Splenic Width Research Articles

Computed Tomography Assessment of Linear Splenic Dimensions and their Correlation with Anthropometric Measurements in Nepalese Population

Background: Geographical locations and ethnicity may influence variations in normal spleen dimensions, potentially leading to errors in assessment. This study aimed to correlate splenic dimensions with anthropometry and predict their variation with age and body surface area.
 Materials and Methods: Subjects (n=384) undergoing abdominal computed tomography were selected by random sampling. Splenic volume was calculated using the standard prolate ellipsoid equation. Correlation of splenic volume with body surface area and body mass index was done with Pearson’s correlation analysis. A multiple regression was run to predict splenic volume from age, height, and body surface area.
 Results: The mean age was 45±18 (range, 18-90 years). The mean splenic length, width, thickness, and volume were 7.6 ± 1.7 cm, 8.8 ± 1.5cm, 3.8 ± 0.9 cm, and 139 ± 58.2 cm3, respectively. The splenic width and splenic volume were significantly lower at extremes of age. A significant (P<0.05) correlation was seen between splenic volume, body surface area(r=0.393) and body mass index (r=0.126); a negative correlation was observed between splenic volume and age (r=-0.180). Splenic dimensions were significantly larger in males. Multiple regression revealed that an increase in body surface area (by 10 cm2), predicted increased splenic volume was 4.3 cm3. An increase in age (by 1-year), predicted decrease in splenic volume was 8.3 cm3. For 10 cm increase in height, predicted increase in splenic volume was 1.7cm3.
 Conclusion: The study showed a positive correlation between splenic volume and body surface area, as well as body mass index and provides a crucial normative data for assessing splenic enlargement in Nepalese population.

Sonographic Measurement of the Spleen in the healthy adult Nigerian Population in Enugu State, Nigeria

Context: measurement of the spleen with ultrasound in order to obtain normal lengths (nomogram) is possible because ultrasound is devoid of ionizing radiation, it is real time, readily available, cheap easily reproducible and has high specificity and high sensitivity values. 
 Aim: Sonographic measurement of the spleen was carried out in 500 healthy adult Nigerians in Enugu State in order to determine the nomogram for the spleen and to correlate the measurements with the sex, age, height, weight and body mass index, so as to find out whether there is a significant difference in the size of this organ as compared to other races in the reviewed literature. 
 Materials and Methods: Measurement of the spleen was carried out in 500 healthy adult Nigerians comprising 195 males (39%) and 305 females (61%). The individuals were not less than twenty (20) years as at the time of data collection. The data was analyzed using SPSS statistical package version 20.0. The mean, median, variance, standard deviation of the spleen sizes were evaluated and correlated with the age, sex, weight, height and body mass index of the subjects. 
 Results: the mean splenic length for males was 104.1±14.5mm and 103.3±13.4mm for females with P values of 0.515. The mean splenic width was 62.9±12.8mm for males and 60.3±10.6 for females with P values of 0.013 which is significant showing that males have longer splenic width than females. There was a significant relationship between age and spleen width in both sexes with P values of 0.001. There is also a significant correlation of the spleen dimension with body mass index in both sexes with P values <0.05. Furthermore, the result shows that there was a correlation of the splenic length and width with age. There was also positive correlation of the splenic length with Body Mass Index P values 0.014, height P values 0.000 but not with subject’s weight P values 0.311. 
 Conclusion: There is significant correlation of the spleen width with height, weight but not with body mass index. Males have greater splenic width than females. There is also a significant correlation of the splenic length and width with age.

The Human Dive Reflex During Consecutive Apnoeas in Dry and Immersive Environments: Magnitude and Synchronicity.

