DOI: 10.1148/rg.254045154
MR Imaging of the Spleen: Spectrum of Abnormalities1
Khaled M. Elsayes, MD,
Vamsidhar R. Narra, MD,
Govind Mukundan, MD,
James S. Lewis, Jr, MD,
Christine O. Menias, MD and
Jay P. Heiken, MD
1 From the Mallinckrodt Institute of Radiology (K.M.E., V.R.N., G.M., C.O.M., J.P.H.) and Department of Surgical Pathology (J.S.L.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110. Recipient of a Certificate of Merit award for an education exhibit at the 2003 RSNA Annual Meeting. Received July 30, 2004; revision requested September 23; revision received and accepted October 5. All authors have no financial relationships to disclose.
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Figure 1. Axial 3D GRE VIBE image obtained immediately after administration of contrast material shows the arciform normal enhancement pattern of the spleen.
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Figure 2. Axial out-of-phase image shows an accessory spleen at the hilum (arrow).
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Figure 3. Axial in-phase GRE image shows situs inversus with multiple masses in the right upper quadrant (arrows), an appearance that represents polysplenia.
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Figure 4a. Coronal GRE cine (a) and axial in-phase GRE (b) images show a cardiac anomaly in the form of pulmonary stenosis (arrow in a) and small masses in the left upper quadrant (arrows in b), an appearance that represents polysplenia.
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Figure 4b. Coronal GRE cine (a) and axial in-phase GRE (b) images show a cardiac anomaly in the form of pulmonary stenosis (arrow in a) and small masses in the left upper quadrant (arrows in b), an appearance that represents polysplenia.
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Figure 5a. Coronal T2-weighted half-Fourier RARE (a) and axial nonenhanced 3D VIBE (b) images show an acute or subacute subcapsular hematoma of the spleen (arrow in a).
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Figure 5b. Coronal T2-weighted half-Fourier RARE (a) and axial nonenhanced 3D VIBE (b) images show an acute or subacute subcapsular hematoma of the spleen (arrow in a).
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Figure 6a. Axial T2-weighted inversion-recovery (a) and gadolinium-enhanced T1-weighted fast multiplanar spoiled GRE (b) images of a patient with acquired immunodeficiency syndrome show a splenic abscess (arrow), which is hyperintense on the T2-weighted image (a) and hypointense on the T1-weighted image (b).
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Figure 6b. Axial T2-weighted inversion-recovery (a) and gadolinium-enhanced T1-weighted fast multiplanar spoiled GRE (b) images of a patient with acquired immunodeficiency syndrome show a splenic abscess (arrow), which is hyperintense on the T2-weighted image (a) and hypointense on the T1-weighted image (b).
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Figure 7. Axial contrast-enhanced 3D VIBE image of an immunocompromised patient shows multiple small, hypointense candidal lesions in the spleen (arrows).
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Figure 8a. Axial contrast-enhanced 3D VIBE (a) and T2-weighted inversion-recovery (b) images show scattered low-signal-intensity lesions, which represent infection of the spleen with Histoplasma capsulatum.
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Figure 8b. Axial contrast-enhanced 3D VIBE (a) and T2-weighted inversion-recovery (b) images show scattered low-signal-intensity lesions, which represent infection of the spleen with Histoplasma capsulatum.
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Figure 9a. Axial T1-weighted (a) and T2-weighted (b) images show an old calcified splenic histoplasmoma, which appears as a low-signal-intensity lesion with characteristic "blooming."
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Figure 9b. Axial T1-weighted (a) and T2-weighted (b) images show an old calcified splenic histoplasmoma, which appears as a low-signal-intensity lesion with characteristic "blooming."
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Figure 10a. Axial T2-weighted inversion-recovery (a), axial arterial phase 3D VIBE (b), and coronal delayed phase 3D VIBE (c) images show multiple small, hypointense, focal splenic lesions, which represent involvement with sarcoidosis. The lesions do not enhance on the early phase image (b) but do enhance on the delayed phase image (c).
