Magnetic Resonance Imaging of Musculoskeletal Manifestations in Sickle Cell Disease

<b>Background</b>: Sickle cell disease (SCD) affects more than 100,000 people in the United States and 8 million people worldwide, with high morbidity and mortality and musculoskeletal (MSK) complications that contribute to functional disability. However, MRI-based characterization of musculoskeletal manifestations remains limited in high-prevalence regions, including the Middle East. This study aimed to review MRI findings of MSK manifestations in SCD patients and assess associations with clinical characteristics. <b>Methods</b>: A retrospective study was conducted on 96 patients with SCD who underwent MSK MRI between 2012 and 2022 at King Abdulaziz University Hospital. Patient demographics, clinical characteristics, and imaging findings were reviewed. The prevalence and distribution of MSK complications were analyzed across age, gender, and BMI categories. <b>Results</b>: Of the 96 patients (47% males; 53% females; mean age 28.9 years), the hip was the most frequently scanned region (46%), followed by the leg, femur, shoulder, and knee. Bone infarction was the most common complication, observed in 57 patients (59.3%), and was more prevalent among older adults. Osteomyelitis was identified in 16 patients (16.7%), with higher rates in children and underweight individuals. Decreased bone marrow signal intensity was seen in 11 patients (11.4%), particularly in older age groups. Other findings and unremarkable scans each accounted for 6 cases (6.3%). Gender analysis showed broadly similar patterns, although decreased marrow signal intensity was more common in females. <b>Conclusions</b>: MRI is an effective imaging modality for detecting and differentiating MSK complications in SCD. Routine use of MRI in follow-up care is recommended to facilitate early diagnosis, guide management, and prevent long-term disability. Larger prospective studies are needed to validate these findings and establish MRI as a routine diagnostic tool for SCD.