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Brain positron emission tomography in splenectomized adults with β-thalassemia intermedia: uncovering yet another covert abnormality

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Abstract

Covert brain infarction is an emerging concern in patients with β-thalassemia intermedia (TI). We have recently observed a high prevalence (60%) of silent brain infarction on brain magnetic resonance imaging (MRI) in 30 splenectomized adults with TI. In this work, we further evaluate cerebral involvement in the same 30 patients using fluorodeoxyglucose positron emission tomography–computed tomography (PET-CT) scanning. The median age was 32 years (range, 18–54 years) with a male to female ratio of 13:17. Nineteen patients (63.3%) had evidence of decreased neuronal function on PET-CT. Involvement was mostly left sided, multiple, and most commonly in the temporal and parietal lobes. Elevated liver iron concentration, beyond 15 mg Fe/g dry weight, characterized patients with decreased neuronal function. The concordance rate between brain MRI and PET-CT for the detection of brain abnormality was only 36.7% (Kappa 0.056, P = 0.757), highlighting that both modalities reveal different types of brain pathology. Decreased neuronal function is a common finding in patients with TI and is associated with iron overload. Moreover, the addition of PET-CT to MRI identifies a greater proportion of TI patients with silent neuroimaging abnormalities.

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Funding source

This study was supported by an unrestricted grant from Novartis Pharmaceuticals.

Conflicts of interest

ATT is a member of Novartis Speakers' Bureau.

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Authors and Affiliations

  1. Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad El-Solh, 1107 2020, Beirut, Lebanon

    Khaled M. Musallam, Ahmed Hankir & Ali T. Taher

  2. Division of Neurology, Rafik Hariri University Hospital, Beirut, Lebanon

    Wassim Nasreddine

  3. Division of Neurology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon

    Ahmad Beydoun

  4. Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon

    Roula Hourani

  5. Chronic Care Center, Hazmieh, Lebanon

    Suzanne Koussa

  6. Department of Nuclear Medicine and PET Center, Mount Lebanon Hospital, Beirut, Lebanon

    Mohamad Haidar

Authors
  1. Khaled M. Musallam
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  2. Wassim Nasreddine
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  3. Ahmad Beydoun
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  4. Roula Hourani
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  5. Ahmed Hankir
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  8. Ali T. Taher
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Corresponding author

Correspondence to Ali T. Taher.

Additional information

Khaled M. Musallam and Wassim Nasreddine contributed equally as first authors.

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Musallam, K.M., Nasreddine, W., Beydoun, A. et al. Brain positron emission tomography in splenectomized adults with β-thalassemia intermedia: uncovering yet another covert abnormality. Ann Hematol 91, 235–241 (2012). https://doi.org/10.1007/s00277-011-1291-3

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  • DOI: https://doi.org/10.1007/s00277-011-1291-3

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