|Year : 2022 | Volume
| Issue : 1 | Page : 53-58
Sonographic evaluation of liver dimension among apparently healthy pediatrics in Kano Metropolis, Nigeria
Mohammed Sidi1, Ahmad S Idris1, Aliyu A Hassan2, Umar Mansur1, Hassan Muhammad1, Adamu Yakubu3
1 Department of Medical Radiography, Faculty of Allied Health Sciences, Collage of Health Sciences, Bayero University, Kano, Nigeria
2 Radiology Department, Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Medical Radiography, Federal University of Lafia, Nasarawa State, Nigeria
|Date of Submission||07-Mar-2021|
|Date of Decision||16-Jun-2022|
|Date of Acceptance||17-Jun-2021|
|Date of Web Publication||12-Jul-2022|
Aliyu A Hassan
Radiology Department, Aminu Kano Teaching Hospital, Kano
Source of Support: None, Conflict of Interest: None
Context: Establishing normal liver size is critical in the diagnosis and determining the treatment method for the underlying liver pathology. Aims: This study aimed at evaluating liver dimensions of apparently healthy pediatrics using ultrasonography in Kano metropolis, Nigeria. Settings and Design: This cross-sectional study was conducted in Kano Metropolis, Nigeria, from May 2020 to August 2020. Materials and Methods: Four hundred and twenty-six apparently healthy pediatric subjects; 213 males and 213 females. The liver was examined with the patient in the supine position, the anteroposterior liver dimension was obtained in a transverse plane through the mid clavicular line from the hepatic dome to the inferior angle. Cranio-caudal liver dimension was obtained in a longitudinal plane with an oblique beam at the level where the widest diameter was demonstrated. Statistical Analysis: Both descriptive inferential statistics were employed for the data analysis. Statistical Package for the Social Sciences Version 23.0 was used for the data analysis and P < 0.05 was considered significant. Result: The mean cranio-caudal liver dimension for male and female subjects were 9.28 ± 2.18 cm and 9.17 ± 2.19 cm, respectively, while the mean antero-posterior liver dimension for male and female subjects was 6.87 ± 1.92 cm and 6.74 ± 1.90 cm, respectively. A statistically significant difference between pediatric age groups was observed (p ≤ 0.001). However, there was no statistically significant difference in cranio-caudal and antero-posterior liver dimensions between male and female subjects (p ≥ 0.10, 0.24, 0.66, 0.30, 0.92, 0.33, and P ≥ 0.11, 0.79, 0.69, 0.45, 0.81, 0.29 for the respective pediatric age groups), respectively. Conclusion: References values for pediatric cranio-caudal and antero-posterior liver dimensions were established.
Keywords: Antero-posterior, cranio-caudal, dimension, liver, ultrasound
|How to cite this article:|
Sidi M, Idris AS, Hassan AA, Mansur U, Muhammad H, Yakubu A. Sonographic evaluation of liver dimension among apparently healthy pediatrics in Kano Metropolis, Nigeria. Niger J Basic Clin Sci 2022;19:53-8
|How to cite this URL:|
Sidi M, Idris AS, Hassan AA, Mansur U, Muhammad H, Yakubu A. Sonographic evaluation of liver dimension among apparently healthy pediatrics in Kano Metropolis, Nigeria. Niger J Basic Clin Sci [serial online] 2022 [cited 2022 Nov 29];19:53-8. Available from: https://www.njbcs.net/text.asp?2022/19/1/53/350725
| Introduction|| |
The liver is a dual organ having both secretory and comprise two functionally independent right and left lobes, defined by the arterial distribution., Evaluation of liver size is crucial as it is affected by various liver diseases. Clinical examination has been used to determine liver size by clinicians through percussion and palpation techniques; however, it has limitations in the detection of small increment in size and lack accuracy and reliability. Ultrasonography is a non-invasive, established, safe, and accurate method for measurement of liver size. The ultrasound did not only help in the determination of liver size, in addition, it also helps in the detection of the disease processes that may be responsible for such changes in size. However, the exact definition of hepatomegaly in the ultrasonographic measurement of liver size remains controversial. This is because many conditions, including malignant diseases, infective processes, and anthropometric variations between individuals from different geographical regions and ethnicities can affect the liver size., Umeh et al., reported that, the liver span was greater in boys than girls and was positively correlated with weight and height. However, Dhingra et al., conducted their study among Indian children involving 597 healthy children between the age of 1 month to 12 years. They reported that, the liver increases significantly with age and using multiple regression analysis considering the liver as an independent variable showed that there was a significantly positive association between liver and height; however, there was no association with age, body weight, and body surface area. Despite these, there is a paucity of data from northern Nigeria.
