53 - Hemolymphangiomatosis of the Spleen: Conventional Diagnostic Imaging and Magnetic Resonance Imaging with Superparamagnetic Contrast Agent

Abstract

Hemolymphangioma is a tumor composed of lymphatic and hematic cells. Signs and symptoms of this tumor are poor; physical examination reveals splenomegaly, and laboratory-hematic analysis shows mild thrombocytopenia without antiplatelet antibodies. Magnetic resonance imaging after administration of a superparamagnetic contrast agent can be used for the splenic pathology. The use of a T2 dual-purpose contrast agent composed of superparamagnetic iron-oxide particles is preferred. Superparamagnetic iron-oxide particles have a strong effect on the shortening of both T1 and T2 relaxation times. Hemolymphangiomatosis must be differentiated from the other primary vascular neoplasms of the spleen. The primary malignant vascular neoplasm of the spleen is angiosarcoma, but the more common neoplastic disorder of the spleen is lymphoma. These pathologies are described on CT/MR imaging only after using iodinated/paramagnetic contrast agents. After administration of the contrast agent, three patterns of enhancement have been described: immediate, homogeneous enhancement; early peripheral enhancement with uniform delayed enhancement; and peripheral enhancement with centripetal progression. Splenic hemolymphangiomatosis is a very rare pathology whose sonography, basal MRI, and late CT contrastographic features may resemble those of other diffuse benign vascular neoplasms. On the other hand, it is not possible to demonstrate a real hemangioma-like enhancement during the vascular phase. Moreover, its late contrastographic pattern can be considered at least very indicative if CT and iron-oxide-enhanced MRI are applied as complementary diagnostic tools.