Diagnosis of diffuse spleen involvement in haematological malignancies using a spleen-to-liver attenuation ratio on contrast-enhanced CT images

Christian Philipp Reinert, Clemens Hinterleitner, Jan Fritz, Konstantin Nikolaou, Marius Horger

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: We aimed to test the hypothesis that the spleen-to-liver-attenuation ratio on portal-venous enhancement phase CT images can identify diffuse splenic infiltration in subjects with lymphoma. Methods: A database search yielded 70 subjects with malignant haematological diseases who underwent contrast-enhanced CT (CECT) between December 2010 and March 2018. Additionally, consecutive control subjects were evaluated. We compared the splenic volume, splenic attenuation, spleen-to-liver, spleen-to-aorta and spleen-to-musculature ratios on portal-venous phase CECT images, pre- to post-treatment and between the different lymphoma entities. The standard of reference for splenic involvement was normalisation of the spleen volume following chemotherapy or normalisation of FDG-uptake. Results: In subjects with diffuse splenic involvement, the spleen attenuation was significantly lower before treatment (93.48 HU) compared to controls (112.39 HU; p <.01) and after successful treatment (113.39 HU; p <.01). The spleen-to-liver attenuation ratio significantly increased after treatment (p <.001) and proved significantly lower at baseline when compared to control subjects (p <.01). The spleen volume significantly decreased after successful treatment (from 586.14.87 cm 3 to 284.90 cm 3 ; p <.001). Spleen-to-liver ratio significantly increased in lymphoma patients after therapy, inversely correlating with the decline in FDG-uptake (n=10) even in patients with normal-sized spleens (2/10), staying unchanged at follow-up. The outcome variables were not significantly different between the lymphoma subtypes. Conclusions: We suggest the additional use of spleen-to-liver attenuation ratio to splenic volume alone for detection of diffuse splenic infiltration in subjects with lymphoma. The course of spleen-to-liver attenuation ratio inversely correlated with that of FDG-uptake in a subgroup of patients working accurately in normal-sized diffusely involved spleens. Key Points: • Involvement of the spleen is frequent in haematological malignancies and is important for staging and appropriate treatment. • Diffuse splenic infiltration often results in only homogeneous splenomegaly without a focal lesion, but even no or only minimal increase in splenic volume is possible. In these cases diagnosis of spleen involvement is a challenge for the radiologist. • Our data support the use of the spleen-to-liver attenuation ratio in addition to size measurements for the detection of diffuse splenic infiltration in subjects with lymphoma.

Original languageEnglish (US)
Pages (from-to)450-457
Number of pages8
JournalEuropean radiology
Volume29
Issue number1
DOIs
StatePublished - Jan 1 2019

Keywords

  • Follow-up studies
  • Haematological diseases
  • Lymphoma
  • Splenomegaly

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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