This study aimed at determining and establishing the normal reference values for cranio-caudal and antero-posterior liver dimensions as well as their variation with respect to gender and pediatric age groups. Thus, the findings of this study may serve as a guide to the sonographers, radiologists, and physicians in the diagnosis and management of children with pathologies that affect the liver size.
| Materials and Methods|| |
This a was cross-sectional study conducted in Murtala Muhammad Specialist Hospital, Ja'en Primary Health Care Hospital and Chiranci Primary Health Care Hospital in Kano Metropolis, Nigeria, from May 2020 to August 2020. Ethical clearance was obtained from the Human Research and Ethics Committee of the Kano State, Ministry of Health and informed consent was obtained either directly from the subjects or from the subject's guardians. The studied subjects were recruited from various Communities in Kano Metropolis and then taken to the abovementioned centers. A systematic and convenient sampling method was employed; 426 apparently normal pediatric subjects from a different community within the Kano metropolis were studied involving 213 males and 213 females less than 18 years.
The subjects were divided into 6 age groups of <28 days, >1 month <12 months, 12–24 months, 24–60 months, 5–13 years, and 13–18 years based on the classification by the American academy of pediatrics for both males and females involving 34, 34, 35, 35, 40, and 35 subjects, respectively. The exclusion criteria included pediatric with recurrent malarial and typhoid fever which is known from the subject's history of recent recurrent fever, a diabetic mother obtained from parent's history, a major congenital anomaly which can be physical or already corrected which could be known from history, systematic illness such as cardiovascular, respiratory, neurological, and abdominal disease which could be obtained from subject's history. Ultrasound scans were performed using Siemens SONOLINE Prima (Serial Number; BBE0617) diagnostic ultrasound system coupled with a 3.5 MHz curvilinear transducer by a qualified radiographer with further training and skills in ultrasound. The inter- and intra-observer variability was tested and there was high agreement in either case. The subject lay supine on the table, the radiographer was on the right side of the subject. The ultrasound gel was applied to the epigastric and right hypochondriac regions. The left hepatic lobe was firstly screened in both longitudinal and transverse sections by continuous sweeping of transducer through the midline at the epigastric region to the level of the IVC. The right hepatic lobe was screened by applying the same sweeping motion of the probe from the midline to the right up to midclavicular or anterior axillary line. The subject was asked to get a deep breath were necessary. The cranio-caudal liver dimension was obtained by scanning through the mid-clavicular line or anterior axillary line as described by Ekpo et al., with slight oblique beams in longitudinal plane at the level of portal vein; at this level the widest liver diameter was obtained. Using the same reference point, the anterior posterior dimension of the liver was obtained with a transverse beam and an electronic caliper was used to measure from the hepatic dome to the tip inferior angle as shown in [Figure 1]. Both the antero-posterior and cranio-caudal dimensions were recorded in the data capture sheet.
|Figure 1: Shows antero-postero and cranio-caudal dimension of apparently normal male pediatric|
Click here to view
The sex, age, height, and weight of each subject were also recorded on the data capture sheet. The Body Mass Index (BMI) and Body Surface Area (BSA) were also calculated and recorded as well. Shapiro–Wilk test was used in carrying out the normality test on the obtained data and the data passed the test, therefore parametric data analysis was used. Both descriptive and inferential statistics were employed for the data analysis. The mean, standard deviation, and range were obtained using descriptive statistics. The independent two-sample t-test was used to compare male and female liver dimension. A one-way ANOVA was employed to compare the liver dimension between the 6 age groups. Furthermore, a Tukey Post-Hoc Test of multiple comparisons was used to compare the liver dimension between one group and the other groups. The data were analyzed using Statistical Package for the Social Sciences (IBM SPSS) Version 23.0. The statistical level of significance was set at P < 0.05.
| Results|| |
Four hundred and twenty-six pediatric were studied out of which 213 were males and 213 were females. [Table 1] shows that, the mean ± SD of age, height, weight, BMI, and BSA for <28 days male subjects were 12.71 ± 7.74 days; 0.57 ± 0.05 m; 3.62 ± 0.70 Kg; 11.39 ± 2.29 Kg/m2; and 0.23 ± 0.03 m2, respectively, for >1 month <12 months were 6.62 ± 3.15 months; 0.62 ± 0.08 m; 7.32 ± 1.41 Kg; 19.01 ± 4.07 Kg/m2; and 0.34 ± 0.05 m2, respectively, for 12–24 months were 15.46 ± 3.62 months; 0.76 ± 0.05 m; 9.80 ± 1.86 Kg; 17.05 ± 2.63 Kg/m2; and 0.44 ± 0.05 m2, respectively, for 24–60 months were 35.43 ± 9.76 months; 0.88 ± 0.09 m; 12.09 ± 2.02 Kg; 15.73 ± 2.21 Kg/m2; and 0.53 ± 0.07 m2, respectively, for 5–13 years were 8.13 ± 2.14 years; 1.20 ± 0.11 m; 21.48 ± 5.09 Kg; 14.79 ± 2.99 Kg/m2; and 0.85 ± 0.13 m2, respectively, and for 13–18 years were 14.83 ± 1.44 years; 1.55 ± 0.10 m; 44.43 ± 4.93 Kg; 18.55 ± 2.74 Kg/m2; and 1.40 ± 0.10 m2, respectively.
