Focal splenic lesions: US findings

Area of Science:

• Radiology
• Medical Imaging
• Gastroenterology

Background:

• Traditional gray-scale ultrasound (US) had limited utility for spleen imaging, primarily for distinguishing cystic from solid lesions.
• Past limitations included low specificity for splenic infarctions and high rates of false negatives with gray-scale US.

Purpose of the Study:

• To re-evaluate the utility of ultrasound imaging for focal splenic lesions.
• To assess the role of contrast-enhanced ultrasound (CEUS) in improving the detection and characterization of splenic pathologies.

Main Methods:

• Comparison of gray-scale ultrasound (US) and contrast-enhanced ultrasound (CEUS) for evaluating focal splenic lesions.
• Analysis of diagnostic accuracy, sensitivity, and specificity for various splenic conditions including infarctions, cysts, and tumors.

Main Results:

• CEUS demonstrates high sensitivity and specificity in detecting and characterizing most focal splenic lesions, unlike gray-scale US.
• CEUS achieves 100% specificity for splenic infarctions, compared to low specificity with gray-scale US.
• CEUS shows good specificity in differentiating benign from malignant splenic lesions, with hypo-enhancement predicting malignancy in 87% of cases.

Conclusions:

• Gray-scale US and particularly CEUS are now widely indicated for the study of focal splenic lesions.
• CEUS is crucial for suspected cystic lymphangioma and differentiating between splenic tumors like angioma, hamartoma, lymphoma, and metastasis.