673466 PMCID: PMC11051151 DOI: 10.3390/jcm13082193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Gadolinium-based contrast agents (GBCAs) have helped to improve the role of magnetic resonance imaging (MRI) for the diagnosis and treatment of diseases. There are currently nine different commercially available gadolinium-based contrast agents (GBCAs) that can be used for body MRI cases, and which are classifiable according to their structures (cyclic or linear) or biodistribution (extracellular-space agents, target/specific-agents, and blood-pool agents). The aim of this review is to illustrate the commercially available MRI contrast agents, their effect on imaging, and adverse reaction on the body, with the goal to lead to their proper selection in different clinical contexts. When we have to choose between the different GBCAs, we have to consider several factors: (1) safety and clinical impact; (2) biodistribution and diagnostic application; (3) higher relaxivity and better lesion detection; (4) higher stability and lower tissue deposit; (5) gadolinium dose/concentration and lower volume injection; (6) pulse sequences and protocol optimization; (7) higher contrast-to-noise ratio at 3.0 T than at 1.5 T. Knowing the patient's clinical information, the relevant GBCAs properties and their effect on body MRI sequences are the key features to perform efficient and high-quality MRI examination.
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Affiliation(s)
- Francesca Iacobellis
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Marco Di Serafino
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Camilla Russo
- Neuroradiology Unit, Department of Neuroscience Santobono-Pausilipon Children’s Hospital, 80122 Naples, Italy;
| | - Roberto Ronza
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Martina Caruso
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Giuseppina Dell’Aversano Orabona
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Costanza Camillo
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Vittorio Sabatino
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Dario Grimaldi
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Chiara Rinaldo
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Luigi Barbuto
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Francesco Verde
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Giuliana Giacobbe
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Maria Laura Schillirò
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Enrico Scarano
- Department of Radiology, “San Carlo” Hospital, 85100 Potenza, Italy;
| | - Luigia Romano
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
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Strumph K, Morrone K, Dhillon P, Hsu K, Gomes W, Silver E, Lax D, Peng Q, Lee SK, Manwani D, Mitchell W. Impact of magnetic resonance angiography parameters on stroke prevention therapy in pediatric patients with sickle cell anemia. Pediatr Blood Cancer 2023; 70:e30109. [PMID: 36441603 DOI: 10.1002/pbc.30109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Degree of cerebrovascular stenosis in pediatric patients with sickle cell anemia (SCA) informs need for chronic transfusion therapy, which has significant risks. Flow artifact, intrinsic to magnetic resonance angiography (MRA), is dependent on technical parameters and can lead to overinterpretation of stenosis. The primary objective of this study was to document any change in stroke prevention therapy that could be attributed to the implementation of a standardized MRA scanning protocol for patients with SCA. METHODS A standardized MRA scanning protocol with an echo time of less than 5 ms was implemented at Montefiore Medical Center (MMC), NY in May 2016. Retrospective chart review identified 21 pediatric patients with SCA, with an MRA head both pre- and post-May 2016. Arterial stenosis on MRA, machine parameters, and treatment plans were compared pre- and post-implementation. RESULTS Ten of the 21 patients met inclusion criteria. Previously seen stenosis was re-classified to a lower degree in six of the 10 patients, leading to discontinuation of transfusions in five patients. No patients required escalation of therapy to chronic transfusions. CONCLUSION Optimizing flow artifact by decreasing echo time to less than 5 ms can improve accurate interpretation of cerebrovascular disease, and ensure appropriate treatment plans are in place for stroke prevention. This is especially important for implementing "TCD With Transfusions Changing to Hydroxyurea (TWiTCH)" clinical trial results in the real-world setting.