[Table 2] shows that the mean ± SD of age, height, weight, BMI, and BSA for female subjects <28 days were 12.56 ± 7.08 days; 0.54 ± 0.03 m; 4.47 ± 0.93 Kg; 15.15 ± 3.01 Kg/m2; and 0.25 ± 0.03 m2, respectively, for >1 month <12 months were 6.44 ± 3.04 months; 0.63 ± 0.06 m; 7.56 ± 1.33 Kg; 19.27 ± 3.28 Kg/m2; and 0.34 ± 0.05 m2, respectively, for 12–24 months were 15.97 ± 3.80 months; 0.73 ± 0.07 m; 8.31 ± 1.18 Kg; 15.58 ± 2.62 Kg/m2; and 0.40 ± 0.05 m2 respectively, for 24–60 months were 38.20 ± 10.11 months; 0.89 ± 0.07 m; 12.66 ± 1.68 Kg; 16.15 ± 2.06 Kg/m2; and 0.55 ± 0.06 m2, respectively, for 5–13 years were 8.23 ± 2.53 years; 1.20 ± 0.14 m; 21.95 ± 0.14 Kg; 15.17 ± 3.32 Kg/m2; and 0.86 ± 0.15 m2, respectively and for 13–18 years were 14.80 ± 1.51 years; 1.52 ± 0.12 m; 42.51 ± 5.90 Kg; 18.73 ± 3.16 Kg/m2; and 1.34 ± 0.12 m2, respectively.
[Table 3] shows that, the mean ± SD of the cranio-caudal and anterior posterior dimension for <28 days male subjects were 6.50 ± 0.38 cm and 4.34 ± 0.32 cm, respectively, while for <28 days female subjects were 6.29 ± 0.4 cm and 4.23 ± 0.26 cm, respectively, for >1 month <12 months male subject were 8.32 ± 1.06 cm and 5.58 ± 1.48 cm, respectively, while for >1 month <12 months female subject were 8.03 ± 0.91 cm and 5.49 ± 1.14 cm, respectively, for 12–24 months male subject were 8.47 ± 0.75 cm and 6.42 ± 0.93 cm, respectively, while for 12–24 months female subject were 8.39 ± 0.68 cm and 6.35 ± 0.69 cm, respectively, for 24–60 months male subject were 8.98 ± 0.88 cm and 6.85 ± 0.72 cm, respectively, while for 24–60 months female subject were 9.18 ± 0.78 cm and 6.72 ± 0.70 cm, respectively, for 5–13 years male subject were 10.57 ± 1.30 cm and 8.00 ± 1.04 cm, respectively, while for 5–13 years female subject were 10.54 ± 1.33 cm and 7.95 ± 0.85 cm, respectively, and for 13–18 years male subject were 12.84 ± 1.06 cm and 9.90 ± 0.96 cm, respectively, while for 13–18 years female subject were 12.61 ± 0.82 cm and 9.68 ± 0.82 cm, respectively.
|Table 3: Mean±SD of liver dimensions among in male and female pediatric subjects|
Click here to view
As shown in [Table 4], there was no statistically significant difference in cranio-caudal liver dimension between male and female subjects. Furthermore, there was no statistically significant difference in anterior-posterior liver dimensions between male and female subjects [Table 5].
|Table 4: Comparison of cranio-caudal liver dimension between male and female subjects|
Click here to view
|Table 5: Comparison of anterior-posterior dimension between male and female subjects|
Click here to view
[Table 6] shows that there was a statistically significant difference in liver dimensions between all age groups (p ≤ 0.001). As indicated in [Table 7], there was a statistically significant difference in cranio-caudal liver dimension between all age groups (p ≤ 0.001) except between 1 month <12 months and 12–24 months age groups P = 0.580.
|Table 6: Comparison of the cranio-caudal and antero-posterior liver dimension between different age groups using one-way ANOVA|
Click here to view
|Table 7: Comparison of cranio-caudal liver dimension between different groups using Tukey Post-Hoc Test|
Click here to view
[Table 8] shows that, there was a statistically significant difference in antero-posterior liver dimension between all age groups (p ≤ 0.001) except between 12–24 months and 24–60 months age groups P = 0.092.
|Table 8: Comparison of antero-posterior liver dimension between different groups using Tukey post-hoc test|
Click here to view
| Discussion|| |
The findings of the current study based on the anthropometric variables as shown in [Table 1] and [Table 2] was contrary to the findings of previous studies by Umeh et al., Weerakul et al., Dhingra et al., and Thapa et al. The reason for the differences might be due to environmental, racial, dietary, and socioeconomic differences. Despite the fact that, Umeh et al., conducted their research in Nigeria, however, they only consider children within the age range of three to twelve years, and this may be the cause the difference in anthropometric variables with the current study.
