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Valizadeh P, Jannatdoust P, Tahamtan M, Soleimani Dorcheh S, Khalaj F, Ghorani H, Ayoobi Yazdi N, Salahshour F. Differentiating malignant from benign splenic lesions: a meta-analysis and pictorial review of imaging features. Abdom Radiol (NY) 2024; 49:2833-2857. [PMID: 38900328 DOI: 10.1007/s00261-024-04447-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/30/2024] [Accepted: 06/07/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVES Splenic lesions might exhibit overlapping imaging features, varying from benign entities like cysts and hemangiomas to malignancies such as lymphoma and angiosarcoma. This meta-analysis aims to delineate imaging characteristics that distinguish malignant from benign splenic lesions. METHODS Adhering to PRISMA guidelines, we searched PubMed, Scopus, and Web of Science for studies on imaging features differentiating malignant from benign splenic lesions. We extracted data on splenic pathology and imaging characteristics and assessed the methodological quality via QUADAS-2. Odds ratio meta-analyses were performed using STATA (Version 17.0, Stata Corp, College Station, TX). RESULTS Portal phase hypoenhancement, hypovascular enhancement pattern, diffusion restriction, and late phase hypoenhancement, with odds ratios above 10, highly indicate malignancy. Other features suggestive of malignancy include solid morphology, lymphadenopathy, presence of perisplenic fluid, arterial hypoenhancement, hypoechogenicity on ultrasound, splenomegaly, and presence of multiple lesions. In contrast, cystic morphology, hypervascular-washout and hypervascular-persistent pattern of enhancement, late phase hyperenhancement, anechogenicity on ultrasound, portal phase hyperenhancement, well-defined borders, and calcification are in favour of benign pathology. CONCLUSION The study underscores the critical role of contrast-enhanced and diffusion-weighted imaging in distinguishing malignant from benign splenic lesions, emphasizing the role of features like portal phase hypoenhancement and restricted diffusion in diagnosing malignancies. Additionally, the study emphasizes the value of contrast-enhanced ultrasound, which allows for the visualization of key contrast-enhancement patterns without the risk of ionizing radiation exposure.
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Affiliation(s)
- Parya Valizadeh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Payam Jannatdoust
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Tahamtan
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
| | - Soroush Soleimani Dorcheh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Student's Scientific Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Fattaneh Khalaj
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Ghorani
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Niloofar Ayoobi Yazdi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
| | - Faeze Salahshour
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran.
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Valizadeh P, Jannatdoust P, Tahamtan M, Ghorani H, Dorcheh SS, Farnoud K, Salahshour F. Diagnostic performance of different imaging modalities for splenic malignancies: A comparative meta-analysis. Eur J Radiol Open 2024; 12:100566. [PMID: 38681661 PMCID: PMC11053287 DOI: 10.1016/j.ejro.2024.100566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 05/01/2024] Open
Abstract
Background and objectives The spleen hosts both benign and malignant lesions. Despite multiple imaging modalities, the distinction between these lesions poses a diagnostic challenge, marked by varying diagnostic accuracy levels across methods. In this study, we aimed to evaluate and compare the diagnostic performance of various imaging techniques for detecting malignant splenic lesions. Methods Following PRISMA guidelines, we searched PubMed, Scopus, and Web of Sciences databases for studies evaluating imaging techniques in detecting malignant splenic lesions. Data extraction included diagnostic accuracy metrics, and methodological quality was assessed using QUADAS-2. Diagnostic Test Accuracy meta-analyses were conducted using R (version: 4.2.1). Subgroup analyses and meta-regression were performed to compare different modalities and clinical settings. Results Our study included 28 studies (pooled sample size: 2358), primarily using retrospective designs with histopathology as the reference standard. PET scan demonstrated the highest diagnostic accuracy (AUC: 92 %), demonstrating a sensitivity of 93 % (95 % CI: 80.4 % - 97.7 %) and a specificity of 82.8 % (95 % CI: 71.1 % - 90.4 %). Contrast-enhanced ultrasound (CEUS), Contrast-enhanced CT scan, and contrast-enhanced MRI also showed impressive performance with AUCs of 91.4 %, 90.9 %, and 85.3 %, respectively. Differences among these modalities were not statistically significant, but they outperformed non-contrast-enhanced methods. PET and CEUS exhibited higher specificity for lymphoma cases compared to studies including other malignancies. Conclusion and clinical implications Overall, PET emerges as the best modality for splenic malignancies, and CEUS and CE-MRI show promise as potential alternatives, notably due to their reduced radiation exposure. Further research is essential for precise malignancy differentiation.
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Affiliation(s)
- Parya Valizadeh
- School of Medicine, Tehran University of Medical Science, Tehran, Iran
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
| | - Payam Jannatdoust
- School of Medicine, Tehran University of Medical Science, Tehran, Iran
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
| | - Mohammadreza Tahamtan
- School of Medicine, Tehran University of Medical Science, Tehran, Iran
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
| | - Hamed Ghorani
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soroush Soleimani Dorcheh
- School of Medicine, Tehran University of Medical Science, Tehran, Iran
- Student's Scientific Research Center, Tehran University of Medical Science, Iran
| | - Khashayar Farnoud
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Faeze Salahshour
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
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Power JW, Dempsey PJ, Yates A, Fenlon H, Mulsow J, Shields C, Cronin CG. Peritoneal malignancy: anatomy, pathophysiology and an update on modern day imaging. Br J Radiol 2022; 95:20210217. [PMID: 34826229 PMCID: PMC9153709 DOI: 10.1259/bjr.20210217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
With increasing subspecialised experience in radical cytoreductive surgery and intra-abdominal chemotherapy for peritoneal malignancy, outcomes have improved significantly in selected patients. The surgery and the treatment regimens are radical and therefore correct patient selection is critical. The radiologist plays a central role in this process by estimating, as precisely as possible, the pre-treatment disease burden. Because of the nature of the disease process, accurate staging is not an easy task. Tumour deposits may be very small and in locations where they are very difficult to detect. It must be acknowledged that no form of modern day imaging has the capability of detecting the smallest peritoneal nodules, which may only be visible to direct inspection or histopathological evaluation. Nonetheless, it behoves the radiologist to be as exact and precise as possible in the reporting of this disease process. This is both to select patients who are likely to benefit from radical treatment, and just as importantly, to identify patients who are unlikely to achieve adequate cytoreductive outcomes. In this review, we outline the patterns of spread of disease and the anatomic basis for this, as well as the essential aspects of reporting abdominal studies in this patient group. We provide an evidence-based update on the relative strengths and limitations of our available multimodality imaging techniques namely CT, MRI and positron emission tomography/CT.