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Affiliation(s)
- Kaitlin Strumph
- Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York, USA
| | - Kerry Morrone
- Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York, USA
| | - Parmpreet Dhillon
- Division of Child Neurology, Department of Neurology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - Kevin Hsu
- Division of Neuroradiology, Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - William Gomes
- Division of Neuroradiology, Department of Radiology, Westchester Medical Center and New York Medical College, New York, New York, USA
| | - Ellen Silver
- Division of Academic General Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York, USA
| | - Daniel Lax
- Division of Child Neurology, Department of Neurology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - Qi Peng
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - Seon Kyu Lee
- Division of Neuroradiology, Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - Deepa Manwani
- Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York, USA
| | - William Mitchell
- Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York, USA
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Verlhac S, Ithier G, Bernaudin F, Oloukoi C, Cussenot I, Balandra S, Kheniche A, Ntorkou A, Ouaziz H, Tanase A, Sekkal A, Belarbi N, Elmaleh M, Alison M. Evolution of Extracranial Internal Carotid Artery Disease in Children With Sickle Cell Anemia. Stroke 2022; 53:2637-2646. [PMID: 35387492 DOI: 10.1161/strokeaha.121.037980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cerebral arteriopathy in patients with sickle cell anemia mainly affects the intracranial anterior circulation. However, the extracranial internal carotid artery (eICA) can also be stenosed and responsible for ischemic lesions. In children with sickle cell anemia, we perform routine annual Doppler ultrasound assessment of the eICA and magnetic resonance imaging with 3-dimensional time-of-flight magnetic resonance angiography of the Willis circle and neck arteries in those with abnormal velocity. Our aim was to report the evolution of eICA stenoses from 2011 to the present as a function of therapy in a retrospective case-series study. We hypothesized that chronic transfusion (CTT) would be more effective than hydroxyurea and simple observation on the evolution of eICA stenosis. METHODS Eligibility criteria were a history of eICA velocity ≥160 cm/s with a minimum Doppler and magnetic resonance imaging follow-up of 1 year. eICAs were graded for stenosis according to NASCET (The North American Symptomatic Carotid Endarterectomy Trial). Magnetic resonance imaging was investigated for ischemic lesions. Treatment with hydroxyurea and CTT were obtained from the chart review. RESULTS Fifty-four patients were included. Eight patients had a stroke history. The median (range) follow-up was 4.7 years (1.1-9.2 years). On the first neck magnetic resonance angiography, stenosis was present in 48/54 (89%) patients. Kinking was found in 39/54 (72%) patients. On the last neck magnetic resonance angiography, the proportion of patients with eICA stenosis decreased to 39/54 (72%). ICA occlusion occurred in 5 patients despite CTT. Three patients had carotid webs without intracranial stenosis. The proportion of patients with improvement in stenosis score was 8% with no treatment intensification, 20% with hydroxyurea, and 48% with CTT (P=0.016). The mean (SD) change per year in stenosis score was 0.40 (0.60) without intensification, 0.20 (0.53) with hydroxyurea, and -0.18 (0.55) with CTT (P=0.006). Ischemic lesions were present initially in 46% of patients, and the incidence of progressive ischemic lesions was 2.5 events/100 patient-years. Cox regression analysis showed that the initial score for eICA stenosis was a significant predictive factor for the risk of new silent cerebral infarct events. CONCLUSIONS Our study reinforces the need to assess cervical arteries for better prevention of cerebral ischemia and encourage initiation of CTT in sickle cell anemia children with eICA stenosis.
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Affiliation(s)
- Suzanne Verlhac
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Ghislaine Ithier
- Department of Pediatrics, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (G.I.)
| | - Françoise Bernaudin
- Referral Center for Sickle Cell Disease, Department of Clinical Research, Intercommunal Creteil Hospital, France (F.B.)
| | - Carmelia Oloukoi
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Isabelle Cussenot
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Stephane Balandra
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Ahmed Kheniche
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Alexandra Ntorkou
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Hayat Ouaziz
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Anka Tanase
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Amina Sekkal
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Nadia Belarbi
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Monique Elmaleh
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Marianne Alison
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
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Machado C, Rodríguez-Rojas R, Leisman G. Partial recovery of vegetative state after a massive ischaemic stroke in a child with sickle cell anaemia. BMJ Case Rep 2020; 13:13/5/e233737. [PMID: 32376659 DOI: 10.1136/bcr-2019-233737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 15-year-old patient with sickle cell disease with recessive homozygous haemoglobin S/HbSS suffered several crises developmentally after the last of which the patient fell into coma. CT scan then revealed a large infarct of the right cerebral hemisphere. Three weeks after the event, the patient began to demonstrate spontaneous eye opening and spastic quadriparesis with no evidence of command-following, gestural or verbal communication, visual pursuit or purposeful motor behaviour. Our case was in an 'unresponsive wakefulness syndrome' with atrophy of lateral and frontal regions of both hemispheres, demonstrated by MRI and preservation of circulation in the posterior arterial system, documented by MR angiography. Currently observed are spontaneous eye opening, preserved visual and auditory startle reflexes, normal brainstem reflexes, and grasp, palmomental and sucking reflexes. Our case demonstrates partial recovery of awareness with significant brain lesions, reflecting preserved brain activity as an indication of the modular nature of functional networks.
