Академический Документы
Профессиональный Документы
Культура Документы
Downloaded from www.ajronline.org by 82.208.160.174 on 01/13/17 from IP address 82.208.160.174. Copyright ARRS. For personal use only; all rights reserved
OznurL.Konu@1 OBJECTIVE. The objectiveof this studywas to determinethe normal rangeof dimen
Ay@egüI
Ozdemir sions for the liver, spleen, and kidney in healthy neonates, infants, and children.
AlaaddinAkkaya SUBJECTS AND METHODS. This prospectivestudyinvolved307 pediatricsubjects
(169 girls and 138 boys) with normal physicalor sonographicfindingswho were examined
GoncaErba@
becauseof problems unrelated to the measuredorgans. The subjects were 5 days to 16 years
Had çelik
old. All measured organs were sonographically normal. At least two dimensions were ob
SedatI@lk tamed for each liver, spleen, and kidney. Relationships of the dimensions of these organs with
sex, age, body weight, height, and body surface area were investigated. Suggested limits of
normal dimensions were defined.
RESULTS. Dimensionsof the measuredorganswere notstatisticallydifferentin boysand
girls. Longitudinaldimensionsof all threeorgansshowedthe bestcorrelationwith age,body
weight, height, and body surface area. Height showed the strongest correlation of all. This
correlationwasa polynomialcorrelation.
CONCLUSION. Determinationof pathologicchangesin sizeof the liver,spleen,andkid
ney necessitates knowing the normal range of dimensions for these organs in healthy neonates,
infants, and children. Presented data are applicable in daily routine sonography. Body height
should be considered the best criteria to correlate with longitudinal dimensions of these organs.
S onography provides a quick as growth curves (who were not in the third to 97th
sessment of visceral organ di percentiles)were not includedin the study.Another
mensions without any risk of major criterion for selection of children was having
no clinically or sonographically pathologic findings
radiation. The normal range of visceral organ
related to the studied organs. Most children were
sizes in adults and children determined with
completely healthy. although some were undergo
sonography has been reported elsewhere [ I—¿
ing follow-up for a disease unrelated to the mea
13]. However, available data are limited for sured organs, such as hip dysplasiaor undescended
the liver and the spleen in children, which testes. No child had a history of oncologic, hemato
causes difficulty in defining hepatomegaly logic, or traumatic conditions. Some children with
and splenomegaly sonographically. urinarytract infectionwereincludedin the study,
Our purposewas primarily to document butonly liverandspleendimensionswererecorded
the normal range of dimensions of the liver inthosepatients. Wealsodidnotrecorddimensions
in children. The relationship of each dimen of a number of spleens for which abdominal gas
AJR:171,December1998 1693
Konu@etal.
planes for the right and left lobes. “¿Midsagiual the next zero or five integer values above the 95th
plane―means that the plane passes through the percentile, considering also the mean, minimum, Jver I Imenslons as
xiphoid process. In both planes, the upper margin of and maximum values of normal [I 1. Revealed by Sonography In
the liver was defined as the uppermost edge under I Pediatric Subjects
the dome of the diaphragm, whereas the lower mar
gin was defined as the lowermost edge of the lobe Results RightLobe Left Lobe
BodyParameter
Downloaded from www.ajronline.org by 82.208.160.174 on 01/13/17 from IP address 82.208.160.174. Copyright ARRS. For personal use only; all rights reserved
A B
Fig.1.—Diagrams
showhowlongitudinal
andanteroposteriordimensionsofliverlobesweremeasured. Fig.2.—Diagram
showshowIon Fig.1—Diagramshows
A,Livermeasurements
wereperformedatmidclavicularandmidlinesagittal
planes. gitudinalandtransverse
dimen how longitudinaland
B,Longitudinal
andanteroposterior
dimensions
of rightandleftlobesweremeasured. sionsof spleenweremeasuredin transverse dimensions
coronal section passing through of kidney were mea
splenichilum. suredincoronalsection
passingthrough renal
hilum.
