Sonographic biometry of spleen among school age children in Nsukka, Southeast, Nigeria

Discrepancies in Splenic Size Measurement: A Comparative Analysis of Ultrasound and Computed Tomography

The accurate measurement of splenic size is essential for the diagnosis and management of various gastrointestinal and hematological conditions. While ultrasound (US) and computed tomography (CT) are widely used imaging modalities for assessing splenic size, discrepancies between their measurements have been observed in clinical practice. This study aimed to analyze the measurement differences between US and CT and identify factors influencing these differences. A retrospective analysis of 598 asymptomatic patients who underwent both abdominal US and CT was conducted. Measurements of splenic size obtained from US, axial CT, and coronal CT scans were compared, and various factors such as patient demographics, operator experience, and imaging parameters were evaluated to elucidate their impact on the measurement discrepancies. The results revealed that US consistently underestimated splenic size compared to CT. The magnitude of the discrepancy was influenced by factors such as patient age, body mass index (BMI), depth of the spleen from skin on US and that on CT, visibility of the splenic hilum on US, sonic window quality, and operator experience. This study underscores the importance of considering these factors when interpreting splenic measurements obtained from different imaging modalities in clinical practice.

Methods of Ultrasound Spleen Morphometry

This article presents a review of the methods of determining spleen size in sonography, computed tomography, and magnetic resonance imaging. The review aims to summarize the data on the methods of estimating the linear dimensions of the spleen and splenic volume and describe the physiological variability of spleen size depending on sex, age, and different physiological conditions. We systematized the methods used for measuring the spleen and presented them in the form of a table, analyzed the results of previous studies, and compared the accuracy of different methods of calculating the splenic volume using a variety of diagnostic methods.

Stroke Prevention with Hydroxyurea Enabled through Research and Education: A Phase 2 Primary Stroke Prevention Trial in Sub-Saharan Africa

INTRODUCTION

Stroke is a severe complication of sickle cell anemia (SCA), with devastating sequelae. Transcranial Doppler (TCD) ultrasonography predicts stroke risk, but implementing TCD screening with suitable treatment for primary stroke prevention in low-resource environments remains challenging. SPHERE (NCT03948867) is a prospective phase 2 open-label hydroxyurea trial for SCA in Tanzania.

METHODS

After formal training and certification, local personnel screened children 2-16 years old; those with conditional (170-199 cm/s) or abnormal (≥200 cm/s) time-averaged mean velocities (TAMVs) received hydroxyurea at 20 mg/kg/day with dose escalation to maximum tolerated dose (MTD). The primary study endpoint is change in TAMV after 12 months of hydroxyurea; secondary endpoints include SCA-related clinical events, splenic volume and function, renal function, infections, hydroxyurea pharmacokinetics, and genetic modifiers.

RESULTS

Between April 2019 and April 2020, 202 children (average 6.8 ± 3.5 years, 53% female) enrolled and underwent TCD screening; 196 were deemed eligible by DNA testing. Most had numerous previous hospitalizations and transfusions, with low baseline hemoglobin (7.7 ± 1.1 g/dL) and %HbF (9.3 ± 5.4%). Palpable splenomegaly was present at enrollment in 49 (25%); average sonographic splenic volume was 103 mL (range 8-1,045 mL). TCD screening identified 22% conditional and 2% abnormal velocities, with hydroxyurea treatment initiated in 96% (45/47) eligible children.

CONCLUSION

SPHERE has built local capacity with high-quality research infrastructure and TCD screening for SCA in Tanzania. Fully enrolled participants have a high prevalence of elevated baseline TCD velocities and splenomegaly. SPHERE will prospectively determine the benefits of hydroxyurea at MTD for primary stroke prevention, anticipating expanded access to hydroxyurea treatment across Tanzania.

Relationship between ultrasound-measured spleen, liver and anthropometry of children living in a rural community in southwest Nigeria: a cross-sectional study

BACKGROUND

Ultrasonography is noninvasive, relatively inexpensive and useful for resource-poor settings. US spleen and liver sizes have been observed to differ among populations, so there is a need for reference values for different geographic populations.

