Hindawi Publishing Corporation

Radiology Research and Practice

Volume 2013, Article ID 219297, 15 pages
http://dx.doi.org/10.1155/2013/219297

Review Article
The Spleen Revisited: An Overview on Magnetic
Resonance Imaging

Joo Palas, Antnio P. Matos, and Miguel Ramalho

Radiology Department, Hospital Garcia de Orta, 2801-951 Almada, Portugal

Correspondence should be addressed to Miguel Ramalho; [email protected]

Received 2 June 2013; Revised 8 October 2013; Accepted 10 October 2013

Academic Editor: Andreas H. Mahnken

Copyright 2013 Joao Palas et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Despite being well visualized by different cross-sectional imaging techniques, the spleen is many times overlooked during the
abdominal examination. The major reason is the low frequency of splenic abnormalities, the majority consisting of incidental
findings. There has been a steady increase in the number of performed abdominal magnetic resonance imaging (MRI) studies;
therefore, it is important to be familiar to the major MRI characteristics of disease processes involving the spleen, in order to
interpret the findings correctly, reaching whenever possible the appropriate diagnosis. The spleen may be involved in several
pathologic conditions like congenital diseases, trauma, inflammation, vascular disorders and hematologic disorders, benign and
malignant tumors, and other disease processes that focally or diffusely affect the spleen. This paper presents a description and
representative MRI images for many of these disorders.

1. Introduction 2. The Normal Spleen

Splenic disease has always been a challenge to the radiologist. The spleen is located in the left hypogastric quadrant of
Despite of being well visualized by different cross sectional the abdomen and is fixed in its intraperitoneal position
imaging techniques, the spleen is many times overlooked beneath the 9th to 11th intercostal spaces by the splenorenal,
during the abdominal examination. The major reason is splenocolic, splenogastric, and phrenicosplenic ligaments.
the low frequency of splenic abnormalities, the majority The configuration of the spleen is variable (typically coffee
consisting of incidental findings. bean shaped), as well as the size, which is related with the
There has been a steady increase in the number of patients morphological type and age [2]. The organs convex
performed abdominal magnetic resonance imaging (MRI) face lies adjacent to the diaphragm. The concave side of the
studies; therefore, it is important to be familiar to the major spleen has contact with the stomach, left kidney, and colon
MR imaging characteristics of disease processes involving the flexure. The splenic hilum is found within this concavity and
spleen, in order to interpret the findings correctly, reaching acts as an entry and exit route for the arterial, venous, and
whenever possible the appropriate diagnosis. Nowadays, MRI lymphatic vessels and nerves. The spleen is divided into two
permits the characterization of the most common splenic compartments, namely, the red and white pulp, separated by
lesions, such as cysts, small hemangiomas, and hamartomas, the marginal zone. The white pulp is made up of T- and B-
and improvement in the detection of malignant diseases such lymphocytes and is located centrally, while the red pulp is
as lymphoma and metastases [1]. composed of rich plexuses of tortuous venous sinuses [3].
The spleen may be involved by several pathologic con- On T1-weighted MR images, the normal signal intensity
ditions including congenital diseases, trauma, inflammation, of the spleen is lower than that of hepatic tissue. Conversely,
vascular disorders and hematologic disorders, benign and on T2-weighted images, the spleen shows higher signal
malignant tumors, and other disease processes that focally or intensity, appearing brighter than the liver [4] (Figure 1).
diffusely affects the spleen. This article presents a description The distinctive microscopic anatomy of the spleen may be
and representative MRI images for many of these disorders. reflected on diffusion-weighted images (DWI) and ADC
2 Radiology Research and Practice

(a) (b)

Figure 1: The normal spleen. Axial T2wi FSE with fat suppression (a) and axial T1wi out-of-phase GRE (b). The spleen shows the typical
coffee bean configuration. On T1wi (b), the normal signal intensity of the spleen is lower than that of hepatic tissue. Conversely, on T2wi, the
spleen shows higher signal intensity.

