Role of Contrast-Enhanced Ultrasound in the Characterization of Focal Splenic Lesions: A Systematic Review

Contrast-enhanced ultrasound (CEUS) is an emerging imaging modality for the characterization of focal splenic lesions, offering real-time evaluation of microvascular perfusion without ionizing radiation. This systematic review assessed the diagnostic performance of CEUS in differentiating benign and malignant splenic lesions using data from five included studies. Across the evidence base, most benign lesions demonstrated sustained or prolonged enhancement, whereas many malignant lesions showed early washout with hypoenhancement, although overlap between lesion types was reported, reflecting underlying vascular disorganization. Diagnostic performance was high, with reported sensitivity ranging from 90% to 98% and specificity from 85% to 95% in primary diagnostic studies. CEUS improved lesion characterization compared with conventional ultrasound and may reduce the need for additional CT or MRI in selected clinical scenarios. However, the evidence was limited by heterogeneity in study design, small sample sizes, and moderate-to-high risk of bias in several studies. CEUS represents a reliable adjunct imaging tool for splenic lesion evaluation, though further large-scale prospective studies are required for standardization and validation.