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Focal splenic lesions: US findings

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Abstract

Ultrasound (US) imaging of the spleen was considered of little use in the past and was performed only to distinguish between cystic and solid lesions. However, in the last decade due to experience acquired and the introduction of second-generation contrast agents, this technique has been re-evaluated as contrast-enhanced US (CEUS) allows detection and characterization of most focal lesions of the spleen with a high sensitivity and a good specificity. Gray-scale US presents a low specificity in splenic infarctions with a high rate of false negative cases, whereas specificity reaches 100 %, if the examination is performed using US contrast agents. Gray-scale US can provide a correct diagnosis in simple cysts, whereas CEUS is useful when cystic lymphangioma is suspected. In the study of splenic lesions, the most important problem is to differentiate between angioma, hamartoma, lymphoma, and metastasis. CEUS reaches a good specificity in the differentiation of benign from malignant splenic lesions, as hypo-enhancement in the parenchymal phase is predictive of malignancy in 87 % of cases. In conclusion, Gray-scale US and particularly CEUS are at present widely indicated in the study of focal splenic lesions.

Riassunto

L’ecografia splenica è stata considerata nel passato poco utile ed indicata solo nella diagnosi differenziale tra lesioni cistiche e solide. Nell’ultimo decennio grazie alla maggior esperienza ed all’utilizzo dei mezzi di contrasto ecografici di II generazione (CEUS), questa metodica è stata rivalutata, in quanto consente di evidenziare e caratterizzare con elevata sensibilità e buona specificità la maggior parte delle lesioni focali della milza. Negli infarti splenici l’ecografia B-Mode ha una bassa specificità con elevata percentuale di falsi negativi, mentre questa risulta il 100 %, quanto l’esame è eseguito con i mezzi di contrasto ecografici. Nelle cisti semplici l’esame ecografico è sufficiente per porre una corretta diagnosi, mentre la CEUS può risultare utile nel sospetto di linfoangioma cistico. Il problema più importante a livello splenico è quello di definire con la maggior accuratezza possibile la diagnosi differenziale tra Angioma/Amartoma e Linfoma/Metastasi. La CEUS presenta nella lesioni spleniche una buona specificità nel differenziare una lesione benigna da una maligna, in quanto la presenza di ipo-ehnancement in fase parenchimale è predittiva nell’87 % dei casi di malignità. In conclusione l’ecografia B-Mode ed ancor più la CEUS trova al momento attuale ampie indicazioni nelle lesioni focali spleniche.

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Authors and Affiliations

  1. Section of Infectious Diseases, Ospedale S. Donato, via di Montione 102, 52100, Arezzo, Italy

    M. Caremani, D. Tacconi, L. Lapini & C. Mazzarelli

  2. Section of Hematology, Ospedale S. Donato, Arezzo, Italy

    U. Occhini, A. Caremani & A. Accorsi

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  1. M. Caremani
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  2. U. Occhini
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  3. A. Caremani
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  4. D. Tacconi
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  5. L. Lapini
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  6. A. Accorsi
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  7. C. Mazzarelli
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Correspondence to M. Caremani.

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Caremani, M., Occhini, U., Caremani, A. et al. Focal splenic lesions: US findings. J Ultrasound 16, 65–74 (2013). https://doi.org/10.1007/s40477-013-0014-0

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  • DOI: https://doi.org/10.1007/s40477-013-0014-0

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