Imaging Pearls ❯ Spleen ❯ Incidentalomas of the Spleen
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- Applying an approach frequently used in imaging to the splenic mass—based on the number and consistency of lesions and refined by supplementary imaging features—allows formulation of a useful differential diagnosis. Solitary cystic masses include true cysts, pseudocysts, and parasitic cysts. When multiple cystic lesions are present, the differential diagnosis expands to include infectious lesions (abscess or microabscesses) and lymphangioma (a benign cystic neoplasm). Hemangioma is the most common solitary solid mass, although other vascular lesions (hamartoma, sclerosing angiomatoid nodular transformation) and nonvascular lesions (inflammatory pseudotumor, lymphoma) manifest as solitary and solid.
Algorithmic Approach to the Splenic Lesion Based on Radiologic-Pathologic Correlation.
Kim N, Auerbach A, Manning MA.
Radiographics. 2022 May-Jun;42(3):683-701. - When multiple solid masses are present, diffuse inflammatory disease (sarcoidosis), littoral cell angioma, and lymphoma should be considered. Malignancies, such as angiosarcoma or metastasis, can manifest as solitary or multiple and solid or cystic masses but are typically associated with symptoms or widespread primary malignancy. Careful assessment of the multimodality imaging characteristics of splenic lesions based on this approach aids the radiologist faced with the incidental splenic lesion.
Algorithmic Approach to the Splenic Lesion Based on Radiologic-Pathologic Correlation.
Kim N, Auerbach A, Manning MA.
Radiographics. 2022 May-Jun;42(3):683-701. - A solitary splenic cyst is almost always benign and usually classified as parasitic or nonparasitic; nonparasitic cysts are then subclassified as primary true or secondary false cysts, as determined by the presence or absence of an epithelial lining. Secondary cysts, also known as nonpancreatic pseudocysts, are more common and are associated with trauma, including hemorrhage, infarction, or inflammation.
Algorithmic Approach to the Splenic Lesion Based on Radiologic-Pathologic Correlation.
Kim N, Auerbach A, Manning MA.
Radiographics. 2022 May-Jun;42(3):683-701. 
- Splenic abscesses can be bacterial, mycobacterial, or fungal and can result from hematogenous seeding, direct extension, sequelae of trauma, or prior infarcts. Common causes of bacterial abscess include endocarditis, pneumonia, gastrointestinal perforation, or arteriovenous malformation. The most common bacterial microbes include Escherichia coli, Staphylococcus, Streptococcus,and Salmonella. Although uncommon in the United States, granulomatous infection with Mycobacterium tuberculosis can result in abscesses due to hematogenous disseminated miliary spread.
Algorithmic Approach to the Splenic Lesion Based on Radiologic-Pathologic Correlation.
Kim N, Auerbach A, Manning MA.
Radiographics. 2022 May-Jun;42(3):683-701. - Fungal microabscesses usually occur in patients with prolonged neutropenia. Predisposing factors include immunocompromise due to HIV infection, chemotherapy, immunosuppression for organ transplantation, or immunodeficiency. The most common fungal pathogens are Candida, Aspergillus, and Cryptococcus. Clinically, patients present with fever, abdominal pain, chills, constitutional symptoms, and sometimes septic shock.
Algorithmic Approach to the Splenic Lesion Based on Radiologic-Pathologic Correlation.
Kim N, Auerbach A, Manning MA.
Radiographics. 2022 May-Jun;42(3):683-701. - Hemangioma is the most common benign lesion in the spleen. Most are found incidentally in asymptomatic patients. Usually solitary, hemangiomas can be multiple or diffuse; hemangiomatosis can reflect a manifestation of systemic angiomatosis in Klippel-Trenaunay syndrome. Kasabach-Merritt syndrome (anemia, thrombocytopenia, and coagulopathy) has been associated with large hemangiomas.
Algorithmic Approach to the Splenic Lesion Based on Radiologic-Pathologic Correlation.
Kim N, Auerbach A, Manning MA.
