Splenic imaging

Before the advent of ultrasonography and computed tomography the spleen was an organ generally neglected by the radiologist. Today, there are five possible ways of splenic imaging: (1) plain radiography, (2) ultrasonography, (3) spleen scintigraphy, (4) computed tomography, and (5) splenic arteriography. The potentials and limitations of these different imaging modalities are discussed. Based upon a recent retrospective analysis of 194 cases with focal splenic lesions, an algorithmic pathway is suggested, where real-time ultrasonography is used as the first imaging method. In equivocal or negative results it is followed by CT which is the most accurate and best reproducible method. Nuclear medicine offers several important non-imaging function tests (e.g. red cell and platelet survival) but splenic scintigraphy is of minor importance except for the detection of aberrant spleens and splenic tissue. Selective splenic arteriography is rarely necessary for diagnostic purposes except the study of portal circulation but may become valuable again for transcatheter embolization ("medical splenectomy").