Comparative sonographic assessment of spleen dimensions and quantitative parenchymal echotexture in children with sickle cell disease at a Tertiary Hospital in Nigeria

Abstract

Sickle cell disease (SCD) causes progressive splenic injury due to recurrent vaso-occlusion and infarction, leading to functional asplenia. In African children’s population, comprehensive sonographic assessments combining spleen biometry with objective echotexture analysis remain underexplored. Objective: The study compared spleen linear dimensions, calculated volume, and
quantitative parenchymal echotexture between children with SCD in steady state and age/sex matched healthy controls. Methodology: This hospital-based cross-sectional comparative study included 45 children with SCD (HbSS) and 45 healthy controls (HbAA), aged 1-14 years. Spleen length, width, and height were measured sonographically, and volume was calculated using the prolate ellipsoid formula. Parenchymal echotexture was quantified as Mean Pixel Intensity (MPI) using a validated in-house MATLAB algorithm applied to standardised regions of interest. Group comparisons were performed using independent samples t-test and Mann-Whitney U test as appropriate. Results: Children with SCD had significantly smaller spleens than controls in terms of length (6.6 ± 1.4 cm and 7.2 ± 1.4 cm, p=0.03), width (3.3 ± 0.7 cm and 4.5 ± 0.9 cm, p<0.001), and volume (70.9 ± 47.1 cm³ and 100.1 ± 55.7 cm³, p=0.008), while splenic height showed no significant difference (p=0.98). Mean Pixel Intensity was significantly higher in the SCD group (63.47 ± 14.67 and 30.9 ± 12.9, p=0.002), indicating markedly increased parenchymal echotexture. Conclusion: Children with SCD demonstrate significant splenic regression and objectively increased parenchymal echogenicity compared with healthy controls. The integration of standard sonographic biometry with quantitative echotexture analysis provides a more comprehensive and objective
approach for evaluating splenic involvement in children with SCD.