Splenic Volume Research Articles

Splenorenal shunt for reconstruction of the gastric and splenic venous drainage during pancreatoduodenectomy with resection of the portal venous confluence

BackgroundResection of the portal venous confluence is frequently necessary for radical resection during pancreatoduodenectomy for cancer. However, ligation of the splenic vein can cause serious postoperative complications such as gastric/splenic venous congestion and left-sided portal hypertension. A splenorenal shunt (SRS) can maintain gastric and splenic venous drainage and mitigate these complications.PurposeThis study describes the surgical technique, postoperative course, and surgical outcomes of SRS after pancreatoduodenectomy.MethodsTen patients who underwent pancreatoduodenectomy and SRS between September 2017 and April 2019 were evaluated. After resection an end-to-side anastomosis between the splenic vein and the left renal vein was performed. Postoperative shunt patency, splenic volume, and any SRS-related complications were recorded.ResultsThe rates of short- and long-term shunt patency were 100% and 60%, respectively. No procedure-associated complications were observed. No signs of left-sided portal hypertension, such as gastrointestinal bleeding or splenomegaly, and no gastric/splenic ischemia were observed in patients after SRS.ConclusionSRS is a safe and effective measure to mitigate gastric congestion and left-sided portal hypertension after pancreatoduodenectomy with compromised gastric venous drainage after resection of the portal venous confluence.

Importance of extracellular volume fraction of the spleen as a predictive biomarker for high-risk esophago-gastric varices in patients with chronic liver diseases: A preliminary report

PurposeTo clarify clinico-radiological factors for high-risk esophago-gastric varices (EGV), including extracellular volume fraction (ECV) of the liver, pancreas, and the spleen. MethodsBetween 2014 and 2018, 70 chronic liver disease patients who underwent 4-phase CT of the upper abdomen and either of upper gastrointestinal tract endoscopy, or actual treatment for bleeding EGV, within three months after CT, were retrospectively included. Patients were subdivided into high-risk EGV group (HRG), who had high-risk endoscopic findings or actual hemostatic treatments, and non-high-risk EGV group (NHRG). ECV of the liver, pancreas, and the spleen was measured on the ECV map generated from routine diagnostic CT data, and additional clinico-radiological factors including direct visualization of EGV on portal venous phase CT, were correlated to HRG, using both univariable and multivariable analyses. ResultsThere were 8 and 62 patients in HRG, and NHRG, respectively. None had symptoms related to EGV at the time of CT examinations. Univariable analysis revealed splenic volume, liver and splenic ECVs, and EGV visualization on portal venous phase CT, as significant factors. Multivariable analysis suggested that EGV visualization, splenic ECV, and splenic volume were independently significant factors. Using these three factors, sensitivity/specificity/positive predictive value/negative predictive value/accuracy = 100/85/40/100/87% were obtained with partition model analysis. ConclusionsHigh-risk EGV can be predicted with acceptable accuracy using routine diagnostic CT data including splenic ECV.

English

BACKGROUND Exposure of various tropical infections and infestations like tuberculosis, filariasis, malaria, anemia, kala-azar and poor sanitation are major health concerns in Bihar and it’s neighboring state. Spleen size increases in several other diseases e.g., metabolism or storage disorder, malignancies and hematological disorders. Determining the normal parameters of spleen is essential for assessment of splenomegaly in routine ultrasonography (USG) or in the computed tomography (CT) scan. In this study, we wanted to estimate the CT based measurement of splenic dimensions in various planes, splenic index (linear dimension) and splenic volume and also to estimate the relationship of splenic index and splenic volume with age, gender and other splenic dimensions. METHODS It was a retrospective study and data was collected from January 2019 to December 2019. A total of 154 cases (including both genders) of age range 18 - 60 years were collected from the vitrea system (Vitrea software used for the 3-D assessment of splenic volume) and clinical data was collected from the medical record section. CT scan data of only those patients were included who had the clinical history of pain in abdomen, abdominal trauma or other diseases not affecting the spleen. Various measurements including splenic length and thickness at hilum and maximum thickness in axial view and height (maximum interpolar and true vertical height) in coronal views were recorded. RESULTS 154 cases including both gender and age range of 18 - 60 years were included in our study. There were 60 males and 94 females. The average age of the male and female patients was 45.93 +/- 15.19 years and 45.87 +/- 15.12 years respectively. The mean splenic dimensions were 9.03 +/- 1.49 cm in length (axial view), 3.69 +/- 0.05 cm thickness at hilum (axial view) and 9.05 +/- 2.23 cm maximum craniocaudal length and 7.9 +/- 2.96 cm true vertical length (coronal view). Mean splenic index and mean splenic volume were 340.30 +/- 107.39 cm3 and 227.02 +/- 62.22 cm3 respectively. There was statistically significant correlation between splenic volume and maximum craniocaudal length (r2 = 0.4848, P = 0.001), maximum axial length (r2 = 0.4765, P < 0.001) and true vertical length (r2 = 0.3142, P = 0.001) with 95 % confidence interval. For all splenic measurements, there was stronger correlation with maximum craniocaudal length followed by maximum axial length. However, there was no statistically significant correlation either of splenic volume with age in either gender (r2 = 0.019, P = 0.043) or splenic index with age in either gender present (r2 = 0.016, P = 0.059). CONCLUSIONS Maximum splenic length both in coronal (craniocaudal) and axial sections are positively and strongly correlated with splenic volume and splenic index but age of the individuals doesn’t show any correlation either with the splenic volume or with splenic index. Hence, a regional reference of splenic parameters was established with a slightly different range of values reported previously. KEY WORDS Splenic Volume, Splenic Index, Computed Tomography

