Sonographic determination of normal spleen size in an adult African population

Influence of splenomegaly on aortic and liver parenchymal CT numbers during contrast-enhance CT in patients with cirrhosis

INTRODUCTION

To compare CT (computed tomography) values for enhancement of the abdominal aorta and liver parenchyma during dynamic contrast enhancement (CE) CT in cirrhotic patients with and without splenomegaly (SM).

METHODS

We considered 258 patients (83 males and 46 females for the splenomegaly group, and 83 males and 46 females for the control group) for this retrospective study. We measured CT values in the abdominal aorta and hepatic parenchyma during the hepatic arterial (HAP) and portal venous (PVP) phases. The aortic CE at HAP and the hepatic parenchymal CE at PVP were compared between the two groups. For success rate of scans, we also calculated the optimal CE rates (>280 HU in the abdominal aorta and >50 HU in the hepatic parenchyma) for each group.

RESULTS

In the SM group, the CE for abdominal aorta was decreased during the aortic phase for a dynamic CE-CT (p < 0.05). When evaluating the success rates, they were found to be 65.1 % and 58.9 % in the SM group and 81.4 % and 72.3 % in the non-SM group (p < 0.05).

CONCLUSION

The success rate of scans and CE for the abdominal aorta during the aortic phase exhibited a significant decrease during dynamic CE-CT scans on patients with SM. Patients with SM may have reduced diagnostic ability with typical contrast injection protocols.

IMPLICATIONS FOR PRACTICE

It may be necessary to change the injection rates and contrast medium volume during CE-CT depending on the presence or absence of SM.

Sonographic measurement of splenic size and its correlation with body parameters

There are controversies regarding the normal size of the adult spleen and its correlation with age, sex and body parameters. The present study aimed to establish a reference value of splenic dimensions, volume and their correlations with different body parameters. The present cross-sectional study was conducted on 300 healthy adult volunteers of both sexes. Age, sex, height, weight and body mass index (BMI) were recorded. The ultrasound measurements of spleen parameters included length, thickness and width. The spleen volume was calculated using the standard prolate ellipsoid formula (length x thickness x width x0.523). The mean ± SD age was 38.7±14 years, the mean height was 166±9.9 cm, the mean weight was 74.7±15.8 kg and the mean BMI was 27±5 kg/m². The mean spleen length, thickness, width and volume were 10.68±1.28 cm, 4.1±0.58 cm, 7.3±0.9 cm and 174.4±52.4 ml, respectively. Males had larger spleen parameters than females. Spleen volume significantly correlated with the subjects' height (r=0.655, P<0.001) and weight (r=0.643, P<0.001). However, weaker correlations were detected between age (r=-0.238, P<0.001) and BMI (r=0.299, P<0.001) with spleen volume. A higher significant correlation was found between spleen volume and spleen length rather than with its thickness and width. In the present study, the normative data of splenic dimensions and volume have been provided and may be used in certain clinical situations.

Estimation of Spleen Volume Using MRI Segmentation: Would One Slice Be Enough?

This study aimed to establish spleen volume in adult Sudanese using manual segmentation and the Cavalieri method with magnetic resonance images (MRI). A total of 345 abdominal MRI scans for adults were retrospectively studied for patients who underwent abdomen MRI between September to October 2016. The data were collected from two scanning centers in Khartoum, Sudan. For each series of sectional images, the spleen was manually segmented, and the volume was calculated using matrix laboratory (MATLAB) code. Furthermore, abdominal circumferences and diameters, in addition to L1 body dimension and spinal canal, were measured.  The mean splenic volume in our study was 187.2 cm³, without a significant change with age (P = 0.269). The average volume in males was 223.5 cm³ while in females it was 170.27 cm³. The average coefficient error (CE) was 0.029. A positive significant correlation was found between the volume and spleen length (beta standardized coefficient = 0.781, P < 0.05). The mean length was 9.18 cm. Additionally, our data showed an insignificant correlation between the volume and the other measurements, except for the abdomen transverse diameter (beta standardized coefficient = 0.267, P < 0.05).  The results of our study coincided with previous studies in the normal range of spleen volume and the strong correlation with length, regardless of the irregular shape of the spleen. In addition, manual segmentation was a reliable method to measure spleen volume objectively. However, our single-slice measurements were insufficient.

