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A Novel, Simple Method of Functional Spleen Volume Calculation by Liver-Spleen Scan

Liver Disease Program, Department of Medicine
Division of Nuclear Medicine, Department of Radiologic Sciences, University of California, Irvine/Medical Center, Orange, California
Department of Pathology, University of Southern California School of Medicine, Los Angeles, California
PET Imaging Center Biomed Research Foundation of Northwest Louisiana, Shreveport, Louisiana

Correspondence: For correspondence or reprints contact: John C. Hoefs, MD, Liver Disease Program, Department of Medicine/Gastrointestinal Division, University of California, Irvine/Medical Center, Bldg. 53, Rte. 81, Orange, CA 92868.

ABSTRACT

Spleen enlargement is commonly associated with portal hypertension from cirrhosis and may cause thrombocytopenia. Thus, accurate assessment of spleen size may be helpful in the clinical evaluation. Spleen length is not a precise estimate of spleen size because of the variation in spleen configuration and, spleen volumes measured by edging techniques can be tedious. We present a new method of measuring the functional spleen volume by liver-spleen scan (LSSs), validation experiments and some clinical data. Methods: The method involves measurement of the total spleen counts by SPECT and divding by a representative voxel concentration on a single frame to obtain the organ volume. Validation included phantom studies and clinical evaluation in 443 consecutive patients, including 216 with histological assessments of chronic liver disease (CLD) and 11 healthy volunteers. Results: A calibration factor determined from phantoms was used to convert the calculated volume (CV) to the "true" volume (V) V: = CV (0.956) – 66.5 (r = 0.9991; P < 0.001). The volume calculations were validated in a second group of phantoms (r = 0.981; P < 0.0001). Spleen volumes were expressed as volume (cm³) and as volume per pound ideal body weight (IBW (cm³/lb) (the conversion factor to convert cm³/lb IBW to cm³/kg IBW is 2.2). Clinical studies of reproducibility included demonstration of a significant (P < 0.0001) linear correlation between volumes calculated from repeat USSs within 9 mo of the initial LSS in 11 healthy volunteers and 32 patients with CUD: y = 1.02x – 25; r = 0.968. The correlation with spleen volumes from autopsy or splenectomy was significant y = 0.766x + 57; r = 0.845; P < 0.001. The normal spleen volumein 11 patients was 201 ± 77 cm³ and 1.43 ± 0.68 cm³/lb IBW (upper limits of normal: 335 cm³ or 2.5 cm³/lb IBW). In 443 consecutive LSSs over 15 mo, half of the patients had spleen volumes above the upper limits of healthy volunteers, and CLD was present in 90.9% of these patients. In 216 patients with histologically proven liver disease, a progressive increase in the percentage of spleen volumes above the upper limits of normal was noted from no fibrosis (10%) to mild to moderate fibrosis (36.7%) to early cirrhosis (52%) to advanced liver disease (75%). The correlation of spleen volume with platelet count was excellent (r = 0.7635; P < 0.005). Conclusion: This novel spleen volume measurement detects serious liver disease and correlates with splenic hyperfunction.

Key Words: liver-spleen scan • spleen volume • chronic liver disease • sulfur colloid • reticuloendothelial cell

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