Introduction: The human dive reflex (HDR), an O2 conserving reflex, is characterised by an interplay of central parasympathetic and peripheral sympathetic reactions, which are presumed to operate independently of each other. The HDR is fully activated during apnoea with facial immersion in water and complete immersion in water is thought to increase the magnitude of HDR during consecutive apnoeas. A comparison of HDR activity between consecutive apnoeas in full-body immersion with consecutive apnoeas in dry conditions has not been fully explored. Also, the interplay between parasympathetic and sympathetic reactions involved in the HDR has not been thoroughly analysed.Methods: 11 human volunteers performed 3 consecutive 60 s apnoeas with facial immersion in dry conditions (FIDC) and 3 consecutive apnoeas with facial immersion in full immersion (FIFI). Heart rate (HR), R-R interval (RRI), finger pulse amplitude (FPA), splenic width (SW) and SpO2 were all measured before, during and after apnoeas. A one-way ANOVA using Dunn’s post hoc test was performed to assess HDR activity, and a Pearson’s correlation test was performed to assess HDR synchronisation between physiological parameters during both conditions.Results: Although HDR activity was not significantly different between both conditions, HR and RRI showed progressively greater changes during FIFI compared with FIDC, while SW and FPA changes were relatively equivalent. During FIDC, significant correlations were found between SW & SpO2 and FPA & SpO2. During FIFI, significant correlations were found between RRI & FPA, SW & FPA, HR & SpO2 and FPA & SpO2.Discussion: While there was no significant difference found between HDR activity during FIDC and FIFI, consecutive apnoeas during FIFI triggered a greater magnitude of cardiac activity. Furthermore, significant correlations between RRI and SW with FPA indicate a crosstalk between parasympathetic tone with splenic contraction and increased peripheral sympathetic outflow during FIFI compared to FIDC. In conclusion, HDR activity during consecutive apnoeas does not differ between FIDC and FIFI. There appears to be however a greater level of synchronicity during apnoeas in FIFI compared to FIDC and that this is most likely due to the physiological effects of immersion, which could induce neural recruitment and increased cross talk of HDR pathways.

Ultrasonographic Study on Size and Echotexture of Spleen in Normal and Diseased Adult Population in Kosi Region of Bihar

Background: The spleen is the largest organ in the reticuloendothelial system. A number of disorders are accompanied by altered spleen size, including infective, infestation, infiltrative, immunologic, and malignant conditions. Ultrasonography affords a useful noninvasive role in evaluating the spleen and used for best advantage, it can demonstrate the existence and composition of splenic masses, disruption of splenic texture or outline, progressive changes in masses and the size of the spleen. Materials & Methods: 166 subjects were selected from the Departments of Medicine, Surgery and Radiology, from a tertiary care teaching hospital and from the other clinics of Kosi region like Purnea, Araria and Madhepura districts during the period of June 2016 to May 2017. Results: The splenic length decreased at a slow rate up to the age of 50 years after which it decreased rapidly in both sexes. The splenic length was greater in males than in female in each age group. Mean splenic width in the first age group i.e. 21 30 years was 60.9 ± 8.4 mm, in the second age group i.e. 31 - 40 years was 56.4 ± 7.9 mm, in the third age group i.e. 41 – 50 years was 46.6 ± 4.3 mm, and in the fourth age group i.e. 51 – 60 years was observed to be 44.6 ± 8.0 mm. Conclusion: The ultrasonography affords a useful noninvasive role in evaluating the spleen, it can demonstrate existence and composition of splenic masses, disruption of splenic texture or outline; and also progressive changes in masses and size of spleen.

The Best Single Measurement for Assessing Splenomegaly in Patients with Cirrhotic Liver Morphology