A clinical and molecular epidemiological survey of hepatitis C in Blantyre, Malawi, suggests a historic mechanism of transmission

Hepatitis C virus (HCV) is a leading cause of liver disease worldwide. There are no previous representative community HCV prevalence studies from Southern Africa, and limited genotypic data. Epidemiological data are required to inform an effective public health response. We conducted a household census-based random sampling serological survey, and a prospective hospital-based study of patients with cirrhosis and hepatocellular carcinoma (HCC) in Blantyre, Malawi. We tested participants with an HCV antigen/antibody ELISA (Monolisa, Bio-Rad), confirmed with PCR (GeneXpert, Cepheid) and used line immunoassay (Inno-LIA, Fujiribio) for RNA-negative participants. We did target-enrichment whole-genome HCV sequencing (NextSeq, Illumina). Among 96,386 censused individuals, we randomly selected 1661 people aged ≥16 years. Population-standardized HCV RNA prevalence was 0.2% (95% CI 0.1-0.5). Among 236 patients with cirrhosis and HCC, HCV RNA prevalence was 1.9% and 5.0%, respectively. Mapping showed that HCV RNA+ patients were from peri-urban areas surrounding Blantyre. Community and hospital HCV RNA+ participants were older than comparator HCV RNA-negative populations (median 53 vs 30 years for community, p = 0.01 and 68 vs 40 years for cirrhosis/HCC, p < 0.001). Endemic HCV genotypes (n = 10) were 4v (50%), 4r (30%) and 4w (10%). In this first census-based community serological study in Southern Africa, HCV was uncommon in the general population, was centred on peri-urban regions and was attributable for <5% of liver disease. HCV infection was observed only among older people, suggesting a historic mechanism of transmission. Genotype 4r, which has been associated with treatment failure with ledipasvir and daclatasvir, is endemic.

Morphometric assessment of spleen dimensions and its determinants among individuals living in Arba Minch town, southern Ethiopia

Introduction

The spleen is a vital lymphoid soft organ that demands constant attention from the clinical point of view. It is a multi-dimensional organ that enlarges in its all dimensions during some disease condition. The detection of the spleen by palpation is not an indicator of an enlarged spleen because normal spleen may be palpable. Therefore, this study aimed to assess the morphometry of spleen dimensions and its determinants among individuals living in Arba Minch town by sonographic examinations.

Methods and materials

Community-based cross-sectional study was conducted in Arba Minch town from February 1 to March 30, 2020. Seven hundred and eight study participants were selected using a multi-stage systematic random sampling technique. Data were checked for completeness, edited, coded and entered into Epi-Data version 3.1 and exported to STATA software version 16 for analysis.

Result

The mean splenic length, width, thickness and volume were 10.24 cm, 4.79 cm, 3.93 cm, and 109.34 cm³, respectively. The mean spleen length, width, thickness and volumes among males were 10.64 cm, 4.92 cm, 4.05 cm and 119.81 cm³ and among females were 9.75 cm, 4.63 cm, 3.78 cm and 96.50 cm³ respectively. As age increased by one year the mean spleen length, width, thickness and volume was decreased by 0.032 cm, 0.018 cm 0.004 cm and 0.012 cm respectively. As height increased by 1 cm the mean spleen width and volume were increased by 0.096 cm and 0.052 cm respectively. As we go from male to female the mean spleen length decreased by 0.294 cm.

Conclusion

The spleen dimensions were higher in males than females. Splenic length was determined by age & sex, the spleen width was determined by age & height, the spleen volume was determined by age & height and the spleen thickness was determined by age.

Classification of the colonic splenic flexure based on three-dimensional CT analysis

Background

Mobilization of the splenic flexure can be a challenging surgical step in colorectal surgery. This study aimed to classify the splenic flexure based on the three-dimensional (3D) coordinates of the splenic hilum and left renal hilum. This classification was used to compare splenic flexure mobilization during colorectal resection.

