Venous hyperintense signal in arterial spin labeling (ASL) MRI has been associated with abnormal tissue-capillary water exchange in adults with sickle cell anemia (SCA). We tested the hypothesis that such hyperintense signal is associated with reduced oxygen extraction fraction (OEF) in adults with SCA. Higher categorical scores of shunting were associated with lower OEF in SCA participants with silent infarcts and/or white matter lesions but not in participants without lesions. These findings indicate that venous hyperintense signal in ASL images may reflect impaired abilities of blood to subserve oxygen and may contribute to lesion development in SCA patients.
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