From the Research
The next imaging step for these rare ovoid splenic lesions should be an MRI with a spleen lesion protocol, as it offers superior soft tissue contrast and can better differentiate between benign hemangiomas and other potential etiologies. The multiple enhancing lesions throughout the spleen, which is normal in size, most likely represent splenic hemangiomas, the most common benign splenic lesion, as discussed in 1. However, since these findings are nonspecific and cannot be compared to prior imaging, further characterization is necessary.
Key Considerations
- MRI protocol should include T1-weighted, T2-weighted, and dynamic contrast-enhanced sequences to evaluate the enhancement pattern of these lesions.
- Hemangiomas typically show peripheral nodular enhancement with progressive centripetal fill-in on delayed images, as noted in 2.
- The addition of diffusion-weighted imaging (DWI) to conventional MRI can improve the differentiation of malignant from benign splenic lesions, as shown in 3.
- Most splenic hemangiomas are asymptomatic and require no treatment unless they are large or causing symptoms, as reported in 4.
- Recent studies, such as 5, highlight the importance of accurate characterization of splenic lesions to determine the risks and benefits of elective splenectomy.
Recommendations
- Perform an MRI with a spleen lesion protocol to further characterize the lesions.
- Include T1-weighted, T2-weighted, and dynamic contrast-enhanced sequences in the MRI protocol.
- Consider adding DWI to the MRI protocol to improve the differentiation of malignant from benign lesions.
- Avoid unnecessary interventions, as most splenic hemangiomas are asymptomatic and require no treatment unless they are large or causing symptoms.