Diagnostics
Role of Ultrasonography in the Diagnosis of Splenic Diseases
By Hiroko Naganuma and Hideaki Ishida.
Abstract
The spleen, which serves as an important indicator of disease activity in various disorders, is routinely examined during abdominal ultrasonography. Although splenic ultrasonography has received relatively little attention compared with that focused on the liver and pancreas, recent advances in ultrasound technology have markedly improved its diagnostic capability. This mini-review re-evaluates the current role of ultrasonography in splenic imaging, focusing on recent technological developments and their clinical applications. Wide-scanning (WS) technology expands the field of view from approximately 70° to 140°, enabling visualization of the entire spleen within a single image. This may facilitate more reliable assessment of splenic size and peripheral lesions and can be combined with Doppler ultrasonography and contrast-enhanced ultrasound (CEUS). Microvascular flow imaging (MVFI) techniques, including Superb Microvascular Imaging and B-flow imaging, provide high-frame-rate imaging with excellent sensitivity for slow blood flow, allowing more detailed assessment of the intralesional vascularity and potentially aiding the evaluation of splenic tumors and infarctions. Splenic elastography offers a non-invasive assessment of portal hypertension and, when interpreted together with liver stiffness, may provide additional diagnostic information in non-cirrhotic portal hypertension. CEUS provides real-time assessment of splenic perfusion and lesion enhancement and may aid the characterization of focal lesions and the evaluation of splenic infarction. However, spleen-specific evidence remains limited, with much of the available literature consisting of small observational studies, case series, and case reports. Based on the available literature and our clinical experience, we also propose a practical multiparametric approach to splenic ultrasonography; however, this approach should be regarded as a clinically oriented framework rather than a prospectively validated diagnostic algorithm.