OBJECTIVE

To describe the sizes of the spleen and liver of children living in a rural community in southwest Nigeria and assess the relationship between these measurements and the children's anthropometry.

MATERIALS AND METHODS

We conducted a community-based cross-sectional study among 358 apparently healthy children ages 1-14 years. We obtained the participants' weights, heights, body mass index and body surface area. They underwent US imaging to obtain longitudinal measurements of their spleen and liver. We used independent t-test to compare means, and linear regression analysis to assess relationships between continuous data. The significance level was set as P < 0.05.

RESULTS

There were more girls (181; 50.6%). Most children were ages 1-5 years (172; 48.0%). The body surface area had significantly strong positive relationships with US spleen size (r = 0.769; R² = 0.592; P < 0.0001) and US liver size (r = 0.819; R² = 0.671; P < 0.0001) but body mass index had weak positive relationships.

CONCLUSION

This study contributes to data on US spleen and liver sizes of Nigerian children. The findings buttress observations that body surface area strongly correlates with US spleen and liver measurements. It is recommended that more studies be conducted among Nigerian children to generate a robust pool of data that are useful for creating homogeneous formulae to ease interpretation of US measurements of these intraabdominal organs.

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.

Sonographic evaluation of spleen size in apparently healthy children in north-west Ethiopia, 2020: time to define splenomegaly

Background

Assessment of spleen size is an important part of the clinical skills of medical students and physicians. Many diseases can affect the size of the aforementioned organ, ranging from infective processes to malignant disorders. However, to detect changes, prior knowledge of the actual normal size of these viscera is required in the population being studied. Establishing a customized chart and curve for a specific population of the same sociodemographic characteristics enables a better interpretation of sonographic assessments.

Methods

A hospital-based cross-sectional study design was conducted among 403 children in primary and referral hospitals of the east and west Gojjam zone. Data were collected using a structured questionnaire, physical examination, and ultrasound. The collected data were entered into Epi Data version 3.1 and exports to SPSS version 24 for analysis. Descriptive data were analyzed using descriptive statistics. A Pearson product-moment correlation was run to determine the relationship between age, anthropometric measurements of children, and ultrasound measurements of the spleen. Reference intervals were established using non-parametric reference limits (2.5th -97.5th ) and (5th – 97th ) percentiles by MedCalc software version 20.0.3.

Results

Four hundred three children aged from 7 to 15 years were included in this study. The mean sonographic longitudinal (length), anteroposterior(depth) and transverse (width) dimension of the spleen was, (8.24 ± 1.26 cm), (3.98 ± 0.57 cm), and (4.26 ± 0.59 cm) respectively. The mean volume of the spleen was 75.04 ± 23.92 cm³. The height and body surface area of children were best correlated with sonographic dimensions of the spleen. Reference intervals were established using height, age, and body surface area specific for clinically practical dimensions of the spleen.

Conclusions

According to this study, the children are considered as having enlarged longitudinal dimension of the spleen(splenomegaly) if he or she has a size above 97.5th percentile based on their respective height.

Sonographic evaluation of the portal vein diameter in patients with chronic liver disease in northeastern Nigeria

INTRODUCTION

Chronic liver disease is a public health burden worldwide. Portal hypertension is a major portosystemic abnormality in chronic liver disease. This study aimed to determine the main, right, and the left portal vein diameter in patients with chronic liver disease.

MATERIALS AND METHODS

A cross-sectional study was carried out at the Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, northeastern Nigeria from December 2018 to September 2019. Ethical clearance was obtained from the institutional review board. A total of 200 subjects were recruited comprising 100 patients with chronic liver disease and 100 age-matched controls, aged 18 years and above. A transabdominal ultrasound scan was carried out measuring the main, right, and left portal vein diameter while lying supine and/or in the right anterior oblique position after overnight fasting, or 6 hours before the scan. Data analysis was done using SPSS version 22.0. Descriptive statistics (mean, standard deviation) and Pearson's correlation were used.

