What is the role of CT scanning in the workup of sickle cell disease (SCD)?

Answer

Although CT is not an initial study in most patients, CT scans can show findings of osteonecrosis, including sclerosis, collapse of bone (especially femoral heads), and a bone-within-bone appearance. CT may be useful to demonstrate subtle regions of osteonecrosis not apparent on plain radiographs in patients who are unable to have an MRI.^[23]

Findings of osteomyelitis, including periosteal reaction, cortical or bone destruction, cloacae (sinus tracts), and sequestra or dead bone can be identified on CT scans (see the images below). Bone and soft tissue abscesses are demonstrated on contrast enhanced CT scans as low attenuation fluid collections with peripheral rim enhancement with or without internal gas. CT is not the test of choice for evaluation of acute osteomyelitis.

Skeletal sickle cell anemia. Osteomyelitis. CT scan in a soft tissue window demonstrates a large abscess in the left thigh encircling the femur, with hypoattenuating pus surrounded by a rim of vivid enhancement.

View Media Gallery

Skeletal sickle cell anemia. Osteomyelitis and bone-within-bone. Bone-window CT scan in the same patient as in the previous image shows a bone-within-bone appearance (concentric rings of cortical bone) in the right femur. On the left, a sinus tract (cloaca) traverses the lateral aspect of the femoral cortex, and a small, shardlike sequestrum is present deep to the sinus tract.

View Media Gallery

Did this answer your question?

Yes No

Additional feedback? (Optional)

Thank you for your feedback!

Olujohungbe A, Howard J. The clinical care of adult patients with sickle cell disease. Br J Hosp Med (Lond). 2008 Nov. 69(11):616-9. [Medline].
Johnson L, Carmona-Bayonas A, Tick L. Management of pain due to sickle cell disease. J Pain Palliat Care Pharmacother. 2008. 22(1):51-4. [Medline].
De D. Acute nursing care and management of patients with sickle cell. Br J Nurs. 2008 Jul 10-23. 17(13):818-23. [Medline].
Archer N, Galacteros F, Brugnara C. 2015 Clinical trials update in sickle cell anemia. Am J Hematol. 2015 Oct. 90 (10):934-50. [Medline].
Sachan AA, Lakhkar BN, Lakhkar BB, Sachan S. Is MRI Necessary for Skeletal Evaluation in Sickle Cell Disease. J Clin Diagn Res. 2015 Jun. 9 (6):TC08-12. [Medline].
Kosaraju V, Harwani A, Partovi S, Bhojwani N, Garg V, Ayyappan S, et al. Imaging of musculoskeletal manifestations in sickle cell disease patients. Br J Radiol. 2017 Mar 10. 20160130. [Medline].
Mauriello A, Giacobbi E, Saggini A, Isgrò A, Facchetti S, Anemona L. Histological features of bone marrow in paediatric patients during the asymptomatic phase of early-stage Black African sickle cell anaemia. Pathology. 2017 Apr. 49 (3):297-303. [Medline].
da Silva Junior GB, Daher Ede F, da Rocha FA. Osteoarticular involvement in sickle cell disease. Rev Bras Hematol Hemoter. 2012. 34 (2):156-64. [Medline].
Ganguly A, Boswell W, Aniq H. Musculoskeletal manifestations of sickle cell anaemia: a pictorial review. Anemia. 2011. 2011:794283. [Medline].
