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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.

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