Spleen: Focal Lesions - SD

Spleen Before Lunch

We have the guidelines.

This was the first one in which you can see there is no chapter dedicated to the spleen, but the spleen is inside the trauma.

Typical Features of Contrast Ultrasound

Again, these are the typical features of contrast ultrasound.

Something can give us, but the vascularization is quite the same of CT and MRI in the first early phases of contrast ultrasound.

You can see that the heterogeneity, heterogenicity in arterial phase is due to dual circulation, and there is a fast hypering as low, high, high poncing, sorry, in the 10 seconds phase.

This is a well known appearance of the spleen in the arterial phase for radiologists.

The zebra part, this one that you can see here on CT in the arterial is typical no, nobody, no one during our reporting, they will look with the suspicious on this spleen.

What is different that the persistent enhancement in the late, very late phase is very important.

Literature on Spleen in Trauma

A lot of paper then appears in the literature and you can see that the first are dedicated to the trauma and but also the obviously the appearance of ischemic slash traumatic lesion is the same.

Hyper financing area inside the spleen better visible in the late phase.

Let me show you this paper on the traumatic patient.

You can see that contrast NA ultrasound misses a large CEUs of solid lesion, and cannot be recommended to replace ct.

This is a conclusion of a paper published in the literature.

Then we move to this other paper, and you can see that CUS may replace CT in many patient in traumatic patient.

There is no consensus in my idea.

However, what is very important is this multicenter study, other study that proved that CS is better than uss.

This is the real message.

If I performed an ultrasound examination in a traumatic patient, it's not the same.

If I inject contrast, I will have more information of parenchymal injuries and homogeneity of the enhancement in the late phase liver and spleen and so on.

This is the conclusion of this paper.

CS is more sensitive than us and is almost as sensitive CT in the detection of lesion in traumatic patient.

New Guidelines and Indications

Again, these are the new ate of guidelines, and you can see that there is a chapter dedicated to the spleen.

These are the three recommended uses and indications, characterize splenic suspected lesion, to confirm suspected splenic infection, so hypovascular area during the late phase and to characterize a accessory spleen.

But we will speak at the end of this third point.

Characterization of Focal Lesions

First characterization of a splenic focal lesion is not the same in respect to liver.

Even if the announcement can be the same, that cure is not the same, because in this paper you can see that in Iman, only two third of the cases will show shows us the typical global announcement in the early phase.

And you can see in two third of the cases that we have less announcement than the spleen lesion is lightly hypo in the late phase.

There is no typical announcement in this lesion.

That was Iman at the end.

Again, in this paper that is focused on characterization of splenic Iman Zoma, you can see that filling announcement is present only in 7% of the cases.

It's not so easy to be sure about the final diagnosis.

We can be sure about the absence of malignancy in this case.

This important paper, in my opinion, is in which you can see that more generally speaking, CS can improve the differential diagnosis between benign and malignant lesion in the spleen is more easy.

In fact, hyper ISO enhancement at CS is a predictor of benign.

This is what we can say in my opinion.

The diagnostic accuracy is absolutely better after contrast media injection respect to Basel ultrasound and also the agreement will be improved.

Malignant Lesions

Moving to malignant lesion is very easy to understand that this lesion is malignant because of the hypo aspect in the late phase, moving to our published paper, we can see that the reduced announcement, so the hypoechoic aspect in the late phase is the typical sign of metastasis.

And again, also in this paper, hypo enhancement in the parenchymal phase is predictive for malignancy in very high percent of the cases.

We can use this.

And also in lymphoma, the same sign the lesion is hypo, the lesion is hypo, and we can detect more lesion in respect to ct.

But we can also better understand if the lesion is really a lesion or not in respect to Basel.

But we can have also better results in respect to pet in this paper that is published in radiology.

But on the contrary, we can find in literature also these other paper in which the conclusion is contrast Resound has no clear advance for the diagnosis of PLE lymphoma involvement because you can see that the lesion, the spleen was you homogeneous and no added values of contrast media injection and the visualization of focal splenic lymphoma lesion in the spleen was equal, better or worse in this case in respect to Basel ultrasound.

This was the conclusion at the end, this is a table for the characterization of lesion in the spleen.

For sure we hope to find the central feeling of the man, but there are a lot of atypical cases.

Please remember that with the T two weighted imaging, we have the diagnosis.

These are the typical appearance of malignant lesion hypo.

We can use this sign for the definition of the malignancy of a focal lesion detecting the spleen.

Abscess Clinical Scenario

What about the abscess clinical scenario?

What about a OC caucus?

There is no enhancement of the inclusion inside.

This is typical on the in the liver everywhere.

This a good conclusion.

This paper that contrast science ultrasound is effective in the characterization of a focal lesion in the spleen.

The CS findings are consistent with the benign CT is not necessary, but I will suggest not CT in every case it's better MRI because we have more parameter to evaluate.

I will show you some examples.

Accessory Spleen

Moving to in fact to the last indication accessory spleen, this is a paper dedicated on this finding on this scenario.

You can see the announcement have to be similar to the spleen, obviously in all phases.

But what I want to add that we can need to have a concordance between different imaging modality.

C-T-M-R-I has to be the same.

If it is really accessory spleen, this in example was suspected to be an accessory spleen, but you can see the morphology is not typical, even if the density is good, is the same.

This is the lesion on BMO in homogeneous announcement, black in the late phase in respect to the spleen.

Completely different in respect to the C to the CT finding it was a rine tumor, the pancreatic tail in this case.

What I want to tell you that using ct, we have only the density during the dynamic phase is the same of CS even if the distribution of contrast is different.

But with MRI, we have more parameters.

We can just lesion on T two, T one per contrast.

We can jet contrast and saw the same of CT SUS, but we can also diffusion with the imaging.

You can see here this was an accessory spleen in the pancreatic tail.

You can see that lesion is ISO to the spleen in the early arterial phase on ct, late phase on CT T two dynamic phase on MRI, but also on the fusion.

We have more parameters to judge the lesion.

What about this patient?

During ultrasound examination, we can have the arterial in one scan in one place and not in the other one.

We know this is a problem.

In this patient you can see a lesion that it was at the end an accessory spleen, but also another lesion in the table of pancreas.

This lesion is iso, this lesion is light hyper ONT two.

This lesion is iso ondy phase to the spleen.

This lesion is light hyper in the arterial phase in respect to the spleen.

This was a tumor was a metastasis from kidney cancer, and this is accessory spleen.

We need also to be panoramic enough to study different lesion in the same site.

Conclusion

The conclusion can be very simple in my opinion.

Contrast ultrasound is more sensitive than the US in the detection of solid organ injury and blood trauma.

CUS improves differential diagnosis between benign and malignant lesion in the spleen because it's very easy to judge as malignant lesion that appears to be hypoechoic after contrast media injection.

Thank you.