When a splenic mass is incidentally discovered and its imaging characteristics are indeterminate, a structured management approach is needed to distinguish a benign course from one requiring further investigation.
This protocol applies to a splenic mass with indeterminate imaging features: heterogeneous texture, intermediate attenuation (>20 HU) on CT, enhancement after contrast, and smooth margins — a combination that does not allow definitive characterisation on initial imaging alone.
For incidentally discovered splenic lesions with these indeterminate features, the protocol involves a defined interval imaging surveillance strategy. The specific timepoints, criteria for reassurance versus escalation, and the complete decision pathway are contained in the full protocol.
Confirm stability of the splenic lesion on follow-up imaging, providing evidence of a benign course or identifying changes that warrant further workup.
Indeterminate imaging features: heterogeneous, intermediate attenuation (>20 HU), enhancement, smooth margins.
Follow-up MRI in 6 and 12 months.
For the remaining indeterminate splenic lesions that are incidentally discovered, a follow-up MRI in 6 months, and if stable in 12 months, is a reasonable approach to aid in management.
DOI: 10.1016/j.jacr.2013.05.020
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