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Published online before print July 20, 2006, 10.1148/radiol.2403050529
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High-Frequency Sonographic Patterns of the Spleen in Children1

Andrea S. Doria, MD, MSc, PhD, Alan Daneman, MD, Rahim Moineddin, PhD, Charles R. Smith, MD, Arun Mohanta, MRT, Jonathan Clarke, MRT and Christian J. Kellenberger, MD2

1 From the Departments of Diagnostic Imaging (A.S.D., A.D., A.M., J.C., C.J.K.) and Paediatric Laboratory Medicine (C.R.S.), the Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Public Health, Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (R.M.). From the 2001 RSNA Annual Meeting. Received March 31, 2005; revision requested June 2; revision received June 22; accepted July 11; final version accepted November 2. Address correspondence to A.D. (e-mail: alan.daneman{at}utoronto.ca).


Figure 1
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  		Figure 1a: Normal high-frequency sagittal gray-scale sonograms of the spleen show (a) granular pattern of echogenicity in splenic parenchyma of 4-year-old girl, (b) mild reticulonodular pattern in 5-year 10-month-old boy, and (c) a marked reticulonodular pattern in 2-year 4-month-old girl.

 

Figure 1
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  		Figure 1b: Normal high-frequency sagittal gray-scale sonograms of the spleen show (a) granular pattern of echogenicity in splenic parenchyma of 4-year-old girl, (b) mild reticulonodular pattern in 5-year 10-month-old boy, and (c) a marked reticulonodular pattern in 2-year 4-month-old girl.

 

Figure 1
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  		Figure 1c: Normal high-frequency sagittal gray-scale sonograms of the spleen show (a) granular pattern of echogenicity in splenic parenchyma of 4-year-old girl, (b) mild reticulonodular pattern in 5-year 10-month-old boy, and (c) a marked reticulonodular pattern in 2-year 4-month-old girl.

 

Figure 2
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  		Figure 2: Bar graphs show distribution of visual classification for in vivo sonographic patterns of splenic parenchyma in patients. Sonographic patterns were classified as grade 1 (granular pattern) in 18 (75%) of 24 neonates and as either grade 2 or grade 3 (mild or prominent reticulonodular pattern) in 23 (85%) of 27 children older than 1 year but younger than 5 years. Within the first 5 years of life, there is an inverse relationship between frequency of grade 1, 2, or 3 patterns and age: The frequency of grade 1 patterns gradually decreases, and that of grade 3 patterns increases as age range of the groups increases.

 

Figure 3
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  		Figure 3: Scattergram shows association between visual classification of in vivo sonographic patterns of splenic parenchyma and longitudinal diameter of patients' spleens (P < .001 for grade 1 pattern vs grade 2 or grade 3 patterns, as calculated with logistic regression analysis).

 

Figure 4
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  		Figure 4a: (a) Sagittal gray-scale high-frequency sonogram of prefixed cadaveric spleen in a 6-year-old girl who died of intracranial hemorrhage shows 2-mm distances between hypoechoic nodules (eg, vertical white line [arrow]) in splenic parenchyma. (b) Macroscopic inspection of corresponding sagittal section of splenic parenchyma of cadaveric specimen shows white nodular regions that represent lymphoid nodules of white pulp scattered throughout brownish background mass of red pulp. Vertical black line (arrow) represents interlymphonodular distance. (c) Microscopic appearance of corresponding histologic slice best differentiates red (black arrow indicates a red color region) and white (red arrow indicates a blue color region) pulp of the spleen. Median distance between lymphoid follicles in parenchyma of the splenic specimens (dotted line) was 0.58 mm, which correlated well with internodular distances (r = 0.71, P = .03) measured with sonography on corresponding splenic specimen. (Hematoxylin-eosin stain; original magnification, x4.)

 

Figure 4
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  		Figure 4b: (a) Sagittal gray-scale high-frequency sonogram of prefixed cadaveric spleen in a 6-year-old girl who died of intracranial hemorrhage shows 2-mm distances between hypoechoic nodules (eg, vertical white line [arrow]) in splenic parenchyma. (b) Macroscopic inspection of corresponding sagittal section of splenic parenchyma of cadaveric specimen shows white nodular regions that represent lymphoid nodules of white pulp scattered throughout brownish background mass of red pulp. Vertical black line (arrow) represents interlymphonodular distance. (c) Microscopic appearance of corresponding histologic slice best differentiates red (black arrow indicates a red color region) and white (red arrow indicates a blue color region) pulp of the spleen. Median distance between lymphoid follicles in parenchyma of the splenic specimens (dotted line) was 0.58 mm, which correlated well with internodular distances (r = 0.71, P = .03) measured with sonography on corresponding splenic specimen. (Hematoxylin-eosin stain; original magnification, x4.)

 

Figure 4
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  		Figure 4c: (a) Sagittal gray-scale high-frequency sonogram of prefixed cadaveric spleen in a 6-year-old girl who died of intracranial hemorrhage shows 2-mm distances between hypoechoic nodules (eg, vertical white line [arrow]) in splenic parenchyma. (b) Macroscopic inspection of corresponding sagittal section of splenic parenchyma of cadaveric specimen shows white nodular regions that represent lymphoid nodules of white pulp scattered throughout brownish background mass of red pulp. Vertical black line (arrow) represents interlymphonodular distance. (c) Microscopic appearance of corresponding histologic slice best differentiates red (black arrow indicates a red color region) and white (red arrow indicates a blue color region) pulp of the spleen. Median distance between lymphoid follicles in parenchyma of the splenic specimens (dotted line) was 0.58 mm, which correlated well with internodular distances (r = 0.71, P = .03) measured with sonography on corresponding splenic specimen. (Hematoxylin-eosin stain; original magnification, x4.)

 

Figure 5
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  		Figure 5: Scattergram shows positive correlation (r = 0.71) between internodular distances on sonograms and inter–white pulp distances at histologic analysis (P = .03).

 




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