Liver and spleen volumes in children with autoimmune hepatitis: association with laboratory parameters and fibrosis stage. A single-center, ambispective, cohort, non-randomized study

Cover Page

Cite item

Full Text

Abstract

Background. Autoimmune hepatitis (AIH) in children is characterized by chronic hepatic inflammation, which may lead to organ enlargement, fibrosis progression, and development of portal hypertension. However, objective assessment of liver and spleen volume changes, and their association with laboratory parameters and fibrosis stage, remains insufficiently studied.

Aim. To evaluate liver and spleen volume dynamics in children with AIH and their correlation with laboratory activity and fibrosis stage.

Materials and methods. The study included 98 children with a confirmed diagnosis of AIH who were followed for 2 years. 62 of them had isolated AIH and 36 had AIH with overlapping cholangitis. All patients underwent laboratory tests (ALT, AST, GGT, albumin), MRI-based volumetric assessment of liver and spleen, and liver elastography with fibrosis staging according to the Metavir scale. Correlation, comparative and multivariate regression analyses were performed, including dynamic changes in parameters. The study was conducted with follow-up assessments at 1 year and 2 years.

Results. Liver enlargement was more frequently observed in children with cholangitis (38.9%), while most patients with isolated AIH had liver volumes within the normal range or reduced. Significant correlations between liver volume, laboratory indicators, and fibrosis stage were found only in the cholangitis group. In children with isolated AIH, a positive dynamic trend was noted, including decreased ALT, AST, GGT levels and reduced liver stiffness on elastography. Spleen volume increase correlated with signs of inflammation and fibrosis but showed no statistically significant change over two years. According to regression analysis, a significant correlation was found between fibroelastography parameters and albumin levels, liver and spleen volumes, ALT and GGT levels, particularly in the group with cholangitis (R2 = 61.4%).

Conclusion. Changes in liver and spleen volumes in children with autoimmune hepatitis may be associated with both disease activity and the degree of fibrosis. Patients with AIH combined with cholangitis more frequently exhibit liver enlargement, lower treatment sensitivity, and a lack of reduction in liver stiffness over time. Measuring liver and spleen volumes, along with assessing fibroelastography parameters, allows for a more comprehensive characterization of the clinical course of AIH in children.

Full Text

Restricted Access

About the authors

Daria V. Parakhina

National Medical Research Center for Children’s Health

Email: dvparakhina@gmail.com
ORCID iD: 0000-0002-8221-0364

Gastroenterologist

Russian Federation, Moscow

Alexander S. Potapov

National Medical Research Center for Children’s Health; Sechenov First Moscow State Medical University

Email: dvparakhina@gmail.com
ORCID iD: 0000-0003-4905-2373

D. Sci. (Med.), Prof.

Russian Federation, Moscow; Moscow

Matvey A. Zimin

Sechenov First Moscow State Medical University

Author for correspondence.
Email: dvparakhina@gmail.com
ORCID iD: 0009-0002-6793-4134

Medical Resident

Russian Federation, Moscow

Goar B. Movsisyan

National Medical Research Center for Children’s Health

Email: dvparakhina@gmail.com
ORCID iD: 0000-0003-2881-4703

Cand. Sci. (Med.)

Russian Federation, Moscow

Alexey I. Firumyants

National Medical Research Center for Children’s Health

Email: dvparakhina@gmail.com
ORCID iD: 0000-0002-5282-6504

Radiologist

Russian Federation, Moscow

Anatoly V. Anikin

National Medical Research Center for Children’s Health

Email: dvparakhina@gmail.com
ORCID iD: 0000-0003-0362-6511

Cand. Sci. (Med.)

