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MRI of Focal Splenic Lesions Without and With Dynamic Gadolinium Enhancement

Antonio Luna1, Ramón Ribes2, Pilar Caro3, Luis Luna1, Eugenia Aumente4 and Pablo R. Ros5

1 Department of Radiology, MR Unit, Clinica Las Nieves, Sercosa, Carmelo Torres 2, Jaén 23007, Spain.
2 Department of Radiology, MR Unit, Reina Sofia Hospital, Córdoba 14004, Spain.
3 MR Unit, Dadisa, Recinto Inferior Zona Franca, Cádiz 11001, Spain.
4 MR Unit, Ressalta, Hospital San Juan de Dios, Córdoba 14012, Spain.
5 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.


Figure 1
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  		Fig. 1A —3-month-old girl with polysplenia syndrome. After chest radiography showed dextrocardia, MRI was performed to rule out associated malformations. Axial unenhanced (A) and delayed contrast-enhanced (B) turbo gradient-echo T1-weighted sequences show mirror-image location of upper abdominal viscera and vessels. Right hypochondrium is occupied by multiple independent splenic nodules of different sizes that show homogeneous enhancement in delayed phase. Findings correspond to polysplenia syndrome associated with situs ambiguous.

 

Figure 2
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  		Fig. 1B —3-month-old girl with polysplenia syndrome. After chest radiography showed dextrocardia, MRI was performed to rule out associated malformations. Axial unenhanced (A) and delayed contrast-enhanced (B) turbo gradient-echo T1-weighted sequences show mirror-image location of upper abdominal viscera and vessels. Right hypochondrium is occupied by multiple independent splenic nodules of different sizes that show homogeneous enhancement in delayed phase. Findings correspond to polysplenia syndrome associated with situs ambiguous.

 

Figure 3
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  		Fig. 2A —34-year-old man with HIV infection and acute hepatosplenic candidiasis. Axial fat-saturated turbo spin-echo T2-weighted image shows multiple round hyperintense lesions in liver and spleen (arrowheads) representing Candida albicans microabscesses.

 

Figure 4
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  		Fig. 2B —34-year-old man with HIV infection and acute hepatosplenic candidiasis. Axial contrast-enhanced turbo spin-echo T1-weighted delayed phase image shows homogeneous enhancement of hepatic lesions and scarce enhancement of splenic lesions (arrowheads), with only one of them detectable. Fat-saturated turbo spin-echo T2-weighted images make lesions appear more conspicuous.

 

Figure 5
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  		Fig. 3A —53-year-old man with Staphylococcus aureus abscess secondary to endocarditis. and B, Axial gradient-echo unenhanced (A) and immediate postcontrast (B) 2D fat-suppressed T1-weighted images show peripheral enhancement of huge cystic-appearing lesion. Clinical data and peripheral enhancement on enhanced MRI sequences led to diagnosis of splenic abscess.

 

Figure 6
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  		Fig. 3B —53-year-old man with Staphylococcus aureus abscess secondary to endocarditis.B, Axial gradient-echo unenhanced (A) and immediate postcontrast (B) 2D fat-suppressed T1-weighted images show peripheral enhancement of huge cystic-appearing lesion. Clinical data and peripheral enhancement on enhanced MRI sequences led to diagnosis of splenic abscess.

 

Figure 7
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  		Fig. 4A —46-year-old woman with splenic hydatid cyst. Septated hyperintense splenic mass is seen on coronal turbo spin-echo T2-weighted image. Smaller peripheral cyst represents daughter cyst (arrow).

 

Figure 8
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  		Fig. 4B —46-year-old woman with splenic hydatid cyst. Axial gradient-echo unenhanced (B) and delayed contrast-enhanced (C) 3D T1-weighted images show cystic nature of mass. These are typical features of hydatid cysts, although similar appearances can be found in epithelial cysts or lymphangiomas. Diagnosis of hydatid cyst was established after splenectomy.

 

Figure 9
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  		Fig. 4C —46-year-old woman with splenic hydatid cyst. Axial gradient-echo unenhanced (B) and delayed contrast-enhanced (C) 3D T1-weighted images show cystic nature of mass. These are typical features of hydatid cysts, although similar appearances can be found in epithelial cysts or lymphangiomas. Diagnosis of hydatid cyst was established after splenectomy.

