Characterization of non traumatic splenic and parasplenic lesions by contrast enhanced ultrasound

Introduction: This report is a retrospective comparison between Contrast Enhanced Ultrasound (CEUS) and CT findings in splenic and para-splenic lesions.

Materials and methods: We assessed the US patterns of splenic lesions by 4 US patterns: hypoechoic, hisoechoic, hyperecoic and anechoic. CEUS was performed using a volume of 2.4ml contrast medium. We identified the CEUS pattern of splenic cysts, malignancy, abscesses, ischemic lesions, hamartoma, angioma, accessory spleen and reactive parasplenic lymph-nodes.

Results: We detected focal splenic and perisplenic lesions (4 anechoic, 8 hypoechoic, 15 hisoechoic and 4 hyperechoic) in 14 and 17 out of 31 patients. CEUS allowed to reach a final diagnosis in 24 out of 31 cases (77.41%). Diagnostic yield was 85.7% in splenic lesions group and 94.1% in parasplenic lesions group. All the cases were confirmed by CT. In 7 out of 31 cases (22.59%) a final diagnosis could not be achieved neither by CEUS nor by CT. In 4 out of these patients a final diagnosis was achieved by splenic biopsy.

Discussion: CEUS showed a high specificity in the assessment of focal splenic and parasplenic lesions. CT seems to be of limited additional value and may be warranted only in selected clinical cases.