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Affiliation(s)
- Jack W Power
- University College Dublin (UCD) School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Philip J Dempsey
- University College Dublin (UCD) School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Andrew Yates
- University College Dublin (UCD) School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Helen Fenlon
- University College Dublin (UCD) School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Conor Shields
- University College Dublin (UCD) School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Carmel G Cronin
- University College Dublin (UCD) School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
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Malgras B, Najah H, Dohan A, Barat M, Soyer P. Diagnosis and treatment of focal splenic lesions. J Visc Surg 2022; 159:121-135. [DOI: 10.1016/j.jviscsurg.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barat M, Hoeffel C, Aissaoui M, Dohan A, Oudjit A, Dautry R, Paisant A, Malgras B, Cottereau AS, Soyer P. Focal splenic lesions: Imaging spectrum of diseases on CT, MRI and PET/CT. Diagn Interv Imaging 2021; 102:501-513. [PMID: 33965354 DOI: 10.1016/j.diii.2021.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 12/12/2022]
Abstract
The spleen can be affected by a variety of diseases. Some of them are readily identified as variations of normal or benign diseases on imaging. However, for a substantial number of focal splenic abnormalities, the diagnosis can be difficult so that histopathologic analysis may be required for a definite diagnosis. In this review, the typical splenic abnormalities that can be diagnosed with imaging with a high degree of confidence are illustrated. The complementary role of computed tomography (CT), magnetic resonance imaging and positron emission tomography/CT that helps make a diagnostic approach is discussed. Finally, current applications and future trends of radiomics and artificial intelligence for the diagnosis of splenic diseases are addressed.
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Affiliation(s)
- Maxime Barat
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, 75006 Paris, France.
| | - Christine Hoeffel
- Department of Radiology, Reims University Hospital, 51092 Reims, France; CRESTIC, University of Reims Champagne-Ardenne, 51100 Reims, France
| | | | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, 75006 Paris, France
| | - Amar Oudjit
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Raphael Dautry
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Anita Paisant
- Department of Radiology, University Hospital of Angers, 49100 Angers, France; Faculté de Médecine, Université d'Angers, 49045 Angers, France
| | - Brice Malgras
- Department of Digestive and Endocrine Surgery, Bégin Army Training hospital, 94160 Saint-Mandé, France; École du Val-de-Grâce, 75005 Paris, France
| | - Anne-Ségolène Cottereau
- Université de Paris, 75006 Paris, France; Department of Nuclear Medicine, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, 75006 Paris, France
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Diffusion-weighted magnetic resonance imaging in peritoneal carcinomatosis from suspected ovarian cancer: Diagnostic performance in correlation with surgical findings. Eur J Radiol 2019; 121:108696. [PMID: 31683251 DOI: 10.1016/j.ejrad.2019.108696] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 09/13/2019] [Accepted: 09/26/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Ovarian cancer (OC) is the commonest cause of death by gynaecological cancer in developed countries. Peritoneal carcinomatosis (PC) complete debulking without residual disease of >1 cm is the best prognostic predictor in advanced OC. PC is assessed with Computed tomography (CT). CT accuracy and cytoreduction success predictive ability are limited. PET/CT is not an imaging standard for PC. PC shows high signal foci in Diffusion-weighted magnetic resonance imaging (DWI MRI). We assessed the diagnostic performance (DP) and tumour burden correlation of Whole body DWI with background suppression MRI (WB-DWIBS/MRI) in PC of suspected OC using the Peritoneal Cancer Index (PCI), referring to cytoreduction surgery as the standard reference. METHOD Fifty patients with suspicion of disseminated OC underwent cytoreduction and WB-DWIBS/MRI. The PCI scores tumour burden (0-3) in 13 anatomical regions (global range of 0-39). Two radiologists (Rad1/Rad2) assessed the PCI preoperatively and with surgical findings. We evaluated regional and global DP, the interobserver agreement (Cohen´s kappa coefficient), statistical differences (McNemar test) and tumour burden (Pearson's test). RESULTS 72% (36/50) were epithelial OC and 78% (39/50) achieved complete cytoreduction. Global-PCI correlation was 0.762 (Rad1) with DP: Sensitivity 0.84, specificity 0.89, accuracy 0.89, and kappa 0.41. Average global-PCI was 7. The pelvis and right hypochondrium showed the highest positive rate and DP, while the intestinal regions presented the lowest. Previous studies reported higher sensitivity than CT or PET/CT, although only a few used the PCI. CONCLUSIONS WB-DWIBS/MRI is reliable to depict, quantify and to predict complete cytoreductive surgery in OC PC.
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