 

Figure 10
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  		Fig. 5A —44-year-old woman with splenic epithelial cyst. Huge cystic mass was discovered in left upper quadrant on sonography. MRI was performed to determine its organ of origin. Axial unenhanced (A) and delayed contrast-enhanced (B) turbo gradient-echo T1-weighted images show huge homogeneous nonenhancing mass intimately related to spleen, which is shifted laterally. Mass corresponds to splenic epithelial cyst as confirmed after splenectomy.

 

Figure 11
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  		Fig. 5B —44-year-old woman with splenic epithelial cyst. Huge cystic mass was discovered in left upper quadrant on sonography. MRI was performed to determine its organ of origin. Axial unenhanced (A) and delayed contrast-enhanced (B) turbo gradient-echo T1-weighted images show huge homogeneous nonenhancing mass intimately related to spleen, which is shifted laterally. Mass corresponds to splenic epithelial cyst as confirmed after splenectomy.

 

Figure 12
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  		Fig. 6A —57-year-old man with pancreatic pseudocyst with splenic involvement. Patient had history of acute pancreatitis episodes. Huge complicated cyst was discovered during routine sonography study in upper abdomen. MRI was performed for further characterization of lesion. Sagittal unenhanced (A) and delayed contrast-enhanced (B) turbo field-echo T1-weighted images reveal bilobulated cystic mass surrounding and extending to spleen (asterisk). Note presence of fluid-fluid level (arrows) within superior component of mass with hyperintense signal on T1-weighted sequence of dependent component, indicating hemorrhagic content.

 

Figure 13
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  		Fig. 6B —57-year-old man with pancreatic pseudocyst with splenic involvement. Patient had history of acute pancreatitis episodes. Huge complicated cyst was discovered during routine sonography study in upper abdomen. MRI was performed for further characterization of lesion. Sagittal unenhanced (A) and delayed contrast-enhanced (B) turbo field-echo T1-weighted images reveal bilobulated cystic mass surrounding and extending to spleen (asterisk). Note presence of fluid-fluid level (arrows) within superior component of mass with hyperintense signal on T1-weighted sequence of dependent component, indicating hemorrhagic content.

 

Figure 14
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  		Fig. 7A —8-year-old boy with multiple small cavernous hemangiomas showing centripetal enhancement pattern. Coronal fat-saturated turbo spin-echo T2-weighted image shows multiple hyperintense splenic nodules.

 

Figure 15
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  		Fig. 7B —8-year-old boy with multiple small cavernous hemangiomas showing centripetal enhancement pattern. Immediate (B), 1 min (C), and delayed (D) postcontrast gradient-echo T1-weighted images show progressive centripetal enhancement typical of hemangiomas. Note progressive peripheral enhancement on immediate- and 1-min postcontrast images and how nodules become almost completely isointense to splenic parenchyma on delayed acquisition.

 

Figure 16
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  		Fig. 7C —8-year-old boy with multiple small cavernous hemangiomas showing centripetal enhancement pattern. Immediate (B), 1 min (C), and delayed (D) postcontrast gradient-echo T1-weighted images show progressive centripetal enhancement typical of hemangiomas. Note progressive peripheral enhancement on immediate- and 1-min postcontrast images and how nodules become almost completely isointense to splenic parenchyma on delayed acquisition.

 

Figure 17
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  		Fig. 7D —8-year-old boy with multiple small cavernous hemangiomas showing centripetal enhancement pattern. Immediate (B), 1 min (C), and delayed (D) postcontrast gradient-echo T1-weighted images show progressive centripetal enhancement typical of hemangiomas. Note progressive peripheral enhancement on immediate- and 1-min postcontrast images and how nodules become almost completely isointense to splenic parenchyma on delayed acquisition.

 

Figure 18
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  		Fig. 8A —43-year-old man with splenic capillary hemangioma showing homogeneous enhancement pattern. Axial unenhanced (A) and immediate postcontrast (B) volumetric 3D gradient-echo T1-weighted images reveal homogeneous enhancement typical of splenic capillary hemangiomas. On delayed acquisition (not shown), although lesion showed some washout, it remained more enhanced than splenic parenchyma.