Radiographics. 2022 May-Jun;42(3):683-701. - Splenic hemangioma can show the well-described imaging characteristics of typical hepatic hemangioma: (a) well-defined hyperechoic mass without posterior acoustic shadowing at US; (b) well-circumscribed mass with peripheral nodular discontinuous early enhancement and homogeneous progressive enhancement at CT and MRI; and (c) homogeneous T2 hyperintensity at MRI. However, splenic hemangioma complicated by fibrosis, hemorrhage, or cystic degeneration can have a variable multimodality imaging appearance.
Algorithmic Approach to the Splenic Lesion Based on Radiologic-Pathologic Correlation.
Kim N, Auerbach A, Manning MA.
Radiographics. 2022 May-Jun;42(3):683-701. - Women are more likely to present with symptomatic larger lesions, suggesting a role for hormonal stimulation. Larger hamartomas can manifest with splenomegaly. Rarely, hematologic disorders including pancytopenia, anemia, or thrombocytopenia can occur from sequestration of hematopoietic cells. Splenic hamartoma has been associated with other hamartomatous entities, including tuberous sclerosis.
Algorithmic Approach to the Splenic Lesion Based on Radiologic-Pathologic Correlation.
Kim N, Auerbach A, Manning MA.
Radiographics. 2022 May-Jun;42(3):683-701. - The multimodality imaging features of SANT have been described in the literature in several case reports and generally parallel the gross appearance as a solitary well-defined mass . A characteristic appearance at contrast-enhanced US, CT, and MRI is early peripheral rim enhancement with radiating bands of progressive centripetal enhancement, described as a spokewheel appearance. At MRI, radiating T2-hypointense bands extending toward the center of the mass are thought to reflect the fibrous stroma. Susceptibility artifact can indicate the presence of hemosiderin.
Algorithmic Approach to the Splenic Lesion Based on Radiologic-Pathologic Correlation.
Kim N, Auerbach A, Manning MA.
Radiographics. 2022 May-Jun;42(3):683-701. - Concomitant with the variable pathologic appearance of angiosarcoma, imaging features are heterogeneous and nonspecific. The spleen is often enlarged, and when infiltrated by diffuse angiosarcoma, will enhance heterogeneously. Discrete angiosarcomas appear as a large dominant mass or multiple masses. As hemorrhage and cystic necrosis are common, angiosarcoma can appear cystic. Increased flow in the bizarre and dilated vascular channels can be shown at color Doppler US. At CT and MRI, angiosarcomas can be solitary or multiple, poorly defined, heterogeneous nodular masses—due to the presence of both solid components and areas of hemorrhage and necrosis—with heterogeneous nodular enhancement of solid components and vascular channels.
Algorithmic Approach to the Splenic Lesion Based on Radiologic-Pathologic Correlation.
Kim N, Auerbach A, Manning MA.
Radiographics. 2022 May-Jun;42(3):683-701. - The term inflammatory pseudotumor (IPT) has been used to describe a reactive tumorlike lesion found throughout the body, rarely in the spleen. Originally described in 1984, splenic IPT is most often seen in middle-aged or older patients . Splenic IPT is strongly associated with Epstein-Barr virus (EBV) infection. IPT-like follicular dendritic cell (FDC) tumor is the most frequent subgroup of EBV-associated IPT. Patients can have a wide range of clinical presentations, from asymptomatic to left upper quadrant or epigastric pain, fever, weight loss, and splenomegaly. Anemia, thrombocytopenia, hypergammaglobulinemia, and elevated levels of inflammatory markers have also been described.
Algorithmic Approach to the Splenic Lesion Based on Radiologic-Pathologic Correlation.
Kim N, Auerbach A, Manning MA.
Radiographics. 2022 May-Jun;42(3):683-701. - Most patients with splenules present have a single splenule varying in size from a few millimeters to centimeters (mean measurement = 1.16 cm). Multiple splenules clustered together are less commonly seen (rarely greater than six per cluster). Splenules appear as ovoid or spherical masses with identical imaging characteristics to those of the orthotopic spleen, and one may be able to identify a branch of the splenic artery supplying the splenule. Splenules are generally asymptomatic and found incidentally. Splenules can also harbor any disease that can involve the spleen itself.”
Spectrum of Heterotopic and Ectopic Splenic Conditions.
Nelson LW, Bugenhagen SM, Lubner MG, Bhalla S, Pickhardt PJ.
