Various aspects of Contrast-enhanced Ultrasonography in splenic lesions – a pictorial essay

Abstract

Spleen pathology is rare in comparison with other abdominal organs, but often its lesions occur in complex pathological contexts, with systemic involvement. Although the lesions could be discretely symptomatic, their evolutionary potential might be severe. Conventional B-mode and Doppler ultrasound are the first-line imaging methods in spleen assessment, but frequently they do not allow the characterization of focal splenic abnormalities. Contrast-enhanced ultrasound (CEUS) is fast, safe, easy to perform, non-irradiating and can be used in patients with renal failure. By highlighting splenic macro and micro-vascularization, CEUS significantly increases the detection rate and allows the characterization of vascular (infarction, ischemia, thrombosis) and traumatic lesions, with high diagnostic accuracy. Additionally, ectopic splenic tissue can be identified with high accuracy. The method improves both the detection and characterization of splenic nodules, but some limitations still remain, especially in the differential diagnosis between malignant and some benign lesions. This article aims to portray aspects of CEUS imaging in various splenic pathologies using clinical examples from our experience and to review the CEUS contribution in the diagnosis of splenic lesions.

Contrast-Enhanced Ultrasound Imaging Features of Focal Splenic Tuberculosis

“…However, CEUS demonstrated that the former patient presented with rim-like enhancement that was maintained during the intermediate parenchymal phase, followed by slow wash-out in the late parenchymal phase; the latter patient showed non-enhancement in all phases. These were inconsistent with the findings from the study by Ioanitescu et al, which showed the malignant splenic lesions like splenic metastases and splenic lymphoma had rapid wash-out [ 24 ]. Therefore, malignant lesions were not considered for these 2 cases, and the 2 cases were finally confirmed by biopsy to be splenic TB.…”

“…In our study, conventional US showed 1 patient with only 3 lesions, whereas 5 lesions with clearer borders were detected by CEUS. Thus, CEUS can be helpful for increasing the lesion detection rate, which is in agreement with the results of Ioanitescu et al [ 24 ].…”

Applications of Contrast-Enhanced Ultrasound in Splenic Studies of Dogs and Cats

“…Although malignant splenic lesions are relatively rare in human medicine [ 17 , 84 , 85 , 86 ], in recent years, the importance of correctly diagnosing malignant lesions [ 84 , 87 , 88 , 89 , 90 ], together with the risk of hemorrhage, immune system impairment, and sepsis associated with invasive procedures [ 84 , 89 ] has propelled research into the use of contrast-enhanced ultrasonography to differentiate between malignant and benign lesions in human medicine [ 69 , 88 , 91 ]. In veterinary medicine, neoplastic splenic lesions are much more common [ 92 , 93 ] and not easily differentiated from benign processes through normal imaging techniques [ 75 , 76 , 77 ].…”

“…In human medicine, studies have shown that the use of CEUS does allow for the identification of malignant vs. benign splenic lesions, the former showing hypo-enhancement in the parenchymal phase independently of the enhancement in the arterial phase, with a faster wash-out rate compared to the surrounding normal splenic tissue [ 17 , 68 , 103 , 104 , 105 , 106 ]. In veterinary medicine, besides there being a greater range of histopathological changes in the spleen, they are more frequently found than in human medicine [ 91 , 92 , 93 ]. This has resulted in the study of a wider variety of neoplastic lesions and their CEUS characteristics.…”

Primary splenic leiomyosarcoma – case report and literature review

“…A clear diagnosis regarding focal splenic lesions is difficult to achieve by imaging means, particularly due to imaging similarities and the scarcity of particular lesions [4][5][6]. Ultrasonography is the first step in diagnosis and evaluation of splenic tumors, and contrast-enhanced ultrasonography (CEUS) can add important information regarding the characteristics of focal splenic lesions [7].…”