Abstract

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.

Key words: Sickle cell disease, SCD, Pulmonary embolism, CTPA, CT pulmonary angiography.