The Incidental Splenic Mass at CT: Does It Need Further Work-up? An Observational Study.

Purpose To evaluate whether an incidentally noted splenic mass at abdominal computed tomography (CT) requires further imaging work-up. Materials and Methods In this institutional review board-approved HIPAA-compliant retrospective study, a search of a CT database was performed for patients with splenic masses at CT examinations of the abdomen and chest from 2002 to 2008. Patients were divided into three groups: group 1, patients with a history of malignancy; group 2, patients with symptoms such as weight loss, fever, or pain related to the left upper quadrant and epigastrium; and group 3, patients with incidental findings. Patients' CT scans, follow-up examinations, and electronic medical records were reviewed. Final diagnoses of the causes of the masses were confirmed with imaging follow-up (83.9%), clinical follow-up (13.7%), and pathologic examination (2.4%). Results This study included 379 patients, 214 (56.5%) women and 165 (43.5%) men, with a mean age ± standard deviation of 59.3 years ± 15.3 (range, 21-97 years). There were 145 (38.3%) patients in the malignancy group, 29 (7.6%) patients in the symptomatic group, and 205 (54.1%) patients in the incidental group. The incidence of malignant splenic masses was 49 of 145 (33.8%) in the malignancy group, eight of 29 (27.6%) in the symptomatic group, and two of 205 (1.0%) in the incidental group (P < .0001). The incidental group consisted of new diagnoses of lymphoma in one (50%) patient and metastases from ovarian carcinoma in one (50%) patient. Malignant splenic masses in the incidental group were not indeterminate, because synchronous tumors in other organs were diagnostic of malignancy. Conclusion In an incidental splenic mass, the likelihood of malignancy is very low (1.0%). Therefore, follow-up of incidental splenic masses may not be indicated. © RSNA, 2018.

MR Enterography of the Ileoanal Pouch: Descriptive Radiologic Analysis With Endoscopic and Pathologic Correlation.

OBJECTIVE: The purpose of this study was to describe the MR enterography (MRE) appearance of inflammation of the ileoanal pouch after ileal pouch-anal anastomosis (IPAA) surgery and to correlate it with pouch endoscopic and histopathologic findings. MATERIALS AND METHODS: All MRE studies performed between October 1, 2007, and September 30, 2013, for patients who had previously undergone IPAA (n = 54) were retrieved. After review of medical records, the patients who underwent MRE, pouch endoscopy, and biopsy within 90 days (14 men, 14 women; mean age, 42.2 years; range, 24-67 years) were selected for inclusion in the study. Two blinded MRI radiologists in consensus retrospectively evaluated MRE studies for multiple MRI features. Two MRI scores were then calculated: an active and a composite inflammation score. A gastroenterologist retrospectively reviewed the pouch endoscopic images, and a pathologist reviewed the slides; both of these investigators were blinded. Both MRI scores were correlated with the pouch endoscopic and histopathologic findings. RESULTS: The composite MRI score had strong positive correlation with the endoscopic score (r = 0.61; p = 0.0005) but weak positive correlation with the histopathologic score (r = 0.31; p = 0.10, not statistically significant). The active inflammation MRI score had moderate positive correlation with the endoscopic score (r = 0.57; p = 0.0017) and weak positive correlation with the histopathologic score (r = 0.20; p = 0.31, not statistically significant). An MRI score ≥ 4 indicated the best results, with sensitivity of 86%, specificity of 79%, positive predictive value of 80%, negative predictive value of 85%, and accuracy of 82% for pouch inflammation. A positive likelihood ratio of 4.00 and negative likelihood ratio of 0.18 were obtained. CONCLUSION: In patients who have undergone IPAA surgery, the MRE findings strongly correlate with the pouch endoscopic findings with high sensitivity and positive predictive value for pouch inflammation. Therefore, MRE is a useful noninvasive test performed without ionizing radiation that can be used to evaluate patients with clinical symptoms and possibly alleviate the need for endoscopy in a select patient population.