Reliability and validity of splenic volume measurement by 3-D ultrasound

Measuring intraobserver and intermethod reliability of endometriotic cyst volumes: A comparison between MRI and 3D transvaginal ultrasound in endometriosis

Objectives:

To identify the intraobserver and intermethod reliability of three-dimensional transvaginal ultrasound (3D-TVUS) using the software VOCAL and XI VOCAL compared with magnetic resonance imaging (MRI) for volumetric measurement of ovarian endometrioma.

Methods:

The intermethod and intraobserver reliability of endometrioma volumes were assessed in 16 women diagnosed with endometriosis through laparoscopy with histologic confirmation and presenting with uni- or bilateral endometriomas. In total, volumes of 23 endometriomas were assessed with two-dimensional and three-dimensional transvaginal ultrasound and 6 mm magnetic resonance imaging. Examinations took place at two moments in one menstrual cycle: day 2–4 (T0) and day 20–22 (T1).

Results:

The intraclass correlation for intraobserver reliability is good to very good for all three techniques ranging from the lowest value of 0.953 to the highest of 1.000. MRI has the most narrow limits of agreement (−3.93 to 4.53), followed by XI VOCAL (−5.16 to 5.65) while VOCAL has the widest limits of agreement (−10.22 to 11.39). Intraclass correlations are poor in the comparison of XI VOCAL to MRI, moderate between VOCAL and XI VOCAL, and good for the comparison between VOCAL and MRI. Limits of agreement vary per technique. When comparing 3D imaging techniques with 2D TVUS, XI VOCAL versus 2D TVUS provide the smallest limits of agreement.

Conclusions:

MRI and XI VOCAL provide the best intraobserver reliability. The different imaging techniques are not interchangeable. As TVUS is a more readily available and cost-efficient imaging technique the usage of XI VOCAL is advised.

Ultrasonography in the diagnosis of complications in patients with portal hypertension

This review focuses on ultrasonography (US) to diagnose patients with complications in portal hypertension. Clinicians first use US to evaluate patients with suspected portal hypertension, because US is quick, simple, and radiation free. US is necessary for grading and performing paracentesis for ascites. Doppler US-based detection of reverse splanchnic vein flow or the presence of a spontaneous portosystemic shunt is highly specific in patients with cirrhosis. Since it is important to estimate spleen size in patients with portal hypertension, spleen size is usually measured by US. Spleen volume can be more accurately measured with 3D-US. Estimation of viable residual splenic volume after partial splenic embolization should be limited to cases with total splenic volume less than 1000 ml. Portal vein thrombosis is often detected during the US examination performed when symptoms first appear or during the follow-up. Two-dimensional transthoracic echocardiography is an excellent noninvasive screening test in patients with pulmonary portal hypertension who can undergo it. By measuring the maximum and minimum diastolic blood flow velocities in the renal arteries using renal color Doppler US, the pulsatility index (PI) and resistive index (RI) can be calculated. The PI and RI in cirrhotic patients were significantly higher than those in healthy subjects and patients with chronic hepatitis, and showed a significant positive correlation with the Child-Pugh Score. In conclusion, US is an essential tool for the diagnosis and treatment of patients with portal hypertension.

Lusutrombopag Reduces Need for Platelet Transfusion in Patients With Thrombocytopenia Undergoing Invasive Procedures

BACKGROUND & AIMS

Platelet transfusion is used to prevent hemorrhagic events in patients with thrombocytopenia undergoing invasive procedures, but there are many disadvantages. We evaluated the efficacy and safety of lusutrombopag in patients with chronic liver disease and thrombocytopenia undergoing invasive procedures.

METHODS

We performed a double-blind, parallel-group, phase 3 study of 96 patients with chronic liver disease and thrombocytopenia (platelet counts below 50,000/μL) undergoing invasive procedures from October 2013 to May 2014 at 81 centers in Japan. Patients were randomly assigned (1:1) to groups given once-daily lusutrombopag (3 mg) or placebo for up to 7 days. The primary efficacy endpoint was the proportion of patients not requiring platelet transfusion before the invasive procedure. The protocol-defined response (platelet count 50,000/μL or more with an increase of 20,000/μL or more from baseline) and the time course of the change in platelet count were also evaluated. Adverse events were recorded.

RESULTS

The proportions of patients who did not require preoperative platelet transfusion were 79.2% (38/48) in the lusutrombopag group and 12.5% (6/48) in the placebo group (P < .0001). A response was observed in 77.1% (37/48) of patients in the lusutrombopag group and 6.3% (3/48) of patients in the placebo group (P < .0001). In the lusutrombopag group without platelet transfusion, the median platelet count was 50,000/μL or more after 5 days; the mean time to reach the maximum platelet count was 13.4 days; and the number of days (adjusted mean) during which the platelet count was 50,000/μL or more was 21.09 days. Adverse drug reactions were reported in 8.3% of patients in the lusutrombopag group and 2.1% of patients in the placebo group. Two patients (1 per group) had a thrombotic event, but neither were associated with an excessive increase in platelet count (200,000/μL or more).

CONCLUSION

In a placebo-controlled trial, lusutrombopag was effective in achieving and maintaining the target platelet count in patients with chronic liver disease and thrombocytopenia undergoing invasive procedures. No significant safety concerns were raised. Japanese clinical trial registration no: JapicCTI-132323.

Relationship between response to lusutrombopag and splenic volume

AIM

To assess the correlation between the efficacy of lusutrombopag and clinical characteristics in patients with chronic liver disease.

