Imaging-guided percutaneous biopsy of focal splenic lesions: update on safety and effectiveness

OBJECTIVE: The purpose of this study is to determine the safety and effectiveness of percutaneous imaging-guided biopsy in the diagnosis of focal splenic lesions. MATERIALS AND METHODS: From May 1995 to November 1997, 20 imaging-guided biopsies of focal splenic lesions were performed in 18 patients, including seven patients with a prior diagnosis of extrasplenic malignancy (breast cancer, n = 3; lymphoma, n = 2; ovarian cancer, n = 1; and osteogenic sarcoma, n = 1), three immunosuppressed patients (cause of immunosuppression: AIDS, n = 1; liver transplantation, n = 1; and bone marrow transplantation, n = 1), two patients with anemia, one patient with a recent history of IV drug abuse, and five patients with incidentally discovered splenic lesions. Biopsies were performed with an 18-gauge (n = 1), a 20-gauge (n = 8), or a 22-gauge (n = 14) self-aspirating needle or an 18-gauge cutting needle (n = 1). Biopsies were considered successful if a specific diagnosis of benign or malignant disease was made. RESULTS: A specific diagnosis was made in 16 (88.9%) of 18 patients, and no complications occurred. Malignancy was diagnosed in six patients including three patients with lymphoma. Benign conditions were diagnosed in 10 patients: a cyst in two patients; hamartoma in one; lipogranuloma in one; infarct in one; and infection in four, including one case each of Candida albicans, Pneumocystis carinii, Mycobacterium tuberculosis, and mixed flora. The tenth benign diagnosis was a pseudotumor of the spleen related to a bulbous tail of the pancreas that was inseparable from the splenic hilum. Biopsy did not establish a diagnosis in one patient with lymphoma and in one patient with presumed splenic candidiasis. A mean of 1.5 needle passes was made per biopsy. CONCLUSION: Imaging-guided splenic biopsy is a safe technique that provides a specific diagnosis in most patients with focal splenic lesions.     

Sonography of focal lesions of the spleen

The sonographic appearances of benign and malignant splenic lesions in 154 patients are illustrated. Sixty-six of the 154 patients had malignant splenic lesions; 55 of these had malignant lymphoma and 11 had splenic metastatic lesions. The lesions were hypoechoic in 64 cases (97%), including all cases of malignant lymphoma, and were hyperechoic in two. Eighty-eight patients had benign splenic lesions; findings included cysts, infarcts, abscesses, hemangiomas, and calcifications.     

脾脏病变的CT诊断(附33例分析)

目的探讨CT检查对脾脏病变的诊断价值。方法回顾性分析经手术病理或穿刺活检证实33例脾脏病变的CT表现。33例均行CT平扫,28例行双期CT增强扫描,6例做了延迟扫描。结果33例中,非肿瘤性病变6例(结核2例,血肿3例,炎性假瘤伴局灶性血管瘤1例),良性肿瘤13例(囊肿5例,血管瘤4例,淋巴管瘤1例,脉管瘤3例),恶性肿瘤14例(淋巴瘤8例,转移瘤4例,恶性肌纤维母细胞瘤1例,血管内皮肉瘤1例)。结论CT对脾脏病变有较高的诊断价值。     

18F-氟化钠PET和PET-CT诊断肺癌骨转移的对比研究

目的 对比研究18F-氟化钠(18F-NaF)PET和PET-CT对肺癌骨转移诊断的准确性.方法 34例初始诊断为肺癌的患者接受18F-NaF PET-CT检查,对PET和PET-CT图像分别进行解释,发现的病变分为恶性、良性和不确定三种.骨转移的综合评价方法包括MRI(34例)、18F-氟脱氧葡糖糖PET-CT(4例)、组织学活检(2例)和临床随访(6例).结果 按患者水平分析时,34例患者中的11例(32%)发生骨转移,其中,18F-NaF PET-CT准确诊断所有患者的骨转移,无假阳性和假阴性,而18F-NaF PET诊断真阳性8例、3例不能确定,18F-NaF PET确诊的8例骨转移患者中的4例PET没有显示全部转移病变(假阴性和不确定病变);按病变水平分析时,118个病变获得最终诊断,其中转移病变47个、良性病变71个,其中,18F-NaF PET诊断真阳性27个、真阴性64个、不确定病变24个、假阴性1个、假阳性2个,而18F-NaF PET-CT诊断真阳性46个、假阴性1个、真阴性71个.按患者水平分析,将不确定病变归为恶性时,18F-NaF PET-CT的特异性高于18F-NaF PET(100% vs 78%,χ2=10.78,P<0.05),二者的灵敏度均为100%;将不确定病变归为良性时,18F-NaF PET-CT诊断骨转移的灵敏度显著高于18F-NaF PET(100% vs 73%,χ2=6.41,P<0.01),二者特异度差异无显著性(100% vs 96%,χ2=2.03,P>0.05);按病变水平分析时,得到与患者水平分析相似结果.结论 18F-NaF PET-CT诊断肺癌骨转移的准确性优于18F-NaF PET,PET-CT中的低剂量CT可进一步提高良、恶性病变的鉴别能力.     

