From the Guidelines
The best radiology image to assess the spleen is an abdominal CT scan with intravenous contrast. This is based on the most recent and highest quality study available, which emphasizes the importance of CT scanning in evaluating splenic anatomy, size, and potential pathologies such as lacerations, infarcts, abscesses, or masses 1. The use of IV contrast enhances the evaluation by highlighting vascular structures and improving detection of focal lesions through differential enhancement patterns.
Some key points to consider when assessing the spleen include:
- The choice of diagnostic technique should be based on the hemodynamic status of the patient, with CT scan being the gold standard in hemodynamically stable or stabilized trauma patients 1.
- Ultrasound can serve as a good initial screening tool, especially in children or pregnant patients, as it avoids radiation exposure and can effectively assess splenic size and detect large lesions or fluid collections 1.
- MRI offers superior soft tissue contrast and may be preferred for characterizing indeterminate lesions found on other imaging modalities, though it is more time-consuming and expensive 1.
- Plain radiographs have limited utility for splenic assessment as they only show gross abnormalities like calcifications or significant size changes 1.
In terms of specific patient populations, it's worth noting that:
- In haemodynamically stable patients after blunt abdominal trauma, non-operative management (NOM) can be the first option in most cases, with CT scan playing a crucial role in diagnosis and monitoring 1.
- In patients with haemorrhagic shock or ongoing bleeding after splenic, kidney or adrenal injury, therapeutic haemostatic angio-embolisation may be considered as an alternative to haemostatic laparotomy 1.
Overall, abdominal CT scan with intravenous contrast remains the gold standard for comprehensive splenic evaluation in most clinical scenarios, due to its excellent visualization of splenic anatomy and potential pathologies, as well as its ability to guide treatment decisions 1.
From the Research
Radiology Image Options for Assessing the Spleen
- Computed Tomography (CT) is a commonly used imaging modality for assessing the spleen, particularly in trauma patients 2, 3, 4.
- CT with intravenous contrast is the preferred imaging modality for hemodynamically normal patients, as it provides superior image quality and helps to classify the grade of injury and identify active bleeding and its stigmata 2, 4.
- However, in patients with contraindications to intravenous contrast, non-contrast CT (DRY imaging) may be used, although it has a lower sensitivity for detecting splenic parenchymal injury 2.
- Contrast-enhanced ultrasound (CEUS) is another imaging modality that can be used to assess the spleen, particularly in patients who are unstable or have contraindications to CT scans 3, 5.
- CEUS has been shown to have a high sensitivity for detecting splenic injury and can be used as an alternative to CT scans in certain situations 3, 5.
- Magnetic Resonance (MR) imaging can also be used to assess the spleen, although it is not as commonly used as CT scans 6.
Comparison of Imaging Modalities
- CT scans with intravenous contrast are generally considered the gold standard for assessing the spleen in trauma patients 2, 4.
- CEUS is a useful alternative to CT scans in certain situations, such as in patients who are unstable or have contraindications to CT scans 3, 5.
- Non-contrast CT (DRY imaging) may be used in patients with contraindications to intravenous contrast, but it has a lower sensitivity for detecting splenic parenchymal injury 2.
- MR imaging can be used to assess the spleen, but it is not as commonly used as CT scans 6.