Manish Dhyani MBBS, Presenter: Nothing to Disclose

Sudha Ayyala Anupindi MD, Abstract Co-Author: Nothing to Disclose

Rama S. Ayyala MD, Abstract Co-Author: Nothing to Disclose

Michael Stanley Gee MD, PhD, Abstract Co-Author: Nothing to Disclose

To identify young patients(<30 years of age) with focal noncystic splenic lesions identified on imaging studies that were followed to diagnosis, to determine the optimal imaging workup for detected splenic lesions.

Database searches were performed on reports from imaging studies performed at MGH and Children’s Hospital of Philadelphia between 2002-2011 to identify young patients(<30 yrs old) who had splenic lesions identified on imaging studies. Electronic medical records were then searched to identify the study indications, followup imaging results, clinical followup and to identify lesion imaging features and changes in lesion appearance. All lesions either had definitive diagnosis (from direct lesion histology or laboratory results consistent with clear infectious or malignant etiology) or lesion stability over > 2years consistent with benign indeterminate etiology. Splenic lesions with features consistent with simple cysts were excluded. Institutional Review Board approved and HIPAA-compliant.

39 cases were found in total. 24 benign (most commonly hemangiomas, abscess, and benign indeterminate lesions) and 16 malignant lesions were found (including 10 cases of lymphoma). The initial imaging modality of diagnosis was CT scan in 22 cases, US in 7 cases, MRI in 3 cases and PET-CT in 7 cases. 8 cases had MRI performed for lesion characterization and 8 cases had PET-CT. In 4 cases MRI provided definitive lesion characterization (hemangioma, infarct), while all 8 cases of lymphoma demonstrated FDG-avidity on PET. All lymphoma cases had extrasplenic sites of disease.

For noncystic splenic lesions discovered in young patients on imaging studies, MRI with gadolinium is helpful to provide definitive diagnosis of some benign lesions (e.g. hemangioma, siderotic nodules, proteinaceous/hemorrhagic cysts, infarcts). As the vast majority of isolated splenic lesions are benign, serial followup ultrasound or CT can be performed on lesions with indeterminate MRI features to confirm lesion stability over time suggestive of benign etiology. PET and PET/CT are beneficial when there is clinical evidence of malignancy to diagnose splenic metastasis, but are less helpful for characterization of isolated splenic lesions.

Defining an imaging algorithm for splenic lesions discovered in young patients would be very helpful for radiologists imaging children and young adults.

Dhyani, M, Anupindi, S, Ayyala, R, Gee, M, Defining an Imaging Algorithm for Non-Cystic Splenic Lesions Identified in Young Patients.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034608.html