Radiographics. 2024 Nov;44(11) - Splenosis is an acquired condition of autotransplanted benign splenic tissue caused by spillage of cells after traumatic or iatrogenic splenic injury. The splenic deposits may be found anywhere throughout the body but most commonly occur in the peritoneal cavity. The splenic deposits can vary in number, size, and shape and can easily be confused with neoplasms, such as lymphoma, mesenchymal tumors, melanoma, and metastatic disease. Unlike congenital splenules, splenosis lesions obtain their blood supply from surrounding tissues and have a poorly formed capsule. Otherwise, splenosis deposits generally have the same imaging characteristics as normal splenic tissue: well-circumscribed homogeneously enhancing lesions at CT and MRI (with increased diffusion restriction), solid round or oval homogeneous hypoechoic masses at US, and lacking high focal fluorodeoxyglucose (FDG) uptake at PET.
Spectrum of Heterotopic and Ectopic Splenic Conditions.
Nelson LW, Bugenhagen SM, Lubner MG, Bhalla S, Pickhardt PJ.
Radiographics. 2024 Nov;44(11) - Torsion of a wandering spleen is a rare but severe complication that can occur when the displaced organ twists on its lax vascular pedicle, causing vascular compromise and infarction. Patients with acute splenic torsion causing ischemia may present with acute abdomen and require emergent surgical intervention. At imaging, a wandering spleen appears as an enlarged spleniform mass in an ectopic location with partial or complete absence of parenchymal enhancement; in some cases, the twisted vascular supply may be evident as a whirl sign, with alternating opaque and lucent bands
Spectrum of Heterotopic and Ectopic Splenic Conditions.
Nelson LW, Bugenhagen SM, Lubner MG, Bhalla S, Pickhardt PJ.
Radiographics. 2024 Nov;44(11) - Heterotaxy syndromes represent a spectrum of abnormal disruption of the typical asymmetric visceral organ positionings in the chest and abdomen along the right and left axes. There are two major subtypes, asplenia and polysplenia, and the degree of organ derangement is variable. It is important to recognize, as these patients can also have associated complex cardiac defects (most severe in asplenia), immune deficiency, and bowel malrotation.
Spectrum of Heterotopic and Ectopic Splenic Conditions.
Nelson LW, Bugenhagen SM, Lubner MG, Bhalla S, Pickhardt PJ.
Radiographics. 2024 Nov;44(11) - The cardiac anomalies associated with polysplenia are typically less severe than those associated with asplenia; they can include endocardial cushion defects, atrial septal defect, ventricular septal defect, and transposition of the great arteries. These patients may also present with immune deficiency, as they are usually functionally hyposplenic despite having multiple spleens. Owing to abnormal splenic development, the accessory splenic tissue is also more susceptible to torsion.
Spectrum of Heterotopic and Ectopic Splenic Conditions.
Nelson LW, Bugenhagen SM, Lubner MG, Bhalla S, Pickhardt PJ.
Radiographics. 2024 Nov;44(11) - Asplenia is right isomerism or bilateral right sidedness. This syndrome is more common in males and is usually diagnosed in childhood, as there is a poor prognosis due to associated severe cardiac anomalies, including large ventricular septal defect, single ventricle, and pulmonic stenosis or atresia). These patients can present with severe cyanosis and respiratory distress due to associated cardiac malformations. Other findings include trilobed lungs, bilateral eparterial bronchi (the main bronchus originates above the ipsilateral pulmonary artery), midline liver, absent gallbladder, intestinal malrotation, and duplication of the inferior vena cava without normal splenic tissue. Since there is congenital absence of the spleen, these patients are prone to life-threatening sepsis
Spectrum of Heterotopic and Ectopic Splenic Conditions.
Nelson LW, Bugenhagen SM, Lubner MG, Bhalla S, Pickhardt PJ.
Radiographics. 2024 Nov;44(11) - “Sarcoidosis is a systemic inflammatory condition characterized by noncaseating granulomas. Its annual incidence ranges from 1 to 15 per 100,000 individuals and is more common in women. While pulmonary and mediastinal lymph node involvement is common, affecting 90% of patients, splenic involvement is reported in close to 24% of cases. Splenic sarcoidosis at CT scans reveals multiple solid hypodense nodules of varying sizes, typically hypoenhancing after contrast administration, often coexisting with hepatic nodules and abdominal lymphadenopathies. Traditionally, these splenic lesions exhibit characteristic MRI features based on disease activity. Inflammatory lesions show high signals on T2 and DWI sequences, whereas fibrous lesions present with low signals on both T1 and T2 sequences.”