Spleen Size and Thrombocytopenia After Transcatheter Aortic Valve Implantation

The pathophysiology of thrombocytopenia after transcatheter aortic valve implantation (TAVI) thrombocytopenia is still poorly understood. We assessed the association of spleen size with acquired thrombocytopenia in patients undergoing TAVI. We included 732 patients who underwent TAVI with new generation transcatheter heart valves (THVs) at our center from February 2016 to July 2019. We measured splenic volume index in consecutive patients derived from multidetector row computed tomographic datasets. Patients were stratified according to post-TAVI thrombocytopenia, which was defined as a decline in platelet count (DPC) ≥50% at nadir, and evaluated regarding baseline characteristics and outcome parameters. After the procedure, platelet counts declined from 212.9 ± 67.4×109/L at baseline to 138.8 ± 49.8×109/L at nadir after a median of 2 days (interquartile range [IQR] 2 to 3). Of all patients, 10.1% showed a DPC ≥50%. Compared with patients with DPC <50%, patients with DPC ≥50% had significantly lower splenic volume index (95.5 ml/m2 [IQR 78.0 to 123.7] vs 85.8 ml/m2 [IQR 71.4 to 102.6], p=0.008). A multivariable analysis revealed that the splenic volume index was negatively associated with a DPC ≥50% (OR 0.89, 95% CI 0.82 to 0.97, p=0.005), independent of the type of THV (balloon-expandable THV: OR 2.06, 95% CI 1.13 to 3.76, p=0.02), major bleeding (OR 13.40, 95% CI 3.58 to 50.40, p <0.001), blood transfusion (OR 3.63, 95% CI 1.54 to 8.56, p=0.003), or postprocedural paravalvular leakage ≥moderate (OR 5.48, 95% CI 1.23 to 24.40, p=0.03). Furthermore, DPC ≥50% was independently associated with 1-year mortality (HR 3.36, 95% CI 1.66 to 6.81, p <0.001). In conclusion, acquired thrombocytopenia remains prevalent in modern TAVI patients. Spleen size appears to be associated with the occurrence of thrombocytopenia after TAVI, which is independently correlated with 1-year mortality.

P–319 Measuring intraobserver and intermethod reliability of endometriotic cyst volumes: a comparison between MRI and 3D transvaginal ultrasound

Abstract Study question Are three-dimensional imaging techniques, MRI and three-dimensional transvaginal ultrasound reliable for the volume measurement of endometriotic cysts? Summary answer MRI and XI VOCAL 3D-transvaginal ultrasound both provide a very good intraobserver reliability. The imaging techniques are however not advised to be used interchangeably. What is known already Two-dimensional transvaginal ultrasound (2D-TVUS) and MRI are commonly used in endometriosis care. However, three-dimensional ultrasound (3D-US) has gained more attention in recent years. The use of 3D-US, more specifically VOCAL and XI VOCAL software has proven to be a reliable tool in the measurement of volumes such as splenic volumes and uterine niche volumes. Up to date, 3D-TVUS has not been evaluated for volume measurements in endometrioma. Study design, size, duration A prospective case-control study was performed in an academic endometriosis centre. In total, 23 endometriosis cysts from 16 patients were included. Participants/materials, setting, methods Women diagnosed with endometriosis through laparoscopy with histological confirmation presenting with uni- or bilateral endometrioma on TVUS were included in this study. All women had a regular menstrual cycle (28 days ± 3 days). Women were seen for examinations at two time points during one menstrual cycle: on cycle day 2–4 (T0) and cycle day 20–22 (T1). At both time points a 2D and 3D TVUS and an MRI at 1,5T were performed. Main results and the role of chance The intraclass correlation for intraobserver reliability is good to very good for all three techniques ranging from the lowest value of 0.953 to the highest of 1.000. MRI has the most narrow limits of agreement (–3.93 to 4.53), followed by XI VOCAL (–5.16 – 5.65) while VOCAL has the widest limits of agreement (–10.22 to 11.39). Intraclass correlations are poor in the comparison of XI VOCAL to MRI, moderate between VOCAL and XI VOCAL, and good for the comparison between VOCAL and MRI. The limits of agreement are widest for XI VOCAL versus MRI (–36.96 –10.54). Similar limits of agreement are found between VOCAL versus XI VOCAL (–7.80 –23.40) as between VOCAL versus MRI (–18.27–8.96). Limitations, reasons for caution No absolute volume measurements were obtained during subsequent surgery to compare the imaging data to. This makes it more difficult to determine an acceptable error margin for the 3D imaging techniques used. Wider implications of the findings: Being able to determine (small) volumetric changes in endometrioma can give more insight into the development and circumstances under which endometrioma grow or decrease in size. For reliable and accurate follow up of endometrioma a single measuring technique must be used as three-dimensional imaging techniques are not interchangeable. Trial registration number Trial NL2106 (NTR2223)

Effect of a long-term high-energy diet on cardiovascular parameters in Shetland pony mares.

