Contrast-Enhanced Ultrasound Imaging Features of Focal Splenic Tuberculosis

Abstract

Background The aim of this study was to characterize the contrast-enhanced ultrasound imaging features of focal splenic tuberculosis. Material/Methods We retrospectively analyzed the conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) imaging features of 22 patients with splenic TB confirmed by surgical histopathology or biopsy. Results Conventional US demonstrated that 15 of the 22 patients had a single lesion, while 7 had multiple lesions. The maximum diameter of the lesions ranged from 1.0 to 3.7 cm. Of the 22, 17 were detected with hypoecho and 5 were detected with complex echo by conventional US. Seven (7/22) were detected with blood flow signals by color Doppler flow image (CDFI). CUES demonstrated that 18 cases (81.8%, 18/22) began to enhance in the arterial phase, mostly followed by slow wash-out in the intermediate or late parenchymal phase, and 4 (18.2%, 4/22) presented with non-enhancement during all phases. The enhancement patterns were categorized into 4 types: Type I, homogeneous enhancement (2/22); Type II, rim-like enhancement (12/22); Type III, septation-like enhancement (4/22); and Type IV, non-enhancement (4/22). Conclusions CEUS showed that splenic TB lesions were enhanced in the arterial phase, followed by slow washed out or persistent enhancement in the intermediate and late parenchymal phases. The rim- or septation-like enhancement may be helpful for diagnosing splenic TB. The splenic lesions presenting round hypoecho by conventional US and complete non-enhancement by CEUS are highly suspicious of splenic TB.

The Role of Contrast-Enhanced Ultrasound in Differentiating Splenic Tuberculosis From Splenic Lymphoma

“…CEUS has little value in improving the display rate of splenic tuberculosis, but it is superior to 2D US in evaluating the internal blood supply to the lesion ( 9 – 12 ). CEUS of splenic tuberculosis showed that the lesions were mostly non-enhanced ( Figure 4 ) ( 13 ). Thin septal enhancement was observed in some heterogeneous enhanced lesions ( Figure 5 ), and splenic lymphoma rare this sign, for splenic tuberculosis infectious disease, blood vessels are less damaging, remaining within the organization can exist in the spleen of lesions, and lymphoma rare necrosis, necrosis is more than spleen infarction, necrosis is more complete.…”

Comments and Illustrations of Ultrasound Findings in Extrapulmonary Tuberculosis Manifestations

“…If this is suspected, examination with a high-resolution linear transducer is recommended. Using CEUS, splenic lesions in the arterial phase showed a hyperenhancement, followed by either a slow washout or a persistent enhancement in the middle and late parenchymal phase [76]. A fast washout was the exception, but nevertheless was also possible.…”

“…These exceptional cases would therefore be difficult to differentiate from malignancies. There was also rim-like enhancement with central nonenhancement, like abscesses and septation-like enhancement [76]. Another study using CEUS in splenic manifestations of tuberculosis presented homogeneous enhancement (6.7%), heterogeneous enhancement (63.3%), and nonenhancement (30.0%).…”