Splenic Lesions and Abdominal Nodes

Source: Heller MT, Harisinghani M, Neitlich JD, Yeghiayan P, Berland LL. Managing incidental findings on abdominal and pelvic CT and MRI, part 3: white paper of the ACR Incidental Findings Committee II on splenic and nodal findings. J Am Coll Radiol. 2013;10(11):833-839. doi:10.1016/j.jacr.2013.05.020

Spleen

^*Cyst: imperceptible wall, near-water attenuation (10 HU), no enhancement.
^†Hemangioma: discontinuous, peripheral, centripetal enhancement (findings that are uncommon in splenic hemangiomas).
^‡Benign imaging features: homogeneous, low attenuation (20 HU), no enhancement, smooth margins.
^§Evaluate: PET vs. MRI vs. biopsy. Suspicious imaging features: heterogeneous, enhancement, irregular margins, necrosis, splenic parenchymal or vascular invasion, substantial enlargement.
^¶Indeterminate imaging features: heterogeneous, intermediate attenuation (20 HU), enhancement, smooth margins.
^#Follow-up MRI in 6 and 12 months.

Lymph Nodes

^*Benign imaging features: normal short-axis diameter (1 cm in retroperitoneum), normal architecture (elongated, fatty hilum), normal enhancement, normal node number.
^†Abnormalimaging features: enlarged short-axis diameter (1 cm in retroperitoneum), architecture (round, indistinct hilum), enhancement (necrosis/hypervascular), increased number (cluster of 3 lymph nodes in single nodal station or cluster of 2 lymph nodes in 2 regions).
^‡Nonneoplastic disease: eg, infection, inflammation, connective tissue.
^§Other evaluation (PET/CT, nuclear scintigraphy [MIBG],endoscopic ultrasound).