Radiological diagnosis of splenic metastasis and its prevalence at autopsy]

CT and US findings of 7 cases of splenic metastases are described and the prevalence of splenic metastases at autopsy in 641 cases with malignant tumors were evaluated. Metastatic foci in spleen appeared mostly as poorly-defined low density masses on CT. Iodinated contrast material was administered in 2 cases, but no contrast enhancement was observed. US showed both hypoechoic and hyperechoic patterns. These appearances were nonspecific, but were similar to those of metastatic lesions in the liver which were often visible on CT associated with splenic metastases. At autopsy splenic metastases were found in 34 of 641 cases (5.3%). Gastric, colon, lung and ovarian cancers were most common primary tumors. However, the rate of splenic metastasis per tumor was highest in ovarian cancer (50.0%), followed by malignant melanoma (33.3%), colon cancer (16.2%) and gastric cancer (8.2%). Hepatoma which had the biggest number of autopsy cases in this series showed the lowest rate of splenic metastasis (0.8%).     

The distinction between benign and malignant liver tumors on sonography: value of a hypoechoic halo.

OBJECTIVE. The purpose of this study was to determine the diagnostic value of the sonographic halo sign (defined as any hypoechoic rim in the periphery of a lesion) in distinguishing between benign and malignant isoechoic and hyperechoic liver lesions on sonography. MATERIALS AND METHODS. Sonograms of the liver in 50 patients with proved benign liver tumors and in 50 patients with proved malignant liver tumors (seven primary liver neoplasms, 43 metastases) selected during a 13-month period were retrospectively analyzed by four radiologists who had no knowledge of the patients' clinical findings or the final diagnoses. Only a single sonogram was studied in each case. The presence or absence of a hypoechoic halo on the sonogram was the only criterion for distinguishing malignant from benign hepatic lesions. RESULTS. For 95 of 100 hepatic lesions, the four radiologists were almost (three vs one) or completely (four vs zero) in agreement about the presence or absence of a hypoechoic halo. In the five cases where there were conflicting decisions (two vs two), a final decision (four vs zero) was achieved by reviewing the entire series of sonographic images. A halo could be detected in 44 malignant tumors (88%) and in only seven benign tumors (14%) (sensitivity, 88%; specificity, 86%; positive and negative predictive values, 86% and 88%, respectively). The sonographic halo sign was particularly helpful in distinguishing hemangiomas (n = 29) from metastases (n = 43) (positive and negative predictive values, 95% and 87%, respectively). CONCLUSION. The results of this study suggest that the halo sign on sonograms is useful to distinguish benign from malignant isoechoic or hyperechoic tumors.     

脾肿瘤的CT诊断及鉴别诊断

目的探讨脾肿瘤CT表现和鉴别诊断价值。方法52例脾肿瘤均行CT平扫 增强检查,其中手术及穿刺活检病理证实27例,征象典型及病史明确25例。结果脾良性肿瘤18例,恶性肿瘤34例。良性肿瘤表现为脾脏内单发或多发,多数大小不等低密度结节病变,1例血管瘤为等密度。血管瘤及淋巴管瘤可显示点状或小片状钙化。增强扫描,血管瘤显示延迟均匀强化特点,淋巴管瘤内间隔可轻度强化。脾囊肿无强化。脾脏恶性肿瘤多较大,密度不均匀,增强扫描不均匀强化。脾淋巴瘤表现为脾肿大或多发结节样低密度病变,增强扫描强化不明显。结论CT是诊断脾肿瘤的主要检查方法,结合临床及B超检查,多可做出诊断。     

Abdominal ultrasonography in myelofibrosis.