Spleen anomalies and lesions in CT and MRI: essentials for radiologists and clinicians—a pictorial review
Herrera-Ortiz AF, Del Castillo V, Aguirre D, et al
Abdom Radiol (NY). 2025 Feb;50(2):860-874. - Splenic metastases are rare and often associated with advanced stages of widespread metastatic disease in melanoma,breast, ovarian, lung, and colon cancers . Splenic metastases are generally multiple, although isolated metastasis has also been reported as an even rarer occurrence. At CT, splenic metastases commonly present as hypodense lesions; nevertheless, their appearance can vary based on the primary tumor, occasionally manifesting as cystic lesions with diverse enhancement patterns. At MRI, splenic metastases present low signal intensity on T1 and high signal intensity on T2 sequences, with a variable degree of contrast enhancement, making their diagnosis challenging.
Spleen anomalies and lesions in CT and MRI: essentials for radiologists and clinicians—a pictorial review
Herrera-Ortiz AF, Del Castillo V, Aguirre D, et al
Abdom Radiol (NY). 2025 Feb;50(2):860-874. - “ Splenic metastases can occur with widespread disease, and parenchymal disease is caused by hematogenous dissemination. The most common primary cancers with splenic metastases include melanoma and cancers of the breast, lung, ovary, stomach, and prostate.”
Nonneoplastic, Benign, and Malignant Splenic Diseases: Cross-Sectional Imaging Findings and Rare Disease Entities
Thipphavong S et al.
AJR 2014;203: 315-322 - Primary splenic angiosarcoma predominantly affects patients in the 6th–7th decade of life, with an annual incidence of one case per 4 million individuals. This aggressive neoplasm displays a predilection for males and has a poor prognosis, marked by a high mortality rate and significant risk of rupture in up to 30% of cases. At CT imaging, splenic angiosarcoma often presents as solitary or multiple poorly defined nodular masses distorting the normal anatomy of the spleen and producing enlargement. The contrast enhancement pattern on CT varies depending on the extent of necrosis within the lesion. Its enhancement is usually centripetal and heterogeneous, and 69–100% of the cases tend to present with metastases, most commonly disseminating to the liver, lungs, adrenals, bones, and lymphatics .
Spleen anomalies and lesions in CT and MRI: essentials for radiologists and clinicians—a pictorial review Andr.s Felipe Herrera‑Ortiz et al.
Herrera-Ortiz AF, Del Castillo V, Aguirre D, et al
Abdom Radiol (NY). 2025 Feb;50(2):860-874. - “Practice Recommendation: Splenic artery aneurysms ≥2 cm, or any aneurysm with features suspicious for a pseudoaneurysm should be referred to interventional radiology (or other endovascular specialist) for consideration of treatment. Aneurysms <2 cm can be followed for growth annually with CT or MR angiography, with discontinuation of follow-up made in consultation with a vascular specialist after a period of ongoing stability.”
CAR Recommendations for the Management of Incidental Findings of the Spleen and Nodes in Adults
Jeffery R. Bird, Gary L. Brahm, Christopher I. Fung et al.
Canadian Association of Radiologists Journal1–10 (2025) - “Practice Recommendation: A single measurement of >13 cm in maximal diameter is recommended to screen for splenomegaly in adults, recognizing that the positive predictive value for disease has not been determined. Volume calculations can be reserved for when more accuracy is required.”
CAR Recommendations for the Management of Incidental Findings of the Spleen and Nodes in Adults
Jeffery R. Bird, Gary L. Brahm, Christopher I. Fung et al.
Canadian Association of Radiologists Journal1–10 (2025) - Although medical calculators can diagnose splenomegaly by correcting for body size, they are cumbersome, requiring knowledge of the patient’s height, weight, and gender.6 Although the literature suggests that splenic volume calculation may represent the future of spleen measurement, other studies showing a close correlation between a single largest measurement and total spleen volume favour continuing with the current status quo of providing a single value to represent spleen size. Volume calculations can be referenced to body size when more accuracy is required, particularly to avoid overdiagnosing splenomegaly in larger patients.
