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CT and MRI findings of sclerosing angiomatoid nodular transformation of the spleen: spoke wheel pattern.

Karaosmanoglu DA, Karcaaltincaba M, Akata D - Korean J Radiol (2008)

Bottom Line: Microscopically, all the reported cases had multiple angiomatoid nodules in a fibrosclerotic stroma.Each angiomatoid nodule was made up of slit-like, round or irregular shaped vascular spaces that were lined by endothelial cells and interspersed ovoid cells.The spoke-wheel pattern that was observed on MRI in this case may be an important imaging clue for making the correct diagnosis of this benign lesion.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.

ABSTRACT
Sclerosing angiomatoid nodular transformation of the spleen is a recently described benign pathologic entity that is characterized by round shaped vascular spaces that are lined by endothelial cells, and the spaces are circumscribed by granulomatoid structures. Microscopically, all the reported cases had multiple angiomatoid nodules in a fibrosclerotic stroma. Each angiomatoid nodule was made up of slit-like, round or irregular shaped vascular spaces that were lined by endothelial cells and interspersed ovoid cells. We present here the CT and dynamic gadolinium-enhanced MR findings of a patient with sclerosing angiomatoid nodular transformation. The spoke-wheel pattern that was observed on MRI in this case may be an important imaging clue for making the correct diagnosis of this benign lesion.

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Sclerosing angiomatoid nodular transformation in 44-year-old man.A. Axial CT image shows predominantly hypodense mass with lobulated contours. Also note rim-style contrast enhancement of external borders of lesion (arrow).B. Fat-saturated precontrast T1-weighted image shows central hyperintensity that is consistent with hemorrhage.C. T2-weighted MR image shows spoke-wheel pattern of lesion that is predominantly hyperintense with central hypointense areas. Note hyperintense radiations towards center of lesion.D, E Postcontrast arterial (D) and delayed venous phase (E) T1 weighted MR images clearly show progressive enhancement from  periphery to center of lesion, which is similar to spoke wheel pattern (arrows).
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Figure 1: Sclerosing angiomatoid nodular transformation in 44-year-old man.A. Axial CT image shows predominantly hypodense mass with lobulated contours. Also note rim-style contrast enhancement of external borders of lesion (arrow).B. Fat-saturated precontrast T1-weighted image shows central hyperintensity that is consistent with hemorrhage.C. T2-weighted MR image shows spoke-wheel pattern of lesion that is predominantly hyperintense with central hypointense areas. Note hyperintense radiations towards center of lesion.D, E Postcontrast arterial (D) and delayed venous phase (E) T1 weighted MR images clearly show progressive enhancement from periphery to center of lesion, which is similar to spoke wheel pattern (arrows).

Mentions: The patient was referred to our department by the attending physician for a CT examination to check for abdominal pathology. CT examination revealed a centrally hypodense lesion that measured 8cm in diameter with well-defined borders and an enhancing peripheral portion that radiated centrally to almost completely fill the splenic parenchyma (Fig. 1A). MRI study confirmed the CT findings, revealing a lesion with heterogeneous intensity with a centrally scattered hyperintense signal on the precontrast fat saturated T1-weighted images; this was suggestive of hemorrhagic components, which were confirmed by pathologic analysis (Fig. 1B). On the T2-weighted images (Fig. 1C), the lesion appeared peripherally hyperintense and centrally hypointense with radiating enhanced areas towards the center of the lesion, which appeared hyperintense. The early arterial phase T1-weighted gradient echo images (Figs. 1D, E) showed peripheral enhancement with progressive central progression in a radiating fashion on the late phase images, and this resembled a spoke-wheel pattern. The central portion was not completely filled on the late phase images, and this was consistent with fibrosis, which was confirmed by the pathology report. There was no lympadenaopathy or any other focal solid organ lesion that was suggestive of metastasis.


CT and MRI findings of sclerosing angiomatoid nodular transformation of the spleen: spoke wheel pattern.

Karaosmanoglu DA, Karcaaltincaba M, Akata D - Korean J Radiol (2008)

Sclerosing angiomatoid nodular transformation in 44-year-old man.A. Axial CT image shows predominantly hypodense mass with lobulated contours. Also note rim-style contrast enhancement of external borders of lesion (arrow).B. Fat-saturated precontrast T1-weighted image shows central hyperintensity that is consistent with hemorrhage.C. T2-weighted MR image shows spoke-wheel pattern of lesion that is predominantly hyperintense with central hypointense areas. Note hyperintense radiations towards center of lesion.D, E Postcontrast arterial (D) and delayed venous phase (E) T1 weighted MR images clearly show progressive enhancement from  periphery to center of lesion, which is similar to spoke wheel pattern (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627191&req=5

Figure 1: Sclerosing angiomatoid nodular transformation in 44-year-old man.A. Axial CT image shows predominantly hypodense mass with lobulated contours. Also note rim-style contrast enhancement of external borders of lesion (arrow).B. Fat-saturated precontrast T1-weighted image shows central hyperintensity that is consistent with hemorrhage.C. T2-weighted MR image shows spoke-wheel pattern of lesion that is predominantly hyperintense with central hypointense areas. Note hyperintense radiations towards center of lesion.D, E Postcontrast arterial (D) and delayed venous phase (E) T1 weighted MR images clearly show progressive enhancement from periphery to center of lesion, which is similar to spoke wheel pattern (arrows).
Mentions: The patient was referred to our department by the attending physician for a CT examination to check for abdominal pathology. CT examination revealed a centrally hypodense lesion that measured 8cm in diameter with well-defined borders and an enhancing peripheral portion that radiated centrally to almost completely fill the splenic parenchyma (Fig. 1A). MRI study confirmed the CT findings, revealing a lesion with heterogeneous intensity with a centrally scattered hyperintense signal on the precontrast fat saturated T1-weighted images; this was suggestive of hemorrhagic components, which were confirmed by pathologic analysis (Fig. 1B). On the T2-weighted images (Fig. 1C), the lesion appeared peripherally hyperintense and centrally hypointense with radiating enhanced areas towards the center of the lesion, which appeared hyperintense. The early arterial phase T1-weighted gradient echo images (Figs. 1D, E) showed peripheral enhancement with progressive central progression in a radiating fashion on the late phase images, and this resembled a spoke-wheel pattern. The central portion was not completely filled on the late phase images, and this was consistent with fibrosis, which was confirmed by the pathology report. There was no lympadenaopathy or any other focal solid organ lesion that was suggestive of metastasis.

Bottom Line: Microscopically, all the reported cases had multiple angiomatoid nodules in a fibrosclerotic stroma.Each angiomatoid nodule was made up of slit-like, round or irregular shaped vascular spaces that were lined by endothelial cells and interspersed ovoid cells.The spoke-wheel pattern that was observed on MRI in this case may be an important imaging clue for making the correct diagnosis of this benign lesion.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.

ABSTRACT
Sclerosing angiomatoid nodular transformation of the spleen is a recently described benign pathologic entity that is characterized by round shaped vascular spaces that are lined by endothelial cells, and the spaces are circumscribed by granulomatoid structures. Microscopically, all the reported cases had multiple angiomatoid nodules in a fibrosclerotic stroma. Each angiomatoid nodule was made up of slit-like, round or irregular shaped vascular spaces that were lined by endothelial cells and interspersed ovoid cells. We present here the CT and dynamic gadolinium-enhanced MR findings of a patient with sclerosing angiomatoid nodular transformation. The spoke-wheel pattern that was observed on MRI in this case may be an important imaging clue for making the correct diagnosis of this benign lesion.

Show MeSH
Related in: MedlinePlus