BackgroundChanges in cardiovascular parameters, including blood pressure (BP) and cardiac anatomical dimensions, are an inconsistent feature of the equine metabolic syndrome. The order in which these changes arise is unknown.ObjectivesDetermine the order in which EMS‐associated changes in cardiovascular parameters arise.AnimalsTwenty Shetland pony mares.MethodsHigh‐energy (HE) diet mares were fed 200% of net energy requirements for 1 (n = 3) or 2 (n = 7) consecutive diet‐years, with 17 weeks of hay‐only between years. Noninvasive BP measurements and echocardiograms were performed during both years. Resting 24‐hour ECGs and measurements of autonomic tone (splenic volume and packed cell volume [PCV]) were performed at the end of diet‐year 1. Results were compared to control mares receiving a maintenance diet for 1 (n = 7) or 2 (n = 3) consecutive years.ResultsIn year 1, HE mares had significantly higher values than control mares for mean relative left ventricular wall thickness (P = .001). After 2 diet‐years, mean systolic (P = .003), diastolic (P < .001) and mean arterial BP (P = .001), heart rate (HR; P < .001), and mean left ventricular wall thickness (P = .001) also were significantly increased in HE compared to control mares. No pathological arrhythmias or differences in splenic volume or PCV were detected.Conclusions and Clinical ImportanceIngesting a HE diet first induced minor changes in BP, and progressed to left‐sided cardiac hypertrophy in Shetland pony mares. These findings are of interest given the increasing incidence of obesity in horses.

Post-embolization outcomes of splenic artery pseudoaneurysms: A single-center experience

PurposeSplenic artery pseudoaneurysms (PSA) are relatively rare but associated with high mortality/morbidity when presenting acutely. Embolization has emerged as the treatment of choice. We aim to evaluate the outcomes of embolization for the treatment of splenic artery PSAs. MethodsFrom 2007 to 2019, all patients that underwent embolization for splenic artery PSAs were included in this IRB-approved review. Evaluated outcomes included complications, morbidity/mortality rates, and 30-day white blood cell count. Student t-tests were performed to compare laboratory values before and after embolization. 5-year survival rates were estimated using Kaplan Meier methodology. ResultsA retrospective analysis of 24 patients (14 males, mean age 51 ± 19 years) who underwent splenic artery PSA embolization was performed. Fifteen PSA embolizations were performed in an emergent setting. There was technical success in 23/24 patients. Etiologies included trauma (10), pancreatitis (9), post-surgical (3), and malignancy (2). Post-embolization patients had a mean length of stay of 19 days and within 30 days, 9 patients developed leukocytosis (median of 14,800/μl). The 5-year survival rate of these patients was 89% [95% CI 75% - 100%]. Post-procedure, 4 patients developed grade 2 complications. Grade 3 complications were observed in 5 patients. One (4.2%) splenic abscess was identified. Of the 19 patients with follow-up imaging, 14 patients had splenic infarcts (5 infarcts were >50% of splenic volume). ConclusionsSplenic artery PSAs are encountered in the emergent setting and are most frequently secondary to trauma or pancreatitis. Embolization can be life-saving in these critically ill patients.

The Concept of Functional Graft Size: An Eternal Theme of Maximizing Donor Safety and Recipient Survival in Living Donor Liver Transplantation.

The Concept of Functional Graft Size: An Eternal Theme of Maximizing Donor Safety and Recipient Survival in Living Donor Liver Transplantation.

HPi: A Novel Parameter to Predict Graft-related Outcome in Adult Living Donor Liver Transplant.