The findings at abdominal ultrasonography (US) in 40 patients with myelofibrosis were reviewed, 20 patients being examined at initial diagnosis and 31 at later stages. Splenomegaly was found in 80% at initial diagnosis and in 97% at later stages. The spleen of 2 patients appeared homogeneously hypoechoic and inhomogeneous in one. Focal splenic lesions were seen in 5, and calcifications in 6. Mixed splenic lesions proved to be metastases in one and hyperechoic lesions in another patient were due to extramedullary hematopoiesis. Hepatomegaly was found in 25% at primary diagnosis and in 39% at later stages. Focal hepatic lesions were seen in 7 patients, and proved to be metastases in 3. The focal lesions in 2 of these patients were extramedullary hematopoiesis, which was hypoechoic in one and hyperechoic in the other. Ascites was seen in 4 patients and lymphadenopathy in one. US could not reliably differentiate between extramedullary hematopoiesis and malignancy. Fine-needle biopsy may be performed for definitive diagnosis.     

胰腺癌CT诊断与鉴别诊断

目的评价CT平扫与增强扫描对胰腺癌的诊断与鉴别诊断价值.方法24例经手术病理或临床证实的胰腺疾病患者,包括胰腺癌(12)例,慢性胰腺炎(7例),胰腺转移瘤(2例),胰腺囊腺瘤(1例),胰腺结核(1例),以及胰头变异(1例),均经增强前与增强后CT扫描,并对全部病例的CT表现进行回顾性分析.结果24例胰腺病变患者中,恶性病变(胰腺癌与转移瘤)14例(58%),良性病变10例(42%).各种胰腺疾病的影像表现随其为良性或恶性病变而不同,例如,胰腺癌患者表现为瘤内的不均匀密度,增强扫描后病变无强化,而慢性胰腺炎患者则表现为病变密度均匀,增强扫描后病变均匀强化.结论CT扫描,尤其是CT增强扫描有助于将胰腺癌与其他胰腺疾病相鉴别.     

ERCP、CT、B超对胰胆管下段疾病的诊断准确性

目的 比较ERCP、CT、B超对胰胆管下段疾病的诊断准确性。方法 100例临床表现为梗阻性黄疸，反复上腹痛、恶心呕吐的患均经ERCP、CT及B超检查本组患经手术病理或活检证实为良性病变(胆总管结石)57例，恶性肿瘤31例，其中胆总管癌11例，胰头癌13例，以及壶腹癌8例。上述3种方法术前的定性诊断准确率均与手术病理结果对照。结果 对胆总管结石的定性诊断准确率：ERCP为98％(n=56)，CT为72％(n=41)，B超为61％(n=35)；对恶性肿瘤的定性诊断准确率：ERCP为97％(n=31)，CT为78％(n=25)，B超为63％(n=20）。结论 ERCP对胰胆管下段良恶性病变的定性诊断准确率明显高于CT和B超，但因CT与B超均属无创性操作且对某些恶性肿瘤也有较高的定性诊断准确率，因此在影像诊断中应考虑3项技术优势互补。     

脾脏囊性占位性病变的螺旋CT诊断价值

目的:探讨脾脏囊性占位性病变的螺旋CT表现及其诊断价值。方法:回顾性分析经手术病理或穿刺活检证 实19例脾脏囊性占位性病变的CT表现。19例均行CT平扫,16例行动态增强扫描。结果:19例中脾囊肿10例,脾转移 瘤4例,脾脏淋巴管瘤2例,脾海绵状血管瘤2例及脾原发性淋巴瘤1例。CT对脾脏囊性占位性病变的检出率极高,能 明确肿块性质、范围及其与周围组织的关系。结论:平扫和动态增强螺旋CT检查对脾脏囊性占位性病变有较高的定性 诊断价值。     

