Splenic imaging and non-vascular intervention: when to intervene on the spleen and how to do it safely

Cross-sectional interventional radiology (CSIR) for the spleen has evolved over the past two decades. Contemporary data show that CT- and US-guided splenic procedures are safer than once assumed, allowing for biopsy and drainage when clinically appropriate. Prior to intervention, however, close imaging evaluation of splenic lesions is required in order to recognize definitively benign, “do not touch” lesions as well as suspicious features that might warrant biopsy. This manuscript will first focus on imaging workup and decision-making for splenic lesions, and then discuss modern CSIR techniques to maximize both safety and yield.