Portal hyperperfusion is frequently associated with early allograft dysfunction (EAD). It is imperative to identify patients who would require portal inflow modulation. We aimed to identify factors associated with hyperperfusion-related graft injury and develop a predictive index for the same. Prospectively maintained database was queried to identify 135 adult living donor liver transplant recipients between September 2016 and July 2020. According to the calculated sample size, 96 patients were randomly selected for "test cohort". The remaining 39 patients made the "validation cohort." EAD was defined according to the A2ALL study. "Hyperperfusion index (HPi)," defined as posttransplant portal pressure gradient (ΔPpost)/graft-to-recipient splenic volume ratio (GRSVR), was devised on the basis of laws of flow dynamics and regression analysis. Overall, 40 patients (29.6%) had EAD, six 90-d mortalities (4.4%) were attributable to EAD. In the test cohort, EAD patients (n = 29, 30.2%) had lower GRSVR (1.00 versus 2.22, P < 0.001), higher ΔPpost (14.8 versus 11.9, P = 0.004), and HPi (20.89 versus 8.67, P < 0.001). Multivariate analysis revealed GRSVR, ΔPpost, and HPi as significant factors to predict EAD. Receiver operating characteristic determined cutoff of HPi ≥9.97 could predict EAD with sensitivity of 90% and specificity of 73% (F-score = 0.712). HPi ≥16.25 predicted 90-d mortality with sensitivity of 100% and specificity of 78.9%. Patients with higher HPi had delayed graft-related recovery. Non-EAD patients had a higher 1-y (96% versus 79%) and 2-y (88% versus 79%) survival. The cutoff of HPi was validated well in the validation cohort (F-score = 0.645) (Hosmer-Lemeshow test, P = 0.89). While predicted GRSVR may help identify at-risk patients preoperatively, intraoperatively calculated HPi is more accurate in identifying patients who would require portal inflow modulation. Achieving an HPi below target cutoff significantly decreases the risk of EAD even in low-GRSVR patients.

Radiographic assessment of splenic size and correlation with splenic measurements estimated by use of computed tomography in healthy cats.

To investigate radiographic variables for correlation with splenic size as estimated with CT in cats. 38 healthy adult cats. The width and height of the splenic head and total length, segmental length, and width of the spleen were measured on radiographic and CT images obtained from 10 cats in prospective, exploratory experiments. Distance between the splenic head and left kidney, anatomic locations of the head and tail of the spleen, and CT-derived splenic volume were also assessed. Correlation and agreement between radiographic and CT measurements and interobserver agreement for measurements with each method were determined. A retrospective evaluation of radiographs obtained without sedation or anesthesia for 28 cats was performed to establish preliminary guidelines for the measurement deemed the most reliable estimator of splenic size. Radiographic measurements of total and segmental splenic length were significantly correlated with the respective CT measurements and with splenic volume. Agreement between radiographic and CT measurements of segmental length was good; interobserver agreement was excellent for all variables. In retrospective evaluations, median segmental length of the spleen was 57.87 mm (range, 34.72 to 105.44 mm) on radiographs; the caudal border of the splenic head on lateral views was located from the cranial part of L1 to the caudal part of L2, and the caudal border of the splenic tail on ventrodorsal views was located from the caudal part of L2 to the caudal part of L5. Results indicated that segmental length of the spleen on radiographs is a reliable estimator of splenic size in healthy cats.

Reconstructing spleno-mesenterico-portal cofluence by bifurcated allogeneic vein in local advanced pancreatic cancer-a feasible method to avoid left-sided portal hypertension.

BackgroundLeft‐sided portal hypertension is usually found in patients undergoing pancreaticoduodenectomy (PD) with spleno‐mesenterico‐portal (S‐M‐P) confluence resection. This study is to explore the outcomes of S‐M‐P confluence reconstruction after resection by using bifurcated allogeneic vein.MethodsClinicopathologic data of patients who underwent extensive PD with S‐M‐P confluence resection for carcinoma of pancreatic head/uncinate process in our hospital between December 2011 and August 2018 were retrospectively reviewed and clinical outcomes of vein reconstruction after resection were analyzed.ResultsOf the 37 patients enrolled, S‐M‐P reconstruction by bifurcated allogeneic vein was performed in 24 cases (group 1) and simply splenic vein ligation in 13 cases (group 2). Items including pathological results, blood loss, and complications were comparable between the two groups, operation time was longer in group 1 (573.8 vs. 479.2 min, p = 0.018). Significantly decreased platelet count (205.9 vs. 133.1 × 109/L, p = 0.001) and increased splenic volume (270.9 vs. 452.2 ml, p < 0.001) were observed in group 2 at 6 months after operation. The mean splenic hypertrophy ratio was 1.06 in group 1 and 1.63 in group 2, respectively (p < 0.001). There were four patients with varices were found in group 2, none in group 1.ConclusionsWithout increased complications, reconstructing S‐M‐P confluence by bifurcated allogeneic vein after resection may help to avoid left‐sided portal hypertension.

Comparison of three embolic materials at partial splenic artery embolization for hypersplenism: clinical, laboratory, and radiological outcomes

