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Impact of MRA Echo Time on Stroke Prevention Therapy in Pediatric Patients with Sickle Cell Disease
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  • Parmpreet Dhillon,
  • Kerry Morrone,
  • Kevin Hsu,
  • William Gomes,
  • Ellen Silver,
  • Daniel Lax,
  • Qi Peng,
  • Seon Kyu Lee,
  • Deepa Manwani,
  • William Mitchell
Parmpreet Dhillon
Montefiore Medical Center

Corresponding Author:parmpreetdhillonmd@gmail.com

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Kerry Morrone
Montefiore Medical Center
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Kevin Hsu
Montefiore Medical Center
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William Gomes
Westchester Medical Center
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Ellen Silver
Yeshiva University Albert Einstein College of Medicine
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Daniel Lax
Montefiore Medical Center
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Qi Peng
Montefiore Medical Center
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Seon Kyu Lee
Montefiore Medical Center
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Deepa Manwani
Montefiore Medical Center
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William Mitchell
Yeshiva University Albert Einstein College of Medicine
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Abstract

Background: Flow artifact, intrinsic to Magnetic Resonance Angiography (MRA), is dependent on technical parameters and can lead to overinterpretation of stenosis. Degree of cerebrovascular stenosis in pediatric patients with sickle cell anemia (SCA) informs need for chronic transfusion therapy, which may have significant risks. 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. Procedure: A standardized MRA scanning protocol with an echo time of <5 msec was implemented at Montefiore Medical Center in May 2016. Retrospective chart review identified 29 patients ≤ 21 years with SCA cerebral vasculopathy and an MRA head pre- and post-May 2016. Level of arterial stenosis on MRA, echo time, and treatment plans were documented both pre- and post-implementation. McNemar analysis determined the significance of change in treatment plans before and after implementation of the standardized scanning protocol. Results: Previously seen stenosis was re-classified to a lower degree in 12/29 patients (41%). Notably, 6 patients had a reclassification of vasculopathy leading to discontinuation of chronic transfusion therapy whereas 0 patients required escalation of therapy to chronic transfusions. McNemar analysis showed this difference to be statistically significant (p = 0.042). Conclusion: Minimizing flow artifact with echo time <5msec improves accurate interpretation of true cerebrovascular disease and ensures appropriate treatment plans are in place for stroke prevention. This is especially important when trying to implement “TCD With Transfusions Changing to Hydroxyurea (TWiTCH)” clinical trial results in the real-world setting.
03 Apr 2022Submission Checks Completed
03 Apr 2022Assigned to Editor
03 Apr 2022Submitted to Pediatric Blood & Cancer
05 Apr 2022Reviewer(s) Assigned
25 Apr 2022Review(s) Completed, Editorial Evaluation Pending
26 Apr 2022Editorial Decision: Revise Major
30 Aug 2022Submission Checks Completed
30 Aug 2022Assigned to Editor
30 Aug 20221st Revision Received
12 Oct 2022Review(s) Completed, Editorial Evaluation Pending
12 Oct 2022Reviewer(s) Assigned
31 Oct 2022Editorial Decision: Accept