(a) (b)

Figure 2: Pattern of enhancement of the normal spleen. Postcontrast axial T1wi 3D-GRE with fat suppression in the arterial (a) and venous
(b) phase. The spleen shows a heterogeneous pattern enhancement immediately after contrast material administration (a), secondary to
differences in flow between the red and white pulps, becoming homogeneous in venous (b) and interstitial phases.

maps. Prior studies have shown significant differences in the near the pancreatic tail (Figure 3). More than two accessory
mean ADCs between the spleen and other abdominal organs spleens occur in less than 5%. The presence of accessory
[5, 6]. splenules may arise within the substance of solid organs,
The spleen demonstrates a heterogeneous serpentine or notably the pancreas [10]. The presence of a well-marginated
arciform pattern enhancement immediately after contrast rounded mass located within 3 cm of the distal tail of the
material administration, secondary to differences in flow pancreas with signal intensity features of the spleen on all MR
between the red and white pulps, becoming homogeneous in sequences suggests the diagnosis of intrapancreatic accessory
venous and interstitial phases [4] (Figure 2). Any heterogene- spleen (IPAS) [11]. However, other entities may mimic the
ity after this period is considered pathologic [7, 8]. signal intensity and postgadolinium enhancement features
of IPAS. Therefore, DWI and SPIO-enhanced MRI can be
used to characterize the lesion and to establish the definite
3. Congenital Diseases and Normal Variants diagnosis [3].
Splenosis develops when splenic tissue is seeded within
The congenital absence of spleen is known as asplenia and the the abdomen or pelvis (Figure 4) following trauma [12].
presence of one or more spleens is known as polysplenia. Both The upside-down spleen is a normal variant due to
are very rare and usually associated with other congenital an abnormal splenic rotation where the hilum is superiorly
abnormalities. located and the convex border is medial and adjacent to the
The accessory spleens may be found in 10% of the left kidney [13] (Figure 5).
population [9], more frequently in women, usually with less All these normal variants and congenital abnormalities
than 4 cm in size and located near the splenic hilum or are usually easy to recognize.
Radiology Research and Practice 3

(a) (b) (c)

Figure 3: Accessory spleen. Axial T2wi FSE with fat suppression (a) and postcontrast axial 3D-GRE T1wi with fat suppression images at
the arterial (b) and venous (c) phases. An accessory spleen is shown near the splenic hilum. Note the similar signal intensity and dynamic
behavior comparable with the splenic parenchyma.

4. Inflammatory/Infectious Diseases disease as scattered hypointense lesions on both T1- and T2-
weighted images. Old granulomas can be calcified, causing
4.1. Abscesses. Splenic abscess is an uncommon lesion with with the characteristic signal intensity changes with blooming
high mortality rates, because of delayed detection and treat- artifacts on MR images [8].
ment [14, 15]. The frequency of splenic abscess has recently
increased due to the higher number of immunocompromised
patients, as those with hematologic disorders (e.g., leukemia), 4.3. Sarcoidosis. Sarcoidosis is a granulomatous systemic
those with recreational intravenous drug abuse, and those disease of unknown etiology that may involve several organs
with acquired immunodeficiency syndrome (AIDS). These and not infrequently the spleen. Of patients with systemic
lesions may be single or multiple [7]. sarcoidosis, 24 to 59% have biopsy-documented splenic
Splenic abscesses are hypointense on T1-weighted images sarcoidosis [17].
and have a moderate to high signal intensity on T2-weighted Nodular sarcoidosis has been reported to demonstrate
images, with irregular and undefined margins [8, 16]. Gas low signal intensity in all MR sequences. The lesions are
might be seen within the abscess as signal voids in the antide- most conspicuous on T2-weighted fat-suppressed or early
pendent position and might be recognized by the presence phase contrast-enhanced images. Sarcoid lesions enhance
of susceptibility artifact on T1-weighted in-phase and out- minimally on delayed images (Figure 8).
of-phase GRE sequences which appear greater on sequences
with higher TE the sequence with higher TE (usually in- 5. Vascular Lesions
phase images). Following intravenous contrast administra-
tion, peripheral enhancement may be seen, although it is less 5.1. Infarct. Splenic infarcts may result from venous or
often intense compared to liver abscess, perhaps due to the arterial blood supply interruption. The vascular occlusions
fairly bright enhancement of the normal splenic parenchyma can be the result of a tromboembolic process caused by any
in the arterial phase [8, 16] (Figure 6). type of hemolytic anemia, endocartitis or chronic valvular
Candidiasis is the opportunistic infection that most diseases, Gaucher disease, portal hypertension, or vascular
frequently affects the liver and the spleen in immunocom- collagen diseases [8, 18].
promised patients. MRI is superior to CT for the detection The typical MR appearance of a splenic infarct is a
and characterization of splenic microabscesses (<1 cm), most triangular wedge-shaped area, at the periphery of the spleen,
commonly secondary to candidiasis and appear as multiple with varying signal intensity according to the age of the
hyperintense lesions in T2-weighted images with peripheral infarct. It shows no enhancement after gadolinium injection
ring enhancement on gadolinium-enhanced images [7, 8] and it is better depicted in late vascular phases, when the
(Figure 7). spleen is homogeneously enhanced [7, 8] (Figure 9).

