Table of Contents:
Purpose: Focal splenic lesions are rare. In the fundamental ultrasound they are
mostly classified by their echogenicity. Differentiation according to their dignity is
often difficult. Histological confirmation is usually not due to the supposedly benign
etiology. The aim of this study was the detection of prognostically relevant factors for
the differentation between benign and malignant focal splenic lesions. The characteristics
of contrast enhanced ultrasound (CEUS) were analyzed using quantitative
Material and methods: In the retrospective, clinical-sonographic study n=51
hyperechoic focal splenic lesions (26 women, 25 men) could be included. Sociodemographic,
fundamental ultrasound morphological and contrast-specific data were collected.
The enhancement of the contrast agent was quantitatively analyzed in 7 time
intervals. The dignity of the lesions was performed in 14 patients (27.5 %) by histopathologic
diagnosis and in 37 (72.5 %) patients by imaging follow-up investigations
with measurement of the lesion size.
Results: Both benign (n=34; 66.7 %) and malignant (n=17; 33.3 %) splenic lesions
showed in the contrast enhanced ultrasound in the average a hypoechoic enhancement.
In malignant splenic lesions, however, there was a significantly lower uptake of
the contrast agent (p = 0.001) compared to benign splenic lesions. If the hyperechoic
lesions showed revealed an isoechoic or a hyperechoic enhancement pattern in one or
more time slots, this was highly significant for a benign lesion (p = 0.0004). A history
of malignancy (p=0.01), an inhomogeneous splenic lesion in the fundamental
ultrasound (p=0.02) and male gender (p=0.04) were significantly correlated with
a malignant splenic lesion.
Conclusion: Malignant lesions are often described in the literature with a pronounced
hypoechoic enhancement compared to benign lesions. In this case, the quantitative
analysis of CEUS can be helpful. However, there are still missing suitable
cut-off-values for the differentiation between benign and malignant lesions. When
the contrast enhancement, the presence of a malignant cancer in another organ, the
homogeneity in the fundamental ultrasound and the patient’s sex are considered together,
the classification of the dignity of a focal echogenic splenic lesion can succeed
in many cases.