Establishment Local Reference of Spleen Length in Sudanese Normal School Age Children Sonographically

Table of contents

1. Introduction

he spleen is the largest organ in the reticulo endothelial system. Spleen size can be used as an indicator of disease activity in a variety of disorders of the reticulo endothelial system. [1] The spleen responds to different pathologic states by dimensional changes. Malaria and sickle cell disease with a geographical bias are known to cause changes in spleen size. A rapid increase in spleen size, secondary to sequestration of red blood cells, platelets and other haematological elements, was observed in neonates on extracoporal membrane oxygenation [2,3,4] There are several studies about normal internal organs character [5,6] All of these are from the populations of Caucasoid and from the populations of Asian, Japan, China, Korea, and India. In the past, Thailand normally used references from American or European references. The problem is that the differences of these factors make the indicators different: race, body structure, genetic, environment, living condition, life style, and food. [7,8]. Spleen size varies widely according to age also many diseases can affect its size, including infections and malignancy. [9,10] . The variations in the anthropometric features of various populations, races and regions are an established fact. The climate of the zone and the socioeconomic status of Sudan, make the population of this region special. There is no comprehensive anthropometric study on the normal measurements of spleen by ultrasonography in Sudanese, and therefore, it was thought to be important to undertake the present study to evaluate the normal measurements of spleen in the school age Sudanese population.

2. II.

3. Materials and Methods

4. Volume XIII Issue II Version I

Note: Year

Abstract-Objectives: The objectives of this study were to establish a local ultrasonic splenic length which can be used as reference for Sudanese healthy school age children and to determine the normal standards spleen length related to gender, age, body weight, height, body mass index (BMI), and abdominal circumference.

Methods: 215 healthy school-aged children (7-13 years) from city centers were evaluated. Gender, age, weight, height, BMI, and abdominal circumference were determined for each case. The sonographic examination for spleen length was performed with a high resolution real time scanner (SSD-500 Aloka Medical System) fitted with a 3.5MHz convex transducer; all of the measured spleens had a normal position, shape, and echo texture. The children were classified into 7groups according to age and gender.

Results: The mean length of the spleen was found to be 9.5-10.4cm.There was significant difference between the spleen length in males and females (Pvalue 0.000), the mean length of spleen in females is greater than in males. A significant relation was found between spleen length and age, weight, height, abdomen circumference and BMI .

5. Conclusion:

The spleen length obtained in this study was in different range of values reported in previous studies and a local reference of spleen length was established. We hope that this study contributes to daily clinical practice in ultrasound clinics for interpretation of sonographic examinations for Sudanese school age children regarding the spleen length.

Radiography and radionuclide studies expose the patient to X and gamma radiation [10,11,12,13]. Ultrasonography is the method of choice for the diagnosis of the abdominal pathologies [14]. Sonography is routinely used to determine the internal structures of the body because the examination is real time, three-dimensional and independent of organ function .Ultrasonography is a non-invasive, established, safe, quick and accurate method for the measurement of spleen size. [13] In Sudan, There is absence of domestic reference for spleen length; and as far as we know, no study was published in the open literature, regarding the spleen length for school age children therefore, the importance of this study lies in finding the normal length of spleen and to determine its correlation with gender, age, height, weight, body mass index (BMI) and abdominal circumference.

6. Results

7. a) Ultrasound Machine

The sonographic examination performed with a high resolution real time scanner (SSD-500 Aloka Medical System Co, Ltd, Tokyo, Japan) with a 3.5MHz convex transducer.

8. b) Sample

A total of 215 (104 males, 111 females) healthy Sudanese children with normal spleen position, shape and echo texture. Any abnormal spleen position, shape and echo texture, children affected with malaria, malignant spleen diseases, benign spleen conditions, traumatic spleen were excluded.

9. c) Measurement Technique for spleen

Spleen Length was taken by measuring the longest dimension in coronal plane. Longitudinal dimensions in the coronal plane were obtained with the subject in supine or slightly right lateral decubitus position; longitudinal size measurement was performed between the most supero medial and the most infero lateral points of the spleen. 5. Ludwig J. Current methods of autopsy practice. Philadelphia: Saunders; 1979: 647-89.

10. From above table (6) it was noticed that all p-values are less than 0.05 that means that there is relationship between the variables. The Pearson Correlation denotes values of the correlation either positive (+) or negative (-) as follows:

IV.

11. Discussion

Ultrasound is simple and reliable in measuring the abdominal visceral organs without the risk of ionizing radiation. Measuring the volume is time-consuming and impractical in daily use and the longitudinal measuring of these organs is used as part of routine abdominal sonographic scanning for purposes of determining the normal anatomy [15]. Therefore, the longitudinal measurement was used because it is more practically considered.