Fig.4.—Scatter
diagram organs without the risk of ionizing radiation.
shows longitudinal(•) Organ volumes or ratios obtained by using
and anteroposterior (0)
dimensions of right lobe various organ dimensions and body surface ar
of liver plotted against eas are already used in correlation with body
heights of patients. Note parameters to describe the normal dimensions
that longitudinal dimen
andto measurethe degreeof pathologic devia
Downloaded from www.ajronline.org by 82.208.160.174 on 01/13/17 from IP address 82.208.160.174. Copyright ARRS. For personal use only; all rights reserved
j—-••—@——.@—100
120
@
@ .-@. . . 4 ..—
(cm)Hei
ght Height(cm)
Fig.5.—Scatter
diagramshowslongitudinal(•)
andanteroposterior
(o) dimen Fig.6.—Scatter
diagram showslongitudinal (•)
andtransverse
(0) dimensions
of
sions of left lobe of liver plotted against heights of patients. Note that longitudinal spleenplottedagainstheightsof patients.
dimensions of left lobe are shorter than anteroposterior dimensions at patient
heights of less than 70 cm but longer at patient heights of morethan 70 cm.
E
E
a..
a,
C
•¿C
.C
@,
0 20 40 60 80 100120Height 140 160 180 200 0 20 40 60 80 100 120 140 160 180 200
(cm) Height(cm)
Fig.1.—Scatter
diagram
showslongitudinal
(•)
andtransverse
(o) dimensions
of Fig.8.—Scatter
diagramshowslongitudinal(•)
andtransverse(0) dimensionsof
right kidney plotted against heights of patients. left kidneyplottedagainstheightsof patients.Leftkidneydimensionsarelonger
thanrightkidneydimensions, asseenin comparison withFigure7.
AJR:171,December1998 1695
Konu@etal.
ILongitudinal
Dimensions
ofRight
Lobe
ofUver
Versus
Height
and
Age
Subjects LongitudinalDimensions(mm)of RightLobeof Liver
Normal5th95thLowermostUppermost47—64
BodyHeight Range . Limitsof
Minimum. MaximumPercentileSuggested
(cm)No.Age (mo)MeanSD.
Downloaded from www.ajronline.org by 82.208.160.174 on 01/13/17 from IP address 82.208.160.174. Copyright ARRS. For personal use only; all rights reserved
•¿I@1:1@@LongItudInaI
AgeSubjectsLongitudinal
Dimensionsof Left KidneyVersus Height and
KidneyBody Dimensions (mm) of Left
Normal5th95thLowermostUppermost48—64
Height Range -
Limitsof
Minimum. MaximumPercentileSuggested
(cm)No.Age (mo)MeanSD-
Downloaded from www.ajronline.org by 82.208.160.174 on 01/13/17 from IP address 82.208.160.174. Copyright ARRS. For personal use only; all rights reserved
determining factor for organ dimensions in direct roentgenography in 350 children to es In the study of Markisz et al. [4] that in
the pediatric age group. tablish normal liver dimensions. They found cluded 116 children, liver and spleen dimen
In most other studies, sizes between the significantly longer dimensions than we did. sions obtained with scintigraphic methods
fifth and the 95th percentile were the ac The reason for the difference is obviously the also exceeded ours. Those authors used vol
cepted normal limits [2, 3, 5, 6, 8—10,13]. magnification factor on radiographs. ume measurements and found a high linear
However, this practice results in approxi Somefindings are contradictoryeven within correlation between the volumes of these or
mately 10% of children with normal visceral onestudy.Forexample,in the studyof Holder et gans and patient weights. Correlations with
organ sizes falling outside these limits [1 1]. al. [2], which included 185children,sonograph age were lessevident. Patient height or organ
Besides, although plus or minus two SDs are ically measureddimensionsof the liver are an dimensions were not consideredin their study
the accepted equivalents of the fifth and 95th averageof 4 cm smaller than the samedimen and limits of normal cannot be derived. From
percentile values statistically [15], some sions measured scintigraphically. Our sono the study of Markisz et al. (like the study of
studies were based on plus or minus one SD graphicallymeasuredliver dimensionsarelarger Holder et al. [2]), we conclude that scinti
[7]. For this reason,we preferredto define than those of Holder et al. The reason is proba graphically obtained organ sizes are larger
the normal lowermost and uppermost longi bly their techniqueof measurement.They used than sonographically obtained ones. There
tudinal dimensions of the studied organs us linear transducersand performed the measure fore, differences in organ size are probably
ing the method originally described by ments in a sagittal plane passing through the due to the difference of imaging techniques.
