Contrast enhanced sonographic study of the spleen

Annabelle Hopkins, Demosthenes D. Cokkinos, Eleni G. Antypa, Ploutarchos N. Piperopoulos


The spleen shows a variety of pathological entities. Ultrasound (US) is the first imaging modality performed for its assessment. When it is not conclusive, the addition of intravenous contrast agents improves performance and aids in narrowing the differential diagnosis. Benign entities include cysts, accessory spleen, infarcts, abscess, benign masses and trauma. In most of these cases Contrast Enhanced US (CEUS) can reach a diagnosis. Malignant entities include lymphoma and metastases, where CEUS is also useful with some limitations. The technique is performed easily, fast, with no radiation, even in patients with renal insufficiency. This article reviews CEUS technique, normal and abnormal findings in the spleen, indications and limitations.


spleen; ultrasound; contrast agent; CEUS

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WSpielmann AL, DeLong DM, Kliewer MA. Sonographic evaluation of spleen size in tall healthy athletes. AJR Am Journal of Roentgenol 2005; 184: 45-49.

Wan YL, Cheung YC, Lui KW, et al. Ultrasonographic findings and differentiation of benign and malignant focal splenic lesions. Postgrad Med J 2000; 76: 488-493.

Woszszyk D, Kolodziej-Jaskula A, Mykala-Ciesla J, et al. Focal lesions in the ultrasonographic examination of the spleen as a symptom of various disease statuses: Literature survey and case descriptions. Med Sci Monit 2006; 12(8): CS67-73.

Stang A, Keles H, Hentschke S, et al. Differentiation of benign from malignant focal splenic lesions using sulphur hexafluoride-filled microbubble contrast-enhanced pulse inversion sonography. AJR Am J Roengenol 2009; 193: 709-721.

Catalano O, Lobianco R, Sandomenico F, et al. Real time contrast enhanced ultrasound of the spleen: Examination technique and preliminary clinical experience. Radiol Med 2003; 106 (4): 338-356.

Tafuto S, Catalano O, Barba G, et al. Real-time contrast-enhanced specific ultrasound in staging and follow-up of splenic lymphomas. Front Biosci 2006; 11: 2224-2229.

Neesse A, Huth J, Kunsch S, et al. Contrast-enhanced ultrasound pattern of splenic metastases - a retrospective study in 32 patients. Ultraschall Med 2010; 31: 264-269.

Picardi M, Soricelli A, Pane F, et al. Contrast-enhanced harmonic compound US of the spleen to increase staging accuracy in patients with Hodgkin lymphoma: A prospective study. Radiology 2009; 251: 574-582.

Metser U, Miller E, Kessler A, et al. Solid splenic masses: Evaluation with 18F-FDG PET/CT. J Nucl Med 2005; 46: 52-59.

Yu X, Yu J, Liang P, et al. Real-time contrast-enhanced ultrasound in diagnosing of focal spleen lesions. Eur J Radiol 2012; 81(3): 430-436.

Goerg C, Schewerk WB, Goerg K. Splenic lesions: Sonographic patterns, follow-up, differential diagnosis. Eur J Radiol 1991; 13: 59-66.

Gray EF. Calcifications of the spleen. AJR Am Journal of Roentgenol 1944; 51: 336-351.

Radin DR, Baker EL, Klatt EC, et al. Visceral and nodal calcification in patients with AIDS-related Pneumocystis carinii infection. AJR Am J Roentgenol 1990; 154(1): 27-31.

Pawar S, Kay CJ, Gonzalez R, et al. Sonography of splenic abscess. AJR Am Journal of Roentgenol 1982; 138: 259-262.

Goerg C, Schewerk WB, Goerg K, et al. Sonographic patterns of the affected spleen in malignant lymphoma. J Clin Ultrasound 1990; 18: 569-574.

Pastakia B, Shawker TH, Thaler M, et al. Hepatosplenic candidiasis: wheels within wheels. Radiology 1988; 166: 417-421.

Piscaglia F, Nolsøe C, Dietrich CF, et al. The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): Update 2011 on non-hepatic applications. Ultraschall Med 2012; 33(1): 33-59.

Catalano O, Sandomenico F, Matarazzo I, et al. Contrast-Enhanced Sonography of the Spleen. AJR Am Journal of Roentgenol 2005; 184: 1150-1156.

Chen MJ, Huang MJ, Chang WH, et al. Ultrasonography of splenic abnormalities. Word J Gastroenterol 2005; 11: 4061-4066.

Goerg C, Bert T. Second-generation sonographic contrast agent for differential diagnosis of perisplenic lesions. AJR Am J Roentgenol 2007; 186: 621-626.

Molins IG, Font JM, Alvaro JC, et al. Contrast-enhanced ultrasound in diagnosis and characterization of focal hepatic lesions. World J Radiol. 2010; 2(12): 455-462.

Cokkinos D, Antypa E, Stefanidis K, et al. Contrast-enhanced ultrasound for imaging blunt abdominal trauma-indications, description of the technique and imaging review. Ultraschall Med 2012; 33(1): 60-67.