The length of the spleen is an adequate indicator of size for most purposes and provides a useful baseline for monitoring changes in disease status. Establishing normal parameters is mandatory for defining the pathologic changes in size of the spleen, in routine sonographic examinations of children. [15] This study included 104(48.4%) males, 111(51.6%) females of school children with ages from 7 up to 13.When measuring the spleen;28 out of 215 (13.0%)got spleen length of 6.5-7.7 cm,43(20%)of 5-8.4cm, 56(26%) of 8.5-9.4cm,67(31.2%)of 9.5-10.4 and measurements greater than 10.5 were found in 21(9.8) of the sample, The mean spleen measurement was found to be 9.0 ±1.2 (max11.7, min6.7),normal spleen has been investigated by only a few researchers [16].When comparing our results with other similar results ,we found that Sudanese children have less length than USA in all group of ages but greater than Greek [16], Indian [17] and Turkish populations [18] When comparing the spleen length measurement with age in all group of ages it was found to be 7.9,7.7,8.9,9.3,9.4,9.9,10.1,9.0 cm for the ages 7,8,9,10,11,12,13 respectively and the relation is significant between the spleen length and this group of children ages at p value 0.000.

DeLand [19] stated that the spleen showed variation according to sex and age. He reported that spleen in females was smaller than males in all age groups. But Niederau et al. [20] in their sonographic study, which was carried out on adults, found that spleen size decreased with increasing age.

In our study a significant difference was detected between males and females in spleen length and abdomen circumference measurements because Pvalue was found to be less than 0.05, that means the mean measurements values of spleen and abdomen circumference in females are greater than males and were found to be 9.3 ± 1.1 and 59.3 ± 8.1, 8.7 ± 1.1and 57.2 ± 5.6 respectively .

The study showed that the BMI, height, weight abdominal circumference have significant relation with the spleen length in all these group of ages.

From table (6) we noticed that all p-values are less than 0.05, that means there is a relationship between the variables. The Pearson Correlation denotes value of the correlation either positive (+) or negative (-) as follows: 0.90 -1.00 very strong relationship, 0.70 -0.89 strong relationship, 0.50 -0.69 middle relationship, 0.00 -0.49 weak relationship.

Scatter plot diagrams showed the linear relationship between spleen length measured in (cm) and females and males, BMI, abdomen circumference (AC) and age respectively. The equations showed that the for BMI and AC ,the spleen length was increased proportionally and by applying the following equations the spleen length can be estimated for these group of ages and known BMI and AC as :

For female Spleen length (cm) =(0.432 X Age) + 5.024 . For male Spleen length (cm) =(0.384 X Age) + 4.827. For female Spleen length (cm) =(0.172 X BMI) + 6.368,For male Spleen length (cm) =(0.209X BMI) + 5.182,For female Spleen length (cm) =(0.083 X AC) + 4.320,For male Spleen length (cm) =(0.089X AC) + 3.546.

In conclusion, the spleen length obtained in this study was in different range of values reported in the previous studies. The mean spleen length in females is greater than males .

By applying the above equations the spleen length can be estimated. A local reference of spleen length was established; further studies are required to establish national reference of spleen length and volume in Sudan for both children and adults.

