Václavů Lena, Baldew Zelonna A V, Gevers Sanna, Mutsaerts Henri J M M, Fijnvandraat Karin, Cnossen Marjon H, Majoie Charles B, Wood John C, VanBavel Ed, Biemond Bart J, van Ooij Pim, Nederveen Aart J
Radiology & Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Br J Haematol. 2018 Feb;180(3):432-442. doi: 10.1111/bjh.15043. Epub 2017 Dec 21.
Stroke risk in children with sickle cell disease (SCD) is currently assessed with routine transcranial Doppler ultrasound (TCD) measurements of blood velocity in the Circle of Willis (CoW). However, there is currently no biomarker with proven prognostic value in adult patients. Four-dimensional (4D) flow magnetic resonance imaging (MRI) may improve risk profiling based on intracranial haemodynamics. We conducted neurovascular 4D flow MRI and blood sampling in 69 SCD patients [median age 15 years (interquartile range, IQR: 12-50)] and 14 healthy controls [median age 21 years (IQR: 18-43)]. We measured velocity, flow, lumen area and endothelial shear stress (ESS) in the CoW. SCD patients had lower haematocrit and viscosity, and higher velocity, flow and lumen area, with lower ESS compared to healthy controls. We observed significant age-related decline in haemodynamic 4D flow parameters; velocity (Spearman's ρ = -0·36 to -0·61), flow (ρ = -0·26 to -0·52) and ESS (ρ = -0·14 to -0·54) in SCD patients. Further analysis in only adults showed that velocity values were similar in SCD patients compared to healthy controls, but that the additional 4D flow parameters, flow and lumen area, were higher, and ESS lower, in the SCD group. Our data suggest that 4D flow MRI may identify adult patients with an increased stroke risk more accurately than current TCD-based velocity.
目前，镰状细胞病（SCD）患儿的中风风险是通过对 Willis 环（CoW）血流速度进行常规经颅多普勒超声（TCD）测量来评估的。然而，目前在成年患者中尚未有经过验证具有预后价值的生物标志物。四维（4D）血流磁共振成像（MRI）可能会基于颅内血流动力学改善风险评估。我们对 69 例 SCD 患者[中位年龄 15 岁（四分位间距，IQR：12 - 50）]和 14 名健康对照者[中位年龄 21 岁（IQR：18 - 43）]进行了神经血管 4D 血流 MRI 和血液采样。我们测量了 CoW 中的血流速度、血流量、管腔面积和内皮剪切应力（ESS）。与健康对照者相比，SCD 患者的血细胞比容和粘度较低，而血流速度、血流量和管腔面积较高，ESS 较低。我们观察到 SCD 患者血流动力学 4D 血流参数随年龄有显著下降；血流速度（Spearman 相关系数 ρ = -0·36 至 -0·61）、血流量（ρ = -0·26 至 -0·52）和 ESS（ρ = -0·14 至 -0·54）。仅对成年人进行的进一步分析表明，SCD 患者的血流速度值与健康对照者相似，但 SCD 组的另外两个 4D 血流参数，即血流量和管腔面积较高，而 ESS 较低。我们的数据表明，与目前基于 TCD 的血流速度相比，4D 血流 MRI 可能更准确地识别中风风险增加的成年患者。
