Table 2.
Patterns of enhancement on imaging of all cases (n = 59) of intrahepatic splenosis from 1939 to 2019
| No. | Year | Author | CT findings | MRI findings | Angiography |
|---|---|---|---|---|---|
| 1 | 1993 | Yoshimitsu [8] | Non-contrast: homogeneous low attenuation mass Contrast: enhanced from the periphery in the early phase, low attenuation in the delayed phase | T1-W: homogeneously low intensity T2-W: not obtained PDI: high intensity | Mass supplied by the left hepatic artery No definite neovascularity |
| 2 | 1997 | Gruen [9] | Contrast: high-attenuation mass | NA | NA |
| 3 | 1998 | D’Angelica [10] | Contrast: high-density mass | NA | NA |
| 4 | 1999 | Foroudi [11] | Contrast: multiple foci of enhancing soft tissue densities | NA | NA |
| 5 | 2000 | De Vuysere [12] | Non-contrast: slightly hypodense Contrast: homogeneously hyperdense in the arterial phase, isodense in the portal venous phase, and slightly hypodense in the late phase | Pre-contrast T1-W: hypointense Pre-contrast T2-W: hyperintense Post-contrast (small iron oxide particles (SPIO-Endorem): remained slightly hyperintense relative to the hypointense liver | NA |
| 6 | 2002 | Gamulin [13] | Contrast: heterogeneous enhancement | NA | NA |
| 7 | 2002 | Lee [14] | Contrast: early contrast enhancement and washout on delayed phase | NA | Tumour stained in segment 6 through the inferior phrenic artery No feeding vessel from hepatic or superior mesenteric artery |
| 8 | 2002 | Pekkafali [15] | Non-contrast: slightly hypodense with prominent hypodense rim around the lesion Contrast: hyperdense in the arterial phase, isodense in the portal venous phase and hypodense in the equilibrium phase | Pre-contrast T1-W: homogenously hypointense with hypointense rim Pre-contrast T2-W: isointense to liver with thin hypointense rim Post-contrast: hyperintense to liver | NA |
| 9 | 2003 | Kim [16] | Contrast: homogeneously well enhanced in the arterial phase and isodense in the equilibrium phase | NA | Mass supplied by inferior phrenic artery |
| 10 | 2004 | Di Costanzo [17] | Contrast: arterial hypervascularization and rapid “washout” of the contrast medium on portal venous phase | NA | NA |
| 11 | Contrast: early enhancement on the arterial phase and complete “washout” of the lesion on portal venous phase | NA | NA | ||
| 12 | 2004 | Kondo [18] | Contrast: low-density tumour in arterial phase, with vessels penetrating inside the tumour. Nearly homogeneous enhancement | T1-W: low signal intensity T2-W: high signal intensity | Hypervascular tumour supplied by the right hepatic artery |
| 13 | 2006 | Ferraioli [19] | NA | Contrast material-enhanced T1-W: liver tumour and accessory spleen were hypointense T2-W: liver tumour and accessory spleen were hyperintense | NA |
| 14 | 2008 | Choi [20] | Contrast: Lesion in segment IVa: slight enhancement during both the arterial and portal phase Lesion in segment VI: slight enhancement only in the portal phase | Contrast: enhancement during arterial phase and slightly hyperintense signal in the liver parenchyma during portal phase | Subtle tumour staining in segment IVa and no tumour staining in segment VI |
| 15 | 2008 | Grande [21] | Non-contrast: slightly hypodense compared to the liver Contrast: hyperdense in the arterial phase and isodense in the portal phase | NA | NA |
| 16 | 2008 | Imbriaco [22] | Non-contrast: hypodense Contrast: heterogeneous enhancement in the arterial phase, hypodense compared with the surrounding parenchyma during the portal and equilibrium phases | Pre-contrast T1-W: hypointense Pre-contrast T2-W: slightly hyperintense Post-contrast: nonhomogeneous enhancement during the arterial phase, hypointensity during the portal and equilibrium phases | |
| 17 | 2008 | Lu [23] | Non-contrast: two hypodense nodules Contrast: homogeneously hyperdense in the arterial phase, isodense in the portal venous phase, and slightly hypodense in the equilibrium phase. | Pre-contrast T1-W: homogeneously hypointense Pre-contrast T2-W: hyperintense contrast (Gd-DTPA): global enhancement in arterial phase, isointense in portal phase | |
| 18 | 2008 | Nakajima [24] | Non-contrast: hypodense mass Contrast: strong enhancement at the early phase and pooling enhancement at the late phase | T1-W: hypointense mass T2-W: hypointense mass |
|
| 19 | 2008 | Yeh [25] | Non-contrast: isodense Contrast: persistent homogeneous enhancement in the arterial and portal venous phases | Pre-contrast T2-W: intermediate to high signal Plain phase: iso-signal in the plain phase Post-contrast: heterogeneous enhancement in the arterial phase and persistent homogeneous enhancement in the portal venous phase | Tumour stain with blood supply via perirenal vessel |
