Are CT scans of the sinuses before stem cell transplantations necessary among patients with sickle cell disease who underwent MRI?

Abstract

Purpose

The utility of CT scans of the sinuses before stem cell transplantation among patients with sickle cell disease (SCD) is unclear, as there have been conflicting results in the literature. This study aimed to assess whether brain MRI screening is sufficient for evaluating the paranasal sinuses (PNS), thus eliminating the need for CT scans of the sinuses prior to hematopoietic stem cell transplantation (HSCT).

Materials and methods

This was a retrospective study in which we included all adult patients with SCD who were scheduled for HSCT and underwent CT scans of the sinuses and brain MRI within one week. The Lund and Mackay staging systems were used to score sinus mucosal thickening on both CT and MRI, each of which was performed separately and blindly. The agreement between the two modalities was assessed by the intraclass correlation coefficient (ICC).

Results

A total of 119 pre-transplant patients were included. There was excellent agreement between MRI and CT, with an ICC of 0.978 (0.967–0.985 at 95% confidence interval; p < .001). There was also substantial agreement between MRI and CT in the evaluation of sinus calcifications or hyperdense material, with a Cohen kappa value of 0.8 (p < .001).

Conclusion

Brain MRI is probably sufficient for assessing PNS disease in SCD patients before stem cell transplantation. Given its effectiveness in detecting sinus disease and silent infarcts without the added risks of radiation, MRI is the preferred and most resource-efficient imaging approach.