CAR Recommendations for the Management of Incidental Findings of the Spleen and Nodes in Adults
Jeffery R. Bird, Gary L. Brahm, Christopher I. Fung et al.
Canadian Association of Radiologists Journal1–10 (2025) - “Lymphoma is the most common malignancy of the spleen, either primary or part of diffuse systemic disease.12,15 Splenic involvement occurs in approximately 33% of patients with Hodgkins and 30% to 40% in patients with non-Hodgkins Lymphoma.16 Lymphoma can present in many forms including splenomegaly, diffuse nodules (either in a miliary pattern or larger nodules), or a solitary mass.12 Primary splenic lymphoma confined only to the spleen ± perisplenic nodes is very rare, comprising less than 1% of cases, and most patients will present with constitutional symptoms.”
CAR Recommendations for the Management of Incidental Findings of the Spleen and Nodes in Adults
Jeffery R. Bird, Gary L. Brahm, Christopher I. Fung et al.
Canadian Association of Radiologists Journal1–10 (2025) - Splenic incidental findings are defined as lesions detected on imaging in the spleen not related to the clinical history. Incidental splenic lesions are less common than in other organs such as liver or kidneys, but increased demand for imaging means that their frequency is rising. Incidental focal splenic lesions have a wide range of etiologies, ranging from common benign diagnoses (cysts, granulomas, and hemangiomas) to lymphoma or metastases to exceedingly rare primary malignancies such as angiosarcoma. In one study, 1.5% of trauma patients with CT had an incidental splenic lesion and the vast majority are benign. Benign lesions are almost always asymptomatic, whereas malignant lesions are very rarely entirely incidental or a solitary isolated finding.
CAR Recommendations for the Management of Incidental Findings of the Spleen and Nodes in Adults
Jeffery R. Bird, Gary L. Brahm, Christopher I. Fung et al.
Canadian Association of Radiologists Journal1–10 (2025) - Practice Recommendation: If an incidental isolated indeterminate splenic mass is found on CT or MR in a patient with no history of malignancy or symptoms, it is unlikely to be clinically significant, and no further evaluation or follow-up is necessary.
Practice Recommendation: In patients with constitutional symptoms (fever, weight loss, night sweats), epigastric or left upper quadrant pain, or a history of prior malignancy, the risk of malignancy is low but not negligible. An incidental indeterminate splenic lesion should be further evaluated with MRI, PET/CT, or biopsy, especially if it may affect patient management.
CAR Recommendations for the Management of Incidental Findings of the Spleen and Nodes in Adults
Jeffery R. Bird, Gary L. Brahm, Christopher I. Fung et al.
Canadian Association of Radiologists Journal1–10 (2025) - “Fortunately, most incidental splenic lesions are benign and clinically insignificant. Although supporting literature is sparse, the white paper on incidental findings by the American College of Radiology (ACR) suggests that splenic lesions smaller than 1 cm in a patient without malignancy are likely benign and do not warrant further imaging. Primary malignant splenic lesions are extremely rare and tend to grow rapidly, whereas benign lesions grow at a rate of less than 3 mm per year. Therefore, small size and stability over 1 year are considered excellent markers for benignity in splenic lesions.”
Incidental Splenic Lesions: A Proposed Algorithm for Assessment and Management
Myles T. Taffel, MD1, Julie Y. An, MD1, Frank H. Miller et al.
Roentgen Ray Rev 2025; 1:e2401039 - “The primary objective of imaging and classification is not necessarily to pinpoint an exact diagnosis but to differentiate between indolent and potentially aggressive lesions, guiding appropriate follow-up or intervention on the basis of malignancy risk.”
Incidental Splenic Lesions: A Proposed Algorithm for Assessment and Management
Myles T. Taffel, MD1, Julie Y. An, MD1, Frank H. Miller et al.
