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Diagnosis of diffuse spleen involvement in haematological malignancies using a spleen-to-liver attenuation ratio on contrast-enhanced CT images

  • Oncology
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Abstract

Objectives

We aimed to test the hypothesis that the spleen-to-liver-attenuation ratio on portal-venous enhancement phase CT images can identify diffuse splenic infiltration in subjects with lymphoma.

Methods

A database search yielded 70 subjects with malignant haematological diseases who underwent contrast-enhanced CT (CECT) between December 2010 and March 2018. Additionally, consecutive control subjects were evaluated. We compared the splenic volume, splenic attenuation, spleen-to-liver, spleen-to-aorta and spleen-to-musculature ratios on portal-venous phase CECT images, pre- to post-treatment and between the different lymphoma entities. The standard of reference for splenic involvement was normalisation of the spleen volume following chemotherapy or normalisation of FDG-uptake.

Results

In subjects with diffuse splenic involvement, the spleen attenuation was significantly lower before treatment (93.48 HU) compared to controls (112.39 HU; p < .01) and after successful treatment (113.39 HU; p < .01). The spleen-to-liver attenuation ratio significantly increased after treatment (p < .001) and proved significantly lower at baseline when compared to control subjects (p < .01). The spleen volume significantly decreased after successful treatment (from 586.14.87 cm3 to 284.90 cm3; p < .001). Spleen-to-liver ratio significantly increased in lymphoma patients after therapy, inversely correlating with the decline in FDG-uptake (n=10) even in patients with normal-sized spleens (2/10), staying unchanged at follow-up. The outcome variables were not significantly different between the lymphoma subtypes.

Conclusions

We suggest the additional use of spleen-to-liver attenuation ratio to splenic volume alone for detection of diffuse splenic infiltration in subjects with lymphoma. The course of spleen-to-liver attenuation ratio inversely correlated with that of FDG-uptake in a subgroup of patients working accurately in normal-sized diffusely involved spleens.

Key Points

• Involvement of the spleen is frequent in haematological malignancies and is important for staging and appropriate treatment.

• Diffuse splenic infiltration often results in only homogeneous splenomegaly without a focal lesion, but even no or only minimal increase in splenic volume is possible. In these cases diagnosis of spleen involvement is a challenge for the radiologist.

• Our data support the use of the spleen-to-liver attenuation ratio in addition to size measurements for the detection of diffuse splenic infiltration in subjects with lymphoma.

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Abbreviations

CLL:

Chronic lymphoid leukaemia

GCSF:

Granulocyte colony stimulating factors

ROI:

Region of interest

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Funding

The authors state that this work has not received any funding.

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Author notes

  1. C. Hinterleitner and M. Horger contributed equally to this work.

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str.3, 72076, Tuebingen, Germany

    Christian Philipp Reinert, Konstantin Nikolaou & Marius Horger

  2. Department of Internal Medicine II, University Hospital Tuebingen, Otfried-Müller-Str.10, 72076, Tuebingen, Germany

    Clemens Hinterleitner

  3. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline Street, JHOC 3140A, Baltimore, MD, 21287, USA

    Jan Fritz

Authors
  1. Christian Philipp Reinert
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  2. Clemens Hinterleitner
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  3. Jan Fritz
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  4. Konstantin Nikolaou
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  5. Marius Horger
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Corresponding author

Correspondence to Christian Philipp Reinert.

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Guarantor

The scientific guarantor of this publication is Prof. Dr. Marius Horger.

Conflict of interest

Jan Fritz received institutional research funds and speaker's honorarium from Siemens Healthcare USA and is a scientific advisor of Siemens Healthcare USA and Alexion Pharmaceuticals, Inc

Marius Horger received institutional research funds and speaker's honorarium from Siemens Healthineers Germany and General Electrics

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• case-control study

• performed at one institution

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Reinert, C.P., Hinterleitner, C., Fritz, J. et al. Diagnosis of diffuse spleen involvement in haematological malignancies using a spleen-to-liver attenuation ratio on contrast-enhanced CT images. Eur Radiol 29, 450–457 (2019). https://doi.org/10.1007/s00330-018-5556-2

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  • DOI: https://doi.org/10.1007/s00330-018-5556-2

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