Methods

CT images of patients with colorectal cancer treated between April 2018 and December 2019 were analysed retrospectively. 3D mutual positioning of the splenic flexure from the ligament of Treitz to the splenic hilum or the left renal hilum was used to classify patients into three groups using cluster analysis. The difference in the procedure time between groups was also analysed in a subset of patients undergoing laparoscopic colectomy with complete splenic flexure mobilization.

Results

Of 515 patients reviewed, 319 with colorectal cancers were included in the study and categorized based on the 3D coordinates of the splenic hilum and left renal hilum as caudal (100 patients), cranial (118) and lateral (101) positions. Male sex (P < 0.001), older age (P = 0.004) and increased bodyweight (P = 0.043) were independent characteristics of the lateral group in multiple logistic regression analysis. Thirty-four patients underwent complete splenic flexure mobilization during the study period; this took significantly longer (mean 78.7 min) in the lateral group than in the caudal and cranial groups (41.8 and 43.2 min respectively; P = 0.006).

Conclusion

Locating the splenic flexure using 3D coordinates could be helpful in predicting a longer duration for mobilization of the splenic flexure.

Determination of splenomegaly by coronal oblique length on CT

PURPOSE

The aims of this study were (a) to determine whether a coronal oblique length (COL) > 12 cm, which is often used to detect splenomegaly (SM) on ultrasound, can be used as a marker of SM on computed tomography (CT), (b) to compare the diagnostic accuracy of COL with other unidimensional linear measurements (ULM) in identifying SM, (c) to determine which ULM most closely correlates with splenic volume (SVol) according to the splenic index on CT, (d) to assess the relationship between SVol and patient's gender, age and body parameters (height, weight), and (e) to determine whether there is a difference between non-contrast-enhanced and contrast-enhanced CT images in identifying SM.

MATERIALS AND METHODS

The body parameters and ULM (width, length, thickness, COL) were obtained from patients who underwent CT for various indications from April 2016 to April 2017. SVol and body mass indexes were calculated for each patient.

RESULTS

Of the 1078 patients [male/female = 526/552; 47.57 (mean) ± 19.21 (standard deviation) years], 392 patients had SM. The sensitivity, specificity, positive and negative predictive values of COL > 12 cm for diagnosing SM were 44.6, 95.6, 85.3 and 75.1%, respectively (p < 0.001). SVol correlated with all ULM (p < 0.001). In the non-SM group (n = 686), the mean SVol was 331.7 ± 92.2 cm³ and females had smaller spleens than males (p < 0.001). SVol showed correlation with gender, age and height (p < 0.001).

CONCLUSION

COL > 12 cm is not superior to other ULM for the detection of SM, but it is very successful in determining normal spleens. The unidimensional measurements and volume of the spleen should be calculated by taking gender and body parameters into account for different ethnic populations. Non-contrast-enhanced CT can also be used to detect SM.

Does coronal oblique length of spleen on CT reflect splenic index?

AIMS AND OBJECTIVES

Splenic dimension of >12 cm on coronal plane on ultrasound is considered to represent splenomegaly. We sought to estimate the accuracy of similar coronal oblique length of spleen on CT in identifying splenomegaly by comparing it with CT splenic index. We also sought to establish the splenic width, craniocaudal dimension (CC), thickness, and coronal oblique length in both normal and splenomegaly groups.

MATERIALS AND METHODS

319 consecutive patients undergoing CT abdomen were included in the study and measurements of width (W), CC, thickness (T), and coronal oblique length (L) made. Splenic index was calculated based on the formula CC × W × T. Diagnostic accuracy of coronal oblique length in identifying splenomegaly on the basis of splenic index was assessed. Patients with splenic trauma were excluded. Patients with perisplenic collection that precluded proper measurement of spleen were excluded.

RESULTS

Of the 319 patients, 41 patients had splenomegaly with splenic index >480. 278 patients showed normal splenic index less than or equal to 480. Sensitivity and specificity of coronal oblique length as ≥12 cm in identifying splenomegaly were 97.8% and 34.1%, respectively. Positive and negative predictive values for the same were 91% and 70%, respectively (p value-0.000). There is overlap of numerical values for thickness and coronal oblique length in the normal and splenomegaly groups for a 95% confidence interval, whereas there is no significant overlap between these groups with respect to the craniocaudal length and width. Hence, craniocaudal length of 9.5 cm and width of 10.6 cm may be used as upper cutoff limit for normal spleen.

