Enhancing diagnostic precision for acute chest syndrome in sickle cell disease: insights from dual-energy CT lung perfusion mapping

Jordan H. Chamberlin, Alexis Ogbonna, Sameer Abrol, Dhruw Maisuria, Emily Miller, Aaron McGuire, Heather Knight, Jim O’Doherty, Dhiraj Baruah, U. Joseph Schoepf, Reginald F. Munden, Ismail M. Kabakus

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

PURPOSE: Acute chest syndrome (ACS) is secondary to occlusion of the pulmonary vasculature and a potentially life-threatening complication of sickle cell disease (SCD). Dual-energy CT (DECT) iodine perfusion map reconstructions can provide a method to visualize and quantify the extent of pulmonary microthrombi.

METHODS: A total of 102 patients with sickle cell disease who underwent DECT CTPA with perfusion were retrospectively identified. The presence or absence of airspace opacities, segmental perfusion defects, and acute or chronic pulmonary emboli was noted. The number of segmental perfusion defects between patients with and without acute chest syndrome was compared. Sub-analyses were performed to investigate robustness.

RESULTS: Of the 102 patients, 68 were clinically determined to not have ACS and 34 were determined to have ACS by clinical criteria. Of the patients with ACS, 82.4% were found to have perfusion defects with a median of 2 perfusion defects per patient. The presence of any or new perfusion defects was significantly associated with the diagnosis of ACS (P = 0.005 and < 0.001, respectively). Excluding patients with pulmonary embolism, 79% of patients with ACS had old or new perfusion defects, and the specificity for new perfusion defects was 87%, higher than consolidation/ground glass opacities (80%).

CONCLUSION: DECT iodine map has the capability to depict microthrombi as perfusion defects. The presence of segmental perfusion defects on dual-energy CT maps was found to be associated with ACS with potential for improved specificity and reclassification.

Original languageEnglish (US)
Article number31
Pages (from-to)73-82
Number of pages10
JournalEmergency Radiology
Volume31
Issue number1
DOIs
StatePublished - Feb 2024

Keywords

  • Acute chest syndrome
  • Dual-energy computed tomography
  • Perfusion mapping
  • Pulmonary embolism
  • Sickle cell disease
  • Angiography/methods
  • Reproducibility of Results
  • Anemia, Sickle Cell/complications
  • Tomography, X-Ray Computed/methods
  • Humans
  • Lung
  • Acute Chest Syndrome/diagnostic imaging
  • Perfusion
  • Retrospective Studies
  • Pulmonary Embolism/diagnostic imaging
  • Iodine

ASJC Scopus subject areas

  • Emergency Medicine
  • Radiology Nuclear Medicine and imaging

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