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Incidental splenic nodules found on MR imaging done for assessment of iron overload in children
Rayan A Ahyad1,2, Christopher Z Lam1,2, Omid Shearkhani2
1Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
Background:
MR imaging is used to assess iron overload in patients with hemoglobinopathies and in those who have undergone multiple blood transfusions. Sometimes splenic nodules are found incidentally on these examinations and this may cause diagnostic uncertainty.
Objective:
To determine the prevalence, imaging characteristics and evolution of splenic nodules found on MR imaging for iron overload evaluation.
Materials And Methods:
Retrospective review of all MR imaging examinations performed for iron overload assessment from 2005 to 2015 in a tertiary pediatric hospital. The presence of focal splenic nodules including number, size, signal characteristics and changes on follow-up MR imaging were recorded. Relevant patient clinical information including underlying hematological disease was also documented.
Results:
A total of 318 patients had MR imaging for iron overload assessment. Of these, 25 (8%) had at least one incidental splenic nodule. Sickle cell disease was present in 22 patients (88%) and thalassemia in 3 (12%). On intermediate-weighted spin-echo images, the nodules had high signal intensity compared to the remainder of the spleen in 23 patients (92%) and low signal intensity in the remaining 2 (8%). In all patients (100%) the nodules showed progressive loss of signal intensity with increasing echo time values. Follow-up MR imaging was performed in 20 (80%) patients, which showed an increase in the size of the splenic nodules in 7 patients (35%) stability in 11 (55%) and a decrease in size in 2 (10%).
Conclusion:
It is not uncommon to find splenic nodules during MR evaluation of iron overload. In patients with sickle cell disease, most of these nodules are thought to represent preserved splenic tissue and appear hyperintense compared to the remainder of the spleen. They frequently remain stable on follow-up imaging, although about a third of them may show growth. Awareness of these nodules is important to avoid concern for potential malignancy and unnecessary investigations.
Insights
Incidental splenic nodules are common during MR imaging for iron overload, particularly in sickle cell disease. These nodules often represent normal splenic tissue and usually do not require further investigation.
Area of Science:
- Radiology
- Pediatric Imaging
- Hematology
Background:
- Magnetic Resonance (MR) imaging is crucial for evaluating iron overload in patients with hemoglobinopathies and those receiving multiple blood transfusions.
- Incidental splenic nodules can be detected during these MR examinations, leading to diagnostic uncertainty.
Purpose of the Study:
- To determine the prevalence of splenic nodules found during MR imaging for iron overload assessment.
- To characterize the imaging features and observe the evolution of these splenic nodules over time.
Main Methods:
- A retrospective review of MR imaging studies for iron overload evaluation was conducted between 2005 and 2015.
- Data collected included nodule characteristics (number, size, signal intensity, changes on follow-up) and patient clinical information, specifically hematological disease.
Main Results:
- Of 318 patients, 25 (8%) had incidental splenic nodules; 88% had sickle cell disease.
- Nodules typically appeared hyperintense on intermediate-weighted spin-echo images and showed signal loss with increasing echo times.
- Follow-up MR imaging in 20 patients revealed stability in 55%, growth in 35%, and decrease in size in 10%.
Conclusions:
- Splenic nodules are not uncommon during MR evaluation for iron overload.
- In sickle cell disease, nodules likely represent preserved splenic tissue and are usually benign.
- Awareness of these findings is vital to prevent misdiagnosis of malignancy and unnecessary investigations.
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