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Splenic hemangiomas and hamartomas: MR imaging characteristics of 28 lesions
M Ramani1, C Reinhold, R C Semelka
1Department of Diagnostic Radiology, Montreal General Hospital, McGill University, Quebec, Canada.
Purpose:
To determine the magnetic resonance (MR) imaging features of splenic hemangiomas and hamartomas, including their pattern of dynamic contrast material enhancement.
Materials And Methods:
The appearance of 28 lesions in 18 patients was retrospectively reviewed on T2-weighted images (16 patients), unenhanced T1-weighted images (18 patients), and dynamic contrast-enhanced T1-weighted images (17 patients). Seventeen of 23 hemangiomas and all five hamartomas were proved at pathologic examination.
Results:
Of the 22 hemangiomas imaged with T2-weighting, 19 were hyperintense, two were isointense, and one was hypointense relative to the spleen. Dynamic gadolinium-enhanced imaging demonstrated a progressive centripetal pattern of enhancement in 19 of 22 hemangiomas. On delayed images, 19 hemangiomas demonstrated uniform enhancement. Of the five hamartomas, four were imaged with T2-weighting; three were hyperintense and one was hypointense relative to the spleen. All hamartomas demonstrated diffuse heterogeneous enhancement on images obtained early after administration of contrast material and became more uniformly enhanced on delayed images.
Conclusion:
Splenic hemangiomas showed signal intensity characteristics and enhancement patterns similar to those described for hepatic hemangiomas. Since these features have been shown to reliably distinguish hemangiomas from other benign and malignant liver lesions, it may be reasonable to consider without histologic verification that lesions in the spleen with these imaging features represent hemangiomas.
Insights
Magnetic resonance (MR) imaging can identify splenic hemangiomas and hamartomas. Splenic hemangiomas exhibit progressive enhancement patterns, similar to hepatic hemangiomas, aiding in diagnosis.
Area of Science:
- Radiology
- Gastroenterology
- Oncology
Background:
- Splenic hemangiomas and hamartomas are rare benign tumors.
- Accurate differentiation from malignant splenic lesions is crucial for patient management.
Purpose of the Study:
- To characterize the magnetic resonance (MR) imaging features of splenic hemangiomas and hamartomas.
- To evaluate the dynamic contrast enhancement patterns of these splenic lesions.
Main Methods:
- Retrospective review of MR imaging features in 18 patients with 28 splenic lesions.
- Analysis of T2-weighted, unenhanced T1-weighted, and dynamic contrast-enhanced T1-weighted images.
- Pathologic confirmation for 17 hemangiomas and 5 hamartomas.
Main Results:
- Splenic hemangiomas typically showed hyperintensity on T2-weighted images.
- Dynamic contrast enhancement in hemangiomas demonstrated a progressive centripetal pattern, becoming uniform on delayed images.
- Hamartomas displayed heterogeneous enhancement early after contrast administration, evolving to more uniform enhancement on delayed images.
Conclusions:
- MR imaging findings, particularly dynamic contrast enhancement patterns, can help differentiate splenic hemangiomas from other splenic lesions.
- The imaging characteristics of splenic hemangiomas resemble those of hepatic hemangiomas, suggesting a similar diagnostic approach.
- Histologic verification may not always be necessary for diagnosing splenic hemangiomas with characteristic MR imaging features.