Rosenberget al. [ 11in 1991. midpoint of the liver's right and left margins. In 1983, Niederau et al. [13] described a
We foundthatheightshowsthebestcorre Linear transducers,becauseof the interposition study of normal liver dimensions in 1000
lation with any one of the mentioned organ of lung betweenthe dome of the liver and the adult patients. Sonographically, their study
dimensions. Body surface area also shows a anteriorabdominalwall, preventsomeof the su showed smaller values than ours. This differ
high correlation with organ dimensions, but perior portion of the liver from being observed. ence is probably the result of the same tech
to a lesser degree. However, its derivation is This effect,asHolder admits,resultsin the “¿obnical reason we discussed with respect to the
not as practical as height. For those reasons, served― lung—liver
border'sbeing determinedas study of Holder et al. [2]. Niederau et al.
we preferred not to use body surface area in the superior margin of the liver, and conse noted that organ sizes increased with height
standard tables and graphics. Age and body quently in the liver's being measuredas having and body surface area in adults.
weight are not as important as height and smaller longitudinal dimensions than the livers In 1983, Dittrich et al. [3] also used
body surface area.Therefore, when deciding we measured.Convex probes,such as the one sonography to study liver dimensions in 194
if sonographically obtained dimensions of an we used, prevent this complication. Besides, un children. Although they reported smaller di
organ are normal, patient height should be like Holderet al.,we believethatthemidpoint of mensions than we did, Dittrich et al. noted
the primary concern. the liver's right and left margins cannot be re the best correlation was found between liver
The liver is an organ of complex shape ferred to as a standard sagittal plane because the dimensions and height, which is a linear cor
and varies widely from patient to patient. left lobe in particular differs in extensionand relation. They found also a high correlation
Our wide range of normal dimensionssup size from one personto anotherand with age. with body surface area, but in their study
ports this opinion. However, it is necessary Instead, midsagittal and midclavicular planes only height was used as a reference parame
to have references for normal liver dimen seem more appropriate for longitudinal liver size ter for further analysis.
sions in the pediatric age group. measurements. In spite of these technical differ Normal spleen dimensions and volume
The findings of various similar studies dif ences, Holder et al. also concluded that height is standards have been investigated by only a
fer somewhat from each other and from ours. the best-correlatedbody parameterwith liver few researchers.Rosenberg et al. [1] studied
Deligeorgis et al. [12] performed a study with longitudinal dimensions. normal spleen longitudinal dimensions in
AJR:171,December1998 1697
Konu@et al.
230 children using sonography.Interestingly, 8). This finding is similar to the findings of should be compared with tables and graphics
their dimensions are smaller than ours for Dinkel et al. [10]. In the infancy period, the of normal parameters.
children under the age of 8 years, whereas in anteroposterior dimension of the left lobe of
children over the age of 8 years, the findings the liver may be somewhat longer than the
of their study and ours are similar. They longitudinal dimension. With aging, these References
stated that body weight showed the best cor phenomena change and the longitudinal di 1. Rosenberg HK, MarkowitzRI, KolbergH, Park
Downloaded from www.ajronline.org by 82.208.160.174 on 01/13/17 from IP address 82.208.160.174. Copyright ARRS. For personal use only; all rights reserved
relation with spleen length, which was mension of the left lobe becomes longer than C, HubbardA, BellahRD. Normalsplenicsizein
roughly logarithmic in type. Height and age, the anteroposterior dimension except in infantsand children:sonographicmeasurements.
AiR 1991;157:119—121
in that order, were less well correlated with obese persons [13]. We observed the same
2. Holder L, Strife J, Padikal TN, Perkins PJ, Ker
spleen length. phenomenon in infants. Anteroposterior di
elakesJG. Liversize determinationin pediatrics
mensionsof the left liver lobeswere foundto
Schlesinger et al. [9] studied normal spleen using sonographic and scintigraphic techniques.