4.2. Histoplasmosis. Although it might be seen in patients 5.2. Hematoma. Splenic hematoma is usually secondary to
with competent immune systems, the prevalence of histo- trauma [18]. Like splenic infarcts, the MR appearance is
plasmosis is greater in immunocompromised patients. MR variable, depending on the age of the lesion. On acute (1 to 2
imaging demonstrates the acute and subacute phases of this days) and early subacute phase (2 to 7 days) hematomas show
4 Radiology Research and Practice

(a) (b)

(c) (d)

Figure 4: Pelvic splenosis. Axial (a) T2wi SSFSE, axial (b) T2 wi FSE and postcontrast axial T1wi 3D-GRE with fat suppression in the arterial
(c) and venous (d) phase. This patient with history of splenectomy following a car accident underwent pelvic MRI to clarify pelvic masses
depicted in previous CT. There are multiple nodular masses in the left hypochondrium (arrows, (a)) consistent with splenosis. There are
also multiple well-defined nodules in the pelvis demonstrating high signal intensity on T2wi (arrow, (b)), with heterogeneous enhancement
immediately after contrast material administration (c), becoming homogeneous in the venous (d) phase, consistent with splenosis.

(a) (b)

Figure 5: Upside-down spleen. Coronal postcontrast 3D-GRE T1wi with fat suppression at the arterial (a) and venous (b) phases. An abnormal
splenic rotation is seen. The hilum is superiorly located and the convex border is adjacent to the left kidney.

low signal intensity on T2-weighted images and intermediate hematoma may have a cystic appearance, regarded as a
and increasingly higher signal intensity on T1-weighted hyperintensity lesion on T2-weighted sequences with low sig-
images, respectively. On late subacute phase (7 to 1428 nal intensity on T1-weighted images [18]. Older hematomas
days), hematomas show hyperintensity on both T1- and T2- appear hypointense on both T1- and T2-weighted images, due
weighted images (Figure 10). After 3 weeks (chronic), the to its fibrotic component.
Radiology Research and Practice 5

(a) (b)

Figure 6: Splenic abscess. Axial T2wi SSFSE with fat suppression (a) and postcontrast axial T1wi 3D-GRE with fat suppression in the venous
(b) phase. A large subcapsular splenic abscess is depicted. This lesion is marked hyperintense on T2wi and hypointense on T1wi with irregular
margin. Note the faint enhancement of the splenic capsule (arrows, (b)).

(a) (b) (c)

Figure 7: Microabscesses in an HIV patient with candidiasis. Axial T2wi SSFSE (a) and postcontrast axial 3D-GRE T1wi with fat suppression
at the arterial (b) and venous (c) phases images. Multiple ill-defined T2w hyperintense lesions (a) with peripheral ring enhancement on
gadolinium-enhanced images ((b) and (c)) are depicted, consistent with abscesses.

