Imaging of cerebrovascular disease in sickle cell anemia.

Cerebral vascular disease is a common and serious complication of sickle ce ll disease that mainly involves the large blood vessels of the skull base. Because recurrences are common and residual deficits severe, attention has turned to detection of preclinical cerebral involvement with the goal of pr eventing clinical damage, Magnetic resonance imaging (MRI), an extremely se nsitive tool for detecting cerebral infarction/ischemia, has shown that 10% of asymptomatic patients exhibit white matter lesions that seem to be asso ciated with impaired cognitive function and may be predictive of stroke; ma gnetic resonance angiography demonstrates occlusions of skull base arteries but is not reliable for the diagnosis of stenosis because of artifacts gen erated by rapid turbulent flow. Transcranial Doppler is sensitive and speci fic for the detection of arterial stenosis and occlusion, even in asymptoma tic patients. Digitized cerebral angiography remains the gold standard inve stigation for pretreatment confirmation of lesions detected by Doppler and/ or MRI.