Contrast-enhanced ultrasound of the spleen: an introduction and pictorial essay

Abstract

A wide variety of pathologies can produce focal lesions within the spleen. These are being more frequently encountered as imaging technology improves. It is vital that radiologists are aware of these pathologies to enable accurate diagnosis. The role of ultrasound contrast in splenic disease will be discussed and illustrated with cases likely to be encountered by general and abdominal radiologists.

Primary spleen lymphoma visualized with contrast enhanced ultrasound – Case report

“…In the arterial phase malignant focal splenic lesions typically present heterogenous or homogenous hypo-enhancement. Reduced arterial enhancement in this case is probably due to neoangiogenesis, which creates a poor and slow flow [2,7].…”

“…There are essentially three enhancement patterns of splenic lesions [6,7]: 1) Lesions without enhancement at any phases. This pattern is typical for benign pathologies, such as simple cyst, splenic infarct, haematoma, sarcoid granulomas, bacterial abscess [7]. 2) Lesions that enhance in the arterial phase followed by persistent enhancement in the parenchymal and late phase, or with late phase washout.…”

“…2) Lesions that enhance in the arterial phase followed by persistent enhancement in the parenchymal and late phase, or with late phase washout. It can be observed typically in splenic haemangiomas, hamartoma [7,8]. The great intensity of early arterial enhancement in benign splenic pathologies reflects hypervascularity caused by an increased arterial blood flow [2].…”

“…Generally, malignant lesions washout markedly and rapidly while benign shows later, more gradual washout [6,7].…”

“…Splenic lymphoma can also appear on the grey scale as small, focal or miliary nodules (less than 5mm), multiple large nodular lesions and bulky solid masses [1,10]. Focal lesions are most often hypoechoic relative to normal splenic parenchyma (60-70%) [2,7]. Hiperechogenicity is not typical feature for splenic lymphoma and require histological confirmation.…”