Neuroimaging and Neurocognitive Markers of Brain Injury in Young Children with Sickle Cell Disease

项目概要/摘要 镰状细胞病（SCD）是一种遗传性血液病，具有几种神经和发育障碍。 并发症特别是2至5岁的SCD幼儿， 缺血性中风和无症状性脑梗塞（SCI）。SCI是高信号T2脑磁共振 无伴随急性神经系统症状但伴有相关损害的MRI病变 认知和未来进行性或额外卒中/SCI的风险增加。神经成像和神经认知 与SCI相关的特征在学龄和成人SCD人群中已得到很好的确立。该信息 由于MRI的镇静/麻醉风险，在6岁以下患有SCD的幼儿中基本未知。 我们的初步研究表明，行为训练可以产生高质量的神经成像数据， 通过初步研究，对3至4岁SCD儿童进行镇静。 本申请的长期目标是开发一种使用以下组合的诊断电池： 非镇静神经成像测量、神经认知测试和血浆脑损伤蛋白水平，以确定 患有SCD的幼儿有发生SCI的风险。通过前瞻性纵向病例对照研究，我们将收集 病史和临床数据，每年进行神经系统检查和抽血， 从研究入组到研究退出的SCD儿童。参与者还将在3点接受初始神经影像学检查 至4岁，在研究退出时重复神经影像学检查以及在研究时进行纵向神经认知测试 入路、初始神经成像和出路神经成像。这一多学科、多模式的建议 有两个目标。目标1将确定3至4年内的横断面神经影像学和神经认知结果- 通过将患有SCD和SCI的老年儿童的结果与患有SCD而没有SCI的儿童的结果进行比较，目的 2将比较6岁儿童与非SCI儿童在MRI检查中的纵向数据。探索性目标 将探讨不同疾病改善治疗的儿童神经影像学指标的差异 （羟基脲）和血浆蛋白水平在儿童与非SCI。拟议的工作将决定 哪些神经影像学测量和神经认知测试可以预测SCI，这导致了一项多地点研究， 在更大的区域异质性SCD人群中验证这些发现。研究PI，a 神经发育医生，是一名早期研究者，非常适合扩展她现有的研究队列 在一组合作调查人员的支持下，包括一名高级行为心理学家和神经成像专家。 物理学家，以及现有的合作者和工作人员。

Project Summary/Abstract Sickle cell disease (SCD) is an inherited blood disorder with several neurological and developmental complications. Young children with SCD between 2 and 5 years of age, in particular, have an increased risk for ischemic stroke and silent cerebral infarctions (SCI). SCI are hyperintense T2 brain magnetic resonance imaging (MRI) lesions with no accompanying acute neurological symptoms but with associated impaired cognition and increased risk of future progressive or additional stroke/SCI. Neuroimaging and neurocognitive profiles associated with SCI are well established in school-aged and adult SCD populations. This information is largely unknown in young children under 6 years of age with SCD due to risk of sedation/anesthesia with MRI. Our preliminary studies have shown that behavioral training can yield high quality neuroimaging data without sedation in 3 to 4 years old children with SCD through a pilot study. The long term goal of this application is to develop a diagnostic battery using a combination of unsedated neuroimaging measures, neurocognitive testing, and plasma brain injury protein levels to identify young children with SCD at risk for SCI. Through a prospective longitudinal case-control study, we will collect medical history and clinical data and perform neurological examination and blood draws annually in 100 children with SCD from study entry to study exit. Participants will also undergo initial neuroimaging battery at 3 to 4 years of age with repeat neuroimaging at study exit as well as longitudinal neurocognitive testing at study entry, with initial neuroimaging, and with exit neuroimaging. This multi-disciplinary and multi-modality proposal has two Aims. Aim 1 will identify the cross-sectional neuroimaging and neurocognitive findings in 3 to 4 year- old children with SCD and SCI on initial MRI by comparing their results to children with SCD without SCI. Aim 2 will compare longitudinal data from 6 year-old children with and without SCI on exit MRI. Exploratory aims will explore differences in the neuroimaging measures in children on different disease-modifying treatments (hydroxyurea) and plasma protein levels in children with and without SCI. The proposed work will determine which neuroimaging measures and neurocognitive testing may predict SCI, leading to a multi-site study to validate these findings in a larger regionally heterogenous SCD population. The study PI, a neurodevelopmental physician, is an early stage investigator well suited to expand her existing study cohort with support from a team of co-investigators, including a senior behavioral psychologist and neuroimaging physicist, as well as existing collaborators and staff.