Characterization of nontraumatic focal splenic lesions using contrast‐enhanced sonography

Abstract

Purpose.To compare contrast‐enhanced sonography (CEUS) with contrast‐enhanced CT in the assessment of nontraumatic focal lesions of the spleen.Methods.CEUS and CT findings in 22 patients with fever of unknown origin and ultrasound‐detected splenic focal lesions were analyzed retrospectively. CEUS was performed using an ultrasound unit equipped with a 3.6‐MHz probe and contrast‐specific software. A 4‐ml bolus of second‐generation contrast medium was used. The CEUS examinations included a 4‐minute recording following injection of the contrast medium. MRI, splenic biopsy, or ultrasound follow‐up were used if findings from CT were inconclusive.Results.The final diagnoses were as follows: seven splenic infarcts, five hemangiomas, three lacerations, two benign cysts, one lymphoma, one granuloma, one abscess, and two lesions of unknown etiology. CEUS and CT had the same specificity (77.2%). Both CEUS and CT failed to characterize nodular hypovascular lesions with a hypoenhancing pattern.Conclusions.CEUS is as effective as CT for characterizing nontraumatic focal lesions of the spleen. If CEUS findings are consistent with a benign splenic lesion, CT seems to be of limited additional value. © 2011 Wiley Periodicals, Inc. J Clin Ultrasound, 2011;

The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): Update 2011 on non-hepatic applications

“…Typical findings for benign splenic lesions include either no contrast enhancement or rapid wash-in, followed by persistent enhancement in the late phase. If CEUS findings are consistent with a benign splenic lesion, CT seems to be of limited additional value [86]. In contrast, the combination of contrast enhancement (diffuse or peripheral) in the arterial phase followed by rapid and marked wash-out is typical for malignant lesions (metastases or lymphoma) [87 -90].…”

Contrast Enhanced Ultrasound of Splenic Lymphoma Involvement Case presentation

“…As reported in Catalano's study, regularly disposed lesions (as the one in lymphoma) or anarchically disposed (metastasis) vessels can be seen first encircling and then entering the nodule and are especially recognizable during the early phase of pacification. Tumor tissue itself enhances less than the surrounding parenchyma [6,7,11]. The CEUS pattern of lymphoma has been described almost exclusively in a secondary splenic involvement.…”

Primary spleen lymphoma visualized with contrast enhanced ultrasound – Case report

“…The spleen is particularly suitable for CEUS studies because of its superficial location, small size, homogeneous parenchyma, high vascularization, and tendency to retain contrast microbubbles longer than other organs (long-lasting and intense contrast enhancement) [4][5][6]. At the present time, the European Guidelines for nonhepatic applications of CEUS warrant the use of this tool for investigation of the spleen in four cases [6]: 1) to characterize splenic parenchymal inhomogeneity or suspected lesions on conventional US; 2) to confirm suspected splenic infarction; 3) to characterize suspected accessory spleens or splenosis; 4) to detect splenic malignant lesions in oncologic patients when CT and/or MRI and PET are contraindicated or inconclusive.…”