Saito N, Nadgir RN, Flower EN, Sakai O. Clinical and radiologic manifestations of sickle cell disease in the head and neck. Radiographics. 2010 Jul-Aug. 30 (4):1021-34. [Medline].
Tuna IS, Tarhan B, Escobar M, Albayram MS. T2-blackout effect on DWI as a sign of early bone infarct and sequestration in a patient with sickle cell disease. Clin Imaging. 2019 Mar - Apr. 54:15-20. [Medline].
Alghamdi A. Recurrent orbital bone sub-periosteal hematoma in sickle cell disease: a case study. BMC Ophthalmol. 2018 Aug 28. 18 (1):211. [Medline].
De Luna G, Ranque B, Courbebaisse M, Ribeil JA, Khimoud D, Dupeux S, et al. High bone mineral density in sickle cell disease: Prevalence and characteristics. Bone. 2018 May. 110:199-203. [Medline].
Vanderhave KL, Perkins CA, Scannell B, Brighton BK. Orthopaedic Manifestations of Sickle Cell Disease. J Am Acad Orthop Surg. 2018 Feb 1. 26 (3):94-101. [Medline].
Soundararajan R, Naswa N, Sharma P, Karunanithi S, Nazar AH, Das KJ, et al. SPECT-CT for characterization of extraosseous uptake of 99mTc-methylene diphosphonate on bone scintigraphy. Diagn Interv Radiol. 2013 Sep-Oct. 19 (5):405-10. [Medline].
Martí-Carvajal AJ, Solà I, Agreda-Pérez LH. Treatment for avascular necrosis of bone in people with sickle cell disease. Cochrane Database Syst Rev. 2014 Jul 10. CD004344. [Medline].
Dahnert W, ed. Radiology Review Manual. 5th ed. Philadelphia: Lippincott, Williams & Wilkins;. 2003: 158-9.
Putman CE, Ravin CE, eds. Textbook of Diagnostic Imaging. 2nd ed. 1361-439.
Pratesi A, Medici A, Bresci R, Micheli A, Barni S, Pratesi C. Sickle cell-related bone marrow complications: the utility of diffusion-weighted magnetic resonance imaging. J Pediatr Hematol Oncol. 2013 May. 35(4):329-30. [Medline].
Elias EJ, Liao JH, Jara H, Watanabe M, Nadgir RN, Sakai Y, et al. Quantitative MRI analysis of craniofacial bone marrow in patients with sickle cell disease. AJNR Am J Neuroradiol. 2013 Mar. 34 (3):622-7. [Medline].
Watanabe M, Saito N, Nadgir RN, Liao JH, Flower EN, Steinberg MH, et al. Craniofacial bone infarcts in sickle cell disease: clinical and radiological manifestations. J Comput Assist Tomogr. 2013 Jan-Feb. 37(1):91-7. [Medline].
Strouse JJ, Lanzkron S, Beach MC, Haywood C, Park H, Witkop C, et al. Hydroxyurea for sickle cell disease: a systematic review for efficacy and toxicity in children. Pediatrics. 2008 Dec. 122(6):1332-42. [Medline].
Linguraru MG, Orandi BJ, Van Uitert RL, Mukherjee N, Summers RM, Gladwin MT, et al. CT and image processing non-invasive indicators of sickle cell secondary pulmonary hypertension. Conf Proc IEEE Eng Med Biol Soc. 2008. 2008:859-62. [Medline].
Cerci SS, Suslu H, Cerci C, Yildiz M, Ozbek FM, Balci TA, et al. Different findings in Tc-99m MDP bone scintigraphy of patients with sickle cell disease: report of three cases. Ann Nucl Med. 2007 Jul. 21(5):311-4. [Medline].
Solav SV, Bhandari R, Solav P. Skeletal scintigraphy manifestations of hematologic disorders. Indian J Nucl Med. 2012 Jan. 27 (1):59-62. [Medline].