RESULTS

There were 106(53%) males and 94(47%) females, aged between 18 and 73 years with a mean age of 46.79 ± 15.43. The main, right, and left portal vein diameter in patients with chronic liver disease was 14.51 ± 0.78 mm, 6.83 ± 0.81 mm, and 6.26 ± 0.74 mm, which were higher than those of their control. The portal vein diameter positively correlated (weak) with age and respiratory phases among participants (P < 0.05).

CONCLUSION

This study found the main, right, and left portal vein diameter among patients with chronic liver disease to be larger than those of the controls. Ultrasonography is a reliable diagnostic tool in evaluating portosystemic pathologies.

Splenomegaly in Children and Adolescents

In contrast to other lymphoid tissues making up the immune system, the spleen as its biggest organ is directly linked into the blood circulation. Beside its main task to filter out microorganism, proteins, and overaged or pathologically altered blood cells, also humoral and cellular immune responses are initiated in this organ. The spleen is not palpable during a physical examination in most but not all healthy patients. A correct diagnosis of splenomegaly in children and adolescents must take into account age-dependent size reference values. Ultrasound examination is nowadays used to measure the spleen size and to judge on reasons for morphological alterations in associated with an increase in organ size. An enormous amount of possible causes has to be put in consideration if splenomegaly is diagnosed. Among these are infectious agents, hematologic disorders, infiltrative diseases, hyperplasia of the white pulp, congestion, and changes in the composition and structure of the white pulp by immunologically mediated diseases. This review attempts to discuss a comprehensive list of differential diagnoses to be considered clinically in children and young adolescents.

Spleen size evaluation in children: Time to define splenomegaly for pediatric surgeons and pediatricians

Background

We determined the range of normal spleen dimensions evaluated by ultrasonography (US) in children according to sex and age and the relationship between splenic measurements, auxological data and body proportions, in order to define splenomegaly parameters in support of the surgical mini-invasive approaches in pediatrics.

Methods

We prospectively examined 317 caucasian children of both sexes. The patients were divided into three groups: 0–3 years; 4–10 years; 11–18 years. Sex, weight, height/length, body mass index (BMI), waist circumference and xipho-pubic distance were determined for each child. US spleen evaluation included longitudinal/antero-posterior/transverse diameters, transverse area and volume. Spleen volume/abdominal volume, longitudinal spleen diameter/longitudinal left kidney diameter and longitudinal spleen diameter/xipho-pubic distance ratios were also calculated.

Results

For caucasian subjects, in different age groups spleen volume, transverse area and diameter increased while the spleen/abdominal volume ratio decreased significantly (p<0.001). A significant (p<0.001) decrease in longitudinal spleen diameter/xipho-pubic distance ratio was noted between the 0–3 years group and both 4–10 and 11–18 years group. Age and auxological data, except BMI, showed a high correlation with spleen dimension (r≥0.8).

Conclusions

The current concept of splenomegaly is not applicable in pediatric surgery. A dedicated classification of splenomegaly is needed for children and would improve the safety and feasibility of treatment.

Sonographic evaluation of the spleen among sickle cell disease patients in a teaching hospital in Nigeria

BACKGROUND

Regional variations in size and parenchyma echo-texture of the spleen among sickle cell disease (SCD) patients have been documented in various publications. The objectives of this study were to assess the size and parenchyma echo-texture of the spleen of SCD patients and ascertain the relationship of age, height and weight with the spleen sizes.

METHODS

This was a cross sectional study involving 103 each of SCD and age matched control subjects. Aloka ST- 550 -3500 ultrasound machine with 3.5 and 5 MHz convex transducers was used to scan the subjects over a 15 months period (September, 2012 to November, 2013). The age, height and weight of each subject were recorded.

RESULTS

The spleen sizes of SCD patients were generally larger than those of the controls (p < 0.05). Abnormal spleen parenchyma of varied appearances was found among the SCD subjects. There were negative correlations between mean spleen sizes and height, weight and age in SCD patients but positive correlations were found between them in the controls.

CONCLUSION

Routine sonographic assessment of spleen size and echo-texture is useful in the management of SCD patients.