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CORRESPONDENCE
Year : 2018  |  Volume : 26  |  Issue : 4  |  Page : 227

Reply to comment on sonographic evaluation of abdominal organs in sickle cell disease


1 Department of Medical Radiography, College of Medical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
2 Department of Medical Radiography and Radiological Sciences, University of Nigeria, Enugu Campus, Enugu State, Nigeria

Date of Web Publication14-Dec-2018

Correspondence Address:
Mr. Geofery Luntsi
Department of Medical Radiography, College of Medical Sciences, University of Maiduguri, Maiduguri, Borno State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JMU.JMU_67_18

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How to cite this article:
Luntsi G, Eze CU. Reply to comment on sonographic evaluation of abdominal organs in sickle cell disease. J Med Ultrasound 2018;26:227

How to cite this URL:
Luntsi G, Eze CU. Reply to comment on sonographic evaluation of abdominal organs in sickle cell disease. J Med Ultrasound [serial online] 2018 [cited 2021 Jan 15];26:227. Available from: http://www.jmuonline.org/text.asp?2018/26/4/227/247293

In our study, we reported that “Assessment of abdominal organs such as the liver, gallbladder, spleen, and kidneys by ultrasound among sickle cell disease (SCD) patients revealed varied remarkable changes in these organ sizes, echotexture, intraluminal deposits, and wall thickness among the studied patients. Abdominal sonography is an easy, affordable, readily available, accurate, and noninvasive diagnostic tool for early detection of organ changes for further management and follow-up of SCD patients.”[1]

It is true that without screening for other common diseases such as hepatitis or metabolic disease, the finding might be a result of other confounding disorders. However, in our study, we clearly noted the limitations of our findings that “findings were not specific, as no biopsy or any other imaging modality was used to confirm sonographic findings.[1] Previous studies[2],[3] reported similar findings.

Our discussions in this study were, however, limited to the scope of the study. Further, discussions on the elaborate clinical importance of findings and management of SCD patients were beyond the scope of this study.

Hepatosplenomegaly, which is the result of extramedullary erythropoiesis, is the common finding in sickle cell disease.[4] Nevertheless, the abdomen ultrasonography is found to inferior to magnetic resonance imaging (MRI). Although the previous studies have reported that for the monitoring of iron overload in transfusion dependent cases, MRI is routinely used.[5],[6] This may probably be the case in developed countries, where this equipment is readily available and routinely used for imaging of complications in SCD. Our study reported that ultrasonography as a simple, affordable, and easily accessible imaging modality that plays an important role in early detection of these changes for further management and follow-up of SCD patients.[1] MRI actually provides superior multiplanar imaging and better image resolution which is important in imaging iron overload in transfusion-dependent cases. Previous researchers Rosado et al.[7] reported ultrasound and MRI as the best methods for characterization of muscle and soft-tissue changes. MR techniques offer advantages over traditional methods of determining iron load as they are noninvasive, and therefore, more acceptable to patients, and MRI techniques measure iron load within the target organ rather than relying on a surrogate indicator.[8] Early monitoring and detection can be enhanced by ultrasonography of the liver, spleen, kidneys, and the gallbladder among others. Ultrasonography is a simple, noninvasive, affordable, and easily accessible imaging modality in a resource scare setting like ours where, ignorance, limited exposure to health education and access to healthcare facilities may play a role. Regional variations in organ size and parenchymal echotexture among SCD patients exist in different publications.[1] There is a need to develop models of care appropriate to the management of SCD in sub-Saharan Africa which will be based on constant monitoring, early detection of crises, and early presentation to the specialist treatment centers, among others were recommendations in our study.[1]