6. Benign Tumors wall, homogeneous hypointense on T1-weighted images, and

hyperintense on T2-weighted images, with no enhancement
6.1. Cysts. Cysts are the most common benign focal splenic on postcontrast images [18] (Figure 11).
masses. They may be separated into epithelial or true cysts It is often impossible to distinguish between true and false
(approximately 25% of splenic cysts), which are lined with cysts; the clinical presentation and patient history may help
epithelium, and pseudocysts that can be posttraumatic or to narrow the differential diagnoses. Cyst wall trabeculation
secondary to pancreatitis, in which the wall is fibrotic and or peripheral septations are much more commonly found in
lacks a true cellular lining (account for approximately 75% of true cysts [7].
splenic cysts) [1, 19].
Posttraumatic pseudocysts are thought to represent the
final stage in evolution of a splenic hematoma, although some 6.2. Hydatid Cyst (Echinococcus granulosus). Usually involves
have suggested that they might also be secondary to infarct the liver or lungs but occasionally may also involve the
or infection [16, 18]. Pancreatic pseudocysts arising in the spleen. Splenic hydatid cysts are very rare even in endemic
tail of the pancreas may involve the spleen by extending regions (less than 2%) [19]. On MRI these cysts share
either beneath the splenic capsule or into the proper splenic imaging characteristics to those located in the liver. They are
parenchyma. Patients usually have a history of acute pancre- hyperintense on T2-weighted images and hypointense on T1-
atitis [16]. weighted images. They can be either unilocular or contain
MRI shows the characteristic findings of a cyst, that daughter cysts, distributed peripherally or throughout the
is, a well-defined round mass, with thin or imperceptible lesion, giving a multilocular appearance. A serpent or
6 Radiology Research and Practice

(a) (b)

(c) (d)

Figure 8: Sarcoidosis. Axial T2wi FSE with fat suppression (a) and postcontrast axial T1wi 3D-GRE with fat suppression in the arterial (b),
venous (c) and interstitial phases (d). Low signal intensity nodules are depicted in the spleen on the T2wi sequences (arrows, (a)). The lesions
are most conspicuous on fat-suppressed T2wi or early phase (b) contrast-enhanced images. Note the progressive enhancement of the sarcoid
lesions on venous (c) and delayed images (d).

snake sign is occasionally noted representing collapsed par- Most hemangiomas are well-defined homogeneous,
asitic membranes within the cyst. Continuous and irregular, hypo- to isointense on T1-weighted images and most
4- to 5-mm-thick, low signal intensity rim surrounding the commonly hyperintense on T2-weighted images compared
cyst corresponding to the dense fibrous capsule encasing with splenic parenchyma [21] (Figure 13). On dynamic
the parasitic membranes is frequently seen. Typically, no contrast-enhanced studies, they usually show peripheral
enhancement is noted following IV contrast administration enhancement with centripetal, delayed progression (see
[18, 20] (Figure 12). Figure 13). Uncommonly, similarly to liver hemangiomas,
these lesions may undergo sclerosis and late phase images
are important to suggest the correct diagnosis. The typical
6.3. Hemangiomas. Splenic hemangiomas are the most com-
nodular peripheral enhancement of hepatic hemangiomas is
mon benign solid tumor of the spleen. Their frequency
uncommonly seen in splenic hemangiomas [22].
in large autopsy series is 0.03%14%, and they are more
frequently found in males (1.4 versus 1.0) [19, 21]. These
lesions are believed to be congenital in origin, arising from 6.4. Hamartomas. Hamartoma is an infrequently benign,
sinusoidal epithelium. Most of them are less than 2 cm in usually asymptomatic tumor of the spleen, with an autopsy
diameter; however, once large they may spontaneously rup- incidence of 0.13% and no gender predilection. Approxi-
ture, causing intra-abdominal hemorrhage. Histologically, mately, one-sixth of hamartomas are found in children (<16
they are composed of endothelial-lined blood-filled spaces years). They are nonneoplastic tumors composed of a mixture
of varying size and can be characterized by the size of these of normal elements of splenic red and white pulp components
spaces as capillary or cavernous lesions [16]. [19, 23]. They are considered to be congenital in origin, but
Diffuse hemangiomatosis of the spleen is a rare benign some theories associate it with previous trauma.
vascular condition occurring as a manifestation of systemic Hamartomas are a sharply defined, rounded, single solid
angiomatosis (associations with Klippel-Trenaunay-Weber, lesion that sometimes may be multiple (Figure 14). On
Turner, Kasabach-Merritt-like, and Beckwith-Wiedemann MRI, they are usually isointense on T1-weighted images
syndromes have been reported) or, less commonly, confined and heterogeneously hyperintense on T2-weighted images
to the spleen [8]. [22]. After intravenous gadolinium administration, there is
Radiology Research and Practice 7

