MEASUREMENT OF SPLEEN SIZE AND ITS RELATION TO HYPERSPLENISM AND PORTAL HEMODYNAMICS IN PORTAL-HYPERTENSION DUE TO HEPATIC CIRRHOSIS

Aims: Splenomegaly is common in portal hypertension due to hepatic cir rhosis, but there are little data comparing different methods of splee n measurement. We have compared ultrasound with radionuclide imaging i n measuring splenomegaly. The relation of splenomegaly to hypersplenis m and portal hemodynamic factors was also studied. Results: Ultrasound and radionuclide measures of spleen volume gave comparable results (r = 0.95, p < 0.0001). Phagocytic activity of the spleen measured by ra dionuclide uptake increased as the volume of the spleen increased (r = 0.46, p < 0.03) but was not related to diminishing liver phagocytic a ctivity. Spleen volume was correlated negatively with leukocyte counts (r = 0.43, p < 0.05) but not with hemoglobin or platelet counts. Sple en radionuclide uptake was negatively correlated with hemoglobin (r = 0.48, p < 0.04) and leukocyte counts (r = 0.46, p < 0.04) but not with platelet counts. Spleen volume was related to portal vein cross-secti onal area (r = 0.91, p < 0.0001) and portal vein blood flow volume (r = 0.57, p < 0.008) but not to portal vein blood flow velocity, portal pressure gradient, or azygos blood flow. Conclusions: Spleen size meas ured by ultrasonography and radionuclide studies gives comparable resu lts. Spleen phagocytic activity in cirrhosis increases as the spleen e nlarges but not in relation to decreased hepatic phagocytic activity. Spleen phagocytic activity probably contributes to anemia and leukopen ia in the splenomegaly of cirrhosis, but other factors must contribute to thrombocytopenia. Portal hemodynamics are probably important in th e splenomegaly, but the interrelation is complex.