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Quantitative Assessment of CT Pulmonary Angiogram (CTPA) in SCD Patients in Comparison to non-SCD Cases in Saudi
Dunya Alfaraj1, Hussain Alkhawaja2, Mohannad Alghamdi1
1Department of Emergency, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia.
Insights
Sickle cell disease (SCD) patients showed no difference in pulmonary embolism diagnosis rates via CT pulmonary angiography (CTPA). However, lower main pulmonary artery enhancement in SCD patients suggests reduced CTPA sensitivity for PE detection.
Area of Science:
- Radiology
- Cardiovascular Imaging
- Pulmonary Medicine
Background:
- Sickle cell disease (SCD) is a genetic blood disorder with widespread systemic complications.
- SCD is most prevalent in specific global regions, including sub-Saharan Africa, the Mediterranean, and the Middle East.
- Saudi Arabia exhibits considerable variation in SCD prevalence and disease severity across its provinces.
Purpose of the Study:
- To compare CT pulmonary angiography (CTPA) quality and pulmonary embolism (PE) detection rates between SCD and non-SCD patients.
- To investigate potential discrepancies in CTPA sensitivity and clinical outcomes for PE diagnosis in SCD patients.
- To evaluate the impact of SCD on the diagnostic accuracy of CTPA for PE.
Main Methods:
- A retrospective study compared 60 adult SCD patients with 60 age-matched non-SCD controls.
- All participants were evaluated for suspected PE using multi-detector CT (MDCT) scanner in the emergency department.
- Data on demographics, clinical information, and CT findings were extracted from electronic health records.
Main Results:
- The rate of positive CTPA for PE was similar between SCD (13.3%) and non-SCD (18.3%) patients (p=0.453).
- SCD patients had significantly lower contrast enhancement in the main pulmonary artery (249.9 HU vs. 283.7 HU; p=0.043).
- Hemoglobin levels were significantly lower in SCD patients (p<0.001).
Conclusions:
- CTPA demonstrated no significant difference in positive PE detection rates between SCD and non-SCD patients.
- Reduced main pulmonary artery enhancement in SCD patients suggests potentially lower CT angiography sensitivity for PE detection.
- Protocol optimization for individualized CTPA protocols is recommended to improve enhancement quality and diagnostic certainty in SCD patients.
Background:
Sickle cell disease (SCD) is a genetic disorder caused by a mutation in the β-globin gene, leading to systemic complications, including stroke, avascular necrosis, and acute chest syndrome. The disease is most prevalent in regions such as sub-Saharan Africa, the Mediterranean, and the Middle East, with Saudi Arabia showing significant variability in prevalence and severity across its provinces.
Objectives:
This study focuses on comparing the quality of CT pulmonary angiography (CTPA) and the rates of pulmonary embolism (PE) diagnosis between SCD and non-SCD patients, addressing discrepancies in detection sensitivity and clinical outcomes.
Methods:
We conducted a retrospective comparison between 60 adult SCD patients and 60 age-matched controls, all of whom were evaluated for suspected PE in our emergency department using an MDCT scanner. Data, including demographic and clinical information, as well as CT findings, were extracted from electronic health records.
Results:
In SCD patients, the rate of positive CT pulmonary angiograms was 13.3% (8/60), while in non-SCD matched controls, it was 18.3% (11/60). There was no significant difference in the rate of positive CTPA studies (p=0.453). SCD patients exhibited significantly lower enhancement in the main pulmonary artery (PA) (mean 249.9 HU) compared to control subjects (mean 283.7 HU) (p-value= 0.043). Moreover, hemoglobin levels were notably lower in SCD patients (p-value < 0.001).
Conclusion:
SCD patients demonstrated no significant difference in the rate of positive studies for acute PE when compared with controls undergoing CTPA. Furthermore, the lower main PA enhancement in SCD patients supports the hypothesis suggesting reduced sensitivity of CT angiography in detecting PE in this population. Quality improvement initiatives should concentrate on individualized protocol optimization to enhance enhancement quality and increase the likelihood of a definitive diagnosis.
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