How to Define Splenomegaly in the Diagnosis of Liver Cirrhosis? : Significance of Splenic Volume MeasurementUsing Ultrasonography = How to Define Splenomegaly in the Diagnosis of Liver Cirrhosis? : Significance of Splenic Volume MeasurementUsing Ultrasonography

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Aims: To date, there is no acceptable criteria of spleen size for the clinical diagnosis of liver cirrhosis even though the recent Baveno consensus states splenomegaly is an adjunctive finding to define liver cirrhosis. We evaluated how relevant spleen volume (SV) measured by ultrasonography is to liver fibrosis stage and investigated the optimal cut-off of SV for liver cirrhosis. Methods: Total 431 patients whose SV was measured by ultrasonography (length x height x width x π/6) and got a liver biopsy for various reasons were included in this study. Spleen volume/body surface area (SV/BSA) in each patient was used for sensitivity analysis. Fibroscan score (kPa) was compared to SV for the relation with liver fibrosis stage. Clinical and laboratory findings were also collected. Results: The baseline characteristics of the patients were as follows: mean age (49.1±12.2), slightly male predominance (223/431, 51.7%), mean BSA (1.7±0.2 m2), most common etiology of liver disease is hepatitis B (190, 44.1%), mean MELD score (9.7±4.1), Child-Pugh class [(A/B/C, 339(78.7%)/75(17.4%)/17(3.9%)], fibrosis stage [F0/F1/F2/F3/F4, 35(8.1%)/40(9.3%)/69(16.0%)/56(12.99%)/231(53.6%)]. SV was significantly larger in young age (<40), male sex, viral hepatitis, high BSA, high MELD and Child-Pugh score. SV was also well correlated with fibroscan score (r=0.509, p<0.001). Mean SV (ml) according to fibrosis stage was F0 (169±59), F1 (189±99), F2 (198±82), F3 (236±79), F4 (457±283). AUROCs of SV and SV/SBA for predicting cirrhosis were 0.891 (95% confidence interval, 0.862-0.921), 0.905 (95% CI, 0.878-0.932). Optimal cut-off of SV and SV/SBA for the diagnosis of cirrhosis were 268ml, 161ml respectively. Conclusions: SV measured by ultrasonography was closely associated with severity of liver disease and fibrosis stage. SV measurement using ultrasonography is useful as a supplementary method for the diagnosis of liver cirrhosis.