Purpose: Nontraumatic focal splenic lesions (FSL) are rare, and the need for tissue diagnosis must be weighed against the very high risk of bleeding after a splenic biopsy. The aim of this study was to explore the feasibility and diagnostic potential of acoustic radiation force impulse (ARFI) elastography as a noninvasive method for different benign and malignant FSLs. No human studies on the elastographic characteristics of FSL exist. Methods: This was a retrospective analysis of 34 patients with FSLs, who underwent abdominal B-mode ultrasound (B-US), contrast-enhanced ultrasound (CEUS), and standardized ARFI examinations between October 2021 and December 2022 at our university hospital. The inclusion criteria were: (i) FSL size ≥ 1 cm; (ii) 10 valid ARFI measurements of the FSL, as well as of the normal splenic parenchyma (NSP) as an in vivo reference; and (iii) diagnostic confirmation of FSL etiology based on histological examination (8/34; 23.5%) or clinical evaluation, which included a clinical and sonographic follow-up (FU), CEUS morphology, and/or morphology on cross-sectional imaging (26/34; 76.5%). CEUS was performed on all patients and the FSLs were classified according to the current guidelines; cross-sectional imaging was available for 29/34 (85.3%). The mean FU duration was 25.8 ± 30.5 months. The mean ARFI velocity (MAV) of the FSL (MAVL), the NSP (MAVP), and the ratio of the MAVLto the MAVP(MAVL/P) were calculated and compared. Results: Of the 34 FSLs, 13 (38.2%) were malignant (mFSL) and 21 (61.8%) were benign (bFSL). The MAVLof all 34 FSLs (2.74 ± 0.71 m/s) was lower than the MAVP(3.20 ± 0.59 m/s),p= 0.009, with a mean MAVL/Pratio of 0.90 ± 0.34. No significant differences in the MAVLwere observed between the mFSL (2.66 ± 0.67 m/s) and bFSL (2.79 ± 0.75 m/s). There were also no significant differences between the MAVPin patients with mFSL (3.24 ± 0.68 m/s) as compared to that in the patients with bFSL (3.18 ± 0.55 m/s). Likewise, the MAVL/Pratio did not differ between the mFSL (0.90 ± 0.41 m/s) and bFSL (0.90 ± 0.30 m/s) groups. Conclusion: ARFI elastography is feasible in evaluating the stiffness of FSLs. The lesions’ stiffness was lower than that of the NSP, regardless of the FSL etiology. However, differentiation between benign and malignant FSL with the help of this elastographic method does not appear possible. Larger prospective studies are needed to validate these findings.
目的：非创伤性局灶性脾脏病变（FSL）较为罕见，且脾脏活检后出血风险极高，因此需权衡组织学诊断的必要性。本研究旨在探讨声辐射力脉冲（ARFI）弹性成像作为一种无创方法，用于鉴别不同良恶性FSL的可行性与诊断潜力。目前尚无关于FSL弹性成像特征的人体研究。方法：本研究回顾性分析了2021年10月至2022年12月期间在我院大学医院接受腹部B型超声（B-US）、超声造影（CEUS）及标准化ARFI检查的34例FSL患者。纳入标准包括：（1）FSL直径≥1厘米；（2）对FSL及正常脾实质（NSP）进行10次有效ARFI测量，并以NSP作为体内参照；（3）通过组织学检查（8/34例，占23.5%）或临床评估（包括临床与超声随访、CEUS形态学和/或断层影像学形态）明确FSL病因（26/34例，占76.5%）。所有患者均接受CEUS检查，并根据现行指南对FSL进行分类；其中29/34例（85.3%）可获得断层影像资料。平均随访时间为25.8±30.5个月。计算并比较FSL的平均ARFI速度（MAVL）、NSP的平均ARFI速度（MAVP）以及两者比值（MAVL/P）。结果：34例FSL中，恶性病变（mFSL）13例（38.2%），良性病变（bFSL）21例（61.8%）。所有34例FSL的MAVL（2.74±0.71 m/s）均低于MAVP（3.20±0.59 m/s），p=0.009，平均MAVL/P比值为0.90±0.34。mFSL组（2.66±0.67 m/s）与bFSL组（2.79±0.75 m/s）的MAVL无显著差异。mFSL患者的MAVP（3.24±0.68 m/s）与bFSL患者（3.18±0.55 m/s）相比亦无显著差异。同样，mFSL组（0.90±0.41 m/s）与bFSL组（0.90±0.30 m/s）的MAVL/P比值也无统计学差异。结论：ARFI弹性成像可用于评估FSL的硬度。无论FSL病因如何，病变硬度均低于正常脾实质。然而，该弹性成像方法似乎无法区分良恶性FSL。未来需要更大规模的前瞻性研究验证这些发现。
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