Recent advancements in imaging have significantly improved the diagnosis and management of abdominal complications in sickle cell disease (SCD). A multimodal strategy that integrates ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) offers clinicians a powerful framework to assess the full spectrum of abdominal manifestations associated with SCD.
Ultrasound remains the frontline modality for initial evaluation, particularly effective in detecting hepatobiliary complications such as cholelithiasis, hepatic sequestration, and splenic infarction. Ultrasound’s ability to capture real-time vascular flow and organomegaly makes it invaluable for early detection and triage, especially in pediatric and emergency settings.
CT, meanwhile, excels in acute care scenarios where speed and resolution are paramount. It is especially useful for identifying bowel ischemia, infarction, and abscesses. The American Journal of Roentgenology emphasizes CT’s diagnostic role in detecting hallmark signs such as bowel wall thickening or the “target sign” of ischemic colitis during vaso-occlusive episodes. These detailed anatomical images allow for rapid clinical decisions when abdominal crises escalate.
MRI rounds out the triad by offering superior soft tissue contrast and sensitivity to ischemic changes, particularly through diffusion-weighted imaging (DWI). Radiographics highlights MRI’s utility in chronic monitoring, including evaluation of iron overload in the liver and spleen using T2-weighted sequences. This makes MRI a critical tool not just for acute diagnosis but also for long-term disease management.
The integration of these three modalities—ultrasound for initial screening, CT for acute pathology, and MRI for ischemic and chronic changes—creates a diagnostic ecosystem that addresses both the urgency and complexity of SCD-related abdominal disease, as abdominal symptoms in SCD can arise from multifactorial processes including infarction, sequestration, and infection.
This synthesis of imaging approaches underscores a growing clinical imperative: to move beyond single-modality diagnostics and embrace an integrated framework that maximizes each tool’s strengths. When used cohesively, ultrasound, CT, and MRI not only enhance diagnostic precision but also facilitate earlier interventions, ultimately improving outcomes for patients with this complex hematologic condition.