Figure 1.
Establishment of Local Reference of SpleenLength in Sudanese Normal School age Children Sonographically
Figure 2. Figure 1 :
1Figure 1 : [A,B,C]Scatter plot diagram shows the linear relationship between spleen length measured in (cm )and female BMI, age and abdomen circumference respectively
Figure 3. Figure 2 :
2Figure 2 : [A,B,C] Scatter plot diagram shows the linear relationship between spleen length measured in (cm )and Male BMI, age and abdomen circumference respectively
Figure 4. Table 1 :
1
013 III.
2
Year Spleen Frequency Percentage
6.5-7.4 28 13.0%
7.5-8.4 43 20.0%
8.5-9.4 56 26.0%
Volume XIII Issue II Version I Mean Std. Deviation Minimum Maximum 9.5-10.4 ? 10.5 Total BMI 16.8 ±3.4 10.4 33.6 Weight (Kg) 32.5 ±10.1 16.0 71.0 67 21 215 Abdominal circumference 58.2 ±7.1 43.0 83.0 31.2% 9.8% 100.0% Height (M) 137.9 ±11.0 112.0 167.0 Spleen (cm) 9.0 ±1.2 6.7 11.7
( ) D
Variable 7 8 9 Age 10 11 12 13 Total P-Value
BMI 14.4 14.7 18.0 17.0 16.7 18.1 18.9 16.8 0.000*
± 2.0 ± 2.2 ± 4.5 ± 2.8 ± 2.7 ± 2.9 ± 3.6 ± 3.4
Weight 22.9 24.1 32.9 33.1 33.5 38.8 44.5 ± 32.5 0.000*
± 3.6 ± 4.8 ± 9.3 ± 7.5 ± 6.0 ± 7.7 10.2 ± 10.1
Abdominal 53.9 53.5 60.2 59.3 58.8 59.1 63.8 ± 58.2 0.000*
circumference ± 4.1 ± 5.2 ± 8.5 ± 6.4 ± 5.3 ± 6.8 7.1 ± 7.1
Height 126.1 ± 127.6 ± 134.7 ± 139.0 ± 141.4 ± 146.0 ± 152.8 ± 137.9 ± 0.000*
5.5 5.4 4.3 7.4 5.1 6.5 8.9 11.0
Spleen 7.9 7.7 8.9 9.3 9.4 9.9 10.1 ± 9.0 0.000*
± 0.7 ± 0.6 ± 1.3 ± 0.8 ± 0.6 ± 0.7 0.7 ± 1.2
Variable Male Gender Female Total P-Value
BMI 16.6 ± 2.3 16.9 ± 4.2 16.8 ± 3.4 0.580
Weight 31.6 ± 7.8 33.4 ± 11.8 32.5 ± 10.1 0.195
Abdominal circumference 57.2 ± 5.6 59.3 ± 8.1 58.2 ± 7.1 0.029*
Height 136.9 ± 10.5 138.8 ± 11.4 137.9 ± 11.0 0.203
Spleen 8.7 ± 1.1 9.3 ± 1.1 9.0 ± 1.2 0.000*
Note: Establishment Local Reference of Spleen Length in Sudanese Normal School Age Children Sonographically
Figure 5. Table 2 :
2
Figure 6. Table 3 :
3
Figure 7. Table 4 :
4
Age Gender BMI* Weight Abdomen circumference Height Spleen
7 Male 15.6 ± 1.8 23.7 ± 3.4 53.5 ± 4.1 123.7 ± 6.9 8.0 ± 0.8
Female 13.6 ± 1.7 22.3 ± 3.7 54.3 ± 4.2 127.9 ± 3.5 7.9 ± 0.5
8 Male 15.7 ± 1.6 26.0 ± 3.7 54.3 ± 3.1 128.4 ± 5.7 7.5 ± 0.6
Female 13.7 ± 2.3 22.1 ± 5.2 52.7 ± 6.8 126.8 ± 5.1 7.8 ± 0.5
9 Male 16.5 ± 1.6 29.5 ± 3.9 57.1 ± 4.9 133.7 ± 4.5 7.9 ± 0.7
Female 19.6 ± 5.9 36.3 ± 11.8 63.3 ± 10.3 ± 4.1 9.9 ± 0.9
10 Male 16.7 ± 2.2 31.9 ± 4.3 58.7 ± 4.3 138.1 ± 5.8 8.6 ± 0.4
Female 17.3 ± 3.3 34.2 ± 9.7 59.9 ± 8.1 140.0 ± 8.9 10.0 ± 0.3
11 Male 16.1 ± 2.2 32.3 ± 5.5 57.3 ± 4.5 141.3 ± 5.8 9.2 ± 0.7
Female 17.3 ± 3.0 34.7 ± 6.4 60.4 ± 5.7 141.5 ± 4.6 9.5 ± 0.3
12 Male 18.3 ± 3.2 37.8 ± 8.3 57.8 ± 6.8 143.2 ± 4.4 9.7 ± 1.0
Female 18.0 ± 2.7 39.8 ± 7.2 60.3 ± 6.8 148.6 ± 7.2 10.0 ± 0.3
13 Male 17.7 ± 2.4 40.3 ± 8.5 61.5 ± 7.0 150.3 ± 9.7 9.8 ± 0.7
Female 20.2 ± 4.3 48.6 ± 10.3 66.1 ± 6.6 155.3 ± 7.5 10.5 ± 0.5
Values are expressed as Mean ± SD. *Body Mass Index (BMI)
Figure 8. Table 6 :
6
Correlations BMI Spleen Weight Abdomen circumference
BMI Pearson Correlation 1.00 0.54 0.88 0.84
P-value . 0.000 0.000 0.000
Spleen Pearson Correlation 0.54 1.00 0.71 0.55
P-value 0.000 . 0.000 0.000
Weight Pearson Correlation 0.88 0.71 1.00 0.85
P-value 0.000 0.000 . 0.000
Abdomen circumference Pearson Correlation 0.84 0.55 0.85 1.00
P-value 0.000 0.000 0.000 .
Height Pearson Correlation 0.43 0.72 0.79 0.56
P-value 0.000 0.000 0.000 0.000
0.90 -1.00 very strong relationship.
0.70 -0.89 strong relationship.
0.50 -0.69 middle relationship.
0.00 -0.49 weak relationship
Note: © 2013 Global Journals Inc. (US) Global Journal of Medical Research 21 Volume XIII Issue II Version I
Figure 9. Table 5 :
5
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Notes
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Date: 2013-01-15