(a) (b)

Figure 9: Splenic infarct. Axial T2wi FSE (a) and axial postcontrast fat-suppressed 3D-GRE T1wi at the venous (b) phase. A small triangular
wedge-shaped area at the periphery of the spleen is noted (arrow, (a)), with hypointensity signal on both T1 and T2wi, with no enhancement
on postcontrast images.

(a) (b) (c)

Figure 10: Hematoma. Axial (a) T2wi SSFSE and postcontrast axial T1wi 3D-GRE with fat suppression in the arterial (b) and interstitial (c)
phases. A chronic hematoma is depicted with a cystic appearance, regarded as a lesion with moderate hyperintensity on T2wi sequences (a)
and hypointensity on T1wi with no perceptible enhancement ((b), (c)).

(a) (b)

Figure 11: Splenic cyst. Axial T2wi FSE with fat suppression (a) and postcontrast axial 3D-GRE T1wi with fat suppression at the interstitial
(b) phase. Note the thin-walled and well-defined nodule, homogeneously hyperintense on T2wi (a), with no enhancement on post contrast
image, characteristic of cysts.
8 Radiology Research and Practice

(a) (b) (c)

Figure 12: Hydatid cyst. Axial T2wi SSFSE with fat suppression ((a) and (b)) and axial postcontrast T1wi 3D-GRE with fat suppression in the
venous (c) phase. A classic hydatid cyst is visualized in the liver (b). A concomitant splenic hydatid cyst is depicted as a multilocular lesion
with moderate hyperintensity on T2wi (arrow, (a)) and hypointensity on T1wi (c). A fibrotic thickened continuous low signal intensity rim
surrounding the cyst is seen on T2wi ((a), (b)). No enhancement is noted following IV contrast administration (c).

(a) (b) (c)

Figure 13: Splenic hemangioma. Axial T2wi FSE with fat suppression (a) and postcontrast axial 3D-GRE T1wi with fat suppression at
the arterial (b) and interstitial (c) phases. The hemangioma is depicted as a well-defined, homogeneous, and hyperintense lesion on T2wi
(arrow, (a)), with a peripheral enhancement with centripetal and delayed progression, on postcontrast images ((b) and (c)). Note the hepatic
hemangiomas on the same imaging plane.

