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Craniofacial Bone Infarcts in Sickle Cell Disease: Clinical and Radiological Manifestations

Watanabe, Memi MD*; Saito, Naoko MD, PhD*; Nadgir, Rohini N. MD*; Liao, Joseph H. MD*; Flower, Elisa N. MD*; Steinberg, Martin H. MD; Sakai, Osamu MD, PhD*

Journal of Computer Assisted Tomography: January/February 2013 - Volume 37 - Issue 1 - p 91–97
doi: 10.1097/RCT.0b013e3182752967

Objective: To investigate the clinicoradiological manifestations of craniofacial bone infarcts in patients with sickle cell disease (SCD).

Materials and Methods: After institutional review board approval, we identified 85 SCD patients who underwent head and neck magnetic resonance imaging (MRI) during a period of 5 years (January 1, 2004–December 31, 2008) and reviewed their clinical presentations and radiological findings.

Results: Of 40 subjects with headache or facial pain, 6 (5 males, 1 female; age range, 2-22 years; 5 Hb SS, 1 Hb SC) were diagnosed with acute bone infarct by MRI. Of these 6, 4 demonstrated infarcts in the mandible. Magnetic resonance images showed bone marrow edema, subperiosteal fluid collections with susceptibility effects suggesting associated hemorrhage, and heterogeneous enhancement.

Conclusions: Acute craniofacial bone infarcts were found in 7% of SCD patients who underwent MRI and in 15% of SCD patients who presented with pain. The MRI showed characteristic imaging findings including marrow edema, subperiosteal hematoma, and heterogeneous enhancement.

From the *Departments of Radiology, and †Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA.

Received for publication June 11, 2012; accepted September 19, 2012.

Reprints: Memi Watanabe, MD, 3rd Floor FGH Bldg, 820 Harrison Ave, Boston, MA 02118 (e-mail:

The authors report no conflicts of interest.

© 2013 Lippincott Williams & Wilkins, Inc.