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MR Features of Abdominal Splenosis

Wen-Chiung Lin1,2, Rheun-Chuan Lee1,2, Jen-Huey Chiang1,2, Chao-Jung Wei1,2, Lee-Shing Chu3,4, Ren-Shyan Liu3,4 and Cheng-Yen Chang1,2,5

1 Department of Radiology, Taipei Veterans General Hospital, 201, Sec. 2. Shih-Pai Rd., Taipei, Taiwan 11217.
2 Department of Radiology, National Yang-Ming University School of Medicine, 155, Sec. 2, Li-Nong St. Taipei, Taiwan 11217.
3 Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 11217.
4 Department of Nuclear Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan 11217.
5 Department of Radiology, National Defense Medical Center, 325, Sec. 2, Cheng-Kung Rd., Taipei, Taiwan 11217.



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  		Fig. 1. —Drawing shows seeding sites and number of splenic implants. HP = hepatic parenchyma, SPS = subphrenic space, LSHS = left subhepatic space, DIA = diaphragm, RSHS = right subhepatic space, SSDC = serosal surface of descending colon, RP = renal parenchyma, PRS = perirenal space, LPG = left paracolic gutter, DMC = descending mesocolon.

 


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  		Fig. 2A. —37-year-old man with history of car crash who underwent splenectomy 13 years ago. Unenhanced T1-weighted MR image (TR/TE, 150/4.2) with fat suppression shows hypointense signal in 2-cm splenic implant (arrow) at left hepatic lobe. Note that nodule is crescent-shaped with anterior border confined by abdominal wall (arrowhead).

 


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  		Fig. 2B. —37-year-old man with history of car crash who underwent splenectomy 13 years ago. T2-weighted MR image (2000/86.8) obtained at same level as A shows hypointense signal in splenic implant (arrow).

 


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  		Fig. 2C. —37-year-old man with history of car crash who underwent splenectomy 13 years ago. Arterial phase of contrast-enhanced dynamic MR image (150/4.2 with fat suppression and three-dimensional spoiled gradient-echo sequence) shows peripheral enhancement in splenic implant (arrow). Excisional biopsy confirmed splenic implant.

 


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  		Fig. 3A. —41-year-old man with history of car crash who underwent splenectomy 20 years ago. T1-weighted MR image (TR/TE, 150/4.2) shows hypointense signal in sheetlike 6-cm splenic implants (large arrow) that are invaginated into two leaves of posterior perirenal fascia (arrowheads). Multiple smaller implants are present in perirenal space (small arrows).

 


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  		Fig. 3B. —41-year-old man with history of car crash who underwent splenectomy 20 years ago. Coronal delayed-phase dynamic MR image obtained 3 min after gadolinium contrast administration shows persistent lack of enhancement in splenic implants at upper and lower poles of left kidney (arrows). Attachment of splenic implants to renal parenchyma is shown.

 


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  		Fig. 3C. —41-year-old man with history of car crash who underwent splenectomy 20 years ago. Unenhanced CT scan, obtained with scanning level approximately 2 cm cranial to A, shows crescent-shaped splenic implants along posterior perirenal fascia. Note that edges limited by posterior perirenal fascia are effaced (arrowheads). Note high density of splenic implants.

 


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  		Fig. 3D. —41-year-old man with history of car crash who underwent splenectomy 20 years ago. Splenic scan obtained with technetium-99m—tagged heat-damaged RBC shows radionuclide uptake at renal parenchyma and perirenal space, consistent with locations of splenic implants on MR imaging. Note that left side of figure is left side of patient.

 


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  		Fig. 4A. —43-year-old man with pedunculated hepatic cellular carcinoma in left hepatic lobe who underwent left lobectomy, partial resection of diaphragm, and splenectomy because of tumor invasion. Follow-up CT scan obtained 3 months after surgery shows that no splenic implants can be identified.

 


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  		Fig. 4B. —43-year-old man with pedunculated hepatic cellular carcinoma in left hepatic lobe who underwent left lobectomy, partial resection of diaphragm, and splenectomy because of tumor invasion. Follow-up CT scan obtained 1 year after A shows well-defined 1.5-cm nodule adhering to left hemidiaphragm, which was confirmed to be splenic implant (arrow) by splenic scan obtained with technetium-99m—tagged heat-damaged RBC (not shown).

 


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  		Fig. 4C. —43-year-old man with pedunculated hepatic cellular carcinoma in left hepatic lobe who underwent left lobectomy, partial resection of diaphragm, and splenectomy because of tumor invasion. Axial T1-weighted MR image obtained 5 years after A shows progressive enlargement of 2-cm splenic implant (arrow).

 


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  		Fig. 4D. —43-year-old man with pedunculated hepatic cellular carcinoma in left hepatic lobe who underwent left lobectomy, partial resection of diaphragm, and splenectomy because of tumor invasion. Arterial phase of dynamic MR image (TR/TE,150/4.2) with fat suppression and three-dimensional spoiled gradient-echo sequence shows peripheral enhancement of splenic implant (arrow).

 


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  		Fig. 5. —80-year-old man who underwent splenectomy 40 years ago. Arterial phase of coronal reformatted MR image (TR/TE, 150/4.2) with fat suppression and three-dimensional fast low-angle shot shows heterogeneous mosaic enhancing 6-cm splenic implant (arrow) on serosal surface of descending colon. Parasitic blood vessel (arrowheads) from inferior mesenteric artery enters ovoid splenic implant (not shown).

 


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  		Fig. 6. —65-year-old man with traumatic disruption of spleen who underwent splenectomy 15 years ago. Reformatted contrast-enhanced T1-weighted MR image (TR/TE,150/4.2) with fat suppression and three-dimensional spoiled gradient-echo sequence in arterial phase shows conglomerate 3-cm splenic implant (arrows) in left subphrenic region.

 

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