Korean J Radiol.  2008 Apr;9(2):162-174. 10.3348/kjr.2008.9.2.162.

Intrapancreatic Accessory Spleen: Findings on MR Imaging, CT, US and Scintigraphy, and the Pathologic Analysis

Affiliations
  • 1Department of Radiology, Seoul National University Hospital, Seoul, Korea. leejm@radcom.snu.ac.kr
  • 2Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea.
  • 3Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
  • 4Department of Radiology, Section of Digestive Diseases, University Hospital, UMD-New Jersey Medical School, Newark, New Jersey, USA.

Abstract

Although the tail of the pancreas is the second most common site of an accessory spleen, intrapancreatic accessory spleen (IPAS) has rarely been noted radiologically. However, as the imaging techniques have recently advanced, IPAS will be more frequently detected as an incidental pancreatic nodule on CT or MRI. Because accessory spleens usually pose no clinical problems, it is important to characterize accessory spleens as noninvasively as possible. An IPAS has similar characteristics to those of the spleen on the precontrast and contrast-enhanced images of all the imaging modalities. In particular, inhomogeneous enhancement of an IPAS in its early phases may be a diagnostic clue. Superparamagnetic iron oxide (SPIO)-enhanced MRI and Levovist-enhanced US, and the mechanisms of which are theoretically similar to that of Tc-99m scintigraphy, can be used as alternative tools to confirm the diagnosis of IPAS. An IPAS shows a significant signal drop similar to the spleen on the SPIO-enhanced T2 or T2*-weighted imaging and prolonged enhancement on the delayed hepatosplenic phase of contrast-enhanced US. We review and illustrate the differential points between IPAS and hypervascular pancreatic tumors in this manuscript.

Keyword

Pancreas; Spleen; Ultrasound (US); Computed tomography (CT); Magnetic resonance (MR)

MeSH Terms

Choristoma/*diagnosis
Diagnosis, Differential
*Diagnostic Imaging
Humans
Pancreatic Diseases/*diagnosis
Pancreatic Neoplasms/diagnosis
*Spleen
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