There is little agreement within the radiology literature as to the best single measurement for assessing splenomegaly. In this study, we evaluate the correlation of multiple unidirectional measurements of the spleen with splenic volume in patients with cirrhotic liver morphology on computed tomography (CT). Splenic volume was retrospectively calculated from CT examinations of 179 adult patients, 47 of whom were approved as renal donors, and 132 of whom were referred for various other indications, and were found to have cirrhotic liver morphology on CT. Seven unidimensional measurements (long-axis, cranial-caudal, width, and four measures of thickness) of each spleen were evaluated to identify which most closely correlated with the calculated volume. The splenic width had the best correlation with splenic volume for mild-to-moderate splenomegaly, and the splenic cranial-caudal measurement had the best correlation with splenic volume for massive splenomegaly. Receiver operating characteristic analysis demonstrates that a splenic width measurement of approximately 10.5 cm has a sensitivity of 89% and a specificity of 78% for mild-to-moderate splenomegaly, and a cranial-caudal measurement of 14.6 cm has a sensitivity of 92% and a specificity of 91% for massive splenomegaly. A splenic width threshold of 10.5 cm is the most sensitive (89%) and specific (78%) single measurement for mild-to-moderate splenomegaly in patients with cirrhotic liver morphology, whereas a cranial-caudal height threshold of 14.6 cm is the most sensitive (92%) and specific (91%) single measurement for massive splenomegaly.

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

Splenic dimension of >12cm 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. 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. 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 ≥12cm 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 9.5cm and width of 10.6cm may be used as upper cutoff limit for normal spleen. Coronal oblique dimension of spleen >12cm 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 >9.5cm, width of >10.6cm, and coronal oblique dimension >12cm may be used.

Assessing splenic enlargement on CT by unidimensional measurement changes in patients with colorectal liver metastases.

The aim of this study was to assess splenic volume and to correlate unidimensional measurements with reference volumetric changes in chemotherapy-treated patients with colorectal cancer (CRC) liver metastases. Forty consecutive patients were selected from the cohort of a previously reported study of chemotherapy-related morbidity following major hepatectomy for CRC liver metastases. Patients were treated for 6months prior to resection, with imaging performed at baseline and after 6months of chemotherapy. Three unidimensional spleen measurements were recorded-width, thickness, and height (W, T, and H). Reference splenic volume was measured at baseline and after chemotherapy. The best unidimensional splenic measurement was determined by regression analysis. The 95% CI for the predicted values and R (2) values was calculated for each regression. The percentage of volume increase at 6months was calculated. W and H showed the highest correlation with splenic volume prior to and following chemotherapy (R (2)=0.65-0.74, p<0.001), while T showed a low correlation (R (2)=0.11 and 0.18, p<0.05). The mean reference splenic volume increased after 6months of chemotherapy compared to baseline (326 vs. 278mL). Splenic volume changes showed the highest correlation with changes in W (R (2)=0.56, p<0.001), then H (R (2)=0.40, p<0.001), but were not significantly correlated with changes in T (R (2)=0.01, p=0.055). Our results show the potential utility of measuring changes in splenic width to predict clinically significant changes in splenic volume in chemotherapy-treated patients with CRC liver metastases.

To evaluate the role of OLT on splenomegaly of portal hypertension by the radiological changes of splenic morphology and collaterals

To explore the effect of orthotopic liver transplantation (OLT) on portal hypertension by observing the radiological changes of splenic volume and collaterals before and after OLT. In our hospital 56 patients performing OLT due to cirrhosis, portal hypertension and splenomegaly were classified into five groups according to their following-up time: A (≤3 months), B (>3-6 months), C (>6-12 months), D (>12-24 months), and E (>24 months). Twenty health people were chose as control group (F). The splenic width, thickness, length, volume, diameter of portal and splenic vein and collaterals were measured and observed in every patient of six groups before and after OLT respectively. After OLT, the splenic volume decreased by 25.4%, 27.8%, 21.9%, 25.2%, 27.7% in five groups respectively, which was still larger than the normal group (P<0.05). Gastroesophageal varices in 31 cases (81.6%, 31/36) became normal after OLT. The opened umbilical vein disappeared and the retroperitoneal varices persisted in five cases after OLT. Splenomegaly and opened collaterals can be relieved by OLT effectively. The splenic volume didn't change obviously until it decreased by 25% in the three months after OLT. Gastroesophageal varices can be removed in most of patients after OLT. The splenomegaly could last paralled with the splenic vein and retroperitoneal varices after OLT. After OLT, correct disposal of splenic and collateral changes could improve the success rate and the long-term treatment effect of OLT.