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Affiliation(s)
- Calixto Machado
- Department of Clinical Neurophysiology, Instituto de Neurología y Neurocirugía, La Habana, Cuba
| | - Rafael Rodríguez-Rojas
- CINAC (Centro Integral de Neurociencias), University Hospital CEU-San Pablo University, Madrid, Spain
| | - Gerry Leisman
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel .,Department of Clinical Elelctrophysiology, Universidad de Ciencias Médicas, Instituto de Neurología y Neurocirugía, Neurofisiología Cliníca, Ciudad de La Habana, Cuba
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Robertson RL, Palasis S, Rivkin MJ, Pruthi S, Bartel TB, Desai NK, Kadom N, Kulkarni AV, Lam HFS, Maheshwari M, Milla SS, Mirsky DM, Myseros JS, Partap S, Radhakrishnan R, Soares BP, Trout AT, Udayasankar UK, Whitehead MT, Karmazyn B. ACR Appropriateness Criteria® Cerebrovascular Disease-Child. J Am Coll Radiol 2020; 17:S36-S54. [PMID: 32370977 DOI: 10.1016/j.jacr.2020.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 10/24/2022]
Abstract
Stroke is an uncommon but an important and under-recognized cause of morbidity and mortality in children. Strokes may be due to either brain ischemia or intracranial hemorrhage. Common symptoms of pediatric acute stroke include headache, vomiting, focal weakness, numbness, visual disturbance, seizures, and altered consciousness. Most children presenting with an acute neurologic deficit do not have an acute stroke, but have symptoms due to stroke mimics which include complicated migraine, seizures with postictal paralysis, and Bell palsy. Because of frequency of stroke mimics, in children and the common lack of specificity in symptoms, the diagnosis of a true stroke may be delayed. There are a relatively large number of potential causes of stroke mimic and true stroke. Consequently, imaging plays a critical role in the assessment of children with possible stroke and especially in children who present with acute onset of stroke symptoms. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Susan Palasis
- Panel Chair, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Michael J Rivkin
- Boston Children's Hospital, Boston, Massachusetts; American Academy of Neurology
| | - Sumit Pruthi
- Panel Vice Chair, Vanderbilt Children's Hospital, Nashville, Tennessee
| | | | | | - Nadja Kadom
- Emory University and Children's of Atlanta (Egleston), Atlanta, Georgia
| | - Abhaya V Kulkarni
- Hospital for Sick Children, Toronto, Ontario, Canada; Neurosurgery expert
| | - H F Samuel Lam
- Sutter Medical Center, Sacramento, California; American College of Emergency Physicians
| | | | - Sarah S Milla
- Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | - John S Myseros
- Children's National Health System, Washington, District of Columbia; Neurosurgery expert
| | - Sonia Partap
- Stanford University, Stanford, California; American Academy of Pediatrics
| | | | - Bruno P Soares
- The University of Vermont Medical Center, Burlington, Vermont
| | - Andrew T Trout
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Boaz Karmazyn
- Specialty Chair, Riley Hospital for Children Indiana University, Indianapolis, Indiana
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Chevret S, Verlhac S, Ducros-Miralles E, Dalle JH, de Latour RP, de Montalembert M, Benkerrou M, Pondarré C, Thuret I, Guitton C, Lesprit E, Etienne-Julan M, Elana G, Vannier JP, Lutz P, Neven B, Galambrun C, Paillard C, Runel C, Jubert C, Arnaud C, Kamdem A, Brousse V, Missud F, Petras M, Doumdo-Divialle L, Berger C, Fréard F, Taieb O, Drain E, Elmaleh M, Vasile M, Khelif Y, Bernaudin M, Chadebech P, Pirenne F, Socié G, Bernaudin F. Design of the DREPAGREFFE trial: A prospective controlled multicenter study evaluating the benefit of genoidentical hematopoietic stem cell transplantation over chronic transfusion in sickle cell anemia children detected to be at risk of stroke by transcranial Doppler (NCT 01340404). Contemp Clin Trials 2017; 62:91-104. [DOI: 10.1016/j.cct.2017.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 01/28/2023]
