In this issue of Blood, Helton et al highlight the neuroradiological findings of children enrolled in the Strokes With Transfusions Changing to Hydroxyurea (SWiTCH) trial. This study, which screened 161 children with sickle cell anemia (SCA) receiving chronic transfusion therapy for prevention of recurrent strokes, is the largest SCA cohort followed prospectively with magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) published to date, giving additional insights into the relationships between strokes and cerebral vasculopathy in SCA.