Evaluation of occult cerebral infarction in children with sickle cell disease: A pilot study

The aim of this study is to investigate whether the use of Tc-99m HMPAO SPE CT is superior to MRI for the detection of small vessel disease in asymptom atic sickle cell anemia patients and to compare these findings with clinica l evaluation. In this study, ten neurologically asymptomatic children under went neurologic and neuropsychologic evaluations, MRI, and SPECT utilizing Tc-99m HMPAO. All studies were analyzed independently. Neurologic examinati on revealed minor abnormalities in three patients: motor slowing and mild a praxia in two patients and absent DTRs in one patient. Neuropsychologic def icits were found in six patients: right hemisphere (three patients), bihemi sphere (one patient), fine motor dexterity and motor speed (two patients). MRI revealed abnormalities in four patients manifested as small foci of hyp erintensity on T2-weighted images in the white matter. In contrast, SPECT i maging showed small vessel disease in nine patients. These data indicate th at Tc-99m HMPAO SPECT imaging may be more sensitive in detecting early cere brovascular disease than MRI, neurologic or neuropsychologic evaluation. Fu rther prospective studies are warranted to confirm the significance of thes e findings.