With respect to liver dimension as shown in [Table 3], the findings of this study were similar to the findings of the previous study conducted by Dhingra et al., and Thapa et al., who also reported a mean ± SD of liver span for both male-female subjects in different age group. These similarities might be due to the fact that the studies adopted similar research methods and consider the same pediatric age range. The similarity of this current study with Dhingra et al., that was conducted in India and Thapa et al., that was conducted in Nepal shows that, irrespective of environment or geographical location, pediatric age group tends to display similar liver span. Therefore, liver span values from different environments can be adopted and used as a reference in the diagnosis and management of liver disease among pediatrics.
However, the findings of this study as also shown in [Table 3] was contrary to the findings of the conducted by Weerakul et al., Umeh et al., and Amatya et al. The differences might be differences in geographical location, socioeconomic status as well as the differences in the research method adopted by the previous study.
This study shows there was no statistically significant difference in cranio-caudal and antero-posterior dimensions between male and female subjects (p > 0.05). This was similar to the previous studies conducted by Umeh et al., and Weerakul et al., who also reported that there was no statistically significant difference in liver dimensions between male and female subjects (p = 0.074) and (p = 0.062), respectively. One-way AVOVA shows a statistically significant difference in liver dimension between the different age groups. Furthermore, Tukey post-hoc test of multiple comparisons shows there was a statistical significant difference in cranio-caudal and antero-posterior liver dimensions between all age groups (p = 0.000), except between >1 month <12 month and 12–24 month (p = 0.580) for cranio-caudal liver dimension, and between 12–24 month and 24–60 month (p = 0.092) for antero-posterior liver dimension. This means that, established reference values for cranio-caudal and antero-posterior liver dimension can be used interchangeably between >1 month <12 month and 12–24 month, and between 12–24 month and 24–60 month age groups, respectively.
| Conclusion|| |
Normal reference values for the pediatric liver dimensions have been established. There was a statistically significant difference between pediatric age groups (p ≤ 0.000). However, there was no statistically significant difference in cranio-caudal and antero-posterior liver dimensions between male and female subjects. Furthermore, it is important that both cranio-caudal and antero-posterior liver dimensions are taken before diagnosis based on the liver size is made. In the light of these current data, we believe our study can be used as a reference source for the evaluation of liver dimensions.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sembulingam K, Sembulingam P. Essentials of Medical Physiology. 6th
ed. New Delhi: Jaypee Brothers Medical Publishers; 2012.
Ryan S. Anatomy for diagnostic imaging. 3rd
ed. Philadelphia: Elsevier; 2004.
Ekpo EU, Ikamaise VC, Egbe NO, Akwa EE, Eyo BA. Sonographic correlation of liver dimension and anthropometric variables of height, weight and body mass index. Journal of Radiography and Radiation Sciences 2013;27:25–31.
Dhingra B, Sharma S, Mishra D, Kumari R, Pandey RM, Aggarwal S. Normal values of liver and spleen size by ultrasonography in Indian children. Indian J Pediatr 2009;47:487–92.
Ozmen Z, Aktas F, Ozmen ZC, Almus E, Demir O. Ultrasound measurement of liver longitudinal length in North Anatolian population: A community-based study. Niger J Clin Pract 2018;21:653–7.
Kratzer W, Fritz V, Mason RA, Haenle MM, Kaechele V; Roemerstein Study Group. Factor affecting liver size: A sonographic survey of 2080 subjects. J Ultrasound Med 2003;22:1155–61.
Umeh E, Adeniji-Sofoluwe AT, Adekanmi AJ, Atalabi OM. Normal sonographic dimensions for liver, spleen and kidneys in healthy south west Nigerian children-a pilot study. West Afr J Ultrasound 2015;16:1–7.
Weerakul J, Galassi W, Chaiyakunapruk N. Physical and ultrasonographic estimation of liver size in healthy Thai children under two years old. Asian Biomed 2011;5:403–6.
Thapa NB, Shah S, Pradhan A, Rijal K, Pradhan A, Basnet S. Sonographic assessment of the normal dimensions of liver, spleen, and kidney in healthy children at tertiary care hospital. Kathmandu Univ Med J 2015;13:286–91.
Amatya P, Shah D, Gupta N, Bhatta NK. Clinical and ultrasonographic measurement of liver size in normal children. Indian J Pediatr 2013;81:441–5.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]