Sonographic pediatric liver size standards based on generalized additive modeling in a diverse population
Amirreza Manteghinejad1, Marcus Meneses2, Julian Lopez Rippe2
1Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA. manteghina@chop.edu.
Insights
Updated ultrasound reference ranges for pediatric liver size show that normal liver size is slightly larger than previously reported. These ranges incorporate age and height for more accurate assessment in children.
Area of Science:
- Pediatric Radiology
- Medical Imaging
- Hepatic Growth Assessment
Background:
- Liver size assessment is crucial in pediatric radiology for evaluating normal growth and disease.
- Existing reference ranges for pediatric liver size on ultrasound are outdated and require revision.
- Evolving pediatric demographics necessitate updated, methodologically sound reference data.
Purpose of the Study:
- To establish current ultrasound-based reference ranges for pediatric liver size.
- To incorporate both patient age and height into these reference ranges.
- To provide updated nomograms for normal liver dimensions in children.
Main Methods:
- Retrospective review of 4,611 pediatric abdominal ultrasound reports (2014-2024).
- Inclusion of patients with normal ultrasound findings and exclusion of those with liver disease or abnormal liver enzymes (AST/ALT).
- Utilized Generalized Additive Models for Location, Scale, and Shape (GAMLSS) with BCPE distribution, incorporating age and height.
Main Results:
- Liver size increases progressively with age, from 4.9-5.5 cm at birth to 17.2 cm in adolescents.
- Height was incorporated using GAMLSS modeling on 3,235 examinations, showing a linear relationship.
- Updated reference ranges extend up to 180 cm in height, with a maximum liver size of 17.5 cm.
Conclusions:
- This study presents contemporary reference ranges and nomograms for pediatric liver size.
- The findings indicate that normal liver size in children is slightly larger than previously documented.
- These updated ranges aid in more accurate interpretation of liver size in pediatric abdominal imaging.
Background:
In pediatric radiology, assessment of liver size is a fundamental component of abdominal imaging, reflecting both normal hepatic growth and potential pathologic processes. Limitations in prior literature, along with evolving demographic characteristics of the pediatric population, highlight the need for updated, methodologically rigorous reference ranges for normal liver size on ultrasound.
Objective:
This study aims to establish contemporary ultrasound-based reference ranges for pediatric liver size, incorporating both age and height as key variables.
Materials And Methods:
In this retrospective study, radiology reports from January 2014 to December 2024 for patients under 18 years of age were reviewed. Patients with an impression of "normal abdominal ultrasound" were included, excluding those with liver diseases or abnormal Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) results. Standard liver length measurement for our institution is the craniocaudal dimension of the right lobe along the midclavicular line. Generalized Additive Models for Location, Scale, and Shape (GAMLSS) with the Box-Cox Power Exponential (BCPE) distribution was used to create reference ranges based on patients' age and height.
Results:
A total of 4,611 abdominal ultrasound examinations met the inclusion criteria. The study included 2,055 males (44.6%) and 2,556 females (55.4%). At birth, the liver size ranged from 4.9 to 5.5 cm (cm), increasing progressively with age to a maximum of 17.2 cm in adolescents aged 17-18 years. A subset of 3,235 examinations (70%) with recorded height was used for GAMLSS modeling, showing a more linear increase in liver size with height. Reference ranges were reported up to 180 cm in height, with a maximum liver size of 17.5 cm.
Conclusion:
This study provides updated reference ranges and nomograms for pediatric liver size based on age and height, which support a normal liver size slightly higher than previously reported.
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