Korean J Radiol.  2016 Oct;17(5):734-741. 10.3348/kjr.2016.17.5.734.

Diffuse Infiltrative Splenic Lymphoma: Diagnostic Efficacy of Arterial-Phase CT

• Lee JE
• Cho JS
• Shin KS
• Kim SS
• You SK
• Park JW
• Shin HS
• Yoon YC

• KMID: 2458065
• DOI: http://doi.org/10.3348/kjr.2016.17.5.734

Abstract

OBJECTIVE
To evaluate the diagnostic performance of obliteration of normal heterogeneous enhancement of the spleen (ONHES) on arterial phase (AP) computed tomography (CT) images in diffuse infiltrative splenic lymphoma (DISL).
MATERIALS AND METHODS
One hundred and thirty-six patients with lymphoma who had undergone two-phase (arterial and portal venous) abdominal CT were included in this study. We retrospectively evaluated the diagnostic performance of ONHES on AP CT in diagnosing DISL. Two observers evaluated ONHES on AP CT using the 5-point confidence level and assessed the presence or absence of subjective splenomegaly on axial CT images. Another two observers measured the splenic index as proposed by objective CT criteria. Statistical analysis included interobserver agreement and diagnostic performance of CT findings.
RESULTS
Eleven of the 136 patients with lymphoma had DISL. The area under the receiver operating characteristic curve of ONHES (0.948 for observer 1 and 0.922 for observer 2) was superior to that of the splenic index (0.872 for observer 3 and 0.877 for observer 4), but the difference was not statistically significant (p > 0.05). The diagnostic performance of ONHES in conjunction with subjective splenomegaly showed higher diagnostic performance, as compared with subjective splenomegaly alone (accuracy: 100% and 85.3% for observer 1, 98.5% and 87.5% for observer 2; positive predictive value: 100% and 35.5% for observer 1, 90.9% and 39.3% for observer 2, respectively).
CONCLUSION
Obliteration of normal heterogeneous enhancement of the spleen in conjunction with subjective splenomegaly can improve the diagnostic performance for DISL. Our results suggest that ONHES on AP CT images could be useful as an adjunctive diagnostic indicator of DISL in patients with lymphoma.

Keyword

Lymphoma; Diffuse infiltrative splenic lymphoma; Splenomegaly; Arterial phase; Heterogeneous enhancement of the spleen

MeSH Terms

Adult
Aged
Aged, 80 and over
Female
Humans
Image Interpretation, Computer-Assisted/methods
Lymphoma/complications/*diagnostic imaging
Male
Middle Aged
Observer Variation
Positron Emission Tomography Computed Tomography/methods
ROC Curve
Retrospective Studies
Splenic Neoplasms/complications/*diagnostic imaging
Splenomegaly/diagnostic imaging/etiology
Tomography, X-Ray Computed/methods
Young Adult

Figure

• 

  Fig. 1 41-year-old man with mantle cell lymphoma. Axial contrast-enhanced MDCT shows marked splenomegaly, multiple lymphadenopathies and obliteration of normal heterogeneous enhancement of spleen on AP image (A) and homogeneous enhancement on PVP image (B). PET/CT shows diffusely increased FDG uptake in spleen and multiple enlarged lymph nodes, suggesting lymphoma involvement (C). After chemotherapy, axial contrast-enhanced MDCT shows restoration of normal heterogeneous enhancement of spleen and interval marked decrease in size of enlarged spleen on AP image (D). Follow-up PET/CT after chemotherapy shows normal splenic uptake less than hepatic uptake (E). AP = arterial phase, FDG = fluorodeoxyglucose, MDCT = multidetector CT, PET/CT = positron emission tomography/CT, PVP = portal venous phase

• 

  Fig. 2 62-year-old man with diffuse large B-cell lymphoma. Axial contrast-enhanced MDCT shows obliteration of normal heterogeneous enhancement of spleen (ONHES) on AP image (A) and homogeneous enhancement on PVP image (B) with 247 cm3 of mean splenic index. However, there is no evidence of increased FDG uptake in spleen, suggesting false-positive finding for ONHES (C). AP = arterial phase, FDG = fluorodeoxyglucose, MDCT = multidetector CT, PVP = portal venous phase

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