- Design
- Retrospective single-centre diagnostic accuracy study
- Population
- 85 patients with hypervascular pancreatic lesions (34 accessory spleens, 51 neoplasms)
- Primary outcome
- Discrimination of accessory spleen from neoplasm
- Effect
- AUC up to 0.97 (iodine, Zeff); visual accuracy 88.1% vs 60.7% with vs without spectral images
A retrospective study in European Radiology, published on 2 October, examined 85 patients with hypervascular pancreatic lesions on portal-venous phase spectral CT: 34 intrapancreatic accessory spleens and 51 neoplasms. Lesion attenuation was compared with the spleen on conventional, virtual monoenergetic, iodine and effective atomic number images.
Lesion-to-spleen ratios on iodine density and effective atomic number maps discriminated well (AUC 0.96 to 0.97 overall, up to 0.99 in the tail). When three radiologists graded tail lesions visually, adding spectral images raised pooled accuracy from 60.7% to 88.1%, and agreement between readers rose (intraclass correlation 0.65 to 0.93).
An accessory spleen in the pancreatic tail is a classic mimic of a neuroendocrine tumour and can lead to EUS, nuclear medicine scans or even resection. Where spectral data are already acquired, they may settle the question without another test. The sample was small and from one institution.
- Consider intrapancreatic accessory spleen for any small, hypervascular lesion in the pancreatic tail that follows splenic enhancement.
- If the CT was spectral, compare lesion and spleen on iodine and effective atomic number maps before recommending further tests.
- Where doubt remains, heat-damaged red cell scintigraphy or MRI can still confirm splenic tissue.
- Mention the accessory spleen differential in the report so the clinician does not proceed straight to resection.
Why it matters
It could spare some patients further imaging or surgery for a lesion that is normal splenic tissue.
Don't overread it
A single-centre retrospective study of 85 patients; it needs external validation.
The statistics, in plain English
An AUC near 0.97 means the measurement almost always ranked an accessory spleen as more spleen-like than a tumour. Small studies tend to overestimate accuracy, so expect lower figures in general use.
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