usually diffuse heterogeneous enhancement, which may be T1-weighted images depict delayed contrast enhancement,
useful in distinguishing this lesion from the typical peripheral suggestive of a vascular lesion with contrast media pooling
enhancement noted in hemangiomas (see Figure 14). Pro- (Figure 15).
longed enhancement may be appreciated, which has been
attributed to stagnant contrast material within the sinusoids 6.6. Lymphangioma. Lymphangioma is a rare vascular
of the red pulp of splenic tissue. Persistent areas of hypointen- benign lesion filled with lymph instead of red blood cells as
sity may also be seen and correspond to areas of necrosis seen in hemangioma [18]. Usually diagnosed in childhood, it
within the lesion [7, 16, 21]. may appear as solitary or multiple splenic lesions or as a dif-
fuse involvement replacing most of the splenic parenchyma,
6.5. Littoral Cell Angioma. Littoral cell angioma is a relatively known as lymphangiomatosis [16].
new clinicopathological entity of a rare benign tumor of the Cystic lymphangioma is the most frequent type and
spleen that develops from the lining cells of the red-pulp is characterized by a honeycomb of large and small thin-
sinuses, the so-called littoral cells, giving rise to littoral cell walled cysts containing lymph-like clear fluid. On MRI,
angioma [24]. It has no malignant histological features and lymphangiomas usually present as well-defined multilocular
has a benign clinical course. cystic lesions, with thin septations and hyperintensity on
Lesions are of variable size and commonly multinodular. T2-weighted sequences. However, some of the cysts may
They are composed of anastomosing vascular channels with be hyperintense on T1-weighted images, due to protein or
irregular lumina featuring cyst-like spaces and lined by tall hemorrhagic content [1, 16, 19].
endothelial cells.
On MRI, lesions are inhomogeneously hyperintense on 7. Malignant Tumors
T2-weighted images, with signal intensity similar to that of
hemangiomas and slightly hypointense on unenhanced T1- 7.1. Lymphoma. Lymphoma is the most common splenic
weighted images. Littoral cell angiomas may show low signal malignancy. Both Hodgkins and non-Hodgkins lymphoma
intensity on all sequences due to hemosiderin accumulation may present in the spleen as the primary site (less than 1%) or
within neoplastic littoral cells [25]. Dynamic postcontrast as part of systemic involvement [1].
Radiology Research and Practice 9

(a) (b)

(c) (d)

Figure 14: Splenic hamartoma. Axial T2wi SSFSE (a), pre- (b) and postcontrast axial T1w 3D-GRE with fat suppression in the arterial (c) and
venous (d) phase. Multiple rounded lesions are seen on T2wi (a) and T1wi (b). These lesions demonstrate hyperenhancing characteristics on
the arterial phase (c) progressing to isointensity on the venous phase (d).

Splenic involvement in lymphoma may produce homo- to several centimeters. At MR imaging, metastases typically
geneous enlargement (the most common finding, although it appear as hyperintense masses on T2-weighted images and
may be absent in up to 30% of patients), multiple small (or hypo- to isointense masses on T1-weighted images with inho-
miliary) nodules, a single solitary mass, or a combination of mogeneous contrast enhancement, usually with peripheral
these appearances [16, 19]. ring-like pattern [19, 23, 26] (Figure 17). Central tumor necro-
Immediate postcontrast MRI images surpass CT in their sis is seen as regions of hyperintensity on T2-weighted images
evaluation; nevertheless, the role of MRI has not been [27]. The presence of blood products from hemorrhage
established yet. or other paramagnetic substances, such as melanin from
Lymphomatous nodules are typically isointense to splenic melanocytic melanomas, may result in high signal intensity
parenchyma on T1- and T2-weighted images, although they on T1-weighted images [18].
may present some hypointensity on T2-weighted images,
which may help to distinguish from metastatic lesions 7.3. Perisplenic Neoplasms Infiltrating the Spleen. Implants
(Figure 16). Lymphomatous lesions are usually hypovascular on the serosal surface of the spleen are seen in patients
with lower signal intensity relative to normal spleen on with peritoneal carcinomatosis, commonly from ovarian
postcontrast images, thereby increasing conspicuity [16, 23]. or gastrointestinal primary neoplasms. These implants may
cause indentation and scalloping of the surface of the spleen.
7.2. Metastasis. Although the spleen is the most vascular Direct tumor invasion of the spleen is uncommon, but can be
organ in the body, it is an infrequent site for metastatic seen in tumors originating from the pancreas, stomach, colon
disease. Metastatic involvement of the spleen is some- or left kidney, and retroperitoneum (Figure 18) [28].
what uncommon, occurring in up to 7% of patients with
widespread malignancy. According to most series, splenic 7.4. Angiosarcoma. Angiosarcoma is exceedingly rare, yet it
metastases are mainly due to melanoma and breast cancers is the most common primary malignant nonlymphoid tumor
and in a less percentage from cancers of the lung, colon, of the spleen [29]. These tumors are highly aggressive (nearly
stomach, ovary, endometrium, and prostate [7, 18]. 80% of patients die 6 months after the diagnosis) and usually
Splenic metastatic lesions may be solitary, multiple, or manifest as widespread metastatic disease or splenic rupture
diffuse and differ in number and size from a few millimeters [7, 8, 16]. Association with thoratrast has been reported.
10 Radiology Research and Practice