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Hall EM, Leonard J, Smith JL, Guilliams KP, Binkley M, Fallon RJ, Hulbert ML. Reduction in Overt and Silent Stroke Recurrence Rate Following Cerebral Revascularization Surgery in Children with Sickle Cell Disease and Severe Cerebral Vasculopathy. Pediatr Blood Cancer 2016; 63:1431-7. [PMID: 27106860 PMCID: PMC5443666 DOI: 10.1002/pbc.26022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 03/21/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Children with sickle cell disease (SCD) and moyamoya may benefit from indirect cerebral revascularization surgery in addition to chronic blood transfusion therapy for infarct prevention. We sought to compare overt and silent infarct recurrence rates in children with SCD undergoing revascularization. METHODS This was a retrospective cohort study of all children with SCD and moyamoya treated at two children's hospitals. Clinical events and imaging studies were reviewed. RESULTS Twenty-seven children with SCD and confirmed moyamoya receiving chronic transfusion therapy were identified, of whom 12 underwent indirect cerebral revascularization. Two subjects had postoperative transient ischemic attacks and another had a subarachnoid blood collection, none of which caused permanent consequences. Two subjects had surgical wound infections. Among these 12 children, the rate of overt and silent infarct recurrence decreased from 13.4 infarcts/100 patient-years before revascularization to 0 infarcts/100 patient-years after revascularization (P = 0.0057); the postrevascularization infarct recurrence rate was also significantly lower than the overall infarct recurrence of 8.87 infarcts/100 patient-years in 15 children without cerebral revascularization (P = 0.025). CONCLUSIONS The rate of overt and silent infarct recurrence was significantly lower following indirect cerebral revascularization. A prospective study of cerebral revascularization in children with SCD is needed.
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Affiliation(s)
- Erin M. Hall
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey Leonard
- Department of Neurosurgery, The Ohio State University School of Medicine and Nationwide Children’s Hospital, Columbus, OH
| | - Jodi L. Smith
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, IN
| | - Kristin P. Guilliams
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Michael Binkley
- Department of Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - Robert J. Fallon
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Monica L. Hulbert
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
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Abstract
Magnetic resonance imaging (MRI) has a superior soft-tissue contrast compared to other radiological imaging modalities and its physiological and functional applications have led to a significant increase in MRI scans worldwide. A comprehensive MRI safety training to protect patients and other healthcare workers from potential bio-effects and risks of the magnetic fields in an MRI suite is therefore essential. The knowledge of the purpose of safety zones in an MRI suite as well as MRI appropriateness criteria is important for all healthcare professionals who will work in the MRI environment or refer patients for MRI scans. The purpose of this article is to give an overview of current magnetic resonance safety guidelines and discuss the safety risks of magnetic fields in an MRI suite including forces and torque of ferromagnetic objects, tissue heating, peripheral nerve stimulation, and hearing damages. MRI safety and compatibility of implanted devices, MRI scans during pregnancy, and the potential risks of MRI contrast agents will also be discussed, and a comprehensive MRI safety training to avoid fatal accidents in an MRI suite will be presented.
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Affiliation(s)
- Steffen Sammet
- Department of Radiology, University of Chicago Medicine, 5841 South Maryland Avenue, MC2026, Chicago, IL, 60637, USA.