The routine use of MRI in monitoring of iron overload in transfusion-dependent cases as discussed by Krittayaphong et al. and Chuansumrit et al.[5],[6] may however, require appropriate calibration and validation for universal acceptability and application of MRI techniques to measure tissue iron concentrations as hematologists no longer need to make subjective decisions about chelation therapy based on the general degree of iron loading inferred from infrequent measures of liver iron concentration (LIC) from liver biopsy and changes in serum ferritin levels over time. Periodic MRI assessments provide quantitative data for the calculation of chelation effectiveness, which allow hematologists to make informed, data-driven, timely decisions about initiation, and adjustment of chelation therapy.[8],[9],[10],[11],[12]

Acknowledgment

We woluld like to appreciate the contributions from all the Staff of Radiology and Haematology Departments of University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Luntsi G, Eze CU, Ahmadu MS, Bukar AA, Ochie K. Sonographic evaluation of some abdominal organs in sickle cell disease patients in a tertiary health institution in Northeastern Nigeria. J Med Ultrasound 2018;26:31-6.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Balci A, Karazincir S, Sangün O, Gali E, Daplan T, Cingiz C, et al. Prevalence of abdominal ultrasonographic abnormalities in patients with sickle cell disease. Diagn Interv Radiol 2008;14:133-7.  Back to cited text no. 2
    
3.
Oguntoye OO, Ndububa DA, Yusuf M, Bolarinwa RA, Ayoola OO. Hepatobiliary ultrasonographic abnormalities in adult patients with sickle cell anaemia in steady state in Ile-Ife, Nigeria. Pol J Radiol 2017;82:1-8.  Back to cited text no. 3
    
4.
Roberts AS, Shetty AS, Mellnick VM, Pickhardt PJ, Bhalla S, Menias CO, et al. Extramedullary haematopoiesis: Radiological imaging features. Clin Radiol 2016;71:807-14.  Back to cited text no. 4
    
5.
Krittayaphong R, Viprakasit V, Saiviroonporn P, Siritanaratkul N, Siripornpitak S, Meekaewkunchorn A, et al. Prevalence and predictors of cardiac and liver iron overload in patients with thalassemia: A multicenter study based on real-world data. Blood Cells Mol Dis 2017;66:24-30.  Back to cited text no. 5
    
6.
Chuansumrit A, Laothamathat J, Sirachainan N, Sungkarat W, Wongwerawattanakoon P, Kumkrua P, et al. Correlation between liver iron concentration determined by magnetic resonance imaging and serum ferritin in adolescents with thalassaemia disease. Paediatr Int Child Health 2016;36:203-8.  Back to cited text no. 6
    
7.
Rosado E, Paixao P, Schmitt W, Penha D, Carvalho FM, Tavares A; Amadora/PT. Sickle Cell Anemia – A Review of the Imaging Findings. C 1227: Educational Exhibit. ECR; 2014.  Back to cited text no. 7
    
8.
Quinn CT, St Pierre TG. MRI measurements of iron load in transfusion-dependent patients: Implementation, challenges, and pitfalls. Pediatr Blood Cancer 2016;63:773-80.  Back to cited text no. 8
    
9.
St Pierre TG, Clark PR, Chua-anusorn W, Fleming AJ, Jeffrey GP, Olynyk JK, et al. Noninvasive measurement and imaging of liver iron concentrations using proton magnetic resonance. Blood 2005;105:855-61.  Back to cited text no. 9
    
10.
Wood JC, Enriquez C, Ghugre N, Tyzka JM, Carson S, Nelson MD, et al. MRI R2 and R2* mapping accurately estimates hepatic iron concentration in transfusion-dependent thalassemia and sickle cell disease patients. Blood 2005;106:1460-5.  Back to cited text no. 10
    
11.
St Pierre TG, Clark PR, Chua-Anusorn W. Single spin-echo proton transverse relaxometry of iron-loaded liver. NMR Biomed 2004;17:446-58.  Back to cited text no. 11
    
12.
Wood JC, Cohen AR, Pressel SL, Aygun B, Imran H, Luchtman-Jones L, et al. Organ iron accumulation in chronically transfused children with sickle cell anaemia: Baseline results from the TWiTCH trial. Br J Haematol 2016;172:122-30.  Back to cited text no. 12
    




 

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