Assessing the relationship between liver and spleen volumes in patients with liver cirrhosis using the Cavalieri principle on cross-sectional images

Year 2024, Volume: 41 Issue: 4, 738 - 745, 31.12.2024

Merve Nur Özgen , Abdurrahman Şahin , Ruken Yuksekkaya , Bünyamin Şahin

Abstract

In the early stages of liver cirrhosis, hepatomegaly is observed, while in the later stages, enlargement of the spleen is observed due to shrinkage of the liver and increased pressure in the portal circulation. This study examined liver and spleen volumes and their proportional relationship to each other in healthy controls (HC) and patients with liver cirrhosis (LC) using computed tomography (CT) images. CT images of 52 LC (26 females, 26 males) and 52 HC (26 females, 26 males) aged 18 to 85 years were used. Liver and spleen volumes and spleen/liver+spleen volume ratio were calculated using the Cavalieri principle. Volume and ratio data were compared between HC and LC. In addition, volumes and ratios were evaluated according to the disease classes in patients. Liver volume was larger in LC (1488.9±502.3 cm3) than in HC (1321.8±277.1 cm3) (p=0.038). Spleen volume was also larger in LC (676.8±347.02 cm3) than in HC (249.37±101.16 cm3) (p<0.001). The spleen/liver+spleen volume ratio was higher in LC (30.75±12.22%) than in HC (15.68±5.09%) (p<0.001). There was no difference in volume ratios between LC and HC according to sex (p>0.05). Liver volumes were 1670.7 cm3, 1357.4 cm3, and 1087.3 cm3, and the spleen/liver+spleen volume ratio were 26.71%, 33.49%, and 40.26% in classes A, B, and C of LC, respectively. As the cirrhosis class progressed, liver volume decreased (p=0.010), and the spleen/liver+spleen volume ratio increased (p=0.020). Liver and spleen sizes and the spleen/liver+spleen volume ratio did not change depending on sex. These values can be used as normal value parameters independent of sex. Liver and spleen volumes and ratios were larger in LC than in HC. As the class of cirrhosis progressed, liver volume decreased, and the ratio increased. Our findings suggest that the spleen/liver+spleen volume ratio can be used to evaluate the classes of liver cirrhosis.

Keywords

Liver, Spleen, Volume, Cirrhosis, Cavalieri principle, Computed tomography

Ethical Statement

This study was initiated with the approval of Tokat Gaziosmanpaşa University Non-Interventional Clinical Research Ethics Committee dated 02.03.2023 and numbered 83116987-146.

Thanks

The authors would like to thank Tokat Gaziosmanpaşa University Research and Application Hospital for the realization of the study and providing the data.