| 21 | 2009 | Kashgari [27] | NA | Pre-contrast T1-W: mildly hypointense Pre-contrast T2-W: homogenously hyperintense Contrast (gadopentetate dimeglumine): heterogenous early arterial enhancement, isointense in porto-venous and equilibrium phase | NA |
| 20 | 2009 | Hilal [26] | Contrast: hypervascular nodule with increased enhancement in the venous phase | Contrast (gadolinium): hypervascular nodule in arterial and portal venous phase | NA |
| 22 | 2009 | Menth [28] | NA | Contrast (Gd-DTPA): marked enhancement in early arterial phase Contrast (SPIO) T2-W: lacks iron uptake | Regular branches of hepatic artery No pathologic vessels or parenchymal foci of hypervascularity |
| 23 | 2009 | Yu [29] | Contrast: strong and slightly inhomogeneous enhancement in the arterial phase, diminished enhancement in the portal venous phase | T1-W: hypointense T2-W: | |
| 24 | 2010 | Mescoli [30] | Contrast: hyper-enhancement in arterial and portal phases The largest nodule showed a hypodense central (necrotic) area | NA | NA |
| 25 | Contrast: hypervascular nodule | NA | NA | ||
| 26 | 2010 | Tsitouridis [31] | Non-contrast: slightly hypodense Contrast: increased enhancement during arterial phase with hypodense rim surrounding lesion. Lesion is isodense during portal phase | Pre-contrast T2-HASTE: intermediate-to-high signal intensity Post-contrast T2-HASTE: homogeneous enhancement with imaging characteristics of an extrahepatic-intraperitoneal lesion | NA |
| 27 | Contrast: hypodense with peripheral enhancement in both arterial and portal phases | Pre-contrast T2-HASTE: intermediate-to-high signal Post-contrast T2-HASTE: delayed peripheral enhancement Coronal plane: imaging characteristics of an extrahepatic lesion mimicking peritoneal implantation | NA | ||
| 28 | 2011 | Kang [32] | No parenchymal abnormality in liver | T1-W: low signal intensity T2-W: slightly high signal intensity slightly high signal intensity on the SPIO-enhanced T2-W: high signal intensity | NA |
| 29 | 2012 | Li [33] | Non-contrast: isodense masses mirroring residual spleen Contrast: enhancement in both hepatic mass and residual spleen | Pre-contrast T1-W: hypointense Pre-contrast T2-W: hyperintense Contrast: heterogeneous enhancement in arterial phase | NA |
| 30 | 2012 | Liu [7] | Non-contrast: homogeneous soft tissue mass with surrounding low-density aureole Contrast: slightly lower density than the liver especially in arterial phase | NA | NA |
| 31 | 2013 | Inchingolo [34] | Contrast: marked enhancement in arterial phase, remained hyperdense in portal venous phase | Post-contrast (gadolinium): increased arterialization after gadolinium injection with some loss of signal in the in-phase, indicating hemosiderin accumulation in the tissue DWI: restricted diffusion within the lesion | NA |
| 32 | 2013 | Krawczyk [35] | NI | Pre-contrast T2-W: hyperintense lesion in liver, with additional lesions dorsal to stomach that looks typical for regenerate spleen tissue Post-contrast T1-W: homogeneous enhancement | |
| 33 | 2013 | Leong [36] | Hypervascular lesion | Non-cystic irregular lesion with features suggestive of neuroendocrine tumour | |
| 34 | 2014 | Kandil [37] | Contrast: enhancement in arterial phase | NA | NA |
| 35 | 2014 | Sato [38] | Contrast: slightly inhomogeneous enhancement in arterial phase, with diminished enhancement in the equilibrium phase | Pre-contrast T2-W: hyperintense Post-contrast (Gd-EOB): hypointense compared to surrounding liver parenchyma | NA |
| 36 | 2014 | Tinoco | NA | Hypervascular lesion | NA |
| [39] | Contrast: homogeneous enhancement in arterial phase, with | ||||
| lavage in the portal phase and equilibrium | |||||
| 37 | 2015 | Grambow | Contrast: hypervascular mass with enhancement typical for HCC | NA | NA |
| [40] | |||||
| 38 | 2015 | Li [41] | Contrast: strong homogeneous enhancement in arterial phase and | Pre-contrast T1-W: slightly hyperintense | Hypervascular tumour supplied by the |
| hypodense during portal phase | Pre-contrast T2-W: slightly hyperintense | branches of the hepatic artery | |||
| Post-contrast T2-W: hyperintense during arterial phase and | |||||
| hypointense during the portal phase | |||||
| 39 | 2015 | Liu [6] | NI | T2-W: intermediate-to-high signal intensity | NA |
| 40 | 2015 | Tamm | Non-contrast: slightly hypodense | Pre-contrast T1-W: hypointense | |
| [42] | Contrast: hypodense during arterial phase and hyperdense during | Pre-contrast T2-W: mildly hyperintense | |||
| portal venous phase | Post-contrast: no brisk arterial enhancement was present after | ||||
