Keywords:
Abdomen, Spleen, Oncology, CT, MR, Diagnostic procedure, Pathology, Cancer
Authors:
A. Abrishami1, S. Kooraki1, Y. Abrishami1, L. Grenacher2, H. U. Kauczor3; 1Tehran/IR, 2Munich/DE, 3Heidelberg/DE
DOI:
10.1594/ecr2018/C-1983
Conclusion
Radiologists are increasingly challenged by incidental splenic lesions on cross sectional imaging studies obtained for other various reasons.
The management of incidentally discovered splenic lesions remains a dilemma.
This study reviewed the importance of possibly helpful imaging features of splenic lesions.
Primary and secondary lesions of the spleen are thought to be rare,
however spleen is a hostile organ for metastases from breast,
colorectal,
ovarian carcinoma and melanoma.
[7,
8,
9]
We did not find lesion Hounsfield unit on non-contrast or contrast enhanced CT scan to be practical for differentiation between benign and malignant lesions.
Enhancement pattern in metastatic lesions is variable depending on the vascularity of the primary neoplasm.
Homogenous lesions are more likely to be benign compared to heterogeneous lesions,
however a considerable minority of benign lesions will demonstrate heterogeneity and this feature cannot be a reliable factor.
Both benign and malignant lesions are more likely to have ill-defined or lobulated border,
however the presence of smooth border weighs toward benign lesion.
Poor defined heterogeneous lesions are worrisome for malignancy and usually require further work up with biopsy or PET.
[6] Typical cystic-appearing lesions of spleen usually require no further work up in asymptomatic patients.
Lesion size is significantly higher in malignant lesions.
Lesions size might be helpful for discrimination between benign and malignant lesion,
however care must be taken,
as considerable overlap exists in size.
Signal intensity in various MRI sequences is not an accurate measure to be relied for discrimination of splenic lesions.
This was consistent with the results of other studies,
which did not find conventional MR features to have diagnostic accuracy for discrimination of benign and malignant splenic lesions.
Diffusion weighted imaging might serve as a promising method for challenging splenic lesions,
as the presence of restricted diffusion was highly indicative of malignancy in this study.
In conclusion,
small size,
smooth lesion border and homogeneity favor benign nature of the incidental splenic lesions,
while restricted diffusion might be a feature of malignancy.
Follow-up imaging might be helpful in a subset of patients fulfilling benign-appearing features.