References

• 1. Ginès P, Krag A, Abraldes JG, Solà E, Fabrellas N, Kamath PS. Liver cirrhosis. Lancet. 2021;398(10308):1359-1376. https://doi.org/10.1016/S0140-6736(21)01374-X
• 2. Karagiannakis DS, Stefanaki K. Spleen stiffness: a predictive factor of dismal prognosis in liver cirrhosis. Clin J Gastroenterol. 2023; 16(2): 121-129. https://doi.org/10.1007/s12328-022-01752-z
• 3. Wilson R, Williams DM. Cirrhosis. Med Clin North Am. 2022; 106(3): 437-446. https://doi.org/10.1016/j.mcna.2021.12.001
• 4. Patidar Y, Mittal K, Patel RK, Thomas SS, Sarin SK. Liver volumetry in cirrhotic patients with or without hepatocellular carcinoma: Its correlation with Child-Pugh, model for end-stage liver diseases and indocyanine green dye test. Indian J Gastroenterol. 2024; 43: 760-767. https://doi.org/10.1007/s12664-023-01490-1
• 5. Xavier SA, Vilas-Boas R, Boal Carvalho P, Magalhães JT, Marinho CM, Cotter JB. Assessment of prognostic performance of Albumin-Bilirubin, Child-Pugh, and model for end-stage liver disease scores in patients with liver cirrhosis complicated with acute upper gastrointestinal bleeding. Eur J Gastroenterol Hepatol. 2018; 30(6): 652-658. https://doi.org/10.1097/MEG.0000000000001087
• 6. Chen XL, Chen TW, Zhang XM, Li ZL, Zeng NL, Li T, et al. Quantitative assessment of the presence and severity of cirrhosis in patients with hepatitis B using right liver lobe volume and spleen size measured at magnetic resonance imaging. PloS One. 2014; 9(3): e89973. https://doi.org/10.1371/journal.pone.0089973
• 7. El-Khateeb E, Darwich AS, Achour B, Athwal V, Rostami-Hodjegan A. Review article: time to revisit Child-Pugh score as the basis for predicting drug clearance in hepatic impairment. Aliment Pharmacol Ther. 2021; 54(4): 388-401. https://doi.org/10.1111/apt.16489
• 8. Zhou XP, Lu T, Wei YG, Chen XZ. Liver volume variation in patients with virus-induced cirrhosis: findings on MDCT. AJR Am J Roentgenol. 2007; 189(3): W153-159. https://doi.org/10.2214/AJR.07.2181
• 9. Geng Y, Shao WQ, Lin J. Spleen to non-cancerous liver volume ratio predicts liver cirrhosis in hepatocellular carcinoma patients. Abdom Radiol. 2023; 48(2): 543-553. https://doi.org/10.1007/s00261-022-03727-7
• 10. Romero-Cristóbal M, Clemente-Sánchez A, Peligros MI, Ramón E, Matilla AM, Colón A, et al. Liver and spleen volumes are associated with prognosis of compensated and decompensated cirrhosis and parallel its natural history. United European Gastroenterol J. 2022; 10(8): 805-816. https://doi.org/10.1002/ueg2.12301
• 11. Patel M, Tann M, Liangpunsakul S. Liangpunsakul, CT-scan based liver and spleen volume measurement as a prognostic indicator for patients with cirrhosis. Am J Med Sci. 2021; 362(3): 252-259. https://doi.org/10.1016/j.amjms.2020.10.031
• 12. Ozturk A, Olson MC, Samir AE, Venkatesh SK. Liver fibrosis assessment: MR and US elastography. Abdom Radiol. 2022; 47(9): 3037-3050. https://doi.org/10.1007/s00261-021-03269-4
• 13. Sahin B, Ergur H. Assessment of the optimum section thickness for the estimation of liver volume using magnetic resonance images: a stereological gold standard study. Eur J Radiol. 2006; 57(1): 96-101. https://doi.org/10.1016/j.ejrad.2005.07.006
• 14. Mazonakis M, Damilakis J. Computed tomography: What and how does it measure?. Eur J Radiol. 2016; 85(8): 1499-1504. https://doi.org/10.1016/j.ejrad.2016.03.002
• 15. Zoli M, Magalotti D, Grimaldi M, Gueli C, Marchesini G, Pisi E. Physical examination of the liver: is it still worth it?. Am J Gastroenterol. 1995; 90(9): 1428-1432.
• 16. Labenz C, Arslanow A, Nguyen-Tat M, Nagel M, Wörns MA, Reichert MC, et al. Structured early detection of asymptomatic liver cirrhosis: results of the population-based liver screening program SEAL. J Hepatol. 2022; 77(3): 695-701. https://doi.org/10.1016/j.jhep.2022.04.009
• 17. Odaci E, Sahin B, Sonmez OF, Kaplan S, Bas O, Bilgic S, et al. Rapid estimation of the vertebral body volume: a combination of the Cavalieri principle and computed tomography images. Eur J Radiol. 2003;48: 316-326. https://doi.org/10.1016/s0720-048x(03)00077-9
• 18. Gundersen HJ, Jensen EB. The efficiency of systematic sampling in stereology and its prediction. J Microsc. 1987; 147(3): 229-263. https://doi.org/10.1111/j.1365-2818.1987.tb02837.x