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9
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Fasano RM, Meier ER, Hulbert ML. Cerebral vasculopathy in children with sickle cell anemia. Blood Cells Mol Dis 2015; 54:17-25. [DOI: 10.1016/j.bcmd.2014.08.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 08/28/2014] [Indexed: 01/14/2023]
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10
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Dinan D, Epelman M, Guimaraes CV, Donnelly LF, Nagasubramanian R, Chauvin NA. The current state of imaging pediatric hemoglobinopathies. Semin Ultrasound CT MR 2014; 34:493-515. [PMID: 24332202 DOI: 10.1053/j.sult.2013.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The hemoglobinopathies are a group of genetic disorders with a broad spectrum of clinical manifestations and radiologic findings. The imaging of pediatric hemoglobinopathies, which is influenced by concomitant hemosiderosis and the sequela of chelation therapy, has evolved over the years along with ever-improving technology. This article reviews and illustrates the most common radiographic and cross-sectional imaging findings of the 2 best known and clinically relevant hemoglobinopathies in pediatric patients, sickle cell disease and β-thalassemia.
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Affiliation(s)
- David Dinan
- Department of Medical Imaging, Nemours Children's Hospital, Orlando, FL
| | - Monica Epelman
- Department of Medical Imaging, Nemours Children's Hospital, Orlando, FL.
| | | | | | | | - Nancy A Chauvin
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA
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Acute silent cerebral ischemia and infarction during acute anemia in children with and without sickle cell disease. Blood 2012; 120:3891-7. [PMID: 22948048 DOI: 10.1182/blood-2012-01-406314] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We hypothesized that the silent cerebral infarcts (SCI), which affect up to 40% of children with sickle cell disease (SCD), could occur in the setting of acute anemic events. In a prospective observational study of children with and without SCD hospitalized for an illness associated with acute anemia, we identified acute silent cerebral ischemic events (ASCIE) in 4 (18.2%) of 22 with SCD and in 2 (6.7%) of 30 without SCD, using diffusion-weighted magnetic resonance imaging. Children with ASCIE had lower hemoglobin concentration than those without (median 3.1 vs 4.4 g/dL, P = .003). The unique temporal features of stroke on diffusion-weighted magnetic resonance imaging permit estimation of incidence rates for ASCIE of 421 (95% confidence interval, 155-920) per 100 patient-years during acute anemic events for all patients. For children with SCD, the estimated incidence was 663 (95% confidence interval, 182-1707) which is much higher than previously reported. Acute anemic events are common in children with SCD and prevalence could partially account for the high SCI. Some ASCIE (1 of 4 in our study) may be reversible. Alterations in management may be warranted for children with severe anemia to identify unrecognized ischemic brain injury that may have permanent neurocognitive sequelae.
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Dillman JR, Ellis JH, Cohan RH, Caoili EM, Hussain HK, Campbell AD, Strouse PJ. Safety of gadolinium-based contrast material in sickle cell disease. J Magn Reson Imaging 2011; 34:917-20. [PMID: 21769966 DOI: 10.1002/jmri.22666] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 05/03/2011] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To assess the safety of intravenously administered gadolinium-based contrast material in sickle cell disease (SCD) patients. MATERIALS AND METHODS All pediatric and adult SCD patients evaluated by magnetic resonance imaging (MRI) at our institution between January 1995 and July 2009 were identified. The medical records of SCD patients who underwent contrast-enhanced MRI as well as an equal-sized cohort of SCD patients who underwent unenhanced MRI were reviewed for adverse (vaso-occlusive and hemolytic) events within 1 week following imaging. RESULTS Eight (five mild and three moderate) adverse events were documented within 1 week following contrast-enhanced MRI (38 patients and 61 contrast injections), while six (five mild and one moderate) similar events occurred within 1 week following unenhanced MRI (61 patients and 61 unenhanced MRI examinations). This difference in the number of adverse events was not statistically significant (odds ratio = 1.4; 95% confidence interval [CI] 0.4, 5.2). No severe adverse event occurred in either patient cohort. CONCLUSION Gadolinium-based contrast materials do not appear to be associated with increased risk of vaso-occlusive or hemolytic adverse events when administered to SCD patients. Larger, prospective studies using multiple gadolinium-based contrast materials would be useful to confirm the results of our investigation.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, Michigan 48109-5252, USA.