Roentgen Ray Rev 2025; 1:e2401039 - Before a lesion is classified as incidental, clinical factors and concomitant nonsplenic imaging findings must exclude the possibility of acute hematoma, abscess, or malignancy. Acute splenic hematomas are almost always the result of recent blunt trauma and should be considered in patients with a compatible history. Abscesses typically present with fever, abdominal pain, chills, and leukocytosis. Microabscesses, often fungal in origin, are encountered in patients who are immunocompromised because of chemotherapy, chronic steroid use, organ transplant, or HIV. Imaging reveals numerous similarly sized small lesions, usually accompanied by hepatic involvement.
Incidental Splenic Lesions: A Proposed Algorithm for Assessment and Management
Myles T. Taffel, MD1, Julie Y. An, MD1, Frank H. Miller et al.
Roentgen Ray Rev 2025; 1:e2401039 - Lymphoma is the most common malignancy involving the spleen. Symptoms include left upper quadrant pain and constitutional systemic symptoms like weight loss, malaise, and fever . As the majority of patients have disseminated lymphoma at presentation, concomitant lymphadenopathy aids in the diagnosis . Nevertheless, primary splenic lymphoma can rarely occur, making up less than 1% of all lymphomas, and is usually non-Hodgkin type.
Incidental Splenic Lesions: A Proposed Algorithm for Assessment and Management
Myles T. Taffel, MD1, Julie Y. An, MD1, Frank H. Miller et al.
Roentgen Ray Rev 2025; 1:e2401039 - Isolated splenic lymphoma presents as solitary or multiple nodules. The nodules typically appear hypoattenuating on CT, hypointense on T1-weighted MRI, and are often hypointense or isointense on T2-weighted MRI. They show hypoenhancement, with restricted diffusion relative to surrounding parenchyma. Given the normally heterogeneous parenchymal enhancement in the arterial phase, hypoenhancing lesions are frequently better detected in the late venous or equilibrium phase of postcontrast imaging. In the absence of suspicious imaging features, these lesions may be indistinguishable from other solid lesions. Lymphoma will show avid FDG uptake on PET/CT, which may be useful in staging. When FDG avidity is absent, lymphoma is unlikely.
Incidental Splenic Lesions: A Proposed Algorithm for Assessment and Management
Myles T. Taffel, MD1, Julie Y. An, MD1, Frank H. Miller et al.
Roentgen Ray Rev 2025; 1:e2401039 - Although angiosarcoma is the most common primary splenic malignancy, it remains extremely rare with an annual incidence of 0.14–0.25 cases per million. Predominantly affecting middle-aged to elderly patients, angiosarcomas typically present with abdominal pain and weight loss; splenomegaly is common, with splenic rupture reported in up to 30%. Imaging typically shows aggressive features such as irregular shape and ill-defined margins, and it can present as a large dominant lesion or multiple nodules. On MRI, lesions are typically T1 hypointense and T2 hyperintense; however, the presence of any of necrosis, hemorrhage, hemosiderin, or calcifications can lead to signal heterogeneity. Areas of hemorrhage may cause T1 hyperintensity, whereas hemosiderin or calcifications may result in T2 hypointensity. After IV contrast administration, masses are usually heterogeneously enhancing. This heterogeneityis greater than seen in hemangiomas and may be so pronounced that the mass appears cystic. Tumors can infiltrate beyond the splenic capsule and present with local or distant metastases.
Incidental Splenic Lesions: A Proposed Algorithm for Assessment and Management
Myles T. Taffel, MD1, Julie Y. An, MD1, Frank H. Miller et al.
Roentgen Ray Rev 2025; 1:e2401039 - “The proposed Sp system presented here is based on expert consensus and has not yet undergone formal validation. Future studies are needed to assess its interreader reliability, diagnostic accuracy, and clinical utility. Despite these limitations, the framework provides a starting point to guide radiologists in evaluating and managing incidental splenic lesions, with the ultimate goal of improving patient care.”
Incidental Splenic Lesions: A Proposed Algorithm for Assessment and Management
Myles T. Taffel, MD1, Julie Y. An, MD1, Frank H. Miller et al.
Roentgen Ray Rev 2025; 1:e2401039 - BACKGROUND. Splenomegaly historically has been assessed on imaging by use of potentially inaccurate linear measurements. Prior work tested a deep learning artificial intelligence (AI) tool that automatically segments the spleen to determine splenic volume.