METHODS

In this retrospective, multicenter study, which conducted at four locations in Japan, 50 thrombocytopenic patients with chronic liver disease were enrolled. All patients received oral lusutrombopag (3.0 mg/d for 7 d) for chronic liver disease. We assessed the increase in platelet count after the trial drug administration. A treatment response was defined as a platelet count ≥ 5 × 104/μL and an increased platelet count ≥ 2 × 104/μL from baseline after drug administration. We evaluated the response to lusutrombopag compared to baseline clinical characteristics in patients with chronic liver disease.

RESULTS

The numbers of responders and non-responders were 40 (80.0%) and 10 (20.0%), respectively. The patients were divided into a responder and non-responder group, and we added factors that may correspond to successful treatment with lusutrombopag. Splenic volume and body weight were lower in the responder group than in the non-responder group. White blood cell count and hemoglobin level were higher in responders compared with non-responders. Using a logistic regression model to assess the relationship between response to lusutrombopag and clinical characteristics, multivariate analysis confirmed that splenic volume was an independent factor that predicted the response of platelet counts (P = 0.025; odds ratio = 11.2; 95% confidence interval: 1.354-103.0). Splenic volume negatively correlated to changes in platelet count (r = -0.524, P = 0.001).

CONCLUSION

Splenic volume influences the change in platelet counts after administration of lusutrombopag in patients with chronic liver disease.

The Liver Segmental Volume Ratio for Noninvasive Detection of Cirrhosis: Comparison With Established Linear and Volumetric Measures

OBJECTIVE

The aim of this study was to compare the liver segmental volume ratio (LSVR), a novel volumetric computed tomography measurement, with established linear measurements for differentiating normal from cirrhotic livers.

METHODS

Hepatic volumes were measured using semiautomated software (Liver Analysis Application, Philips IntelliSpace Portal) on contrast-enhanced abdominal computed tomography scans in 312 adults, including 108 patients with end-stage liver disease (mean age, 55 years; 63 men/45 women) and 204 healthy controls (potential renal donors; mean age, 46 years; 82 men/122 women). The LSVR was defined as the volume ratio of Couinaud segments I to III to segments IV to VIII. Linear measures included the caudate-to-right lobe ratio and maximal splenic dimension.

RESULTS

Differences in LSVR between cirrhotics and controls were highly significant (P < 0.0001; mean, 0.55 ± 0.29 versus 0.27 ± 0.07; receiver operating characteristic [ROC] area under the curve [AUC], 0.916). Linear caudate-to-right lobe ratio differences were not statistically significant between the 2 cohorts (P = 0.051; ROC AUC, 0.567). Total liver volume was ineffective for discrimination (ROC AUC, 0.598). An LSVR threshold of 0.35 or greater had a sensitivity and specificity for cirrhosis of 81.5% and 88.7%, respectively.

CONCLUSIONS

Regional hepatic volume changes, as reflected by the LSVR, are more effective than standard linear measures or total liver volume for differentiating cirrhotic from normal livers.

Reference ranges of fetal spleen biometric parameters and volume assessed by three-dimensional ultrasound and their applicability in spleen malformations

AIM

The aims of this article are to establish three-dimensional ultrasonographic nomograms of normal fetal spleen size and to evaluate the clinical application value.

METHODS

An observational, cross-sectional study was performed on 455 women with a normal singleton pregnancy between 18 and 38 weeks' gestational age (GA). Fetal spleen volume was measured using three-dimensional ultrasound equipped with virtual organ computer-aided analysis, and biometric parameters were assessed in multiplanar mode to create reference ranges to GA. Thirty cases were randomly selected to conduct reliability analyses via intraobserver and interobserver ultrasonographic measurement. Moreover, 50 cases of suspected splenic malformations were evaluated by the newly established nomograms and followed up subsequently.

RESULTS

Using regression formulas, we found that fetal spleen size increased with GA. We observed strong reliability in intraobserver and interobserver volume measurements with intraclass correlation coefficients of 0.994 and 0.962. Bland-Altman analyses showed narrow limits of agreement [intraobserver: (-3.2 to 3.5)%; interobserver: (-3.2 to 4.3)%]. Of the 50 cases with suspected splenic malformations, six cases of splenomegaly and one case of splenic cyst were diagnosed.

CONCLUSION

Three-dimensional ultrasound nomograms of normal fetal spleen size across a range of GA have a strong diagnostic value. Volume measurements with good reliability were optimal in clinical practice.

Standard Splenic Volume Estimation in North Indian Adult Population: Using 3D Reconstruction of Abdominal CT Scan Images

A prospective study was carried out to establish normative data for splenic dimensions in North Indian population and their correlation with physical standard on abdominal CT of 21 patients aged between 20 and 70 years having no splenic disorders. Splenic volume was measured by two methods—volume and surface rendering technique of Able 3D doctor software and prolate ellipsoid formula. Volumes measured by both the techniques were correlated with their physical standards. Mean splenic volume was 161.57 ± 90.2 cm³ and range 45.7–271.46 cm³. The volume of spleen had linear correlation with body height (r = 0.512, P < .05). Splenic volume (cm³) = 7 × height (cm) − 961 can be used to generate normal standard volume of spleen as a function of body height in North Indian population (with 95% confidence interval). This formula can be used to objectively measure the size of the spleen in adults who have clinically suspected splenomegaly.