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Non-invasive imaging of intracranial pediatric vascular lesions. Childs Nerv Syst 2010; 26:1275-95. [PMID: 20596870 DOI: 10.1007/s00381-010-1203-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 06/11/2010] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The goal of this review is to discuss the different non-invasive imaging techniques as well as the age-specific pediatric vascular pathologies and their imaging features. MATERIAL AND METHODS Ultrasound, computed tomography, and magnetic resonance imaging features of pediatric ischemic stroke, intracranial hemorrhage, aneurysms, cavernomas, developmental venous anomalies, and arteriovenous malformations are presented. In addition, multiple non-invasive angiographic techniques (CT and MR angiography) and functional MRI sequences (diffusion, perfusion, and susceptibility-weighted imaging) are discussed. CONCLUSION Neurovascular imaging plays a central role in the early, sensitive, and specific diagnosis of pediatric intracranial vascular disorders. A detailed knowledge of the quality and exact angioarchitecture of pediatric vascular pathologies as well as their impact on the cerebral hemo-dynamics is essential to guide and monitor treatment options and to predict functional outcome.
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Dowling MM, Quinn CT, Rogers ZR, Buchanan GR. Acute silent cerebral infarction in children with sickle cell anemia. Pediatr Blood Cancer 2010; 54:461-4. [PMID: 19813251 PMCID: PMC2807470 DOI: 10.1002/pbc.22242] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Silent cerebral infarctions (SCI) occur in up to 35% of children with sickle cell anemia (HbSS) but are rarely recognized during the initial 10-14 days when diffusion weighted magnetic resonance imaging (MRI) can differentiate acute infarctions from remote events. We report acute SCI in seven children with HbSS who had areas of restricted diffusion on MRI without persistent focal neurologic deficits. Four had acute SCI identified following acute anemic events. Our observations suggest that SCI are detectible in the acute phase, present with subtle neurologic symptoms, result in permanent neurologic injury, and may be caused by acute anemic events.
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Affiliation(s)
- Michael M. Dowling
- Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas,Department of Neurology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas,The Southwestern Comprehensive Sickle Cell Center, Children’s Medical Center Dallas, Dallas, Texas
| | - Charles T. Quinn
- Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas,The Southwestern Comprehensive Sickle Cell Center, Children’s Medical Center Dallas, Dallas, Texas
| | - Zora R. Rogers
- Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas,The Southwestern Comprehensive Sickle Cell Center, Children’s Medical Center Dallas, Dallas, Texas
| | - George R. Buchanan
- Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas,The Southwestern Comprehensive Sickle Cell Center, Children’s Medical Center Dallas, Dallas, Texas
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Joint quality improvement guidelines for pediatric arterial access and arteriography: from the Societies of Interventional Radiology and Pediatric Radiology. Pediatr Radiol 2010; 40:237-50. [PMID: 20058129 DOI: 10.1007/s00247-009-1499-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Heran MK, Marshalleck F, Temple M, Grassi CJ, Connolly B, Towbin RB, Baskin KM, Dubois J, Hogan MJ, Kundu S, Miller DL, Roebuck DJ, Rose SC, Sacks D, Sidhu M, Wallace MJ, Zuckerman DA, Cardella JF. Joint Quality Improvement Guidelines for Pediatric Arterial Access and Arteriography: From the Societies of Interventional Radiology and Pediatric Radiology. J Vasc Interv Radiol 2010; 21:32-43. [DOI: 10.1016/j.jvir.2009.09.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Revised: 09/16/2009] [Accepted: 09/27/2009] [Indexed: 11/28/2022] Open
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Kwiatkowski JL, Zimmerman RA, Pollock AN, Seto W, Smith-Whitley K, Shults J, Blackwood-Chirchir A, Ohene-Frempong K. Silent infarcts in young children with sickle cell disease. Br J Haematol 2009; 146:300-5. [PMID: 19500105 PMCID: PMC2793684 DOI: 10.1111/j.1365-2141.2009.07753.x] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Silent infarcts have been reported most commonly in school-aged children with homozygous sickle cell disease (SCD-SS) and are associated with neurocognitive deficits. However, the prevalence of silent infarcts in younger children with SCD-SS is not well defined. In this retrospective study, brain magnetic resonance imaging and angiography (MRI/A) studies performed before 6 years of age in a cohort of children with SCD-SS were analysed and the prevalence of abnormalities was calculated. Clinical and laboratory parameters were compared between the groups with and without silent infarcts. Sixty-eight of 96 children in the cohort had brain MRI/A performed prior to age 6 years. Of the 65 who were neurologically asymptomatic, 18 (27.7%, 95% CI 17.3-40.2%) had silent infarcts (mean age 3.7 +/- 1.1 years, range 1.3-5.9 years). Factors associated with silent infarcts included cerebral vessel stensosis by magnetic resonance angiography, lower rates of vaso-occlusive pain and acute chest syndrome and lower haemoglobin levels. The prevalence of silent infarcts in young children with SCD-SS is similar to that of older children and anaemia and severe vasculopathy may be risk factors.