OBJECTIVE. The purpose of this study is to apply the deep learning AI tool in a large screening population to establish volume-based splenomegaly thresholds.
METHODS. This retrospective study included a primary (screening) sample of 8901 patients (4235 men, 4666 women; mean age, 56 Å} 10 [SD] years) who underwent CT colonoscopy (n = 7736) or renal donor CT (n = 1165) from April 2004 to January 2017 and a secondary sample of 104 patients (62 men, 42 women; mean age, 56 Å} 8 years) with endstage liver disease who underwent contrast-enhanced CT performed as part of evaluation for potential liver transplant from January 2011 to May 2013. The automated deep learning AI tool was used for spleen segmentation, to determine splenic volumes.
Automated Deep Learning Artificial Intelligence Tool for Spleen Segmentation on CT: Defining Volume-Based Thresholds for Splenomegaly
Alberto A. Perez, Victoria Noe-Kim, Meghan G. Lubner, et al.
AJR 2023; 221:1–9 - RESULTS. In 8853 patients included in analysis of splenic volumes (i.e., excluding a value of 0 mL or error values), the mean automated splenicvolume was 216 Å} 100 [SD] mL. The weight-based volumetric threshold (expressed in milliliters) for splenomegaly was calculated as (3.01 Å~ weight [expressed as kilograms]) + 127; for weight greater than 125 kg, the splenomegaly threshold was constant (503 mL). Sensitivity and specificity for volume-defined splenomegaly were 13% and 100%, respectively, at a true craniocaudal length of 13 cm, and 78% and 88% for a maximum 3D length of 13 cm. In the secondary sample, both observers identified segmentation failure in one patient. The mean automated splenic volume in the 103 remaining patients was 796 Å} 457 mL; 84% (87/103) of patients met the weight-based volume-defined splenomegalythreshold. CONCLUSION. We derived a weight-based volumetric threshold for splenomegaly using an automated AI-based tool. CLINICAL IMPACT. The AI tool could facilitate large-scale opportunistic screening for splenomegaly.
Automated Deep Learning Artificial Intelligence Tool for Spleen Segmentation on CT: Defining Volume-Based Thresholds for Splenomegaly
Alberto A. Perez, Victoria Noe-Kim, Meghan G. Lubner, et al.
AJR 2023; 221:1–9 - Key Finding
A previously tested automated deep learning AI tool was used to calculate splenic volumes from the CT examinations of 8853 patients from an outpatient screening population. Splenic volume was most strongly associated with weight among a range of patient factors, and a weight-based volume-defined threshold for splenomegaly was derived.
Importance
Use of the automated deep learning AI tool and weightbased volumetric thresholds could allow large-scale evaluation for splenomegaly on CT examinations performed for any indication.
Automated Deep Learning Artificial Intelligence Tool for Spleen Segmentation on CT: Defining Volume-Based Thresholds for Splenomegaly
Alberto A. Perez, Victoria Noe-Kim, Meghan G. Lubner, et al.
AJR 2023; 221:1–9 - “In conclusion, we derived a simple weight-based volumetric threshold for determining the presence of splenomegaly using an automated AI-based tool for determining splenic volume from CT examinations. Standard linear splenic measurements (which historically have been used as a surrogate for splenic volume) had suboptimal performance in detecting volume-based splenomegaly, and the weight-based volumetric thresholds indicated the presence of splenomegaly in most patients who underwent pre–liver transplant CT. The AI tool could be applied for more robust evaluation for splenomegaly in comparison with linear measurements as well as for large-scale opportunistic screening for splenomegaly.”
Automated Deep Learning Artificial Intelligence Tool for Spleen Segmentation on CT: Defining Volume-Based Thresholds for Splenomegaly
Alberto A. Perez, Victoria Noe-Kim, Meghan G. Lubner, et al.
AJR 2023; 221:1–9
- “ Unexpected splenic lesions are commonly detected on CT examinations of the abdomen and chest and often pose a diagnostic challenge to both the radiologist and clinician.”
Splenic Incidentalomas
Ahmed S, Horton KM, Fishman EK
Radiol Clin N Am 49 (2011) 323-347