| contrast administration. Presence of homogeneous enhancement | |||||
| at 1 minute, with central washout and a residual rim of peripheral | |||||
| enhancement at 5 minutes | |||||
| 41 | 2015 | Toktas [43] | Isodense with spleen | NA | NA |
| 42 | 2015 | Wu [44] | Non-contrast: homogeneous hypodense mass | T1-W: low signal intensity | NA |
| T2-W: high signal intensity | |||||
| 43 | 2016 | Fung [45] | Contrast: early arterial enhancement with | Pre-contrast T1-W: hypointense | NA |
| contrast washout in delayed phase | Pre-contrast T2-W: hyperintense | ||||
| Post-contrast T2-W: enhancement in arterial phase followed by | |||||
| washout in delayed phase | |||||
| 44 | 2016 | Chen [46] | Contrast: marked | Pre-contrast T1-W: low signal intensity | NA |
| enhancement at arterial phase and delayed phase | Post-contrast T1-W: lower enhancement after contrast | ||||
| administration | |||||
| 45 | 2016 | Jereb [47] | Contrast: hypodense lesions in portal phase | Post-contrast T1-W: hypointense in both arterial and late phase | NA |
| Post-contrast T2-W: hyperintense during arterial phase, | |||||
| hypointense in late phase | |||||
| 46 | 2017 | Keck [48] | NA | Arterial enhancement with washout | NA |
| 47 | 2017 | Somsap | NA | Pre-contrast T1-W: hypointense | NA |
| [49] | Post-contrast T1-W: heterogenous enhancement during arterial | ||||
| phase, more homogeneous in portal and delayed phase | |||||
| 48 | 2017 | Wang [5] | Non-contrast: hypodense | Pre-contrast T1-W: slightly hypointense | NA |
| Contrast: strong homogeneous enhancement in arterial phase and | Pre-contrast T2-W and DWI: high signal intensity | ||||
| hypodense during portal phase | Post-contrast T2-W: uneven enhancement with decreased signal | ||||
| 49 | 2017 | Wang [50] | Contrast: marked homogeneous enhancement in arterial and portal | Pre-contrast T1-W: hypointense | NA |
| venous phase, with diminished enhancement in the equilibrium phase | Pre-contrast T2-W: hyperintense | ||||
| Post-contrast: moderate homogeneous enhancement with marked | |||||
| delayed ring enhancement mimicking a pseudocapsule similar to | |||||
| hepatocellular carcinoma (HCC) in equilibrium phase | |||||
| 50 | 2018 | Aramoana | Contrast: enhancement in arterial phase | Post-contrast T2-W: peak enhancement at 60 s and washout | NA |
| [51] | at 10 min | ||||
| 51 | 2018 | Budak | NA | T2-HASTE: hyperintense | NA |
| [52] | Post-contrast T1-W: hepatic lesion showed marked enhancement | ||||
| in arterial phase. Multiple nodule formations in peritoneal cavity | |||||
| similarly showed similar contrast uptake pattern | |||||
| 52 | 2018 | Guzman | NI | NI | NA |
| [53] | |||||
| 53 | 2018 | Smolen | Non-contrast: multiple isodense lesions | NA | NA |
| [54] | Contrast: hyperenhancement in arterial phase, iso- to | ||||
| hypoenhancement in portal and delayed phase) | |||||
| Carcinoma could not be ruled out | |||||
| 54 | 2018 | Teles [55] | NI | NI | NA |
| 55 | 2018 | Varghese | Contrast: heterogeneous “arciform” enhancement in arterial phase, | NA | NA |
| [56] | with continued homogeneous enhancement in delayed phase with | ||||
| slow washout | |||||
| 56 | 2018 | Vergara | Contrast: mild enhancement in arterial phase | Pre-contrast T1-W: low signal intensity | NA |
| [57] | Pre-contrast T2-W: slightly hyperintense | ||||
| Post-contrast T1-W: lower enhancement compared surrounding | |||||
| liver parenchyma | |||||
| 57 | 2018 | Xuan [58] | Non-contrast: slightly hypodense | Pre-contrast T1-W and T2-W: slightly hypointense | NA |
| Contrast: inhomogeneous enhancement during arterial phase and | DWI: slightly hyperintense | ||||
| diminished enhancement during the portal and equilibrium phase | Post-contrast: strongly heterogeneous and hyperintense during | ||||
| the arterial phase and relatively hypointense during the portal | |||||
| 58 | 2019 | Guedes | NA | Pre-contrast T1-W: hypointense | NA |
| [59] | Pre-contrast T2-W: hyperintense | ||||
| Post-contrast: increased vascularity and washed out during late | |||||
| venous phase | |||||
| 59 | 2019 | Luo [4] | Non-contrast: multiple hypodense lesions | NA | NA |
| Contrast: enhancement during arterial phase with hypodense rim |
CT – computed tomography, DWI – diffusion-weighted imaging, Gd-DTPA – gadolinium-diethylenetriaminepentaacetic acid, Gd-EOB – gadoxetic acid, HCC – hepatocellular carcinoma, MRI – magnetic resonance imaging, PDI – proton density image,
SPIO – superparamagnetic iron oxide, T1-W – T1-weighted, T2-W – T2-weighted
NA – not applicable, NI – no information on enhancement pattern