Trends in CT pulmonary angiography utilization and recurrent imaging in sickle cell disease: a longitudinal study

Trends in CT pulmonary angiography utilization and recurrent imaging in sickle cell disease: a longitudinal study

CT angiography, Pulmonary embolism, Sickle cell disease, Ventilation/perfusion scintigraphy, COVID-19,
Bahrain

Abstract
Background Sickle cell disease (SCD) is a common inherited hemoglobinopathy associated with vaso-occlusive
events that can mimic pulmonary embolism (PE), leading to the frequent use of computed tomography pulmonary
angiography (CTPA). However, trends in CTPA utilization over time remain unclear. This study aims to evaluate
temporal trends and recurrent imaging patterns.
Methods A retrospective cohort study was conducted at Salmaniya Medical Complex, Bahrain, including SCD
patients who underwent CTPA for suspected PE between April 15, 2013, and April 15, 2024. Descriptive statistics were
used to report the frequency of recurrent scans, whereas linear regression analysis was employed to assess trends in
CTPA utilization over the study period.
Results The study included 1,084 patients (median age: 35 years, 55.7% male) with SCD who underwent a total of
1,934 CTPA scans. CTPA utilization remained stable from 2014 to 2020, averaging 10.0–13.6 scans per month. However,
a significant surge was observed post-2020, coinciding with the COVID-19 pandemic, peaking in 2023, with an
average of 31.3 scans per month, indicating a 2.9-fold increase (p=0.03). During the study period, 415 patients (38.3%)
underwent recurrent CTPA scans, with one-third (32.5%, n=276) of these scans occurring within a 6-month interval.
Although the PE positivity rate was lower in recurrent scans than in initial scans, the difference was not statistically
significant (8.8% vs. 10.5%; p=0.22).
Conclusions CTPA utilization among SCD patients remained stable for several years but increased significantly after
2020, coinciding with the COVID-19 pandemic. A substantial proportion of scans were recurrent, with many occurring
within a short interval. Moving forward, efforts should focus on mitigating radiation exposure through low-dose
protocols and investigating potential factors contributing to the recent increase in scan utilization.
Keywords CT angiography, Pulmonary embolism, Sickle cell disease, Ventilation/perfusion scintigraphy, COVID-19,
Bahrain

Ali Hassan1* , Najla Alomani1

, Mawaheb Kalalah2

, Nawra Mujbel1

, Zainab Khamdan3

, Murtadha Alobaydun4
,

Mohammed AlAlmai4

, Zuhur Alazmi4

, Abdulelah Musihel4

, Hamad Qabha4

and Jalila Adnan1

https://doi.org/10.1186/s12245-025-00871-x

2025

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