CONCLUSION

Coronal oblique dimension of spleen >12 cm is highly sensitive and shows good positive predictive value in diagnosing splenomegaly but has poor specificity and negative predictive value. Ideally, splenic index calculated using the CC, width, and thickness is the most reliable measurement for diagnosing splenomegaly. But if single measurements are to be used for identifying splenomegaly, craniocaudal length >9.5 cm, width of >10.6 cm, and coronal oblique dimension >12 cm may be used.

Spleen Size Is Significantly Influenced by Body Height and Sex: Establishment of Normal Values for Spleen Size at US with a Cohort of 1200 Healthy Individuals

PURPOSE

To define height- and sex-corrected normal values for spleen length and volume determined with ultrasonography (US).

MATERIALS AND METHODS

The authors performed a retrospective data review of stem cell donors who had provided written informed consent for stem cell donation and use of anonymized data and biologic materials for scientific and quality control purposes. Spleen length, spleen volume, and anthrophometric data were correlated in 1230 healthy volunteers to identify variables that affect spleen size. Multiple linear regression analysis was performed to weight effects of various variables on spleen size. Linear regression through the 95th percentile for men and women of different height cohorts generated the formula for the upper limit of normal for spleen length and volume. For validation, the upper limit of normal was calculated for each volunteer and compared with the observed value. Formulae to calculate the additional percentiles were similarly generated and validated. A cohort of 75 volunteers was analyzed twice to assess the stability of spleen length and volume over time.

RESULTS

Spleen length and volume were significantly and independently associated with sex (length: P < .001; volume: P = .012), body height (P < .001 for both), and weight (P < .001 for both), with men and taller and heavier individuals having longer and larger spleens. The spleen length of 20 of 324 women (6%) and 234 of 906 men (26%) exceeded the previously reported upper limit of normal of 12 cm. Repeat measurements indicated that spleen length (median difference, 0.10 cm; range, -1.8 to 1.7 cm) and volume (median difference, 3 cm(3); range, -106 to 142 cm(3)) were quite stable. A mobile application that performs these calculations is available for download.

CONCLUSION

The authors define height- and sex-corrected normal values for spleen length and volume for women with a body height of 155-179 cm and men with a body height of 165-199 cm and propose validated algorithms to gauge the percentile of an individual's spleen size.

Determination of normal dimension of the spleen by ultrasound in an endemic tropical environment

Background:

To determine the normal dimensions of spleen by ultrasonography in our environment exposed to endemic tropical infection and infestation.

Materials and Methods:

A prospective study of normal spleen ultrasound-based measurements in 200 Nigerian adults at the University of Benin Teaching Hospital Benin, Nigeria.

Results:

There were 91 males and 109 females; their age ranged between 20 and 60 years. For the males the mean age was 32.4 years (± 9.2 SD), mean height was 175.0 cm (±7.3 SD), mean weight was 72.5 kg (±10.1 SD), and mean body mass index was 23.6 (±2.8 SD) and the females the mean age was 29.7 years (±9.0 SD) mean height was 164.6 cm (±5.8 SD), mean weight 64.1 kg (±12.9 SD), and mean BMI was 24.9 (±1.4 SD). For the males the mean splenic length, width, depth, and volume were 11.1 cm (±0.9 SD), 4.4 cm (±0.5 SD), 7.8 cm (±0.6 SD), and 202.7 cm³ (±49.4 SD), respectively. For the females the corresponding values of splenic length, width, depth, and volume were 10.1 cm (±0.7 SD), 4.0 cm (±0.4 SD), 7.1 cm (±0.5 SD), and 153.7 cm³ (±33.2 SD), respectively.

Conclusion:

Comparison between mean splenic dimension parameters for males and females (from unpaired t-test determination) showed a statistically significant difference (P<0.001 for splenic length, width, depth, and volume). There was also statistically significant increasing value correlation between subjects’ weight and height (in favor of height) when compared to spleen length, width, depth, and volume. The other parameters show no significant correlation in both female and male. In particular there was also no statistically significant correlation of splenic measurements with age in either sex. This is similar to what was noted in other centers.