 

Figure 19
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  		Fig. 8B —43-year-old man with splenic capillary hemangioma showing homogeneous enhancement pattern. Axial unenhanced (A) and immediate postcontrast (B) volumetric 3D gradient-echo T1-weighted images reveal homogeneous enhancement typical of splenic capillary hemangiomas. On delayed acquisition (not shown), although lesion showed some washout, it remained more enhanced than splenic parenchyma.

 

Figure 20
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  		Fig. 9A —8-year-old boy with systemic angiomatosis and cavernous hemangioma with central scar. Unenhanced (A) and delayed contrast-enhanced (B) fat-saturated turbo spin-echo T1-weighted images show hypointense nodule that shows peripheral and heterogeneous internal enhancement after IV contrast administration, related to presence of central scar, in cavernous hemangioma. Biopsy was not necessary as this patient had multiple hemangiomas in spleen, liver, and neck (not shown).

 

Figure 21
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  		Fig. 9B —8-year-old boy with systemic angiomatosis and cavernous hemangioma with central scar. Unenhanced (A) and delayed contrast-enhanced (B) fat-saturated turbo spin-echo T1-weighted images show hypointense nodule that shows peripheral and heterogeneous internal enhancement after IV contrast administration, related to presence of central scar, in cavernous hemangioma. Biopsy was not necessary as this patient had multiple hemangiomas in spleen, liver, and neck (not shown).

 

Figure 22
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  		Fig. 10A —52-year-old man with splenic hematoma. Axial T2-weighted image shows round hypointense mass in anterior portion of spleen, representing old, healed hematoma.

 

Figure 23
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  		Fig. 10B —52-year-old man with splenic hematoma. Axial unenhanced (B) and delayed contrast-enhanced (C) gradient-echo T1-weighted images show hypointense mass on T1-weighted image with peripheral and heterogeneous internal enhancement. Appearance of lesion on MRI was diagnostic and did not change in several follow-up MRI studies.

 

Figure 24
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  		Fig. 10C —52-year-old man with splenic hematoma. Axial unenhanced (B) and delayed contrast-enhanced (C) gradient-echo T1-weighted images show hypointense mass on T1-weighted image with peripheral and heterogeneous internal enhancement. Appearance of lesion on MRI was diagnostic and did not change in several follow-up MRI studies.

 

Figure 25
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  		Fig. 11A —41-year-old woman with diffuse splenic hemangiomatosis. Coronal turbo spin-echo T2-weighted image shows multiple hyperintense focal splenic lesions (arrowheads) and hypointense nodule representing siderotic nodule (arrow) in enlarged spleen.

 

Figure 26
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  		Fig. 11B —41-year-old woman with diffuse splenic hemangiomatosis. Axial unenhanced gradient-echo T1-weighted image shows hypovascular nodules with areas of magnetic susceptibility artifact (arrows) representing siderotic nodules.

 

Figure 27
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  		Fig. 11C —41-year-old woman with diffuse splenic hemangiomatosis. Postcontrast (1 min) gradient-echo T1-weighted image reveals subtle peripheral enhancement of both nodules (arrows). Superior nodule also presents heterogeneous internal enhancement. Heterogeneous splenic appearance is also possible in cases of angiosarcoma or littoral cell angioma.

 

Figure 28
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  		Fig. 12A —27-year-old woman with splenic lymphangioma. Complex cystic mass was detected in previous routine sonography study and confirmed later on enhanced CT. Axial unenhanced (A) and contrast-enhanced (B) gradient-echo T1-weighted images show subcapsular multilocular mass with hypo- (arrowheads) and hyperintense (arrow) nonenhancing areas, revealing their cystic nature. Hyperintense areas were secondary to proteinaceous content. Diagnosis was confirmed after splenectomy. Ghosting artifact was result of poor breath-holding.

 

Figure 29
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  		Fig. 12B —27-year-old woman with splenic lymphangioma. Complex cystic mass was detected in previous routine sonography study and confirmed later on enhanced CT. Axial unenhanced (A) and contrast-enhanced (B) gradient-echo T1-weighted images show subcapsular multilocular mass with hypo- (arrowheads) and hyperintense (arrow) nonenhancing areas, revealing their cystic nature. Hyperintense areas were secondary to proteinaceous content. Diagnosis was confirmed after splenectomy. Ghosting artifact was result of poor breath-holding.