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Affiliation(s)
- Janet L Kwiatkowski
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Goodwin PL, Vaphiades MS, Johnson AP, Stroud CE. Bilateral Central Retinal Artery Occlusion Associated with Moyamoya Syndrome in a Sickle Cell Disease Patient. Neuroophthalmology 2009. [DOI: 10.1080/01658100701818156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Niebanck AE, Pollock AN, Smith-Whitley K, Raffini LJ, Zimmerman RA, Ohene-Frempong K, Kwiatkowski JL. Headache in children with sickle cell disease: prevalence and associated factors. J Pediatr 2007; 151:67-72, 72.e1. [PMID: 17586193 PMCID: PMC2538680 DOI: 10.1016/j.jpeds.2007.02.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2006] [Revised: 12/29/2006] [Accepted: 02/02/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the prevalence of frequent headache in children with sickle cell disease (SCD) to that of black control subjects and to assess factors associated with headache in SCD. STUDY DESIGN In this cross-sectional study, a headache questionnaire was administered to subjects with SCD and black control subjects. Subjects answered supplementary questions about SCD complications. Clinical and radiographic information were abstracted from medical charts for subjects with SCD. RESULTS Children (n = 241) with SCD and 141 control subjects were studied; 32.4% (95% CI 26.5%-38.7%) of subjects with SCD reported having headaches at least weekly, similar to control subjects at 27% (95% CI 19.8%-35.1%, P = NS); however, in children <13 years, headache was more common in subjects with SCD than in control subjects (24% vs 9.7%, P = .013). The prevalence of headache was similar among the different SCD genotypes. Factors associated with frequent headaches in subjects with SCD included older age, frequent vaso-occlusive pain episodes, symptoms of obstructive sleep apnea, and cerebral vessel stenosis detected by magnetic resonance angiography. CONCLUSION The prevalence of headaches in children with SCD is similar to the general population; however, younger children with SCD report headaches more frequently than control subjects. The cause of headache is likely multifactorial, and SCD-specific factors may contribute.
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Zimmerman RA, Bilaniuk LT. 3T magnetic resonance arteriography in pediatric cerebrovascular disease. J Neuroradiol 2007; 34:95-100. [PMID: 17448536 DOI: 10.1016/j.neurad.2007.01.128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Based on a series of 20 cases, eight with 1.5T and 3T MRA's, 3T MRA provides improvement over 1.5T MRA in imaging the vessels of the circle of Willis in pediatric patients with vascular disease. Dephasing artifact is reduced and laminal stenosis or occlusions become better depicted.
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Affiliation(s)
- R A Zimmerman
- Department of Radiology, Wood Room 2115, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Abstract
Arterial ischemic stroke and sinovenous thrombosis are a significant yet under-recognized causes of mortality and morbidity in the pediatric population. With increasingly complex etiologies yet urgency for rapid diagnosis and treatment, pediatric stroke teams likely will become the standard of care. A common terminology must be developed to avoid confusing types of acute cerebral insults--such as focal arterial ischemic stroke and global hypoxia and ischemia--that have different causes and pathophysiologic mechanisms of injury. Increased awareness of unique pediatric stroke subtypes, their clinical presentation, and their imaging findings will facilitate early identification and development of optimal treatment strategies.
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