Prognostic role of spleen volume measurement using computed tomography in patients with compensated chronic liver disease from hepatitis B viral infection
Yoo J., Kim S.W., Lee D.H., Bae J.S., Cho E.J.
European Radiology. March 2021; 31(3):1432-42.
DOI: 10.1007/s00330-020-07209-6 PMID: 32880698
Predict the development of decompensation (considered as the presence of variceal bleeding, ascites, jaundice, or encephalopathy) in patients with compensated chronic liver disease (cCLD) is important because it is one of the main determinants of survival (1). Furthermore, the risk of hepatocellular carcinoma (HCC) (2,3) or death (4,5) is higher in the decompensated stage than in compensated one.
The authors of this study have investigated retrospectively the prognostic role of spleen volume measurement in patients with compensated chronic liver disease (cCLD) from chronic hepatitis B (CHB), particularly regarding the occurrence of HCC, the development of decompensation, and overall survival (OS), since splenomegaly is a common finding in patients with cirrhosis and portal hypertension (6).
A total of 584 patients underwent contrast-enhanced multiphasic liver CT scan, including quadruple-phase with pre-contrast, late arterial phase (LAP), portal venous phase (PVP), and delayed phase (DP) for surveillance of HCC were included. The inclusion criteria include patients with CLD from CHB with Child-Pugh class A liver function without ascites, previous history of HCC treatment or hepatic decompensation, and absence of concomitant serious medical illness; who pursued at least more than 5 years of follow-up after the CT examination date without HCC occurrence, the development of decompensation, or death.
The PVP images were used to measure the spleen. Unidimensional measurement size was performed by a board-certified radiologist. The longest dimension between the poles of the spleen was manually measured and recorded. The same radiologist, performed volumetric analysis independently using a semi-automated volumetric software program that was approved for liver volumetry. In each patient, less than 1 minute was needed for spleen volume measurement.
Spleen length and volume were successfully measured in all patients. Mean spleen length ± standard deviation (SD) was 116.1 ± 23.3 mm, and mean spleen volume ± SD was 333.0 ± 216.4 mL (range, 40.5– 2206.1 mL).
During a median follow-up period of 92 months, HCC occurred in 114 of 584 patients (19.5%), 30 patients (5.1%) experienced hepatic decompensation, and 23 patients (3.9%) died. Multivariate analysis revealed that spleen volume was an independent prognostic factor for HCC occurrence (hazard ratio (HR) = 1.01, 95% confidence interval = 1.01–1.01, p = 0.009), was a significant predictive factor for hepatic decompensation (HR = 1.01, 95% CI = 1.01–1.01, p = 0.005) and also was an independent predictor of OS (HR = 1.01, 95% CI = 1.01–1.01, p = 0.007). The optimal cutoff spleen volume was set at 532 mL for HCC occurrence, 656.9 mL for the development of decompensation, and 741.1 mL for OS. Conversely, the results after multivariate analysis were not statistically significant for spleen length. In this study, larger spleen volume was a significant risk factor for the development of HCC, decompensation, and death in CHB patients.
We believe that this study is relevant because although US is currently the surveillance imaging modality of choice for HCC in patients at high risk (7,8), multiphasic CT scans are frequently performed. To measure the spleen volume could be easily acquired using a semi-automated 3D volumetric software program, and would provide relevant prognostic information regarding HCC occurrence, the development of decompensation, and OS.
The study had some limitations. Firstly, there may be a potential risk of selection bias owing to the retrospective design of this study, particularly since patients that were enrolled had cCLD from CHB, and underwent multiphasic liver CT scans for HCC surveillance. Secondly, only patients with cCLD from CHB were studied, consequently, further studies in patients with other etiologies of chronic liver disease are needed to extrapolate the results on the prognostic role of splenic volume.
In conclusion, spleen volume obtained using CT and semi-automated 3D volumetry software can provide prognostic information easily to obtain in patients with cCLD from CHB, regarding the probability of HCC occurrence, development of decompensation, and death.
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Vicente Belloch-Ripollés is a second-year radiology resident at the Hospital Universitari i Politècnic La Fe in Valencia, Spain. Dr. Belloch-Ripollés graduated at Universitat de Valencia with merit in June 2018. He has a wide range of interests in diagnostic imaging and is considering pursuing his career in abdominal radiology, with a special focus on liver imaging.
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