 

Figure 30
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  		Fig. 13A —72-year-old woman with disseminated tuberculosis and hepatosplenic peliosis. Axial T1 gradient-echo unenhanced (A) and immediate postcontrast (B) images show multicystic mass on spleen (arrows, B) with septal and peripheral enhancement and several liver lesions with peripheral enhancement or multicystic appearance (arrowheads, B). Liver lesions were not detectable on unenhanced image.

 

Figure 31
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  		Fig. 13B —72-year-old woman with disseminated tuberculosis and hepatosplenic peliosis. Axial T1 gradient-echo unenhanced (A) and immediate postcontrast (B) images show multicystic mass on spleen (arrows, B) with septal and peripheral enhancement and several liver lesions with peripheral enhancement or multicystic appearance (arrowheads, B). Liver lesions were not detectable on unenhanced image.

 

Figure 32
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  		Fig. 14A —3-year-old boy with splenic hamartoma. Coronal fat-saturated turbo spin-echo T2-weighted image reveals heterogeneous hyperintense mass in inferior pole of spleen.

 

Figure 33
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  		Fig. 14B —3-year-old boy with splenic hamartoma. Unenhanced (B) and delayed contrast-enhanced (C) turbo spin-echo T1-weighted images show intense mildly heterogeneous enhancement within mass, which was hypointense on precontrast image. This is typical presentation of hamartoma. Larger hemangiomas may have similar appearance, and biopsy may be necessary for differentiation. Although splenectomy was performed in this case, follow-up imaging may be acceptable strategy to assess benign origin of hamartomas.

 

Figure 34
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  		Fig. 14C —3-year-old boy with splenic hamartoma. Unenhanced (B) and delayed contrast-enhanced (C) turbo spin-echo T1-weighted images show intense mildly heterogeneous enhancement within mass, which was hypointense on precontrast image. This is typical presentation of hamartoma. Larger hemangiomas may have similar appearance, and biopsy may be necessary for differentiation. Although splenectomy was performed in this case, follow-up imaging may be acceptable strategy to assess benign origin of hamartomas.

 

Figure 35
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  		Fig. 15A —47-year-old woman with left flank pain and primary splenic nodular non-Hodgkin's lymphoma. Splenic mass was detected in previous sonography study, and MRI study was performed for its characterization. Axial STIR image reveals irregular heterogeneous hypointense mass with extension beyond splenic margins (white arrows).

 

Figure 36
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  		Fig. 15B —47-year-old woman with left flank pain and primary splenic nodular non-Hodgkin's lymphoma. Splenic mass was detected in previous sonography study, and MRI study was performed for its characterization. Axial unenhanced (B) and immediate postcontrast (C) gradient-echo T1-weighted images show hypovascular mass on immediate image that becomes isointense to spleen on delayed acquisition (not shown). Notice presence of small peripheral siderotic nodules (arrowhead).

 

Figure 37
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  		Fig. 15C —47-year-old woman with left flank pain and primary splenic nodular non-Hodgkin's lymphoma. Splenic mass was detected in previous sonography study, and MRI study was performed for its characterization. Axial unenhanced (B) and immediate postcontrast (C) gradient-echo T1-weighted images show hypovascular mass on immediate image that becomes isointense to spleen on delayed acquisition (not shown). Notice presence of small peripheral siderotic nodules (arrowhead).

 

Figure 38
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  		Fig. 16A —56-year-old man with weight loss, weakness, and multinodular non-Hodgkin's lymphoma. T2-weighted image shows normal spleen with no evidence of focal lesions.

 

Figure 39
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  		Fig. 16B —56-year-old man with weight loss, weakness, and multinodular non-Hodgkin's lymphoma. Axial unenhanced (B), immediate postcontrast (C), and delayed postcontrast (D) gradient-echo T1-weighted images show multiple small hypovascular nodules on immediate acquisition that are not detectable on delayed acquisition. Splenectomy was performed and multinodular non-Hodgkin's lymphoma was confirmed.

 

Figure 40
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  		Fig. 16C —56-year-old man with weight loss, weakness, and multinodular non-Hodgkin's lymphoma. Axial unenhanced (B), immediate postcontrast (C), and delayed postcontrast (D) gradient-echo T1-weighted images show multiple small hypovascular nodules on immediate acquisition that are not detectable on delayed acquisition. Splenectomy was performed and multinodular non-Hodgkin's lymphoma was confirmed.

