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. 2022 Oct;10(8):805-816.
doi: 10.1002/ueg2.12301. Epub 2022 Sep 6.

Liver and spleen volumes are associated with prognosis of compensated and decompensated cirrhosis and parallel its natural history

Mario Romero-Cristóbal  1 , Ana Clemente-Sánchez  1   2 , María-Isabel Peligros  3 , Enrique Ramón  4 , Ana-María Matilla  1   2 , Arturo Colón  5 , Sonia Alonso  1   2 , María-Vega Catalina  1 , Ainhoa Fernández-Yunquera  1 , Aranzazu Caballero  1 , Rita García  2   6 , Jose Ángel López-Baena  5 , María-Magdalena Salcedo  1   2   7 , Rafael Bañares  1   2   7 , Diego Rincón  1   2   7
Affiliations

Liver and spleen volumes are associated with prognosis of compensated and decompensated cirrhosis and parallel its natural history

Mario Romero-Cristóbal et al. United European Gastroenterol J. 2022 Oct.

Abstract

Objective: Cirrhosis is characterized by the complex interplay among biological, histological and haemodynamic events. Liver and spleen remodelling occur throughout its natural history, but the prognostic role of these volumetric changes is unclear. We evaluated the relationship between volumetric changes assessed by multidetector computerised tomography (MDCT) and landmark features of cirrhosis.

Methods: We included consecutive cirrhotic patients who underwent liver transplantation (LT) or hepatocellular carcinoma (HCC) resection in whom dynamic MDCT was available. Different volumetric indices were calculated. Fibrosis was evaluated by the collagen proportional area and Laennec sub-stages. Correlation and logistic regression analysis were performed to explore associations of volumetric indexes and fibrosis with key prognostic features across the clinical stages of cirrhosis.

Results: 185 patients were included (146 LT; 39 HCC); the predominant aetiology was viral hepatitis (51.35%); 65.9% had decompensated disease and 85.08% clinically significant portal hypertension (CSPH). The standardised liver volume and liver-spleen volume ratio negatively correlated with Model for End-stage Liver Disease (MELD), albumin and hepatic venous pressure gradient (HVPG) and were significantly lower in decompensated patients. The liver segmental volume ratio (segments I-III/segments IV-VIII) best captured the characteristic features of the compensated phase, showing a positive correlation with HVPG and a good discrimination between patients with and without CSPH and varices. Volumetric changes and fibrosis severity were independently associated with key prognostic events, with no association between these two parameters.

Conclusions: Liver and spleen volumetric indices evolve differently along the natural history of cirrhosis and are associated with key prognostic factors in each phase, regardless of fibrosis severity and portal hypertension.

Keywords: cirrhosis; fibrosis; natural history; portal hypertension; tomography.

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Conflict of interest statement

No conflict of interest to declare.

Figures

FIGURE 1
FIGURE 1
Association between visceral volume indices, clinical events and variables related to liver failure. LSVR, liver segmental volume ratio (segments I‐III/segments IV‐VIII); LV/SV, liver to spleen volume (SV) ratio; MELD, model for end stage liver disease; SdLV, standardised liver volume (LV) according to height and weight
FIGURE 2
FIGURE 2
Association between visceral volume indices and variables related to portal hypertension. CSPH, clinically significant portal hypertension; HVPG, hepatic venous pressure gradient; LSVR, liver segmental volume ratio (segments I‐III/segments IV‐VIII); LV/SV, liver to spleen volume (SV) ratio; SdLV, standardised liver volume (LV) according to height and weight
FIGURE 3
FIGURE 3
Association between volume indices and severity of fibrosis. CPA, collagen proportional area; LSVR, liver segmental volume ratio (segments I‐III/segments IV‐VIII); LV/SV, liver to spleen volume (SV) ratio; SdLV, standardised liver volume (LV) according to height and weight
FIGURE 4
FIGURE 4
Comparison of SdLV distribution in patients with and without clinical decompensation across fibrosis stages according to the Laennec classification (a) and consecutive quartiles of collagen proportional area (CPA) (%) (b). CPA, collagen proportional area; SdLV, standardised liver volume (LV) according to height and weight
FIGURE 5
FIGURE 5
Variation of fibrosis‐free liver volume (Ff‐LV) according to the loss of portal tracts and central veins. Ff‐LV, standardised fibrosis‐free liver volume
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