Media Gallery

Skeletal sickle cell anemia. H vertebrae. Lateral view of the spine shows angular depression of the central portion of each upper and lower endplate.
Skeletal sickle cell anemia. Hand-foot syndrome. Soft tissue swelling with periosteal new-bone formation and a moth-eaten lytic process at the proximal aspect of the fourth phalanx.
Skeletal sickle cell anemia. Advanced dactylitis. Lytic processes are present at the first and fifth metacarpals, along with periostitis, which is most prominent in the third metacarpal.
Skeletal sickle cell anemia. Expanded medullary cavity. The diploic space is markedly widened due to marrow hyperplasia. Trabeculae are oriented perpendicular to the inner table, giving a hair-on-end appearance.
Skeletal sickle cell anemia. Detailed view of the expanded medullary cavity in the same patient as in the previous image.
Skeletal sickle cell anemia. Osteonecrosis. Image shows flattening of the femoral heads with a mixture of sclerosis and lucency characteristic of osteonecrosis.
Skeletal sickle cell anemia. Osteonecrosis. Detail of the right hip.
Skeletal sickle cell anemia. Osteonecrosis. Detail of the left hip.
Skeletal sickle cell anemia. Bone infarct. Image shows patchy sclerosis of the humeral head and shaft representing multiple prior bone infarcts.
Skeletal sickle cell anemia. Chronic infarcts and secondary osteoarthritis. Image shows advanced changes of irregular sclerosis and lucency on both sides of the knee joint reflecting numerous prior infarcts. The joint surfaces are irregular and the cartilages are narrowed due to secondary osteoarthritis.
Skeletal sickle cell anemia. Bone-within-bone appearance. Following multiple infarctions of the long bones, sclerosis may assume the appearance of a bone within a bone, reflecting the old cortex within the new cortex.
Skeletal sickle cell anemia. Medullary sclerosis. Image shows patchy sclerosis of the proximal tibia due to old infarctions. In other cases, sclerosis may be diffuse rather than patchy.
Skeletal sickle cell anemia. Osteonecrosis. Coronal T1-weighted MRI shows a slightly flattened femoral head with a serpentine margin of low signal intensity around an area of ischemic marrow with signal intensity similar to that of fat.
Skeletal sickle cell anemia. Osteonecrosis in the same patient as in the previous image. Coronal T2-weighted MRI shows a serpentine area of low signal intensity and additional focal areas of abnormal low signal intensity in the femoral head; these findings reflect collapse of bone and sclerosis.
Skeletal sickle cell anemia. Osteomyelitis. CT scan in a soft tissue window demonstrates a large abscess in the left thigh encircling the femur, with hypoattenuating pus surrounded by a rim of vivid enhancement.
Skeletal sickle cell anemia. Osteomyelitis and bone-within-bone. Bone-window CT scan in the same patient as in the previous image shows a bone-within-bone appearance (concentric rings of cortical bone) in the right femur. On the left, a sinus tract (cloaca) traverses the lateral aspect of the femoral cortex, and a small, shardlike sequestrum is present deep to the sinus tract.
Skeletal sickle cell anemia. Bone deformity. Image shows shortening of the second and third metacarpals and phalanges with partial or complete early fusion of the growth plates due to osteonecrosis in infancy. Osteomyelitis is now superimposed the third metacarpal.
Skeletal sickle cell anemia. Radiograph of osteomyelitis shows a lytic process with periostitis and marked soft tissue swelling that is best seen on the lateral view.
Skeletal sickle cell anemia. Osteomyelitis. Coronal T1-weighted MRI shows marrow edema in the shortened third metacarpal, which appears dark. Note the loss of cortex along the radial aspect of the metacarpal.
Skeletal sickle cell anemia. Osteomyelitis in the same patient as in the previous image. On this T2-weighted MRI, the marrow and surrounding tissues are very bright as a result of inflammatory edema.
Skeletal sickle cell anemia. Osteomyelitis in the same patient as in the previous image. Axial T2-weighted MRI again shows the marrow edema and surrounding subperiosteal pus collection, with a thin, dark rim representing the periosteal membrane. There is diffuse bright signal intensity in the soft tissues; this represents inflammation and edema.
Skeletal sickle cell anemia. Bone infarction in an infant (see also next image). Image shows a curvilinear area of sclerosis with central lucency in the metaphysis of the femur representing a bone infarct.
Skeletal sickle cell anemia. Bone scan of bone infarct shows an area of increased uptake in the distal femoral metaphysis corresponding to the infarct demonstrated on the previous plain radiograph.

of 23

Author

Ivan Ramirez, MD Radiologist, CMI Radiology Group

Ivan Ramirez, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Radiology, Radiological Society of North America

Disclosure: Nothing to disclose.

Coauthor(s)

Welansa Asrat, MD Staff Physician, Departments of Medicine and Pediatrics, Saint Vincent's Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Bernard D Coombs, MB, ChB, PhD Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand

Disclosure: Nothing to disclose.

William R Reinus, MD, MBA, FACR Professor of Radiology, Temple University School of Medicine; Chief of Musculoskeletal and Trauma Radiology, Vice Chair, Department of Radiology, Temple University Hospital

William R Reinus, MD, MBA, FACR is a member of the following medical societies: Alpha Omega Alpha, Sigma Xi, American College of Radiology, American Roentgen Ray Society, Radiological Society of North America

Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, MBA, MEd Professor, Department of Radiology, Vice Chairman for Academic Innovation, Section Head of Musculoskeletal Radiology, University of Washington School of Medicine

Felix S Chew, MD, MBA, MEd is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North America

Disclosure: Nothing to disclose.

Additional Contributors

Henrique M Lederman, MD, PhD Professor of Radiology and Pediatric Radiology, Chief, Division of Diagnostic Imaging in Pediatrics, Federal University of Sao Paulo, Brazil

Henrique M Lederman, MD, PhD is a member of the following medical societies: Society for Pediatric Radiology

Disclosure: Nothing to disclose.

Acknowledgements

Dvorah Balsam, MD Chief, Division of Pediatric Radiology, Nassau University Medical Center; Professor, Department of Clinical Radiology, State University of New York at Stony Brook

Disclosure: Nothing to disclose.

Mark HJ Choi, MD Fellow in Musculoskeletal Radiology, Department of Radiology, University of Pennsylvania School of Medicine

Mark HJ Choi, MD is a member of the following medical societies: American College of Radiology

Disclosure: Nothing to disclose.

What is the role of CT scanning in the workup of sickle cell disease (SCD)?

Answer

Related Questions:

References

Tables

Contributor Information and Disclosures