High cervical arterial flow velocity may cause rapid erythrocyte transit through cerebral capillaries resulting in arteriovenous shunting, which may present as hyperintensities in pseudo-continuous arterial spin labeling (pCASL) MR difference images in draining veins. In an analysis of 36 adults with sickle cell anemia (SCA) and 11 age-matched controls, hyperintense superior sagittal sinus pCASL signal was present in 9% of controls and 61% of patients and correlated with elevated flow velocities. This shunting effect also trended with other markers of hemo-metabolic impairment in patients, such as elevated oxygen extraction fraction, elevated cerebral blood flow, and decreased blood hematocrit.
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