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SPECIAL ULTRASOUND CAN DETERMINE WHICH SICKLE CELL PATIENTS ARE AT RISK FOR STROKE
CHICAGO -- Children with sickle cell disease may benefit from being tested with a powerful, high-quality ultrasound to see if they have a common condition that puts them at risk for stroke, suggests a study being presented here today at the 85th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA).
About 10 percent to 12 percent of children with sickle cell disease, which predominantly affects African Americans, have a narrowing in one or more arteries in the head and are at risk for developing a cerebral stroke if they're not treated. Treatment, however, involves giving the child monthly blood transfusions, which is not without risk, so it's important that those children who are at highest risk for stroke be identified.
An inherited, chronic blood disease, sickle cell disease, also called sickle cell anemia, affects 1 in 375 African Americans. It is also found in Hispanic Americans from the Caribbean, Central America and parts of South America, and in individuals from Turkey, Greece, Italy, the Middle East and East India. Many of those with the disease die of organ failure between ages 20 and 40.
"After a large study using pulsed Doppler ultrasound demonstrated that children with the most abnormal blood flow had a 40 percent risk of stroke, the National Institutes of Health (NIH) funded a study that showed that chronic blood transfusion dramatically reduced the chance of stroke," said Abe Malouf, Jr., M.D., assistant professor of radiology at the University of Mississippi Medical Center, Jackson. "The machines used in that study did not allow the vessels to be visualized. We used a very sensitive piece of ultrasound equipment called power Doppler to give us a clear picture of the blood flow and arteries, making evaluation easier."
In the study, 126 sickle cell patients between 2 and 16 years old were imaged with power Doppler ultrasound. Blood vessel abnormalities were found in 10 patients (8 percent). Results in 18 patients (14 percent) were conditional, meaning the children were at a slightly increased risk for stroke and needed to be followed closely. Ninety patients (71 percent) were normal, and researchers were unable to read results for 8 patients (6 percent). The percentages were similar to the NIH findings.
In the University of Mississippi study, the findings were confirmed in all 8 (100 percent) of the patients with an abnormal power Doppler study who had follow-up magnetic resonance angiography (MRA). Two of the patients who were determined by ultrasound with power Doppler to be abnormal did not have follow-up MRA studies.
"Ultrasound with power Doppler is non-invasive, and it is much less expensive," said Dr. Malouf. "Because so many centers have the equipment, it opens up the number of places that can do this test."
Co-authors of a paper on the topic being presented at RSNA by Dr. Malouf are: Jennifer H. Turner, M.D.; Michael C. Doherty, M.D.; and Rathi Iyer, M.D.
The RSNA is an association of 31,000 radiologists and physicists in medicine dedicated to education and research in the science of radiology. The Society's headquarters are located at 820 Jorie Blvd., Oak Brook, Illinois 60523-2251.
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Note: Copies of 1999 RSNA news releases are available online at http://www.pcipr.com/rsna beginning Monday, Nov. 29.
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