 

Figure 41
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  		Fig. 16D —56-year-old man with weight loss, weakness, and multinodular non-Hodgkin's lymphoma. Axial unenhanced (B), immediate postcontrast (C), and delayed postcontrast (D) gradient-echo T1-weighted images show multiple small hypovascular nodules on immediate acquisition that are not detectable on delayed acquisition. Splenectomy was performed and multinodular non-Hodgkin's lymphoma was confirmed.

 

Figure 42
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  		Fig. 17A —5-year-old boy with acute myeloid leukemia. MRI was performed for staging after positive bone marrow biopsy. Unenhanced (A) and immediate postcontrast (B) 3D fat-suppressed gradient-echo T1-weighted images show multiple hypovascular nodules (arrows, B) not seen on unenhanced MRI. Nodules became isointense to spleen on delayed acquisition (not shown). Nodules represent chloromas, which tend to be more conspicuous, as in cases of lymphoma, on immediate postcontrast acquisition. In this case, lesions disappeared after chemotherapy.

 

Figure 43
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  		Fig. 17B —5-year-old boy with acute myeloid leukemia. MRI was performed for staging after positive bone marrow biopsy. Unenhanced (A) and immediate postcontrast (B) 3D fat-suppressed gradient-echo T1-weighted images show multiple hypovascular nodules (arrows, B) not seen on unenhanced MRI. Nodules became isointense to spleen on delayed acquisition (not shown). Nodules represent chloromas, which tend to be more conspicuous, as in cases of lymphoma, on immediate postcontrast acquisition. In this case, lesions disappeared after chemotherapy.

 

Figure 44
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  		Fig. 18A —63-year-old woman with treated colon adenocarcinoma and splenic metastasis. Axial turbo spin-echo T2-weighted image shows heterogeneous mass with central hyperintense areas.

 

Figure 45
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  		Fig. 18B —63-year-old woman with treated colon adenocarcinoma and splenic metastasis. Axial unenhanced (B), immediate postcontrast (C), and 5-min-delayed postcontrast (D) gradient-echo T1-weighted images reveal hypovascular mass on immediate acquisition difficult to detect on delayed acquisition, where remaining central hypovascular area can be seen. Note correlation between nonenhancing areas on delayed postcontrast acquisition and hyperintense areas on T2-weighted images, representing areas of necrosis.

 

Figure 46
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  		Fig. 18C —63-year-old woman with treated colon adenocarcinoma and splenic metastasis. Axial unenhanced (B), immediate postcontrast (C), and 5-min-delayed postcontrast (D) gradient-echo T1-weighted images reveal hypovascular mass on immediate acquisition difficult to detect on delayed acquisition, where remaining central hypovascular area can be seen. Note correlation between nonenhancing areas on delayed postcontrast acquisition and hyperintense areas on T2-weighted images, representing areas of necrosis.

 

Figure 47
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  		Fig. 18D —63-year-old woman with treated colon adenocarcinoma and splenic metastasis. Axial unenhanced (B), immediate postcontrast (C), and 5-min-delayed postcontrast (D) gradient-echo T1-weighted images reveal hypovascular mass on immediate acquisition difficult to detect on delayed acquisition, where remaining central hypovascular area can be seen. Note correlation between nonenhancing areas on delayed postcontrast acquisition and hyperintense areas on T2-weighted images, representing areas of necrosis.

 

Figure 48
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  		Fig. 19A —Other splenic lesions. 22-year-old woman with nodular splenomegaly in patient with Niemann-Pick disease type B. Axial fat-saturated T2-weighted image shows well-defined hypointense splenic nodule (arrow). Hyperintense splenic nodules on T2-weighted images were also seen in same patient (not shown). Diagnosis was established according to imaging and clinical criteria, results of hepatic and bone marrow biopsies, and levels of glucocerebrosidase and sphingomyelinase.

 

Figure 49
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  		Fig. 19B —Other splenic lesions. 56-year-old man with alcoholic cirrhosis and Gamna-Gandy nodules. Axial contrast-enhanced fat-saturated turbo spin-echo T1-weighted image shows cirrhotic liver and multiple millimetric hypointense nodules with associated susceptibility artifact within enlarged spleen. Siderotic nodules represent areas of microhemorrhages.

 

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