Lim AKP, Patel N, Eckersley RJ, et al. Evidence for spleen-specific uptake of a microbubble contrast agent: A quantitative study in healthy volunteers. Radiology 2004; 231: 785-788.

Jang HJ, Yu H, Kim TK. Contrast-enhanced ultrasound in the detection and characterization of liver tumors. Cancer Imaging 2009; 9(1): 96-103.

Sutherland T, Temple F, Galvin A, et al. Contrast-enhanced ultrasound of the spleen: an introduction and pictorial essay. Insights Imaging 2011; 2: 515–524.

Popescu A, Sporea I, Sirli R, et al. The role of contrast-enhanced ultrasonography with second generation contrast agents in the evaluation of focal splenic lesions. Med Ultrason 2009; 11(3): 61-65.

Ota T, Ono S. Intrapancreatic accessory spleen: Diagnosis using contrast enhanced ultrasound. Br J Radiol 2004; 77(914): 148-149.

Goerg C, Schwerk WB, Goerg K. Sonography of focal lesions of the spleen. AJR Am Journal of Roentgenol 1991; 156: 949-953.

Robertson F, Leander P, Ekberg O. Radiology of the spleen. Eur Radiol 2001; 11: 80-95.

Mostbeck G, Grois N, Mallek H, et al. Hepatosplenic abscesses in immunocompromised patients. [Article in German]. Rofo 1989; 151(6): 692-696.

Bhayana D, Kim TK, Jang HJ. Hypervascular liver masses on contrast-enhanced ultrasound: The importance of washout. AJR Am J Roentgenol 2010; 194: 977-983.

Liu GJ, Lu MD, Xie XY, et al. Realtime contrast-enhanced ultrasound imaging of infected focal liver lesions. J Ultrasound Med 2008; 27: 657-666.

Warshauer DM, Dumbleton SA, Molina PL, et al. Abdominal CT findings in sarcoidosis: radiologic and clinical correlation. Radiology 1994; 192: 93-98.

Perez-Grueso MJ, Repiso A, Gomez R, et al. Splenic focal lesions as manifestation of sarcoidosis: Characterization with contrast-enhanced sonography. J Clin Ultrasound 2007; 35(7): 405-408.

Giovagnoni A, Giorgi C, Goteri C. Tumors of the spleen. Cancer Imaging 2005; 5: 73-77.

Caremani M, Occhini U, Caremani A, et al. Focal splenic lesions: US findings. J Ultrasound 2013; 16: 65-74.

Goerg C, Goerg K, Bert T, et al. Colour Doppler ultrasound patterns and clinical follow-up of incidentally found hypoechoic, vascular tumours of the spleen: Evidence for a benign tumour. Br J Radiol 2006; 79: 319-325.

Stang A, Keles H, Hentschke S, et al. Incidentally detected splenic lesions in ultrasound: Does contrast-enhanced ultrasonography improve the differentiation of benign hemangioma/hamartoma from malignant lesions? Ultraschall Med 2011; 32(6): 582-592.

Goerg C, Weide R, Schwerk WB. Malignant splenic lymphoma: Sonographic patterns, diagnosis and follow-up. Clin Radiol 1997; 52(7): 535-540.

Von Herbay A, Barreiros AP, Ignee A, et al. Contrast enhanced ultrasonography with sonovue: Differentiation between benign and malignant lesions of the spleen. J Ultrasound Med 2009; 28: 421-434.

Schoen CA, Goerg C, Ramaswamy A, et al. Splenic metastases in a large unselected autopsy series. Pathol Res Pract 2006; 202(5): 351-356.

Agha-Mohammadi S, Calne RY. Solitary splenic metastasis: case report and review of the literature. Am J Clin Oncol 2001; 24(3): 306-310.

Lee SS, Morgenstern L, Phillips EH. Splenectomy for splenic metastases: A changing clinical spectrum. Am Surg 2000; 66(9): 837-840.

Moore EE, Cogbill TH, Jurkovich GJ, et al. Organ injury scaling: Spleen and liver (1994 revision). J Trauma 1995; 38(3): 323-324.

Hassan R, Aziz AA, Md Ralib AR, et al. Computed Tomography of Blunt Spleen Injury: A Pictorial Review. Malays J Med Sci 2011; 18(1): 60-67.

Liang QR, Huang CY, Liang T, et al. Contrast-enhanced ultrasonography in evaluation of splenic trauma and injury grading and its clinical application. [article in Chinese]. Chinese J Med Ultrasound (Electronic Edition) 2008; 5(2): 288-294.

Rafailidis V, Deganello A, Watson T, et al. Enhancing the role of paediatric ultrasound with microbubbles: A review of intravenous applications. Br J Radiol 2016; Sep 26: 20160556. [Epub ahead of print]. DOI:10.1259/bjr.20160556

Sidhu PS, Cantisani V, Deganello A, et al. Role of Contrast-Enhanced Ultrasound (CEUS) in Paediatric Practice: An EFSUMB Position Statement. Ultraschall in Med 2016; Jul 14. [Epub ahead of print]. DOI: 10.1055/s-0042-110394

Miele V, Piccolo CL, Trinci M, et al. Diagnostic imaging of blunt abdominal trauma in pediatric patients. Radiol Med 2016; 121(5):409-430.



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