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Imaging of the spleen: a proposed algorithm.

The /sup 99m/Tc sulfur colloid scan is an effective initial method for evaluating splenic size, position, and focal or diffusely altered radionuclide uptake. Sonography is a useful next step in determining whether focal lesions are solid or cystic and the relation of the spleen to adjacent organs. In our opinion, computed tomography (CT) may be reserved for the few instances in which diagnostic questions remain unanswered after radionuclide scanning and sonography. Angiography is used primarily in splenic trauma. We evaluated 900 patients suspected of having liver-spleen abnormality. This experience, which led to a logically sequenced noninvasive imaging approach for evaluating suspected splenic pathology, is summarized and illustrated by several cases.