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Figure 10b. Axial T2-weighted inversion-recovery (a), axial arterial phase 3D VIBE (b), and coronal delayed phase 3D VIBE (c) images show multiple small, hypointense, focal splenic lesions, which represent involvement with sarcoidosis. The lesions do not enhance on the early phase image (b) but do enhance on the delayed phase image (c).
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Figure 10c. Axial T2-weighted inversion-recovery (a), axial arterial phase 3D VIBE (b), and coronal delayed phase 3D VIBE (c) images show multiple small, hypointense, focal splenic lesions, which represent involvement with sarcoidosis. The lesions do not enhance on the early phase image (b) but do enhance on the delayed phase image (c).
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Figure 11. Axial contrast-enhanced 3D VIBE image shows a nonenhancing wedge-shaped area of infarction in the spleen (arrow).
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Figure 12a. Axial contrast-enhanced 3D GRE VIBE images show aneurysmal dilatation of the distal end of the splenic artery (arrow).
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Figure 12b. Axial contrast-enhanced 3D GRE VIBE images show aneurysmal dilatation of the distal end of the splenic artery (arrow).
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Figure 13. Axial venous phase gadolinium-enhanced 3D GRE VIBE image shows a thrombus filling the splenic vein (arrowheads). The thrombus appears as an area of signal void.
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Figure 14a. Axial T2-weighted inversion-recovery (a) and contrast-enhanced 3D VIBE (b) images show a splenic lesion that appears as an area of signal void (arrow). The lesion demonstrates serpentine enhancement on the contrast-enhanced image (b) and represents an arteriovenous malformation.
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Figure 14b. Axial T2-weighted inversion-recovery (a) and contrast-enhanced 3D VIBE (b) images show a splenic lesion that appears as an area of signal void (arrow). The lesion demonstrates serpentine enhancement on the contrast-enhanced image (b) and represents an arteriovenous malformation.
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Figure 15. Coronal T2-weighted half-Fourier RARE image of a patient with sickle cell disease shows decreased signal intensity of the spleen. This appearance is due to repeated blood transfusion.
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Figure 16. Axial contrast-enhanced T1-weighted GRE image of a patient with sickle cell disease shows a very small spleen, which is indicative of autosplenectomy.
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Figure 17a. Axial in-phase (a) and out-of-phase (b) images show a splenic area of extramedullary hematopoiesis (arrow). The lesion has reduced signal intensity on the in-phase image (a) compared with that on the out-of-phase image (b). This difference is secondary to iron deposition.
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Figure 17b. Axial in-phase (a) and out-of-phase (b) images show a splenic area of extramedullary hematopoiesis (arrow). The lesion has reduced signal intensity on the in-phase image (a) compared with that on the out-of-phase image (b). This difference is secondary to iron deposition.
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Figure 18a. Axial contrast-enhanced T1-weighted 3D VIBE (a) and T2-weighted half-Fourier RARE (b) images show the typical features of a splenic cyst (arrow).
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Figure 18b. Axial contrast-enhanced T1-weighted 3D VIBE (a) and T2-weighted half-Fourier RARE (b) images show the typical features of a splenic cyst (arrow).
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Figure 19a. Axial T2-weighted fast spin-echo (a) and contrast-enhanced 3D VIBE (b) images show the typical MR imaging features of a splenic hemangioma (arrow).
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Figure 19b. Axial T2-weighted fast spin-echo (a) and contrast-enhanced 3D VIBE (b) images show the typical MR imaging features of a splenic hemangioma (arrow).
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Figure 20a. Axial contrast-enhanced 3D VIBE (a) and T2-weighted (b) images of a patient with Klippel-Trénaunay-Weber syndrome show diffuse angiomatosis of the spleen and chest wall.
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Figure 20b. Axial contrast-enhanced 3D VIBE (a) and T2-weighted (b) images of a patient with Klippel-Trénaunay-Weber syndrome show diffuse angiomatosis of the spleen and chest wall.