^18F-氟化钠PET和PET-CT诊断肺癌骨转移的对比研究

目的对比研究^18F-氟化钠（^18F-NaF）PET和PET-CT对肺癌骨转移诊断的准确性。方法34例初始诊断为肺癌的患者接受^18F-NaFPET-CT检查,对PET和PET-CT图像分别进行解释,发现的病变分为恶性、良性和不确定三种。骨转移的综合评价方法包括MRI（34例）、^18F-氟脱氧葡糖糖PET-CT（4例）、组织学活检（2例）和临床随访（6例）。结果按患者水平分析时,34例患者中的11例（32％）发生骨转移,其中,^18F-NaFPET—CT准确诊断所有患者的骨转移,无假阳性和假阴性,而^18F-NaFPET诊断真阳性8例、3例不能确定,^18F-NaFPET确诊的8例骨转移患者中的4例PET没有显示全部转移病变（假阴性和不确定病变）;按病变水平分析时,118个病变获得最终诊断,其中转移病变47个、良性病变71个,其中,^18F-NaFPET诊断真阳性27个、真阴性64个、不确定病变24个、假阴性1个、假阳性2个,而^18F-NaFPET-CT诊断真阳性46个、假阴性1个、真阴性71个。按患者水平分析,将不确定病变归为恶性时,^18F-NaFPET-CT的特异性高于^18F-NaFPET（100％vs78％,χ2=10．78,P〈0．05）,二者的灵敏度均为100％;将不确定病变归为良性时,^18F-NaFPET-CT诊断骨转移的灵敏度显著高于^18F-NaFPET（100％vs73％,r=6．41,P〈0．01）,二者特异度差异无显著性（100％vs96％,χ^2=2．03,P〉0．05）;按病变水平分析时,得到与患者水平分析相似结果。结论 ^18F-NaFPET-CT诊断肺癌骨转移的准确性优于^18F-NaFPET,PET—CT中的低剂量CT可进一步提高良、恶性病变的鉴别能力。     

Ultrasound guided fine needle aspiration biopsy of splenic lesions

Fine needle aspiration biopsy (FNAB) of focal splenic lesions has been infrequently utilized because of the risk of haemorrhage. This study was carried out to evaluate the safety and efficacy of ultrasound guided FNAB of splenic lesions. 35 patients with focal splenic lesions underwent FNAB under real-time ultrasound guidance using a free hand technique. Ultrasound findings were single or multiple focal hypoechoic lesions (n = 33), focal hyperechoic lesion (n = 1) and diffuse heterogeneous echotexture (n = 1). Aspirations were performed with 22 G spinal needles using either the subcostal or the intercostal approach. Definite cytological diagnosis was made in 22 patients (62.8%), including tuberculosis in 10 patients, lymphoma in seven patients, extramedullary haematopoiesis in two patients and aspergillosis, histoplasmosis and bacterial abscess in one patient each. FNAB was negative in 12 patients because the aspirates were either scanty or contained only blood. FNAB was falsely positive in one patient. Only one patient had significant intraabdominal bleeding, which was managed conservatively. In conclusion, splenic FNAB performed under ultrasound guidance is a safe and accurate method in the diagnosis of focal splenic lesions.     

The benefit of SPECT when added to planar scintigraphy in patients with bone metastases in the spine.

PURPOSE: This study compared the efficiency of SPECT with planar bone scans in differentiating malignant from benign lesions and in detecting metastases to the spine. METHODS: Planar scintigraphy and SPECT were performed in 37 patients with low back pain without known malignancy and in 38 patients with confirmed malignancy. The type, location, and intensity of tracer accumulation were compared on the planar and SPECT scans. The malignant or benign nature of lesions was proved by radiologic methods, histologic findings, 6 month follow-up, or all of these. RESULTS: More metastases were detected by SPECT (SPECT, 58 of 64; planar, 42 of 64; P < 0.01). In three of seven patients with known malignancy who had a normal result of planar scan, only SPECT detected metastases. Fifty-nine metastases were radiologically mainly osteolytic, one was osteoblastic and four were mixed. Most lesions showed increased radioactivity (40 of 42 on planar scans vs. 45 of 58 on SPECT) and 2 of 42 (5%) vs. 12 of 58 (21%) were cold with marginally increased uptake. One of 58 metastases was a cold lesion seen on SPECT only. Lesions were more often malignant than benign when seen on SPECT in a pedicle (n = 5; malignant = 3, benign = 2), in the body and pedicle (n = 22; malignant = 14, benign = 8), within the vertebral body (n = 5; malignant = 4, benign = 1) and in the whole vertebra (n = 6; malignant = 4, benign = 2). The lesion to background ratio was higher on SPECT than on planar scans (SPECT, 2.26; planar scans, 1.86; P < 0.05 in malignant lesions). CONCLUSIONS: SPECT of the spine improved the diagnostic accuracy of bone scans when added to a planar scan in patients with known malignancy and clinical suspicion of spinal metastases when the planar scan was borderline abnormal. It helps in differentiating between benign and malignant lesions of the spine.     