PurposeTo compare effectiveness of three widely used embolic agents in partial splenic embolization (PSE) by analyzing their clinical, laboratory, and radiological outcomes within one year of follow-up.Materials and methodsThis retrospective study examined 179 patients who underwent PSE to manage hypersplenism secondary to cirrhosis. Patients were divided into 3 groups according to embolic agent used. Group 1 (gelatin sponge) included 65 patients, group 2 (embospheres) included 58 patients, and group 3 (PVA) included 56 patients. Clinical, laboratory, and radiological outcomes were compared between groups.ResultsThe technical success rate was 100% in all groups. Pain as a major complication was lower in the gelatin sponge group (20%) compared to the embosphere group (31%) and PVA group (32.3%). Major complications other than pain were found in 20.1%; 24.6% in gelatin sponge group, 15.5% in embosphere group and 19.6% in PVA group (p = 0.045). WBCs and platelet counts showed a significant increase after PSE in all groups. Entire splenic volume as measured by computed tomography after PSE showed no significant difference among the 3 groups; however, the volume of infarcted spleen was significantly lower in the gelatin sponge group compared to other two groups (p = 0.001). The splenic span was significantly reduced one-year post-procedure in three groups (p = 0.006), and it was significantly less in embosphere and PVA groups compared to gelatin sponge group (p < 0.05). Recurrent bleeding was higher in gelatin sponge group (p < 0.05).ConclusionsPermanent embolic materials achieved better laboratory and radiological outcomes than gelatin sponge particles in PSE of cirrhotic hypersplenism patients. However, permanent particles were associated with greater abdominal pain.

Single-Arm Salvage Therapy with Pegylated Interferon Alfa-2a for Patients with High-Risk Polycythemia Vera or High-Risk Essential Thrombocythemia Who Are Either Hydroxyurea-Resistant or Intolerant: Final Results of the Myeloproliferative Disorders-Research Consortium (MPD-RC) Protocol 111 Global Phase II Trial

Abstract Background: Several phase 2 trials have independently reported high response rates with recombinant interferon treatment in patients with essential thrombocythemia (ET) and polycythemia vera (PV). To further clarify the role of interferon therapy, we carried out a large trial to investigate pegylated-rIFN-α2a (PEG) as therapy in ET/PV patients. Methods: MPD-RC 111 (NCT01259817) was an international, multicenter, phase 2 trial evaluating complete and partial response rates (ELN Criteria) toPEG in patients with high-risk ET/PV who were either refractory or intolerant to hydroxyurea (HU) (Modified ELN Criteria). The study was designed to accrue 74 patients with ET and 74 with PV, but it was closed after accrual of 115 patients for administrative reasons. The starting PEG dose was 45 mcg weekly and was titrated for response to a maximum of 180 mcg weekly. Results Patients : The study enrolled 65 patients with ET and 50 patients with PV from 02/2012 to 12/2015. The median age was 64.0 years (range 20-85) (Table 1). Median time from diagnosis was 37.3 months (0.4-290.9) for ET and 54.8 months (0.5-393.7) for PV, entire cohort 42.3 months (0.5-394). Prior thrombosis was present in 32.3% of ET and 22% of PV patients. Palpable splenomegaly was present in 18.5% of ET patients and 56% of PV patients. Response CR / PR (ORR=CR+PR) at 12 months were observed in 43.1% / 26.2% (69.2%) in ET, and 22% / 38% (60%) in PV. The intention-to-treat (ITT) best ORR was 70.8% for ET and 64% for PV. In 77 patients (42 ET and 35 PV) who completed 24 months on-study, the ITT ORR (CR) was 73.8% (47.6%) for ET and 74.3% (42.9%) for PV. Patients with disease duration 42.3 months with 57% ORR (p=0.115). Higher treatment doses of PEG were not associated with increase in response rate (mean 118.2 vs 106.2 mcg, p: 0.225). Age Mutational analysis at baseline was available for 107 patients. JAK2V617F, CALR and MPL mutations are listed in table 1. Additional mutations included ASXL1 in 10, and TP53 in 5 patients. CR rate was higher in CALR mutated patients (56.3% vs. 28.6%, p= 0.02). None of 5 patients with TP53 mutation, and only 3/10 of ASXL1 mutated patients achieved CR. Safety Seventy-two % of patients remained on therapy for over 12 months with a median (range) duration of 78.5 (1-245) weeks in ET and 82 (4-209) weeks in PV. The mean (SD) weekly dose of PEG was 102.7 (52.3) mcg for ET and 128.7 (46.4) for PV. The causes for discontinuation of therapy are listed in Table 2. Grade 3 AEs regardless of attribution occurred in 38% of patients. Five grade 4 AEs were reported (AML, depression, hyperuricemia, and 2 subjects with neutropenia). Four non-myeloid malignancies developed in study patients. There were 3 off-trial deaths to date: drug abuse, lung adenocarcinoma, and patient decision unknown. Conclusions PEG is an effective agent to treat patients with ET/PV, capable of achieving 12 month ORR in 69% and 60% of ET and PV patients, respectively. The presence of CALR at baseline was associated with superior CR rates in ET. Treatment was associated with significant numbers of AEs which can limit tolerability. Thrombotic events and evolution to MF or AML continued to occur during the treatment period. The effects of PEG on the mutational burdens will be available at the time of presentation. QOL data will be presented separately. Download : Download high-res image (294KB) Download : Download full-size image Disclosures Yacoub: Novartis: Speakers Bureau; Sandoz: Consultancy; CTI: Consultancy; Pfizer: Consultancy; Seattle Genetics: Consultancy, Speakers Bureau; Incyte: Consultancy, Speakers Bureau. Mascarenhas: Janssen: Research Funding; Merck: Research Funding; Novartis: Other: DSMB member , Research Funding; Incyte: Other: Clinical Trial Steering Committee , Research Funding; CTI Biopharma: Research Funding; Promedior: Research Funding. Berenzon: Incyte Corporation: Research Funding. Ritchie: Incyte: Consultancy, Speakers Bureau; Novartis: Consultancy, Other: Research funding to my institution, and travel, Speakers Bureau; Bristol-Myers Squibb: Other: Research funding to my institution; Celgene: Consultancy, Other: Travel, Speakers Bureau; Astellas Pharma: Other: Research funding to my institution; NS Pharma: Other: Research funding to my institution; Pfizer: Consultancy, Other: Research funding to my institution. Rambaldi: Novartis, Amgen, Celgene, Sanofi: Other: Travel, Accomodations, Expenses; Novartis, Roche/Genentech, Amgen, Italfarmaco: Consultancy. Vannucchi: Novartis: Honoraria, Speakers Bureau; Shire: Speakers Bureau. Hexner: Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding. Mesa: Promedico: Research Funding; Incyte Corporation: Research Funding; Novartis Pharmaceuticals Corporation: Consultancy; Celgene Corporation: Research Funding; Ariad: Consultancy; CTI BioPharma Corp.: Research Funding; Galena Biopharma, Inc.: Consultancy; Gilead Sciences, Inc.: Research Funding.