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Figure 21a. Axial T2-weighted inversion-recovery (a), early contrast-enhanced 3D VIBE (b), and late contrast-enhanced 3D VIBE (c) images show a splenic lesion with high signal intensity on the T2-weighted image (a), low signal intensity on the T1-weighted image (b), and more uniform enhancement on the delayed image (c). The lesion represents a splenic hamartoma.
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Figure 21b. Axial T2-weighted inversion-recovery (a), early contrast-enhanced 3D VIBE (b), and late contrast-enhanced 3D VIBE (c) images show a splenic lesion with high signal intensity on the T2-weighted image (a), low signal intensity on the T1-weighted image (b), and more uniform enhancement on the delayed image (c). The lesion represents a splenic hamartoma.
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Figure 21c. Axial T2-weighted inversion-recovery (a), early contrast-enhanced 3D VIBE (b), and late contrast-enhanced 3D VIBE (c) images show a splenic lesion with high signal intensity on the T2-weighted image (a), low signal intensity on the T1-weighted image (b), and more uniform enhancement on the delayed image (c). The lesion represents a splenic hamartoma.
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Figure 22a. Coronal contrast-enhanced 3D VIBE (a) and T2-weighted half-Fourier RARE (b) images show a splenic mass with low signal intensity on the T1-weighted image (a), high signal intensity on the T2-weighted image (b), and heterogeneous enhancement. The mass represents a splenic angiosarcoma.
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Figure 22b. Coronal contrast-enhanced 3D VIBE (a) and T2-weighted half-Fourier RARE (b) images show a splenic mass with low signal intensity on the T1-weighted image (a), high signal intensity on the T2-weighted image (b), and heterogeneous enhancement. The mass represents a splenic angiosarcoma.
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Figure 23. Axial contrast-enhanced 3D GRE VIBE image shows multifocal involvement of the spleen by multiple hypointense lymphomatous lesions.
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Figure 24. Coronal T2-weighted half-Fourier RARE image of a patient who underwent left nephrectomy for renal cell carcinoma shows hyperintense splenic metastases (arrows).
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Figure 25a. Axial contrast-enhanced VIBE (a) and coronal T2-weighted half-Fourier RARE (b) images show hepatosplenomegaly secondary to portal hypertension. Note the diffuse enhancement of the splenic parenchyma in a and the collateral veins at the hilum (arrows in a).
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Figure 25b. Axial contrast-enhanced VIBE (a) and coronal T2-weighted half-Fourier RARE (b) images show hepatosplenomegaly secondary to portal hypertension. Note the diffuse enhancement of the splenic parenchyma in a and the collateral veins at the hilum (arrows in a).
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Figure 26a. Axial out-of-phase T1-weighted GRE (a) and T2-weighted inversion-recovery (b) images show multiple tiny hypointense foci in the spleen that represent Gamna-Gandy nodules (arrows).
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Figure 26b. Axial out-of-phase T1-weighted GRE (a) and T2-weighted inversion-recovery (b) images show multiple tiny hypointense foci in the spleen that represent Gamna-Gandy nodules (arrows).
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Figure 27a. Coronal T2-weighted half-Fourier RARE (a), axial T2-weighted inversion-recovery (b), and axial contrast-enhanced 3D VIBE (c) images show splenomegaly with Gaucher lesions, which are hypointense on both T1-and T2-weighted images.
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Figure 27b. Coronal T2-weighted half-Fourier RARE (a), axial T2-weighted inversion-recovery (b), and axial contrast-enhanced 3D VIBE (c) images show splenomegaly with Gaucher lesions, which are hypointense on both T1-and T2-weighted images.
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Figure 27c. Coronal T2-weighted half-Fourier RARE (a), axial T2-weighted inversion-recovery (b), and axial contrast-enhanced 3D VIBE (c) images show splenomegaly with Gaucher lesions, which are hypointense on both T1-and T2-weighted images.
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Copyright © 2005 by the Radiological Society of North America.