胃肠道间质瘤的CT诊断

目的：分析胃肠道间质瘤（GIST）的CT表现特点，探讨CT对该肿瘤的诊断价值。资料与方法：回顾性分析经手术病理证实的GIST21例，术前均行CT平扫和增强扫描。结果：肿瘤发生于胃部11例，十二指肠1例，空肠5例，回肠4例，病灶多呈圆形或类圆形，平扫：肿瘤呈均匀等密度者8例，肿块周边呈等密度，中间呈略低密度或低密度者12例，呈高，等，低混杂密度者1例，增强扫描：病灶中度或明显强化者10例；不均匀强化，其内可见多数小囊状坏死者5例，病灶中央坏死，液化，周边强化者6例，21例GIST中，良性7例，肿块直径多小于5cm，边界清楚，多均匀强化，恶性14例，肿块直径大于5cm,边界多不清楚，10例肿块内有坏死，5例出现转移灶。结论：CT检查对于GIST的定位准确，对肿瘤良恶性的判断亦很有价值，但CT表现无特异性，确诊仍有赖于病理学检查。     

Solid splenic masses: evaluation with 18F-FDG PET/CT.

Our objective was to assess the role of (18)F-FDG PET/CT in the evaluation of solid splenic masses in patients with a known malignancy and in incidentally found lesions in patients without known malignancy. METHODS: Two groups of patients were assessed: (a) 68 patients with known malignancy and a focal lesion on PET or a solid mass on CT portions of the PET/CT study; and (b) 20 patients with solid splenic masses on conventional imaging without known malignancy. The standard of reference was histology (n = 16) or imaging and clinical follow-up (n = 72). The lesion size, the presence of a single versus multiple splenic lesions, and the intensity of (18)F-FDG uptake expressed as a standardized uptake value (SUV) were recorded. The ratio of the SUV in the splenic lesion to the background normal splenic uptake was also calculated. These parameters were compared between benign and malignant lesions within each of the 2 groups of patients and between the 2 groups. RESULTS: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of (18)F-FDG PET/CT in differentiating benign from malignant solid splenic lesions in patients with and without malignant disease were 100%, 100%, 100%, and 100% versus 100%, 83%, 80%, and 100%, respectively. In patients with known malignant disease, an SUV threshold of 2.3 correctly differentiated benign from malignant lesions with the sensitivity, specificity, PPV, and NPV of 100%, 100%, 100%, and 100%, respectively. In patients without known malignant disease, false-positive results were due to granulomatous diseases (n = 2). CONCLUSION: (18)F-FDG PET can reliably discriminate between benign and malignant solid splenic masses in patients with known (18)F-FDG-avid malignancy. It also appears to have a high NPV in patients with solid splenic masses, without known malignant disease. (18)F-FDG-avid splenic masses in patients without a known malignancy should be further evaluated as, in our series, 80% of them were malignant.     

Papillary lesions of the breast: evaluation with stereotactic directional vacuum-assisted biopsy.

PURPOSE: To evaluate the use of stereotactic directional vacuum-assisted biopsy (SDVAB) in diagnosing and managing papillary lesions of the breast. MATERIALS AND METHODS: The authors retrospectively reviewed the mammographic and histopathologic findings of 26 cases in which papillary lesions were diagnosed at SDVAB. In all cases, subsequent surgical excision (n = 20) or long-term imaging follow-up (n = 6) was performed and correlated with findings at SDVAB. RESULTS: SDVAB of 26 lesions yielded tissue that was classified as benign in 12, atypical in six, and malignant in eight. Of the 12 lesions that were diagnosed as histologically benign at SDVAB, six were surgically excised. Of these six lesions, five yielded benign correlative results. The sixth lesion was thought to be discordant with the imaging findings, and was surgically excised and determined to be malignant. Of the six benign lesions that were not surgically sampled for biopsy, five decreased in size and one was not seen at radiographic follow-up. Of the six lesions diagnosed as atypical at SDVAB that were surgically excised, one was benign and five were atypical. None proved to be malignant. Of the eight lesions diagnosed as malignant at SDVAB, surgical excision demonstrated ductal carcinoma in situ in all eight; two also had foci of invasive carcinoma. CONCLUSION: Benign and malignant papillary lesions of the breast can be reliably diagnosed at SDVAB when the SDVAB results correlate with the imaging findings. However, the extent of malignant papillary disease may be underestimated at SDVAB; in our study, invasive carcinoma was later discovered in 25% of patients with this diagnosis.     

