Diffuse Infiltrative Splenic Lymphoma: Diagnostic Efficacy of Arterial-Phase CT

Abstract

ObjectiveTo evaluate the diagnostic performance of obliteration of normal heterogeneous enhancement of the spleen (ONHES) on arterial phase (AP) computed tomography (CT) images in diffuse infiltrative splenic lymphoma (DISL).Materials and MethodsOne hundred and thirty-six patients with lymphoma who had undergone two-phase (arterial and portal venous) abdominal CT were included in this study. We retrospectively evaluated the diagnostic performance of ONHES on AP CT in diagnosing DISL. Two observers evaluated ONHES on AP CT using the 5-point confidence level and assessed the presence or absence of subjective splenomegaly on axial CT images. Another two observers measured the splenic index as proposed by objective CT criteria. Statistical analysis included interobserver agreement and diagnostic performance of CT findings.ResultsEleven of the 136 patients with lymphoma had DISL. The area under the receiver operating characteristic curve of ONHES (0.948 for observer 1 and 0.922 for observer 2) was superior to that of the splenic index (0.872 for observer 3 and 0.877 for observer 4), but the difference was not statistically significant (p > 0.05). The diagnostic performance of ONHES in conjunction with subjective splenomegaly showed higher diagnostic performance, as compared with subjective splenomegaly alone (accuracy: 100% and 85.3% for observer 1, 98.5% and 87.5% for observer 2; positive predictive value: 100% and 35.5% for observer 1, 90.9% and 39.3% for observer 2, respectively).ConclusionObliteration of normal heterogeneous enhancement of the spleen in conjunction with subjective splenomegaly can improve the diagnostic performance for DISL. Our results suggest that ONHES on AP CT images could be useful as an adjunctive diagnostic indicator of DISL in patients with lymphoma.

Computed tomographic heterogeneous enhancement of spleen in healthy cats: comparing with diffuse infiltrative splenic lesions

“…In humans, it has been suggested that infiltrative splenic lymphoma typically affects the periarterial lymphatic sheaths (PALS) of the white pulp. As a result, it is believed that the white pulp’s involvement, which reduces its flow rate, is primarily responsible for the obliteration of splenic heterogeneity ( 21 ). Therefore, it is likely that a similar mechanism suggested in humans led to the observation of these findings in cats with DISL; however, more comprehensive research including histological evaluations is necessary.…”

“…Furthermore, the absence of splenomegaly is not sufficient to exclude a diagnosis of infiltrative tumors, which can manifest as a normally appearing spleen with microscopic involvement only ( 18 , 20 ). In humans, it is reported that in conjunction with subjective splenomegaly, the obliteration of normal heterogeneous enhancement patterns of the spleen on CT can improve the diagnostic performance for diffuse infiltrative splenic lymphoma ( 21 ). However, to the best of our knowledge, there is no study related to these changes of splenic enhancement on CT in cats with diffuse infiltrative splenic lesions (DISL).…”

Selection and Reporting of Statistical Methods to Assess Reliability of a Diagnostic Test: Conformity to Recommended Methods in a Peer-Reviewed Journal

“…Regarding the DTA studies, one reviewer experienced in DTA studies selected eligible articles according to criteria established elsewhere ( 9 ) with additional confirmation by another DTA expert in cases of ambiguity. Of the initial 124 candidate articles, 63 articles ( 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 ) were finally included. Regarding the studies that analyzed reliability, eligible articles were chosen by consensus after review by two of four independent reviewers experienced in the relevant methodology.…”

“…These studies could be viewed as extensions of DTA analysis of non-binary data, which require different statistical analyses ( 81 ), than the standard analysis used for reliability, although some published studies seem to have failed to distinguish between them. Of the initial 71 article candidates, 36 articles ( 15 19 42 45 53 57 58 64 66 67 69 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 ) were finally included.…”

Machine Learning Radiomics Signature for Differentiating Lymphoma versus Benign Splenomegaly on CT

“…Among the many possible causes of splenomegaly, lymphoma is the most vital to detect because the additional information gleaned from such detection can aid in establishing the proper tumor staging, treatment protocols, and prognosis [4]. Pathological confirmation of the lesion can be performed through percutaneous biopsy of the spleen.…”