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Implementation of the STOP Protocol for Stroke Prevention in Sickle Cell Anemia by Using Duplex Power Doppler Imaging¹

¹ From the Departments of Radiology (A.J.M., J.E.H.T., M.C.D., G.S.D.) and Pediatrics (R.V.I., M.G.S.), University of Mississippi Medical Center, Jackson. From the 1999 RSNA scientific assembly. Received March 29, 2000; revision requested May 10; revision received July 14; accepted August 2. Address correspondence to A.J.M., 226 Oakwood Ct, Winston-Salem, NC 27103 (e-mail: abemalouf@yahoo.com).

PURPOSE: To compare the results of the nonduplex ultrasonography (US) Stroke Prevention Trial in Sickle Cell Anemia (STOP) with those of transcranial duplex power Doppler US by using the STOP protocol and to correlate abnormal transcranial Doppler findings with magnetic resonance (MR) imaging and MR angiographic findings.

MATERIALS AND METHODS: One hundred twenty-five asymptomatic patients aged 2–16 years with sickle cell anemia or sickle cell-ß thalassemia were examined by using transcranial duplex power Doppler US with a 2.5-MHz transducer and classified according to STOP criteria. The results were compared with those obtained in the nonduplex STOP study. Eight of 10 patients with abnormal results, as well as one who had normal results and a subsequent stroke, were examined with MR imaging and MR angiography.

RESULTS: Ten (8.0%) patients were judged to have abnormal findings by using the duplex Doppler US and STOP criteria compared with 9.4% of patients in the nonduplex US STOP study. Of the eight patients with abnormal transcranial Doppler US results who underwent MR imaging and MR angiography, six had abnormal MR imaging findings and all eight had abnormal MR angiographic findings.

CONCLUSION: The STOP protocol can be reproduced by using duplex power Doppler US. Abnormal results with the STOP criteria strongly suggest vascular abnormality.

Index terms: Brain, infarction, 13.4352, 13.78 • Cerebral blood vessels, US, 178.12984, 178.12989 • Sickle cell disease (SS, SC), 13.651, 13.652 • Ultrasound (US), power Doppler studies, 178.12984, 178.12989

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