CT-scan Based Liver and Spleen Volume Measurement as a Prognostic Indicator for Patients with Cirrhosis

Patel, Milan; Tann, Mark; Liangpunsakul, Suthat

doi:10.1016/j.amjms.2020.10.031

Cited by 14 publications

(9 citation statements)

References 22 publications

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“…Therefore, it is particularly important to screen EGVs in patients with hepatitis B cirrhosis (HBC) in advance and prevent bleeding. The spleen in cirrhotic patients with portal hypertension can be palpated on physical examination and the volume of the spleen as measured by CT is increased, as has been demonstrated in several studies (7)(8)(9). Previous studies have shown that portal vein diameter and liver/spleen volume ratio measured by computed tomography (CT) can predict the presence of portal hypertension and EGVs (10-12).…”

Section: Discussionmentioning

confidence: 89%

Nomogram based on spleen volume expansion rate predicts esophagogastric varices bleeding risk in patients with hepatitis B liver cirrhosis

et al. 2022

Front. Surg.

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BackgroundWe aimed to explore the risk factors for hemorrhage of esophagogastric varices (EGVs) in patients with hepatitis B cirrhosis and to construct a novel nomogram model based on the spleen volume expansion rate to predict the risk of esophagogastric varices bleeding.MethodsUnivariate and multivariate logistic regression analysis was used to analyze the risk factors for EGVs bleeding. Nomograms were established based on the multivariate analysis results. The predictive accuracy of the nomograms was assessed using the area under the curve (AUC or C-index) of the receiver operating characteristic (ROC) and calibration curves. Decision curve analysis was used to determine the clinical benefit of the nomogram. We created a nomogram of the best predictive models.ResultsA total of 142 patients' hepatitis B cirrhosis with esophagogastric varices were included in this study, of whom 85 (59.9%) had a history of EGVs bleeding and 57 (40.1%) had no EGVs bleeding. The spleen volume expansion rate, serum sodium levels (mmol/L), hemoglobin levels (g/L), and prothrombin time (s) were independent predictors for EGVs bleeding in patients with hepatitis B liver cirrhosis (P < 0.05). The above predictors were included in the nomogram prediction model. The area under the ROC curve (AUROC) of the nomogram was 0.781, the C-index obtained by internal validation was 0.757, and the calibration prediction curve fit well with the ideal curve. The AUROCs of the PLT-MELD and APRI were 0.648 and 0.548, respectively.ConclusionIn this study, a novel nomogram for predicting the risk of EGVs bleeding in patients with hepatitis B cirrhosis was successfully constructed by combining the spleen volume expansion rate, serum sodium levels, hemoglobin levels, and prothrombin time. The predictive model can provide clinicians with a reference to help them make clinical decisions.

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Section: Discussionmentioning

confidence: 89%

Nomogram based on spleen volume expansion rate predicts esophagogastric varices bleeding risk in patients with hepatitis B liver cirrhosis

et al. 2022

Front. Surg.

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“…In a subsequent analysis of the same cohort, Patel et al assessed the value of splenic volume and LSR. They found a significant correlation between a larger spleen and transplantation and mortality, but the correlation was not significant when age and MELD score were incorporated into the analysis [ 55 ].…”

Section: Methodsmentioning

confidence: 99%

“…The presence and risk of bleeding of gastroesophageal varices represent an important part of the initial assessment and monitoring of CLD patients with portal hypertension [ 89 ]. Studies utilising volumetry for assessment of this specific outcome are summarised in Supplementary Table 5 [ 30 , 33 – 38 , 55 , 57 , 108 – 114 ]. Kim et al assessed CLD patients for the presence of varices and the development of variceal bleeding.…”

Section: Methodsmentioning

confidence: 99%

The impact of hepatic and splenic volumetric assessment in imaging for chronic liver disease: a narrative review

