Korean J Radiol.  2018 Oct;19(5):930-937. 10.3348/kjr.2018.19.5.930.

Role of CT in Differentiating Malignant Focal Splenic Lesions

• Jang S
• Kim JH
• Hur BY
• Ahn SJ
• Joo I
• Kim MJ
• Han JK

• KMID: 2418557
• DOI: http://doi.org/10.3348/kjr.2018.19.5.930

Abstract

OBJECTIVE
The purpose of this study was to asses the CT findings and clinical features differentiating malignant from benign focal splenic lesions.
MATERIALS AND METHODS
Among 673 patients with splenectomy, we included 114 patients with pathologically confirmed focal splenic lesions (malignant = 66, benign = 48). Two radiologists retrospectively assessed CT findings including: size, number, solid component, margin, wall, calcification, contrast-enhancement, lymph node (LN) enlargement and possible malignancy. We assessed clinical features including age, sex, underlying malignancy, fever, and leukocytosis. Multivariate logistic regression analysis was performed to identify significant predictors of malignant lesion. We used receiver operating curve analysis for determination of diagnostic performance.
RESULTS
Common findings of malignant lesions include enhanced, mainly solid, ill-defined margin, absence of splenomegaly, absence of the wall, absence of calcification, LN enlargement, and presence of underlying malignancy (p < 0.05). Among them, mainly solid features (odds ratio [OR], 39.098, p = 0.007), LN enlargement (OR, 6.326, p = 0.005), and presence of underlying malignancy (OR, 8.615, p = 0.001) were significant predictors of malignancy. The mean size of benign splenic lesions (5.8 ± 3.3 cm) was larger than that of malignant splenic lesions (4.0 ± 3.4 cm). Diagnostic performance of CT findings by two reviewers using receiver operating characteristic curve analysis for differentiation of malignant lesions was 0.856 and 0.893, respectively.
CONCLUSION
Solid nature of the splenic mass on CT images, LN enlargement, and presence of underlying malignancy are significant predictors of malignant splenic lesion.

Keyword

Spleen; Splenic diseases; Splenectomy; Computed tomography; Malignancy

MeSH Terms

Equidae
Fever
Humans
Leukocytosis
Logistic Models
Lymph Nodes
Retrospective Studies
ROC Curve
Spleen
Splenectomy
Splenic Diseases
Splenomegaly

Figure

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  Fig. 1 Illustrated flow charts of patient enrollment.*Examples include idiopathic thrombocytic purpura, hemolytic anemia, hereditary spherocytosis, diffuse lymphoproliferative disease, etc. SANT = sclerosing angiomatoid nodular transformation

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  Fig. 2 30-year-old female patient with epithelial cyst.She had incidental splenic lesion detected during routine examination. A, B. Axial and coronal contrast-enhanced CT images show 6.3 cm well-defined cystic mass (arrows) with surrounding wall and multifocal calcifications. Splenic size was 9.5 cm, and patient had no fever or leukocytosis. C. Surgical specimen shows smooth inner surface of epithelial cyst (arrows).

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  Fig. 3 66-year-old female patient with splenic metastasis.She had history of subtotal gastrectomy due to advanced gastric cancer. A, B. Axial and coronal contrast-enhanced CT images show 2.9 cm ill-defined solid mass (arrows) with heterogeneous enhancement. There was no wall or calcification. Splenic size was 9.1 cm, and patient did not have fever or leukocytosis. C. Surgical specimen shows yellowish solid mass (arrows) in spleen.

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  Fig. 4 Comparison of ROC curves predicting malignant focal splenic lesions according to reviewers 1 and 2.Areas under ROC curve were 0.856 with reviewer 1 and 0.893 with reviewer 2. ROC = receiver operating characteristic

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