Enhanced splenic volume and contraction in elite endurance athletes.

Splenic contraction, which leads to ejection of stored erythrocytes, is greater in athletes involved in regular freediving or high-altitude activities. As this response facilitates oxygen-carrying capacity, similar characteristics may be expected of elite endurance athletes. Therefore, our aims were to compare resting and apnea-induced splenic volume in endurance athletes and untrained individuals, and to assess the athletes' exercise-induced splenic volume. Twelve elite biathletes (7 women) and 12 controls (6 women) performed a maximal effort apnea in a seated position. In addition, the biathletes completed a maximal roller-skiing time trial. Splenic dimensions were measured by ultrasonic imaging for subsequent volume calculations, whereas Hb was analyzed from capillary blood samples and cardiorespiratory variables were monitored continuously. Baseline splenic volume was larger in the biathletes (214 ± 56 mL) compared with controls (157 ± 39 mL, P = 0.008) and apnea-induced splenic contraction was also greater in the biathletes (46 ± 20 mL vs. 30 ± 16 mL, P = 0.035). Hb increased immediately after apnea in the biathletes (4.5 ± 4.8%, P = 0.029) but not in the controls (-0.7 ± 3.1%, P = 0.999). Increases in exercise-induced splenic contraction (P = 0.008) and Hb (P = 0.001) were greater compared with the apnea-induced responses among the athletes. Baseline splenic volume tended to be correlated with V̇o2max (r = 0.584, P = 0.059). We conclude that elite biathletes have greater splenic volume with a greater ability to contract and elevate Hb compared with untrained individuals. These characteristics may transiently enhance O2-carrying capacity and possibly increase O2 uptake, thereby helping biathletes to cope with high intermittent O2 demands and severe O2 deficits that occur during biathlon training and competition.NEW & NOTEWORTHY This study demonstrates that elite biathletes have larger splenic volume, apnea-induced splenic contraction, and Hb elevation compared with untrained individuals, which is likely functional to cope with high O2 demands and substantial O2 deficits. We believe that enhanced splenic contraction may be of importance during competitions involving cross-country skiing, to regulate circulating Hb and enhance O2-carrying capacity, which may protect [Formula: see text] and increase O2 uptake.

Splenic Volume as a Surrogate Marker of Immune Checkpoint Inhibitor Efficacy in Metastatic Non Small Cell Lung Cancer.

Simple SummaryMonoclonal antibodies targeting PD1/PD-L1 are game changers in the treatment of advanced non-small cell lung cancer (NSCLC), but biomarkers are lacking. We previously reported the prognostic role of splenic volume in digestive cancer and its correlation with the presence of immunosuppressive cells. The aim of this study was to evaluate the prognostic role of splenic volume in NSCLC patients treated with immune checkpoint inhibitors (ICIs).Monoclonal antibodies targeting PD1/PD-L1 are game changers in advanced non-small cell lung cancer (NSCLC), but biomarkers are lacking. We previously reported the prognostic role of splenic volume in digestive cancer and its correlation with the presence of immunosuppressive cells. The aim of this study was to evaluate the prognostic role of splenic volume in NSCLC patients treated with immune checkpoint inhibitors (ICIs). We conducted a retrospective study of 276 patients receiving ICIs for advanced NSCLC in the Georges François Leclerc Cancer Center. The association between splenic volume at baseline and at two months of therapy and progression-free survival (PFS) during ICI treatment or overall survival (OS) from ICI initiation was evaluated using univariate and multivariable Cox analyses. Splenic volume during treatment and the change in splenic volume were associated with poor PFS (respectively p = 0.02 and p = 0.001) and with OS (respectively p < 1.10−3 and p < 1.10−3). Baseline splenic volume at the first evaluation was also associated with poor OS (p = 0.001). LDH rate and dNLR were positively correlated with splenic volume, as well as with its evolution. After the adjustment of clinical variables, splenic volumes remained a predictive marker of immunotherapy efficacy. Splenic volume is a prognostic biomarker in patients with advanced NSCLC treated with ICIs.