Kutaiba,

Chung,

Goodwin

et al. 2024

Insights Imaging

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Chronic liver disease is responsible for significant morbidity and mortality worldwide. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) can fully visualise the liver and adjacent structures in the upper abdomen providing a reproducible assessment of the liver and biliary system and can detect features of portal hypertension. Subjective interpretation of CT and MRI in the assessment of liver parenchyma for early and advanced stages of fibrosis (pre-cirrhosis), as well as severity of portal hypertension, is limited. Quantitative and reproducible measurements of hepatic and splenic volumes have been shown to correlate with fibrosis staging, clinical outcomes, and mortality. In this review, we will explore the role of volumetric measurements in relation to diagnosis, assessment of severity and prediction of outcomes in chronic liver disease patients. We conclude that volumetric analysis of the liver and spleen can provide important information in such patients, has the potential to stratify patients’ stage of hepatic fibrosis and disease severity, and can provide critical prognostic information. Critical relevance statement This review highlights the role of volumetric measurements of the liver and spleen using CT and MRI in relation to diagnosis, assessment of severity, and prediction of outcomes in chronic liver disease patients. Key Points Volumetry of the liver and spleen using CT and MRI correlates with hepatic fibrosis stages and cirrhosis. Volumetric measurements correlate with chronic liver disease outcomes. Fully automated methods for volumetry are required for implementation into routine clinical practice. Graphical Abstract

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“…The SLD was defined as the length of the superior pole to the inferior line of the spleen at the plane of maximum surface area. The PVD needs to be measured at the midpoint between the portal vein bifurcation site and the vein confluence site[ 24 ].…”

Section: Methodsmentioning

confidence: 99%

Non-invasive model for predicting high-risk esophageal varices based on liver and spleen stiffness

Yang¹,

Gao²,

Li³

et al. 2023

World J Gastroenterol

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BACKGROUND Acute bleeding due to esophageal varices (EVs) is a life-threatening complication in patients with cirrhosis. The diagnosis of EVs is mainly through upper gastrointestinal endoscopy, but the discomfort, contraindications and complications of gastrointestinal endoscopic screening reduce patient compliance. According to the bleeding risk of EVs, the Baveno VI consensus divides varices into high bleeding risk EVs (HEVs) and low bleeding risk EVs (LEVs). We sought to identify a non-invasive prediction model based on spleen stiffness measurement (SSM) and liver stiffness measurement (LSM) as an alternative to EVs screening. AIM To develop a safe, simple and non-invasive model to predict HEVs in patients with viral cirrhosis and identify patients who can be exempted from upper gastrointestinal endoscopy. METHODS Data from 200 patients with viral cirrhosis were included in this study, with 140 patients as the modelling group and 60 patients as the external validation group, and the EVs types of patients were determined by upper gastrointestinal endoscopy and the Baveno VI consensus. Those patients were divided into the HEVs group (66 patients) and the LEVs group (74 patients). The effect of each parameter on HEVs was analyzed by univariate and multivariate analyses, and a non-invasive prediction model was established. Finally, the discrimination ability, calibration ability and clinical efficacy of the new model were verified in the modelling group and the external validation group. RESULTS Univariate and multivariate analyses showed that SSM and LSM were associated with the occurrence of HEVs in patients with viral cirrhosis. On this basis, logistic regression analysis was used to construct a prediction model: Ln [P/(1-P)] = -8.184 -0.228 × SSM + 0.642 × LSM. The area under the curve of the new model was 0.965. When the cut-off value was 0.27, the sensitivity, specificity, positive predictive value and negative predictive value of the model for predicting HEVs were 100.00%, 82.43%, 83.52%, and 100%, respectively. Compared with the four prediction models of liver stiffness-spleen diameter to platelet ratio score, variceal risk index, aspartate aminotransferase to alanine aminotransferase ratio, and Baveno VI, the established model can better predict HEVs in patients with viral cirrhosis. CONCLUSION Based on the SSM and LSM measured by transient elastography, we established a non-invasive prediction model for HEVs. The new model is reliable in predicting HEVs and can be used as an alternative to routine upper gastrointestinal endoscopy screening, which is helpful for clinical decision making.

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CT-scan Based Liver and Spleen Volume Measurement as a Prognostic Indicator for Patients with Cirrhosis

Cited by 14 publications

References 22 publications

Nomogram based on spleen volume expansion rate predicts esophagogastric varices bleeding risk in patients with hepatitis B liver cirrhosis

Nomogram based on spleen volume expansion rate predicts esophagogastric varices bleeding risk in patients with hepatitis B liver cirrhosis

The impact of hepatic and splenic volumetric assessment in imaging for chronic liver disease: a narrative review

Non-invasive model for predicting high-risk esophageal varices based on liver and spleen stiffness

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