What imaging modalities can be used to rule out splenic infarction?

From the Guidelines

To rule out splenic infarction, contrast-enhanced CT scan of the abdomen is the recommended first-line imaging modality. The CT should be performed with intravenous contrast to clearly visualize areas of decreased perfusion within the spleen. Typical findings of splenic infarction include wedge-shaped, peripheral areas of hypoattenuation that do not enhance with contrast.

Key Points to Consider

• If CT is contraindicated (such as in patients with contrast allergy or renal insufficiency), MRI with gadolinium contrast is an excellent alternative that provides similar diagnostic information 1.
• Ultrasound may be used as an initial screening tool, particularly in pregnant patients or children, but it has lower sensitivity for detecting splenic infarction compared to CT or MRI.
• The choice of imaging should consider the patient's clinical status, as splenic infarction typically presents with left upper quadrant pain, fever, and elevated inflammatory markers.
• Prompt imaging is important as early diagnosis allows for appropriate management of the underlying cause, which may include atrial fibrillation, endocarditis, hypercoagulable states, or embolic disease.

Imaging Modalities

• CT scan with intravenous contrast is the gold standard in hemodynamically stable or stabilized trauma patients 1.
• MRI with gadolinium contrast is an excellent alternative to CT scan.
• Ultrasound may be used as an initial screening tool, but it has lower sensitivity compared to CT or MRI.
• Nuclear medicine studies such as technetium-99m sulfur colloid scans can also detect splenic infarction but are rarely used as first-line tests.

Clinical Considerations

• The patient's clinical status should be considered when choosing an imaging modality.
• Splenic infarction typically presents with left upper quadrant pain, fever, and elevated inflammatory markers.
• Prompt imaging is important to allow for early diagnosis and management of the underlying cause.
• The use of contrast-enhanced US (CEUS) can increase sensitivity for the evaluation of splenic flow and injuries 1.

From the Research

Imaging Modalities for Ruling Out Splenic Infarction

The following imaging modalities can be used to rule out splenic infarction:

• Contrast-enhanced ultrasound (CEUS) 2, 3: CEUS is a simple, poorly-invasive, and accurate tool for the evaluation of splenic disorders, including splenic infarction. It can detect parenchymal changes, lesion extent, and lesion conspicuity, and is particularly useful in patients with renal failure.
• Computed Tomography (CT) 4, 5, 6: CT is currently the choice for evaluation of the spleen and can readily diagnose segmental splenic infarction. Contrast-enhanced CT is the imaging modality of choice in suspected cases of splenic infarction.
• Magnetic Resonance Imaging (MRI) 4: MRI may be increasingly used as newer pulse sequences and organ-specific contrast agents are developed, but its role in diagnosing splenic infarction is currently limited.

Characteristics of Imaging Modalities

The characteristics of these imaging modalities are:

• CEUS: fast, safe, easy to perform, non-irradiating, and can be used in patients with renal failure 3
• CT: can detect small or infiltrating lesions, and is particularly useful in evaluating the spleen after blunt trauma 5
• MRI: can provide detailed images of the spleen, but its role in diagnosing splenic infarction is currently limited 4

Clinical Significance

The clinical significance of these imaging modalities is:

• Early recognition and treatment of splenic infarction can help prevent potentially life-threatening events 6
• Patients with splenic infarction should be advised to avoid sports that may precipitate splenic rupture 6