Department of Radiology, Salmaniya Medical Complex, Manama, Bahrain.
Emerg Radiol. 2023 Apr;30(2):209-216. doi: 10.1007/s10140-023-02126-9. Epub 2023 Mar 22.
Pulmonary complications are common in sickle cell disease (SCD) and can mimic pulmonary embolisms (PEs), leading to potential overuse of computed tomography pulmonary angiography (CTPA). Maximizing the quality of CTPA is essential for its diagnostic accuracy. However, little is known about the positive rate and quality of CTPA in SCD.
This retrospective case‒control study aimed to determine the positive rate and quality of CTPA studies performed to rule out PE in SCD (HbSS genotype) patients compared to a control group. Logistic regression analysis was used to identify independent factors associated with suboptimal CTPA studies, defined as a mean enhancement of < 210 HU in the pulmonary artery.
The study included 480 patients, consisting of 240 SCD patients and 240 controls. The positive rate of PE was 4.0%, with a similar rate in both SCD patients and the control group (4.2% vs. 3.8%, p = 0.08). However, SCD patients had significantly lower contrast enhancement of the pulmonary artery than the control group (266.1 ± 90.5 HU vs. 342.2 ± 116.1 HU, p < 0.01). Notably, 25.4% of SCD patients had suboptimal scans. The logistic regression model demonstrated that SCD was significantly associated with suboptimal pulmonary arterial contrast enhancement compared to the control group (OR = 4.4; 95% CI: 2.4-8.3).
This study revealed a relatively low positive rate of CTPA in both SCD patients and the control group. However, SCD was significantly associated with suboptimal image quality due to inadequate contrast enhancement of the pulmonary artery. Further research is needed to identify measures that can enhance the quality of CTPA studies in SCD patients and to establish a specific imaging protocol for this patient population.
镰状细胞病（SCD）患者常发生肺部并发症，这些并发症可能与肺栓塞（PE）类似，导致计算机断层肺动脉造影（CTPA）的过度使用。提高 CTPA 的质量对于其诊断准确性至关重要。然而，目前对于 SCD 患者 CTPA 的阳性率和质量知之甚少。
本回顾性病例对照研究旨在确定与对照组相比，用于排除 SCD（HbSS 基因型）患者中 PE 的 CTPA 研究的阳性率和质量。采用逻辑回归分析确定与 CTPA 质量不佳相关的独立因素，定义为肺动脉平均增强值＜210HU。
该研究纳入了 480 名患者，其中包括 240 名 SCD 患者和 240 名对照组。PE 的阳性率为 4.0%，SCD 患者和对照组的阳性率相似（4.2% vs. 3.8%，p=0.08）。然而，SCD 患者的肺动脉对比增强明显低于对照组（266.1±90.5 HU vs. 342.2±116.1 HU，p＜0.01）。值得注意的是，25.4%的 SCD 患者的 CTPA 扫描质量不佳。逻辑回归模型显示，与对照组相比，SCD 与肺动脉对比增强不佳显著相关（OR=4.4；95%CI：2.4-8.3）。
本研究表明，SCD 患者和对照组的 CTPA 阳性率相对较低。然而，SCD 与肺动脉对比增强不佳显著相关，这可能导致图像质量不佳。需要进一步研究以确定提高 SCD 患者 CTPA 质量的措施，并为该患者群体建立特定的影像学方案。