Comparison Between Liver Stiffness Measurement by Fibroscan and Splenic Volume Index as NonInvasive Tools for the Early Detection of Oxaliplatin-induced Hepatotoxicity

Oxaliplatin remains an essential component of many chemotherapy protocols for gastrointestinal cancers; however, neurotoxicity and hepatotoxicity may be dose-limiting. The gold standard for the diagnosis of oxaliplatin-induced hepatotoxicity is liver biopsy, which is invasive and costly. Splenomegaly has also been used as a surrogate for liver biopsy in detecting oxaliplatin-induced sinusoidal obstruction syndrome (SOS), but splenic measurement is not routine and can be inaccurate and complex. We investigated the correlation between increased liver elasticity assessed by Fibroscan and the increase in spleen volume on cross-sectional imaging after oxaliplatin as a noninvasive technique to assess liver stiffness associated with oxaliplatin-induced SOS. Forty-six patients diagnosed with gastrointestinal cancers and planned to take oxaliplatin containing regimens were included in this prospective study at the American University of Beirut Medical Center (AUBMC). Measurement of spleen volume using cross-sectional imaging and of liver elasticity using Fibroscan was performed at baseline, 3 and 6 months after starting oxaliplatin. Mean liver elasticity measurements were compared between patients stratified by the development of splenomegaly using the Student t-test. Splenomegaly was defined as 50% increase in spleen size compared with baseline. Patients who developed splenomegaly afteroxaliplatin use had significantly higher mean elasticity measurements as reported by Fibroscan at 3(16.2vs. 7.8kPa, P= 0.036) and 6 (9.3 vs. 6.7kPa, P= 0.03) months. Measurement of elasticity using Fibroscan could be potentially used in the future as a noninvasive test for predicting oxaliplatin-induced hepatotoxicity.

Effects of Butorphanol With Alfaxalone or Dexmedetomidine on Feline Splenic Size and Appearance on Ultrasound and Computed Tomography.

The purpose of the study was to determine the effects of intramuscular butorphanol with dexmedetomidine or alfaxalone on feline splenic size, echogenicity, and attenuation using ultrasound and computed tomography (CT). Ten healthy research cats underwent ultrasound and CT without sedation (controls), 15 min after protocol AB (alfaxalone 2 mg/kg and butorphanol 0.2 mg/kg) and 10 min after protocol DB (dexmedetomidine 7 μg/kg and butorphanol 0.2 mg/kg), with a one-week wash-out period between each sedation, using a cross-over study design. Images were randomized and anonymized for evaluation by a board-certified radiologist. On ultrasound, the sedative protocols affected splenic thickness, at the body and the tail (p = 0.002 and 0.0003, respectively). Post-hoc tests revealed that mean ± SEM thickness was greater after AB (body: 10.24 ± 0.30 mm; tail: 7.96 ± 0.33 mm) than for the control group (body: 8.71 ± 0.30 mm; tail: 6.78 ± 0.33 mm), while no significant difference was observed following DB. Splenic echogenicity was unchanged between treatments (p = 0.55). On CT, mean ± SEM splenic volume was increased after AB (37.82 ± 1.91 mL) compared to the control group (20.06 ± 1.91 mL) (p < 0.0001), but not after DB (24.04 ± 1.91 mL). Mean splenic attenuation increased after AB (p = 0.0009), but not DB. Protocol DB may be preferable for profound sedation in cats while avoiding changes in feline splenic imaging. When protocol AB is selected, splenomegaly should be expected, though mild on ultrasound. The increased splenic attenuation after AB is unlikely to be clinically relevant.

Prognostic value of splenic volume in hepatocellular carcinoma patients receiving transarterial chemoembolization.

