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Spleen Size in Cirrhosis of Different Etiologies o date, only a few studies have reported that measurementsof spleen size, such as maximum length and volume, vary among the different etiologies of cirrhosis1–4; the consen-sus is that alcoholic cirrhosis results in a smaller spleen than in other etiologies. Spleen size, as measured by sonography and computed tomography (CT), has been introduced as a diagnostic or prog- nostic criterion for cirrhosis and the adverse outcomes related to this devastating liver disorder.5,6The clinical implication of differentspleen sizes among the etiologic groups of cirrhosis is more pro- nounced when considering the role of spleen size in the diagnosis or prognosis of the disease and its associated complications. This con- cept raises the possibility that spleen size cutoff values, when applied as diagnostic or prognostic criteria, may vary among different eti- ologies of cirrhosis. On the other hand, most studies on spleen sizeAmir Kashani, MD, MPH, Banafsheh Salehi, MD, Deborah Anghesom, MD, MPH, Anas M. Kawayeh, MD,Glenn A. Rouse, MD, Bruce A. Runyon, MDReceived March 17, 2014, from the Department ofMedicine, Riverside County Regional Medical Center, Moreno Valley, California USA (A.K.); Department of Radiology, Loma Linda Univer- sity Medical Center, Loma Linda, California USA (B.S., G.A.R.); Department of Gastroenterology and Hepatology, VA Loma Linda Medical Center, Loma Linda, California USA 92357 (D.A.); Department of Internal Medicine, Loma Linda University Medical Center, Redlands, California USA (A.M.K.); and Department of Gastroen- terology and Hepatology, UCLA Medical Center, Santa Monica, California USA (B.A.R.). Revision requested April 22, 2014. Revised manuscript accepted for publication May 21, 2014.We thank Mark Ghamsary, PhD, MS, forguidance with the statistical analysis of this research work.Address correspondence to Amir Kashani,MD, MPH, Department of Medicine, Riverside County Regional Medical Center, 26520 Cactus Ave, Moreno Valley, CA 92555 USA.E-mail: samirkashani@yahoo.comAbbreviationsBMI, body mass index; CI, confidence inter-val; CT, computed tomographyT©2015 bytheAmericanInstituteofUltrasoundinMedicine |JUltrasoundMed2015; 34:233–238 |0278-4297 |www.aium.org ORIGINALRESEARCH Objectives—The purpose of this study was to evaluate the impact of cirrhosis etiologyon spleen size as measured by sonography and computed tomography (CT).Methods—The spleen images of 139 patients with cirrhosis secondary to alcohol abuse,hepatitis C, or nonalcoholic steatohepatitis were reviewed retrospectively. The maximum diagonal spleen length on a single sonogram and maximum spleen diameter on axial, coronal, or sagittal CT, whichever was largest, was compared among the etiologic groups.Results—In 127 patients who underwent sonography, the mean spleen size ± SD onsonography in the alcohol group (13.1 ± 2.5 cm) was significantly smaller than in the hepatitis C (15.0 ± 3.4 cm) and nonalcoholic steatohepatitis (15.2 ± 3.0 cm) groups (95% confidence intervals of the mean difference, 0.6 to 3.3 and 0.8 to 3.4 cm, respec- tively). In 87 patients who underwent CT, the mean spleen size on CT in the alcohol group (14.0 ± 2.7 cm) was smaller than in the hepatitis C (15.9 ± 3.4 cm) and nonal- coholic steatohepatitis (15.5 ± 3.6 cm) groups, but the difference was not statistically sig- nificant. The spleen sizes on both sonography and CT in 79 patients were strongly correlated (r= 0.88; P< .0001).Conclusions—Spleen size in patients with cirrhosis varies by the etiology of the disease.Therefore, to apply spleen size as a diagnostic or prognostic criterion in this context, it is important to recognize that cutoff values derived from spleen size in one etiologic group may not produce the same results when extrapolated to another etiologic group. Key Words—alcoholic; computed tomography; gastrointestinal ultrasound; hepatitisC; liver cirrhosis; nonalcoholic fatty liver disease; radiography; sonography; spleen doi:10.7863/ultra.34.2.2333402jum-179-332-online_Layout 1 1/20/15 10:12 AM Page 233
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