Abstract：
BACKGROUND: Sickle cell disease (SCD) is a genetic hematological disorder associated with severe complications, such as vaso-occlusive crises, acute chest syndrome (ACS), and an increased risk of thromboembolic events, including pulmonary embolism (PE). The diagnosis of PE in SCD patients presents challenges due to the overlapping symptoms with other pulmonary conditions. Our previous study revealed that nearly 96% of computed tomography pulmonary angiography (CTPA) scans in SCD patients were negative for PE, highlighting a gap in understanding the significance of CTPA findings when PE is absent.
METHODS: In this retrospective follow-up study conducted at the Salmaniya Medical Complex in Bahrain, we examined SCD patients with HbSS genotypes who underwent CTPA from January 1, 2018, to December 31, 2021, for suspected PE, but the results were negative. The aim of this study was to identify alternative diagnoses and incidental findings from CTPA scans. Experienced radiologists reviewed the CTPA images and reports to assess potential alternative diagnoses and incidental findings, incorporating an additional analysis of chest X-rays to evaluate the diagnostic value of CTPA. Incidental findings were classified based on their location and clinical significance.
RESULTS: Among the 230 evaluated SCD patients (average age 39.7 years; 53% male) who were CTPA negative for PE, 142 (61.7%) had identifiable alternative diagnoses, primarily pneumonia (49.1%). Notably, 88.0% of these alternative diagnoses had been previously suggested by chest radiographs. Furthermore, incidental findings were noted in 164 (71.3%) patients, with 11.0% deemed clinically significant, necessitating immediate action, and 87.8% considered potentially significant, requiring further assessment. Notable incidental findings included thoracic abnormalities such as cardiomegaly (12.2%) and an enlarged pulmonary artery (11.3%), as well as upper abdominal pathologies such as hepatomegaly (19.6%), splenomegaly (20.9%), and gallstones (10.4%).
CONCLUSIONS: This study underscores the limited additional diagnostic yield of CTPA for identifying alternative diagnoses to PE in SCD patients, with the majority of diagnoses, such as pneumonia, already suggested by chest radiographs. The frequent incidental findings, most of which necessitate further evaluation, highlight the need for a cautious and tailored approach to using CTPA in the SCD population.
METHODS: In this retrospective follow-up study conducted at the Salmaniya Medical Complex in Bahrain, we examined SCD patients with HbSS genotypes who underwent CTPA from January 1, 2018, to December 31, 2021, for suspected PE, but the results were negative. The aim of this study was to identify alternative diagnoses and incidental findings from CTPA scans. Experienced radiologists reviewed the CTPA images and reports to assess potential alternative diagnoses and incidental findings, incorporating an additional analysis of chest X-rays to evaluate the diagnostic value of CTPA. Incidental findings were classified based on their location and clinical significance.
RESULTS: Among the 230 evaluated SCD patients (average age 39.7 years; 53% male) who were CTPA negative for PE, 142 (61.7%) had identifiable alternative diagnoses, primarily pneumonia (49.1%). Notably, 88.0% of these alternative diagnoses had been previously suggested by chest radiographs. Furthermore, incidental findings were noted in 164 (71.3%) patients, with 11.0% deemed clinically significant, necessitating immediate action, and 87.8% considered potentially significant, requiring further assessment. Notable incidental findings included thoracic abnormalities such as cardiomegaly (12.2%) and an enlarged pulmonary artery (11.3%), as well as upper abdominal pathologies such as hepatomegaly (19.6%), splenomegaly (20.9%), and gallstones (10.4%).
CONCLUSIONS: This study underscores the limited additional diagnostic yield of CTPA for identifying alternative diagnoses to PE in SCD patients, with the majority of diagnoses, such as pneumonia, already suggested by chest radiographs. The frequent incidental findings, most of which necessitate further evaluation, highlight the need for a cautious and tailored approach to using CTPA in the SCD population.
摘要：
背景：镰状细胞病（SCD）是一种与严重并发症相关的遗传性血液病，如血管闭塞危象,急性胸部综合征（ACS），血栓栓塞事件的风险增加，包括肺栓塞（PE）。由于与其他肺部疾病的症状重叠，SCD患者的PE诊断面临挑战。我们先前的研究显示，在SCD患者中，近96％的计算机断层扫描肺动脉造影（CTPA）扫描为PE阴性，突出了当PE不存在时，在理解CTPA结果的重要性方面存在差距。
方法：在巴林Salmaniya医疗中心进行的这项回顾性随访研究中，我们检查了2018年1月1日至2021年12月31日接受CTPA的HbSS基因型SCD患者的可疑PE，但是结果是阴性的。这项研究的目的是确定CTPA扫描的替代诊断和偶然发现。有经验的放射科医生审查了CTPA图像和报告，以评估潜在的替代诊断和偶然发现。结合胸部X线的额外分析，以评估CTPA的诊断价值。偶然发现根据其位置和临床意义进行分类。
结果：在230名评估的SCD患者（平均年龄39.7岁；53%为男性）中，142（61.7%）有可识别的替代诊断，主要是肺炎(49.1%)。值得注意的是,这些替代诊断中有88.0％以前是由胸部X光片建议的。此外，在164例(71.3%)患者中发现了偶然的发现，11.0%被认为具有临床意义，必须立即采取行动，87.8%被认为具有潜在意义，需要进一步评估。值得注意的偶然发现包括胸部异常，如心脏扩大（12.2%）和肺动脉扩大（11.3%），以及肝肿大等上腹部病变（19.6%），脾肿大（20.9%），和胆结石(10.4%)。
结论：本研究强调了CTPA在确定SCD患者PE替代诊断方面的额外诊断产量有限，在大多数诊断中，比如肺炎,胸部X光片已经暗示了。常见的偶然发现，其中大多数需要进一步评估，强调在SCD人群中使用CTPA需要谨慎和量身定制的方法。
方法：在巴林Salmaniya医疗中心进行的这项回顾性随访研究中，我们检查了2018年1月1日至2021年12月31日接受CTPA的HbSS基因型SCD患者的可疑PE，但是结果是阴性的。这项研究的目的是确定CTPA扫描的替代诊断和偶然发现。有经验的放射科医生审查了CTPA图像和报告，以评估潜在的替代诊断和偶然发现。结合胸部X线的额外分析，以评估CTPA的诊断价值。偶然发现根据其位置和临床意义进行分类。
结果：在230名评估的SCD患者（平均年龄39.7岁；53%为男性）中，142（61.7%）有可识别的替代诊断，主要是肺炎(49.1%)。值得注意的是,这些替代诊断中有88.0％以前是由胸部X光片建议的。此外，在164例(71.3%)患者中发现了偶然的发现，11.0%被认为具有临床意义，必须立即采取行动，87.8%被认为具有潜在意义，需要进一步评估。值得注意的偶然发现包括胸部异常，如心脏扩大（12.2%）和肺动脉扩大（11.3%），以及肝肿大等上腹部病变（19.6%），脾肿大（20.9%），和胆结石(10.4%)。
结论：本研究强调了CTPA在确定SCD患者PE替代诊断方面的额外诊断产量有限，在大多数诊断中，比如肺炎,胸部X光片已经暗示了。常见的偶然发现，其中大多数需要进一步评估，强调在SCD人群中使用CTPA需要谨慎和量身定制的方法。