(a) (b)

(c) (d)

Figure 15: Littoral cell angioma. Axial T2wi FSE with fat suppression (a), pre- (b) and postcontrast axial 3D-GRE T1wi with fat suppression at
the venous phase (c) and after 10 minutes of contrast injection (d). A hypointense nodular lesion is depicted on T2wi (arrow, (a)), with areas
of magnetic susceptibility artifact, and hypovascular nodules that show subtle peripheral enhancement with progressive slow centripetal
accumulation of contrast (arrow, (d)). This mass was thought to represent a sclerosed splenic hemangioma. This heterogeneous splenic
appearance is also possible with angiosarcoma and in cases of splenic hemangiomatosis. Note the anteriorly adjacent splenic cyst.

Angiosarcoma typically appears as multiple nodular het- length is more than 12 cm (Figure 19). This may result from
erogeneous masses, with variable signal intensity on T1- congestion (portal hypertension, splenic vein occlusion, or
weighted and T2-weighted images, due to the presence of thrombosis), infiltrative disease (Gaucher disease or histio-
hemorrhage with different ages, siderotic nodules, and areas cytosis), hematologic disorders (polycythemia vera, myelofi-
of necrosis. Following the intravenous administration of brosis), inflammatorys/infectious diseases (HIV, mononu-
gadolinium, the lesion demonstrates heterogeneous enhance- cleosis, amyloidosis, Feltys syndrome, or mycobacterial infec-
ment. MRI seems to be more precise than CT in the overall tion), cysts, or tumors (leukemia, lymphoma, or metastases)
assessment and staging of this type of tumor and is of [7, 10, 23].
particular value for timely diagnosis [30].
There are other extremely rare primary malignant 8.2. Siderotic Nodules. Foci of hemosiderin deposition are
splenic tumors including malignant fibrous histiocytoma, seen in about 9%12% of patients with portal hypertension
leiomyosarcoma, fibrosarcoma, malignant teratoma, and and are the so-called Gamma-Gandy bodies (Figure 20).
Kaposi sarcoma, all of which are with nonspecific appearance. These foci of hemosiderin have low signal intensity on all
pulse sequences and exhibit blooming artifact on gradient
echo sequences, secondary to iron deposition [8, 23].
8. Diffuse Diseases
8.1. Splenomegaly. Splenomegaly is a radiologic and clinical 8.3. Gaucher Disease. Gaucher disease is an autosomal reces-
sign, classically described when the craniocaudal splenic sive lysosomal disorder secondary to lack of the enzyme
Radiology Research and Practice 11

(a) (b)

(c) (d) (e)

Figure 16: Lymphoma. Axial T2wi SSFSE (a), axial pre- (b) and postcontrast T1wi 3D-GRE with fat suppression in the arterial (c) and venous
(d) phase. Coronal fat-suppressed T1wi 3D-GRE in the interstitial phase (e). The spleen is enlarged. Lymphomatous nodules are isointense
to splenic parenchyma on T1wi (b) and T2wi (a). One nodule is moderately hypointense T2wi (arrow, (a)). This feature aids in distinction
against metastatic lesions, which are commonly hyperintense. Lymphomatous lesions demonstrate hypovascular nature with lower signal
intensity relative to normal spleen on postcontrast images ((c), (d) (e)), thereby increasing conspicuity.