• 19. Xu Z, Yang D, Luo J, Xu H, Jia J, Yang Z. Diagnosis of sarcopenia using the L3 skeletal muscle index estimated from the l1 skeletal muscle index on MR images in patients with cirrhosis. J Magn Reson Imaging 2023; 58(5): 1569-1578. https://doi.org/10.1002/jmri.28690
• 20. Zheng T, Qu Y, Chen J, Yang J, Yan H, Jiang H, et al. Noninvasive diagnosis of liver cirrhosis: qualitative and quantitative imaging biomarkers. Abdom Radiol. 2024; 49(6): 2098-2115. https://doi.org/10.1007/s00261-024-04225-8
• 21. Sahin NE, Oner Z, Oner S, Turan MK. A study on the correlation between spleen volume estimated via Cavalieri principle on computed tomography images with basic hemogram and biochemical blood parameters. Anat Cell Biol. 2022; 55(1): 40-47. https://doi.org/10.5115/acb.21.177
• 22. Patel M, Puangsricharoen P, Arshad HMS, Garrison S, Techasatian W, Ghabril M. Does providing routine liver volume assessment add value when performing CT surveillance in cirrhotic patients?. Abdom Radiol. 2019; 44(10): 3263-3272. https://doi.org/10.1007/s00261-019-02145-6
• 23. Li WX, Zhao XT, Chai WM, Zhu NY, DU LJ, Huang W, et al. Hepatitis B virus-induced liver fibrosis and cirrhosis: the value of liver and spleen volumetry with multi-detector spiral computed tomography. J Dig Dis. 2010; 11(4): 215-223. https://doi.org/10.1111/j.1751-2980.2010.00441.x
• 24. Durand F, Valla D. Assessment of the prognosis of cirrhosis: Child-Pugh versus MELD. J Hepatol. 2005; 42(1): S100-S107. https://doi.org/10.1016/j.jhep.2004.11.015
• 25. Arya LS, Dinand V, Bakhshi S, Thavaraj V, Singh R, Dawar R. Significance of splenomegaly in childhood Hodgkin disease. J Pediatr Hematol Oncol. 2004; 26(12): 807-812.
• 26. Caglar V, Alkoc OA, Uygur R, Serdaroglu O, Ozen OA. Determination of normal splenic volume in relation to age, gender and body habitus: a stereological study on computed tomography. Folia Morphol. 2014; 73(3): 331-338. https://doi.org/10.5603/FM.2014.0038
• 27. Kalshabay Y, Zholdybay Z, Di Martino M, Medeubekov U, Baiguissova D, Ainakulova A, et al. CT volume analysis in living donor liver transplantation: accuracy of three different approaches, Insights Imaging. 2023; 14(1): 82. https://doi.org/10.1186/s13244-023-01431-8
• 28. Canan S, Bahadır A, Yıldırım Ş, Odacı E, Şahin B, Baş O, et al. Stereolojik uygulamalarda kullanılan pratik gereçler ve bilgisayar destekli stereolojik analiz cihazları. Türkiye Klinikleri Tıp Bilimleri. 2004; 24: 672-680.
• 29. Canan S, Şahin B, Ünal B, Aslan H, Bilgiç S, Kaplan S. Parçacıkların toplam sayısının hesaplanması için bir metot: parçalama. Turkiye Klinikleri J Med Sci. 2002; 22(1): 30-46.
• 30. Odacı E, Bahadır A, Yıldırım Ş, Şahin B, Canan S, Baş O, et al. Cavalieri prensibi kullanılarak bilgisayarlı tomografi ve manyetik rezonans görüntüleri üzerinden hacim hesaplanması ve klinik kullanımı. Türkiye Klinikleri Tıp Bilimleri Dergisi. 2005; 25(3): 421-428.
• 31. Royet JP. Stereology: a method for analyzing images. Prog Neurobiol. 1991; 37(5): 433-474. https://doi.org/10.1016/0301-0082(91)90009-p
• 32. Sahin B, Aslan H, Unal B, Canan S, Bilgic S, Kaplan S, Tumkaya L. Brain volumes of the lamb, rat and bird do not show hemispheric asymmetry: a stereological study. Image Analysis & Stereology. 2001; 20(1): 9-13. https://doi.org/10.5566/ias.v20.p9-13
• 33. Sahin B, Emirzeoglu M, Uzun A, Incesu L, Bek Y, Bilgic S, et al. Unbiased estimation of the liver volume by the Cavalieri principle using magnetic resonance images. Eur J Radiol. 2003; 47(2): 164-170. https://doi.org/10.1016/s0720-048x(02)00152-3
• 34. Yaşar F, İmamoğlu, T, Adam G, Erdoğan N. Manyetik rezonans görüntüleme ile karaciğer hacminin hesaplanmasında formül ve Cavalieri yönteminin karşılaştırılması. Tepecik Eğitim Araştırma Dergisi. 2011; 21(1): 19-24.
• 35. Reiner CS, Karlo C, Petrowsky H, Marincek B, Weishaupt D, Frauenfelder T. Preoperative liver volumetry: how does the slice thickness influence the multidetector computed tomography- and magnetic resonance-liver volume measurements?. J Comput Assist Tomogr. 2009; 33(3): 390-397. https://doi.org/10.1097/RCT.0b013e3181806c29
• 36. Hori M, Suzuki K, Epstein ML, Baron RL. Computed tomography liver volumetry using 3-dimensional image data in living donor liver transplantation: effects of the slice thickness on the volume calculation. Liver Transpl. 2011; 17(12): 1427-1436. https://doi.org/10.1002/lt.22419