Liver function is a key determinant for the survival of hepatocellular carcinoma (HCC) patients receiving transarterial chemoembolization (TACE). However, establishing robust prognostic indicators for liver insufficiencies and patient survival remains an unmet demand. This retrospective study evaluated the prognostic value of splenic volume (SV) in HCC patients undergoing TACE. A total of 67 HCC patients who underwent at least two consecutive TACE procedures were retrospectively included in this study. Comprehensive clinical information and follow-up data were collected, and the SV was measured based on dynamic contrast enhanced images. Risk factors of SV enlargement were assessed. The prognostic value of SV on survival was analyzed and compared with Child-Pugh (CP) classification and albumin-bilirubin (ALBI) grade. The baseline SV was 299.74±143.63 cm3, and showed a moderate and statistically significant correlation with CP classification (R=0.31, P<0.05). The SV increased remarkably after the first and second TACE procedures (330.16±155.38 cm3, P<0.01, and 355.63±164.26 cm3, P<0.01, respectively). In survival analysis, the optimal cut-off value of SV was determined as 373 cm3 using X-tile software, and the patients were divided into the small SV group and the large SV groups accordingly. Based on the pre-TACE SV, the median overall survival (mOS) for patients in the small SV group and the large SV group was 458 days and 249 days, respectively (P<0.05). After the first and second TACE, the mOS in the small SV group and the large SV group were 454 vs. 266 days (P<0.05) and 526 vs. 266 days (P<0.05), respectively. No prognostic value of CP classification and ALBI grade was identified for these patients. Furthermore, there were no significant differences between the small and large SV groups in age, tumor stage, and ALBI grade, except for CP classification (P<0.05). SV was correlated with CP classification and was a robust predictor for HCC patients undergoing TACE treatment.

68Ga-Pentixafor PET/CT for Detection of Chemokine Receptor CXCR4 Expression in Myeloproliferative Neoplasms.

C-X-C motif chemokine receptor 4 (CXCR4) is an attractive target for cancer diagnosis and treatment, as it is overexpressed in many solid and hematologic malignancies. This study investigated the feasibility of CXCR4-directed imaging with PET/CT using 68Ga-pentixafor to visualize and quantify disease involvement in myeloproliferative neoplasms (MPNs). Methods: Twelve patients with MPNs (4 with primary myelofibrosis, 6 with essential thrombocythemia, and 2 with polycythemia vera) and 5 controls underwent 68Ga-pentixafor PET/CT. Imaging findings were compared with immunohistochemical stainings, laboratory data, and splenic volume. Results:68Ga-pentixafor PET/CT was visually positive in 12 of 12 patients, and CXCR4 target specificity could be confirmed by immunohistochemical staining. A significantly higher tracer uptake could be detected in the bone marrow of MPN patients (SUVmean, 6.45 ± 2.34 vs. 4.44 ± 1.24). Dynamic changes in CXCR4 expression determined by 68Ga-pentixafor PET/CT corresponded with treatment response. Conclusion:68Ga-pentixafor PET/CT represents a novel diagnostic tool to noninvasively detect and quantify the extent of disease involvement in MPNs.

Positron emission tomography and magnetic resonance imaging in experimental human malaria to identify organ-specific changes in morphology and glucose metabolism: A prospective cohort study.

Plasmodium vivax has been proposed to infect and replicate in the human spleen and bone marrow. Compared to Plasmodium falciparum, which is known to undergo microvascular tissue sequestration, little is known about the behavior of P. vivax outside of the circulating compartment. This may be due in part to difficulties in studying parasite location and activity in life. To identify organ-specific changes during the early stages of P. vivax infection, we performed 18-F fluorodeoxyglucose (FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) at baseline and just prior to onset of clinical illness in P. vivax experimentally induced blood-stage malaria (IBSM) and compared findings to P. falciparum IBSM. Seven healthy, malaria-naive participants were enrolled from 3 IBSM trials: NCT02867059, ACTRN12616000174482, and ACTRN12619001085167. Imaging took place between 2016 and 2019 at the Herston Imaging Research Facility, Australia. Postinoculation imaging was performed after a median of 9 days in both species (n = 3 P. vivax; n = 4 P. falciparum). All participants were aged between 19 and 23 years, and 6/7 were male. Splenic volume (P. vivax: +28.8% [confidence interval (CI) +10.3% to +57.3%], P. falciparum: +22.9 [CI -15.3% to +61.1%]) and radiotracer uptake (P. vivax: +15.5% [CI -0.7% to +31.7%], P. falciparum: +5.5% [CI +1.4% to +9.6%]) increased following infection with each species, but more so in P. vivax infection (volume: p = 0.72, radiotracer uptake: p = 0.036). There was no change in FDG uptake in the bone marrow (P. vivax: +4.6% [CI -15.9% to +25.0%], P. falciparum: +3.2% [CI -3.2% to +9.6%]) or liver (P. vivax: +6.2% [CI -8.7% to +21.1%], P. falciparum: -1.4% [CI -4.6% to +1.8%]) following infection with either species. In participants with P. vivax, hemoglobin, hematocrit, and platelet count decreased from baseline at the time of postinoculation imaging. Decrements in hemoglobin and hematocrit were significantly greater in participants with P. vivax infection compared to P. falciparum. The main limitations of this study are the small sample size and the inability of this tracer to differentiate between host and parasite metabolic activity. PET/MRI indicated greater splenic tropism and metabolic activity in early P. vivax infection compared to P. falciparum, supporting the hypothesis of splenic accumulation of P. vivax very early in infection. The absence of uptake in the bone marrow and liver suggests that, at least in early infection, these tissues do not harbor a large parasite biomass or do not provoke a prominent metabolic response. PET/MRI is a safe and noninvasive method to evaluate infection-associated organ changes in morphology and glucose metabolism.