Establishing CT-based reference ranges for liver and spleen sizes in the Pakistani pediatric population
DOI:
https://doi.org/10.59736/IJP.23.04.1025Keywords:
Computed Tomography, Liver, Organ Dimensions, SpleenAbstract
Background: Accurate liver and spleen reference ranges are essential for diagnosing pediatric abnormalities. Most existing data rely on ultrasound, while CT offers greater measurement precision, yet age-specific CT-based norms remain limited. This study aims to establish CT based reference values for liver and spleen sizes based on age, gender and anthropometric parameters in Pakistani pediatric population.
Methods: This study analyzed CT scans of 772 children aged 0 to 16 years, selected from 7,000 records from January 2010 to December 2024 at Aga khan University hospital Karachi. The participants were grouped into 19 age categories ranging from 0-1 week to 15-16 years. At least four liver measurements and three spleen measurements were taken on axial and coronal images for every case. Mean and standard deviation were calculated, and variations between age groups and genders were evaluated.
Results: Liver and spleen sizes increased significantly with age (p < 0.001). The mean liver anteroposterior (AP) diameter taken at mid-clavicular increased from 76.59 ± 15.25 mm in the youngest age group to 129.49 ± 14.05 mm in the older children. Similarly, the liver’s transverse diameter increased from 85.76 ± 22.03 mm to 154.14 ± 26.20 mm (p < 0.001). Spleen dimensions also displayed consistent age-dependent growth (p < 0.001). Although males had marginally higher mean values, the differences were statistically insignificant. Furthermore, height and BMI were found to be the strongest independent predictors overall through the regression analysis.
Conclusion: Both liver and spleen dimensions showed a steady increase with age, with no significant differences between boys and girls. These CT-based reference ranges provide valuable benchmarks to distinguish normal organ growth from pathological enlargement in children.
References
Rosenberg HK, Markowitz RI, Kolberg H, Park C, Hubbard A, Bellah RD. Normal splenic size in infants and children: sonographic measurements. AJR Am J Roentgenol. 1991;157(1):119-21.doi: 10.2214/ajr.157.1.2048509.
Poddar U, Jagadisan B. Measuring liver and spleen by ultrasonography. Indian Pediatr. 2010;47(6):475-6.doi: 10.1007/s13312-010-0086-2.
Prassopoulos P, Cavouras D. CT assessment of normal splenic size in children. Acta Radiol. 1994;35(2):152-4
Wood L, Baker PM, Martindale A, Jacobs P. Splenectomy in haematology--a 5-year single centre experience. nt J Hematol. 2005;10(6):505-9.doi: 10.1080/10245330500183418.
de Padua VAV, Dillman JR. Computed tomography-based measurements of normative liver and spleen volumes in children. Pediatric radiology. 2023;53(3):378-86.doi: 10.1007/s00247-022-05551-z.
Bayramoğlu Z, Ayyıldız H, Ersoy B. Reference Ranges of Age-Based Liver, Spleen, Pancreas, and Kidney Size in Conjunction with Waist Circumference in Children. Turkish archives of pediatrics. 2022;57(2):175-85.doi: 10.5152/TurkArchPediatr.2022.21097
El-Shafie AM, Bahbah WA, Zefzaf HMSE, Mousa WA, Abdellatif HA, El-Hossary RH, et al. Establishment of Z score reference of liver, spleen, and kidney parameters for Egyptian children and adolescents: a cross-sectional randomized study. Gaz Egypt Paediatr Assoc. 2024;72(1):75.doi: 10.1186/s43054-024-00313-y.
Ünlü S, Ilgar M. Measurement of normal spleen volume and dimensions in all child age groups by abdominal computed tomography. Eur Rev Med Pharmacol Sci. 2022;26(14):5128-35.doi: 10.26355/eurrev_202207_29301.
Waelti S, Fischer T, Wildermuth S, Leschka S, Dietrich T, Guesewell S, et al. Normal sonographic liver and spleen dimensions in a central European pediatric population. BMC Pediatr. 2021;21(1):276.doi: 10.1186/s12887-021-02756-3.
Schlesinger AE, Edgar KA, Boxer LA. Volume of the spleen in children as measured on CT scans: normal standards as a function of body weight. AJR Am J Roentgenol. 1993;160(5):1107-9.doi: 10.2214/ajr.160.5.8470587.
Debnath P, Tkach JA, Saad M, Vitale DS, Abu-El-Haija M, Trout AT. Magnetic resonance imaging T1 mapping of the liver, pancreas and spleen in children. Abdominal Radiology. 2024;49(11):3963-74.doi: 10.1007/s00261-024-04428-z.
Khan SA, Yasmeen S, Adel H, Adil SO, Huda F, Khan S. Sonographic Evaluation of Normal Liver, Spleen, and Renal Parameters in Adult Population: A Multicenter Study. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 2018;28(11):834-9.doi: 10.29271/jcpsp.2018.11.834.
Ezenwuba BN, Hynes CM. Ultrasound screening of paediatric non-alcoholic fatty liver disease (NAFLD): A critical literature review. Radiography. 2024;30(5):1317-25.doi: 10.1016/j.radi.2024.07.006.
Yang X, Wang H, Dong B, Hu B, Hao X, Chen X, et al. Standard Liver Volume-Predicting Formulae Derived From Normal Liver Volume in Children Under 18 Years of Age. Frontiers in pediatrics. 2021;9:629645.doi: 10.3389/fped.2021.629645.
Calle-Toro JS, Back SJ. Liver, Spleen, and Kidney Size in Children as Measured by Ultrasound: A Systematic Review. J Ultrasound Med. 2020;39(2):223-30.doi: 10.1002/jum.15114.
Suttorp M, Classen CF. Splenomegaly in Children and Adolescents. Frontiers in pediatrics. 2021;Volume 9 - 2021.doi: 10.3389/fped.2021.704635.
Barr RG, Wilson SR, Rubens D, Garcia-Tsao G, Ferraioli G. Update to the Society of Radiologists in Ultrasound Liver Elastography Consensus Statement. Radiology. 2020;296(2):263-74.doi: 10.1148/radiol.2020192437.
Kim DW, Ha J, Lee SS, Kwon JH, Kim NY, Sung YS, et al. Population-based and Personalized Reference Intervals for Liver and Spleen Volumes in Healthy Individuals and Those with Viral Hepatitis. Radiology. 2021;301(2):339-47.doi: 10.1148/radiol.2021204183
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Copyright (c) 2025 Muhammad Yousaf, Waseem Akhtar Mirza, Mariam Sajjad, Muhammad Masood Alam, Muhammad Aman, Burhan Zafar, Aisha Rasheed, Faizan UL Islam, Ayesha Hassan, Kaleem Ahmad Zafar

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