glucocerebrosidase, leading to the accumulation of gluco- and 8%10% (heterozygous form). The spleen is the most
cerebrosides in the cells of the reticuloendothelial system, commonly organ involved. In patients with sickle cell disease,
causing hepatosplenomegaly. Splenic infarcts and fibrosis the spleen appears as a nearly signal void area due to iron
associated with Gaucher disease may exhibit a multifocal deposition from blood transfusion. Autosplenectomy is often
pattern [8]. found in patients with homozygous sickle cell disease [7, 8]
(Figure 22).
8.4. Hemosiderosis and Sickle Cell Disease. Hemosiderosis,
with splenic involvement, shows diffuse diminished signal 8.5. Extramedullary Hematopoiesis. Extramedullary hemato-
intensity of the organ on both T1- and T2-weighted images poiesis is a compensatory response to failure of the bone
relative to musculature as a result of hemosiderin deposition marrow cells. A focal mass-like involvement of the liver
[1] (Figure 21). and spleen, which are the main affected organs, may be
Sickle cell disease is common in the Afro-descendent present. On MRI, the appearance of the nodular lesions
population with a prevalence of 0.2% (homozygous form) depends on the evolution of the hematopoiesis. Active lesions
12 Radiology Research and Practice

(a) (b) (c)

Figure 17: Splenic metastasis on a patient with a small-cell lung carcinoma. Axial T2wi SSFSE (a) and postcontrast axial 3D-GRE T1wi with
fat suppression at the arterial (b) and venous (c) phases. Note the nodular lesion depicted as a hyperintense nodule on T2wi with peripheral
ring-like enhancement.

(a) (b)

(c) (d)

Figure 18: Pancreatic tail clear cell renal cell carcinoma metastases with infiltration of the spleen through the splenic hilum. Axial T2wi SSFSE
without (a) and with (b) fat suppression and axial postcontrast T1wi 3D-GRE with fat suppression in the arterial (c) and venous (d) phase. A
large heterogeneous mass is seen in the pancreatic tail infiltrating the spleen.

reveal intermediate signal intensity on T1-weighted images, 9. Conclusion

high signal intensity on T2-weighted images, and moderate
enhancement after administration of intravenous gadolin- Focal and diffuse lesions of the spleen are uncommon and
ium. Older lesions are hypointense on T1- and T2-weighted usually discovered incidentally on cross-sectional imaging
images and do not show any enhancement. These lesions studies. Due to the widespread of MRI there has been an
usually demonstrate low signal intensity on in-phase T1- increase in the detection of diseases involving the spleen. By
weighted GRE images compared with that on out-of phase virtue of its excellent contrast resolution and the possibility of
images due to the presence of iron [8]. tissue characterization through the use of different sequences,
Radiology Research and Practice 13

(a) (b)

Figure 19: Splenomegaly. Coronal T2wi SSFSE (a) and postcontrast axial T1wi 3D-GRE with fat suppression in the interstitial phase (b). A
homogeneous splenomegaly resulting from congestion (portal hypertension) is easily seen.

(a) (b) (c)

(d) (e)

Figure 20: Siderotic splenic nodules (Gamma-Gandy bodies). Axial T2 (a), axial 2D-GRE T1w in-phase (b) and out-of-phase (c), and pre (d)
and postcontrast axial 3D-GRE T1wi with fat suppression at the arterial phase (e). Note the splenomegaly with multiple foci of hemosiderin
with low signal intensity on all pulse sequences and exhibiting the blooming artifact on in-phase (longer TE) GRE sequences, secondary to
iron deposition. No enhancement is depicted.

(a) (b) (c)

Figure 21: Paroxysmal nocturnal hemoglobinuria. Coronal (a) and axial (b) T2wi SSFSE and axial T2 (c) images. This patient with
paroxysmal nocturnal hemoglobinuria shows diffuse diminished signal intensity of the liver and spleen on T2wi as a result of hemosiderin
deposition. Notice the iron accumulation on the renal cortex (a).
14 Radiology Research and Practice

(a) (b) (c)

Figure 22: Autosplenectomy is found in a patient with homozygous sickle cell disease. Axial T2wi SSFSE (a), coronal SSFP (b), and
postcontrast axial 3D-GRE T1wi with fat suppression at the arterial phase (c). Note the small remnant of spleen and the diffuse diminished
signal intensity of the hepatic parenchyma on both T1wi and T2wi as a result of iron deposition.

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