Document Type : Research articles

Authors

1 Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China

2 Department of Nursing, Huashan Hospital, Fudan University, Shanghai, China. Department of Digestive Diseases, Huashan Hospital, Fudan University, Shanghai, China

3 Department of Digestive Diseases, Huashan Hospital, Fudan University, Shanghai, China

4 Department of Nursing, Huashan Hospital, Fudan University, Shanghai, China

5 Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China. Department of Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China

6 Department of Endoscopy Center, Zhongshan Hospital, Wusong Branch of Zhongshan Hospital, Fudan University, Shanghai, China.

Abstract

Background: Splenomegaly and hypersplenism are common presentations of portal hypertension and can result in severe comorbidities. The degree of splenomegaly is associated with disease severity and has been established as a reliable noninvasive indicator for disease surveillance.
Objectives: This study aimed to propose a simple and repeatable splenic measurement model to estimate the splenic volume in patients with portal hypertension.
Methods: In total, 161 patients with portal hypertension were admitted to our hospital from March 2017 to August 2020, with a final enrollment of 106 subjects. The splenic volume calculated via IQQA-Liver software was used for reference. Radiological data were retrospectively reviewed to measure the height, length, and width of the spleen. Different volume prediction models were constructed based on statistically significant laboratory and radiological parameters.
Results: The average spleen volume measured by the IQQA-Liver software was 852.29±362.26cm3. Model 0 was constructed based on hematological and radiological parameters, while Models 1 and 2 were based on radiological parameters alone. Model 1 was superior to the others according to the Bland-Altman scatterplot and correlation analysis.
Conclusion: The proposed estimation model is a reliable predictor for splenic volume, providing valuable information in patients with portal hypertension. The simple technique allows for widespread clinical application.

Keywords

  1. References:
  2. Adinolfi L, Giordano MG, Andreana A, Tripodi MF, Utili R. Hepatic fibrosis plays a central role in the pathogenesis of thrombocytopenia in patients with chronic viral hepatitis. Brit J Haematol. 2001;113(3): 590-595.
  3. Bolognesi M, Merkel C, Sacerdoti D, Nava V, Gatta A. Role of spleen enlargement in cirrhosis with portal hypertension. Dig Liver Dis. 2002;34(2):144-50.
  4. McCormick PA, Murphy KM. Splenomegaly, hypersplenism and coagulation abnormalities in liver disease. Best Pract Res Cl Ga. 2000;14(6):1009-31.
  5. Shah SH, Hayes PC, Allan PL, Nicoll J, Finlayson ND. Measurement of spleen size and its relation to hypersplenism and portal hemodynamics in portal hypertension due to hepatic cirrhosis. Am J Gastroenterol. 1996;91(12):2580-3.
  6. Manenti A, Botticelli A, Gibertini G, Botticelli L. Experimental congestive splenomegaly: histological observations in the rat. Pathologica. 1993;85(1100):721-4.
  7. Yan SP, Wu H, Wang GC, Chen Y, Zhang CQ, Zhu Q. A new model combining the liver/spleen volume ratio and classification of varices predicts HVPG in hepatitis B patients with cirrhosis. Eur J Gastroenterol Hepatol. 2015;27(3):335-43.
  8. de Franchis R. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63(3):743-52.
  9. Garcia-Tsao G. Current Management of the Complications of Cirrhosis and Portal Hypertension: Variceal Hemorrhage, Ascites, and Spontaneous Bacterial Peritonitis. Dig Dis. 2016;34(4):382-6.
  10. Giannini E, Botta F, Borro P, Risso D, Romagnoli P, Fasoli A, et al. Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut. 2003;52(8):1200-5.
  11. Chen XL, Chen TW, Zhang XM, Li ZL, Zeng NL, Zhou P, et al. Platelet count combined with right liver volume and spleen volume measured by magnetic resonance imaging for identifying cirrhosis and esophageal varices. World J Gastroenterol. 2015;21(35):10184-91.
  12. Kihira S, Kagen AC, Vasudevan P, Jajamovich GH, Schiano TD, Andrle AF, et al. Non-invasive prediction of portal pressures using CT and MRI in chronic liver disease. Abdom Radiol (NY). 2016;41(1):42-9.
  13. Zhang QW, Wang Y, Wang J, Zhao HB, Yu H, Liu SY, et al. A non-invasive magnetic resonance imaging-based model predicts portal venous pressure. J Dig Dis. 2016;17(3):175-85.
  14. Yetter EM, Acosta KB, Olson MC, Blundell K. Estimating splenic volume: sonographic measurements correlated with helical CT determination. AJR Am J Roentgenol. 2003;181(6):1615-20.
  15. Yan S, Wu H, Wang G, Chen Y, Zhang C, Zhu Q. A new model combining the liver/spleen volume ratio and classification of varices predicts HVPG in hepatitis B patients with cirrhosis. Eur J Gastroen Hepat. 2015;27(3):335-43.
  16. Pattanayak P, Turkbey EB, Summers RM. Comparative Evaluation of Three Software Packages for Liver and Spleen Segmentation and Volumetry. Acad Radiol. 2017;24(7):831-839.
  17. Prassopoulos P, Daskalogiannaki M, Raissaki M, Hatjidakis A, Gourtsoyiannis N. Determination of normal splenic volume on computed tomography in relation to age, gender and body habitus. Eur Radiol. 1997;7(2):246-8.
  18. Perello A, Escorsell A, Bru C, Gilabert R, Moitinho E, Garcia-Pagan JC, et al. Wedged hepatic venous pressure adequately reflects portal pressure in hepatitis C virus-related cirrhosis. Hepatology. 1999;30(6):1393-7.
  19. Iwao T, Toyonaga A, Ikegami M, Sumino M, Oho K, Sakaki M, et al. Wedged hepatic venous pressure reflects portal venous pressure during vasoactive drug administration in nonalcoholic cirrhosis. Dig Dis Sci. 1994;01;39(11):2439-44.
  20. Bosch J, Abraldes JG, Berzigotti A, Garcia-Pagan JC. The clinical use of HVPG measurements in chronic liver disease. Nat Rev Gastroenterol Hepatol. 2009;6(10):573-82.
  21. Hayashi H, Beppu T, Okabe H, Nitta H, Imai K, Doi K, et al. Combined measurements of serum bile acid level and splenic volume may be useful to noninvasively assess portal venous pressure. J Gastroenterol. 2012;47(12):1336-41.
  22. Murata Y, Abe M, Hiasa Y, Azemoto N, Kumagi T, Furukawa S, et al. Liver/spleen volume ratio as a predictor of prognosis in primary biliary cirrhosis. J Gastroenterol. 2008;43(8):632-6.
  23. Maleux G, Willems E, Fieuws S, Heye S, Vaninbroukx J, Laleman W, et al. Prospective study comparing different indirect methods to measure portal pressure. J Vasc Interv Radiol. 2011;22(11):1553-8.