volume in 48 children using CT. These re be somewhat longer than the longitudinal di Radiology1975;!17:349—353
searchersfoundthatspleenvolumecorrelated mensions. The reason is that the intraabdom 3. Dittrich M, Milde S. Dinkel E, Baumann W,
better with body weight than with age. The inal visceral organs are larger in children Weitzel D. Sonographic biometry of liver and
best regressionmodel was a simple linear re than in adults when compared with total spleen size in childhood. Pediatr Radiol 1983;13:
lationshipof spleenvolumeto bodyweight. body volume. This finding leads to the con 206—211
4. Markisz JA, TrevesST.Davis RT Normal hepatic
Renal dimensions, as well as cross-sec clusion that measurements of the midclavic
and splenic size in children: scintigraphic deter
tional areas and volumetric standards of the ular and midsagittal longitudinal dimensions mination.PediatrRadiol 1987;17:273—276
kidneys, have been investigated by many dif suffice to estimate the liver size in most chil 5. Christophe C, Cantraine F, Bogaert C, et al. Ultra
ferent authors for pediatric age groups. dren, and that measurements of anteroposte sound: a method for kidney size monitoringin
Christophe et al. [5] measured kidney rior dimensions, particularly of the left lobe, children. EurJ Pediatr 1986;145:532—538
sizes sonographically in 170 children. Values must be obtained only in infants. 6. Han BK, Babcock DS. Sonographic measure
of longitudinal kidney dimensionsin their Data of normal visceral organ sizes accord ments and appearance of normal kidneys in chil
dren.AJR1985;145:611—616
study are also similar to ours. These re ing to age have been given in table form in
7. Dremsek PA, Kritscher H, BöhmG, Hochberger
searchers found a linear relationship between several previous studies [1, 7]. However, the
0. Kidneydimensionsin ultrasoundcomparedto
renal length and height. Additionally, they selected age groups in those studies present a somatometric parameters in normal children. Pe
found that the longitudinal dimension of the wide range like 5 years, as in the studies of diatrRadiol 1987;17:285—290
kidneys versus body surface area yielded the Rosenberg et al. [1] and Dremsek et al. [7] 8. Rosenbaum
DM, KorngoldE, TeeleRL. Sono
most accurate correlation. However, as they (whereas our selected age groups had an age graphic assessment of renal length in normal chil
stated, correlating renal length with body range of 3 months or 2 years). In other studies, then.AJR1984;142:467—469
height is more practical. data were given only in graphic form [2—6, 9. SchlesingerAE,EdgarKA,BoxerLA.Volumeof
the spleenin childrenas measuredon CT scans:
In 1985, Dinkel et al. [10] studied renal di 10]. We present our data both in tabular and
normal standards as a function of body weight.
mensions and volumes in 325 children with graphic forms with the aim ofenabling a more AJR 1993;160:1107—l 109
sonographyandprovidedseparategraphicsfor practical evaluation during a sonographic ex 10. DinkelE, ErtelM, DittrichM, PetersH, BerresM,
the right and left kidneys. Correlations of renal amination. Schulte-Wissermann H. Kidneysizein childhood:
dimensionswith body parametersin that study Establishing normal parametersis manda sonographic growthchartsfor kidneylengthand
are similarto our findings,and thoseauthors tory for defining the pathologic changes in volume. PediatrRadiol 1985;15:38—43
11. Zerin JM, Blanc CE. Sonographicassessmentof
statedthat renal length showeda high correla size of the liver, spleen, and kidneys in rou
renal length in children: a reappraisal. PediatrRa
tion with body height. However, in their study, tine sonographic examinations of children.
diol 1994;24:l0l—106
the correlation was a linear relationship. These The methodsof measurementand analysis 12. Deligeorgis D, YannakosD, Doxiadis S. Normal
researchers also found that renal volume we used in this study are standardizedand size of liver in infancy and childhood: x-ray
showed the best correlation with body surface easy to apply. Findings are handy and reli study.ArchDis Child1973;48:790—793
area and showedalmostthe samecorrelation able and are suitable particularly for sonog 13. Niederau C, Sonnenberg A, Muller JE, Ercken
with body weight. For practical purposes,how raphy units and pediatric departments with brecht JF, ScholtenT, FritschWE Sonographic
large numbers of patients. measurements of the normal liver, spleen, pancreas,
ever, they proposed to use the correlation of re
and portal vein. Radiology 1983;149:537—540
nalvolumewith bodyweight. Longitudinal dimension and patient height
14. Berhman RE, Kliegman R. Nelson essentialsof
We observed that the increase in the longi are the most important determining factors of pediatrics. Philadelphia: Saunders, 1990:712
tudinal dimensions of these organs is much organ size among studied dimensions and 15. Remington 1W, Schork MA. Statistics with appli
more rapid during the first years of life, body parameters. Therefore, any specific cation to the biological and health sciences, 2nd
which mirrors the accentuated body growth longitudinal dimension should primarily be ed. Englewood Cliffs, NJ: Prentice Hall, 1985:
during infancyand early childhood(Figs. 4— correlated with patient height, and findings 23—43
1698 AJR:171,December1998