Contrast-Enhanced Ultrasound Pattern of Splenic Metastases – a Retrospective Study in 32 Patients

Ultrasound (US) imaging of the spleen was considered of little use in the past and was performed only to distinguish between cystic and solid lesions. However, in the last decade due to experience acquired and the introduction of second-generation contrast agents, this technique has been re-evaluated as contrast-enhanced US (CEUS) allows detection and characterization of most focal lesions of the spleen with a high sensitivity and a good specificity. Gray-scale US presents a low specificity in splenic infarctions with a high rate of false negative cases, whereas specificity reaches 100 %, if the examination is performed using US contrast agents. Gray-scale US can provide a correct diagnosis in simple cysts, whereas CEUS is useful when cystic lymphangioma is suspected. In the study of splenic lesions, the most important problem is to differentiate between angioma, hamartoma, lymphoma, and metastasis. CEUS reaches a good specificity in the differentiation of benign from malignant splenic lesions, as hypo-enhancement in the parenchymal phase is predictive of malignancy in 87 % of cases. In conclusion, Gray-scale US and particularly CEUS are at present widely indicated in the study of focal splenic lesions.Keywords Focal splenic lesion Á Splenic angioma/ hamartoma Á Splenic cysts Riassunto L'ecografia splenica è stata considerata nel passato poco utile ed indicata solo nella diagnosi differenziale tra lesioni cistiche e solide. Nell'ultimo decennio grazie alla maggior esperienza ed all'utilizzo dei mezzi di contrasto ecografici di II generazione (CEUS), questa metodica è stata rivalutata, in quanto consente di evidenziare e caratterizzare con elevata sensibilità e buona specificità la maggior parte delle lesioni focali della milza. Negli infarti splenici l'ecografia B-Mode ha una bassa specificità con elevata percentuale di falsi negativi, mentre questa risulta il 100 %, quanto l'esame è eseguito con i mezzi di contrasto ecografici. Nelle cisti semplici l'esame ecografico è sufficiente per porre una corretta diagnosi, mentre la CEUS può risultare utile nel sospetto di linfoangioma cistico. Il problema più importante a livello splenico è quello di definire con la maggior accuratezza possibile la diagnosi differenziale tra Angioma/Amartoma e Linfoma/Metastasi. La CEUS presenta nella lesioni spleniche una buona specificità nel differenziare una lesione benigna da una maligna, in quanto la presenza di ipoehnancement in fase parenchimale è predittiva nell'87 % dei casi di malignità. In conclusione l'ecografia B-Mode ed ancor più la CEUS trova al momento attuale ampie indicazioni nelle lesioni focali spleniche.

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“…11a, b). In the detection of splenic metastases CEUS is 38 % more sensitive than Gray-scale US [1,24,25].…”

Section: Splenic Metastasismentioning

confidence: 99%

Focal splenic lesions: US findings

et al. 2013

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“…CEUS is useful for the detection of malignant FSLs in oncologic patients, when CECT and/or CEMRI and/or PET are contraindicated or inconclusive. Studies showed 90% sensitivity and 100% specificity as compared to CECT with respect to lesion detection in lymphoma patients [86] and increased the detection rate of metastases by 38% as compared to splenic conventional US [75]. In monitoring response to chemotherapy, the positive results are seen earlier on CEUS compared to PET-CT [70].…”

Section: Spleenmentioning

confidence: 79%

“…In such cases the analysis of the patient's medical history and complementary investigations are necessary. Splenic metastases are very rare and appear in the late stages of a known malignancy [75]. Some splenic metastases are hyperechoic on conventional US and can have a complex pattern on CEUS, but the clinical context is clear and the diagnosis is already set.…”

Section: Spleenmentioning

confidence: 99%

Romanian National Guidelines on Contrast Enhanced Ultrasound in clinical practice

et al. 2017

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Contrast-enhanced ultrasound (CEUS) allows a real-time assessment of the vascular pattern of different types of lesions, as it has no renal or liver toxicity, it lacks radiation exposure and it is also cheaper than other imaging methods, having a diagnostic capability that matches contrast-enhanced CT or MRI. In Romania CEUS is used more and more, especially by clinicians, and since some centres have extensive experience in this domain, we felt the need to disseminate our expertise in order to implement this method in as many centres as possible. These Guidelines present the clinical applications of CEUS in the liver, spleen, pancreas, kidney, testis, bowel, intra-cavitary and endoscopic ultrasound, as well as other applications.

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“…Splenic lesions in general are not frequent, they appear in 0.2-0.6 % of ultrasound investigations [23]. From a diagnostic point of view they can be divided into neoplastic and non-neoplastic.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous biopsies of splenic lesions – a clinical and contrast enhanced ultrasound based algorithm

Ignee

Cui

Hirche

et al. 2014

Clinical Hemorheology and Microcirculation

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OBJECTIVE: Splenic lesions are rare and characterization is difficult. Secondary spread is more frequent than primary malignant lesions. Thus clinical circumstances are important in the general work-up. Contrast enhanced ultrasound (CEUS) had high accuracy in recent studies but the positive predictive value is low. Biopsy is considered dangerous. Recent studies have brought back this method into focus showing an excellent efficacy and safety. The aim of this study was to estimate the rate of relevant biopsy results in patients with splenic lesions concerning the clinical circumstances. DESIGN: Patients with unclear splenic lesions which appeared progressively hypoenhancing in the late phase of CEUS with BR1 were included. Biopsy was performed with ultrasound guidance. Patients were sorted into 5 groups according to their clinical symptoms. RESULTS: 44 patients were enrolled, 59% had benign lesions. 73% were rated relevant. For the subgroups the rate was: patients with hints for hemato-oncological diseases 83%, patients without symptoms 38%, patients with infections of unknown origin 100%, patients with suspicion of metastases 33%, immunocompromised patients 100%. One bleeding could be managed conservatively, another bleeding was detected incidentally 2 weeks later. CONCLUSION: Percutaneous biopsy of unclear splenic lesions which appear hypoenhancing in the late phase of CEUS with BR1 results in a high rate of relevant lesions. The results should be tested in larger numbers of patients.

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Contrast-Enhanced Ultrasound Pattern of Splenic Metastases – a Retrospective Study in 32 Patients

Abstract: CEUS of splenic metastases is characterized by reduced contrast enhancement in both the arterial and the parenchymal phase in most cases. Moreover, CEUS improved the visualization of splenic metastases in about 40 % of cases in comparison to standard B-mode sonography.

Cited by 24 publications

References 14 publications

Focal splenic lesions: US findings

Focal splenic lesions: US findings

Romanian National Guidelines on Contrast Enhanced Ultrasound in clinical practice

Percutaneous biopsies of splenic lesions – a clinical and contrast enhanced ultrasound based algorithm

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