title: Diffuse Infiltrative Splenic Lymphoma: Diagnostic Efficacy of Arterial-Phase CT.
abstract: To evaluate the diagnostic performance of obliteration of normal heterogeneous enhancement of the spleen (ONHES) on arterial phase (AP) computed tomography (CT) images in diffuse infiltrative splenic lymphoma (DISL).
  
  
  
  One hundred and thirty-six patients with lymphoma who had undergone two-phase (arterial and portal venous) abdominal CT were included in this study. We retrospectively evaluated the diagnostic performance of ONHES on AP CT in diagnosing DISL. Two observers evaluated ONHES on AP CT using the 5-point confidence level and assessed the presence or absence of subjective splenomegaly on axial CT images. Another two observers measured the splenic index as proposed by objective CT criteria. Statistical analysis included interobserver agreement and diagnostic performance of CT findings.
  
  
  
  Eleven of the 136 patients with lymphoma had DISL. The area under the receiver operating characteristic curve of ONHES (0.948 for observer 1 and 0.922 for observer 2) was superior to that of the splenic index (0.872 for observer 3 and 0.877 for observer 4), but the difference was not statistically significant (p > 0.05). The diagnostic performance of ONHES in conjunction with subjective splenomegaly showed higher diagnostic performance, as compared with subjective splenomegaly alone (accuracy: 100% and 85.3% for observer 1, 98.5% and 87.5% for observer 2; positive predictive value: 100% and 35.5% for observer 1, 90.9% and 39.3% for observer 2, respectively).
  
  
  
  Obliteration of normal heterogeneous enhancement of the spleen in conjunction with subjective splenomegaly can improve the diagnostic performance for DISL. Our results suggest that ONHES on AP CT images could be useful as an adjunctive diagnostic indicator of DISL in patients with lymphoma.
authors: Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 35015, Korea.
authors: Jeong Eun
authors: JE
authors: Lee
authors: Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 35015, Korea.
authors: June-Sik
authors: JS
authors: Cho
authors: Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 35015, Korea.
authors: Kyung Sook
authors: KS
authors: Shin
authors: Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 35015, Korea.
authors: Song Soo
authors: SS
authors: Kim
authors: Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 35015, Korea.
authors: Sun Kyoung
authors: SK
authors: You
authors: Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 35015, Korea.
authors: Jae Woo
authors: JW
authors: Park
authors: Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 35015, Korea.
authors: Hye Soo
authors: HS
authors: Shin
authors: Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 35015, Korea.
authors: Yeo Chang
authors: YC
authors: Yoon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008223:Lymphoma / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods; D012372:ROC Curve; D012189:Retrospective Studies; D013160:Splenic Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D013163:Splenomegaly / Q000000981:diagnostic imaging / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
keywords: Arterial phase; Diffuse infiltrative splenic lymphoma; Heterogeneous enhancement of the spleen; Lymphoma; Splenomegaly