Sonographic diagnosis of solitary solid liver nodules in cancer patients

The purpose of this study was to analyse the sonographic patterns of solitary solid liver lesions in cancer patients and to evaluate the diagnostic accuracy of ultrasound alone and in combination with other techniques (liver function tests, histology). A total of 422 solitary solid liver lesions (SSLL) were diagnosed by ultrasound in cancer patients; 197 lesions were benign and 225 malignant. The predominant aetiology for hypoechoic SSLL (128 cases) was metastasis (112 cases), whereas most hyperechoic SSLL (265 cases) were haemangiomas (155 cases) rather than a metastasis (86 cases). The 29 isoechoic SSLL included 27 metastases and 2 benign lesions. A halo was found to be highly predictive of malignancy (97%–100%). The positive predictive value for malignancy of an SSLL was very high when the results of liver function tests were abnormal (97%–100%). In our experience, histological proof is unnecessary in the majority of liver lesions in cancer patients. Correspondence to: J. N. Bruneton     

Association of prostate-specific antigen levels and patterns of benign and malignant uptake detected. on bone scintigraphy in patients with newly diagnosed prostate carcinoma

The bone scan patterns of benign and malignant uptake in 432 patients with newly diagnosed prostate carcinoma were reviewed in relation to prostate-specific antigen (PSA) levels determined within 4 months of scintigraphy. Scan results were categorized in terms of likelihood of metastatic disease and anatomical locations of benign and malignant lesions were tabulated. At least one suspect focus was identified in 138 scans (32%), and metastatic bone disease was present in 38 (9%). Metastatic disease prevalence increased from 1% for PSA <20 ng x ml(-1) to 58% for PSA>100 ng x ml(-1). Among patients with PSA>20 ng x ml(-1) (n = 157), 70 (45%) had at least one bone scan finding of concern for metastases and 35 (22%) proved to have metastatic disease. Almost all scans with metastases had either limited disease (< or = 5 suspicious lesions; n = 16; 42%) or extensive metastases (> 20 abnormalities; n = 19; 50%). The majority of patients with limited skeletal metastases had PSA < 100 ng x ml(-1) (11/16; 69%), while almost all patients with extensive skeletal involvement had PSA >100 ng x ml(-1) (17/19; 89%). Among those with limited metastatic disease, most (13/16; 81%) had at least one lesion in the pelvis or sacrum; the next most common sites were in the thoracic and lumbar spine (six each; 38%). In scans with a low to moderate suspicion for bone metastases, the only anatomical site with a significantly higher prevalence of malignant than benign lesions was the pelvis.     

Image guided percutaneous splenic interventions

AIM: The objective of this study is to evaluate the efficacy and safety of image-guided percutaneous splenic interventions as diagnostic or therapeutic procedures. MATERIALS AND METHODS: We performed a retrospective review of our interventional records from July 2001 to June 2006. Ninety-five image-guided percutaneous splenic interventions were performed after informed consent in 89 patients: 64 men and 25 women who ranged in age from 5 months to 71 years (mean, 38.4 years) under ultrasound (n=93) or CT (n=2) guidance. The procedures performed were fine needle aspiration biopsy of focal splenic lesions (n=78) and aspiration (n=10) or percutaneous catheter drainage of a splenic abscess (n=7). RESULTS: Splenic fine needle aspiration biopsy was successful in 62 (83.78%) of 74 patients with benign lesions diagnosed in 43 (58.1%) and malignancy in 19 (25.67%) patients. The most common pathologies included tuberculosis (26 patients, 35.13%) and lymphoma (14 patients, 18.91%). Therapeutic aspiration or pigtail catheter drainage was successful in all (100%) patients. There were no major complications. CONCLUSIONS: Image-guided splenic fine needle aspiration biopsy is a safe and accurate technique that can provide a definitive diagnosis in most patients with focal lesions in the spleen. This study also suggests that image-guided percutaneous aspiration or catheter drainage of splenic abscesses is a safe and effective alternative to surgery.