Multimodal imaging features to diagnose abdominal complications of sickle cell disease

Sickle cell disease (SCD) is a hereditary hemoglobinopathy, marked by chronic hemolysis and recurrent vaso-occlusive crises, which frequently leads to a wide range of abdominal complications. Sickled erythrocytes have reduced deformability and increased adhesion to vessel walls, leading to chronic vascular occlusion, inflammation, and hemolysis. Comprehensive imaging plays a pivotal role in the early detection and assessment of these complications, thereby mitigating morbidity and severe outcomes. Ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) are the three modalities commonly used on SCD patients to evaluate hepatosplenic involvement, renal pathology, pancreatobiliary disorders, gastrointestinal ischemia, extramedullary hematopoiesis, and genital abnormalities. The US is a first-line imaging tool due to its accessibility and low cost. CT offers high-resolution, cross-sectional imaging and is often utilized in emergency settings. MRI, with its superior soft tissue contrast, is excellent for problem-solving. A thorough understanding of the abdominal manifestations of SCD is essential for radiologists to provide accurate diagnoses, guide clinical decision-making, and reduce morbidity and mortality. This review highlights the most significant imaging findings from SCD abdominal complications, emphasizing their clinical implications, underlying pathophysiology, and radiological features in all three modalities.