Defining an imaging algorithm for noncystic splenic lesions identified in young patients

The purpose of this study was to classify noncystic splenic lesions detected on imaging in young patients (0-30 years) and to determine the optimal imaging workup for such lesions.

This study was conducted at three academic institutions by performing a database search of radiology reports (2002-2011) to identify patients with noncystic splenic lesions. Medical records were then searched to identify radiology examination indications, clinical follow-up, and lesion changes on subsequent imaging. All lesions had either definitive diagnosis (histopathology or laboratory results consistent with infectious cause) or lesion stability more than 2 years consistent with a benign cause.

Benign (n = 32), benign indeterminate (n = 7), and malignant (n = 14) lesions were identified in 53 patients (26 males and 27 females; mean age, 19 years; age range, 1 month-30 years). Lesions were initially detected on the following imaging modalities: CT (n = 27), ultrasound (n = 12), MRI (n = 6), and PET/CT (n = 8). A total of 14 patients underwent MRI for lesion characterization, and 12 underwent PET/CT. MRI permitted definitive characterization of benign lesions in 10 of 14 (72%) patients, whereas PET/CT was used to diagnose nine of nine (100%) malignant splenic lesions and helped exclude malignancy in two of three benign lesions.

Contrast-enhanced MRI is recommended for imaging workup of noncystic splenic lesions discovered in young patients because it can enable definitive diagnosis of most benign lesions. Lesions with indeterminate MRI features can be followed-up with ultrasound or CT. PET or PET/CT is recommended for patients with clinical evidence of malignancy but is less helpful for characterization of isolated splenic lesions.