Russian Federation, Moscow

References

  1. Ringl H. Personalized Reference Intervals Will Soon Become Standard in Radiology Reports. Radiology. 2021;301(2):348-4. doi: 10.1148/radiol.2021211221
  2. Mack CL, Adams D, Assis DN, et al. Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases. Hepatology. 2020;72(2):671-722. doi: 10.1002/hep.31065
  3. Terziroli Beretta-Piccoli B, Mieli-Vergani G, Vergani D. Chapter 44 – Autoimmune hepatitis. In: Gershwin ME, Tsokos GC, Diamond B. The Rose and Mackay Textbook of Autoimmune Diseases (Seventh Edition). Academic Press, 2024. doi: 10.1016/B978-0-443-23947-2.00074-6
  4. Aljumah AA, Al-Ashgar H, Fallatah H, Albenmousa A. Acute onset autoimmune hepatitis: Clinical presentation and treatment outcomes. Ann Hepatol. 2019;18(3):439-44. doi: 10.1016/j.aohep.2018.09.001
  5. Zhao CJ, Ren C, Yuan Z, et al. Spleen volume is associated with overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with portal hypertension. World J Gastrointest Surg. 2024;16(7):2054-104. doi: 10.4240/wjgs.v16.i7.2054
  6. Vergani D, Terziroli Beretta-Piccoli B, Mieli-Vergani G. A reasoned approach to the treatment of autoimmune hepatitis. Dig Liver Dis. 2021;53(11):1381-433. doi: 10.1016/j.dld.2021.05.033
  7. Komori A. Recent updates on the management of autoimmune hepatitis. Clin Mol Hepatol. 2021;27(1):58-69. doi: 10.3350/cmh.2020.0189
  8. Gerstenmaier JF, Gibson RN. Ultrasound in chronic liver disease. Insights Imaging. 2014;5(4):441-55. doi: 10.1007/s13244-014-0336-2
  9. Schoenberger H, Chong N, Fetzer DT, et al. Dynamic Changes in Ultrasound Quality for Hepatocellular Carcinoma Screening in Patients With Cirrhosis. Clin Gastroenterol Hepatol. 2022;20(7):1561-9.e4. doi: 10.1016/j.cgh.2021.06.012
  10. Vernuccio F, Cannella R, Bartolotta TV, et al. Advances in liver US, CT, and MRI: moving toward the future. Eur Radiol Exp. 2021;5(1):52. doi: 10.1186/s41747-021-00250-0
  11. Computed Tomography | SpringerLink. Available at: https://link.springer.com/chapter/10.1007/978-3-540-74658-4_16. Accessed: 30.03.2025.
  12. AAPM Position Statements, Policies and Procedures – Details. Available at: https://www.aapm.org/org/policies/details.asp?id=318&type=PP. Accessed: 30.03.2025.
  13. Harvey HB, Brink JA, Frush DP. Informed Consent for Radiation Risk from CT Is Unjustified Based on the Current Scientific Evidence. Radiology. 2015;275(2): 321-5. doi: 10.1148/radiol.2015142859
  14. Hendee WR, O'Connor MK. Radiation risks of medical imaging: separating fact from fantasy. Radiology. 2012;264(2):312-21. doi: 10.1148/radiol.12112678
  15. Бозоров Э.Х., Эргашев А.Ж., Ёдгорова Д.М., и др. Магнитно-резонансная томография. Наука и мир. 2022;3:8-11. Режим доступа: https://scienceph.ru/f/science_and_world_no_3_103_march.pdf#page=8. Ссылка активна на 30.03.2025 [Bozorov EKh, Ergashev AZh, Yodgorova DM., et al. Magnetic resonance imaging. Science and World. 2022;3:8-11. Available at: https://scienceph.ru/f/science_and_world_no_3_103_march.pdf#page=8. Accessed: 30.03.2025 (in Russian)].
  16. Feuerriegel GC, Sutter R. Managing hardware-related metal artifacts in MRI: current and evolving techniques. Skeletal Radiol. 2024;53(9):1737-70. doi: 10.1007/s00256-024-04624-4
  17. Copeland A, Silver E, Korja R, et al. Infant and Child MRI: A Review of Scanning Procedures. Front Neurosci. 2021;15:666020. doi: 10.3389/fnins.2021.666020
  18. Callahan MJ, Cravero JP. Should I irradiate with computed tomography or sedate for magnetic resonance imaging? Pediatr Radiol. 2022;52(2):340-4. doi: 10.1007/s00247-021-04984-2
  19. Perez AA, Noe-Kim V, Lubner MG, et al. Deep Learning CT-based Quantitative Visualization Tool for Liver Volume Estimation: Defining Normal and Hepatomegaly. Radiology. 2022;302(2):336-42. doi: 10.1148/radiol.2021210531
  20. Kim DW, Ha J, Lee SS, 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
  21. Son JH, Lee SS, Lee Y, et al. Assessment of liver fibrosis severity using computed tomography-based liver and spleen volumetric indices in patients with chronic liver disease. Eur Radiol. 2020;30(6):3486-546. doi: 10.1007/s00330-020-06665-4
  22. Azuri I, Wattad A, Peri-Hanania K, et al. A Deep-Learning Approach to Spleen Volume Estimation in Patients with Gaucher Disease. J Clin Med. 2023;12(16):5361. doi: 10.3390/jcm12165361
  23. Gaucher Disease – ScienceDirect. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0973688314000115. Accessed: 10.03.2025.
  24. Xu XY, Wang WS, Zhang QM, et al. Performance of common imaging techniques vs serum biomarkers in assessing fibrosis in patients with chronic hepatitis B: A systematic review and meta-analysis. World J Clin Cases. 2019;7(15):2022-107. doi: 10.12998/wjcc.v7.i15.2022
  25. Ozturk A, Olson MC, Samir AE, Venkatesh SK. Liver fibrosis assessment: MR and US elastography. Abdom Radiol (NY). 2022;47(9):3037-100. doi: 10.1007/s00261-021-03269-4
  26. Cosgrove D, Piscaglia F, Bamber J, et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall Med. 2013;34(3):238-53. doi: 10.1055/s-0033-1335375
  27. Yin M, Venkatesh SK. Ultrasound or MR elastography of liver: which one shall I use? Abdom Radiol (NY). 2018;43(7):1546-51. doi: 10.1007/s00261-017-1340-z
  28. Archer AJ, Belfield KJ, Orr JG, et al. EASL clinical practice guidelines: non-invasive liver tests for evaluation of liver disease severity and prognosis. Frontline Gastroenterol. 2022;13(5):436-3. doi: 10.1136/flgastro-2021-102064
  29. Heymsfield SB, Fulenwider T, Nordlinger B, et al. Accurate measurement of liver, kidney, and spleen volume and mass by computerized axial tomography. Ann Intern Med. 1979;90(2):185-7. doi: 10.7326/0003-4819-90-2-185
  30. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Autoimmune hepatitis. J Hepatol. 2015;63(4):971-1004. doi: 10.1016/j.jhep.2015.06.030
  31. Громов А.И., Аллиуа Э.Л., Кульберг Н.С. Подходы к определению объема печени и факта гепатомегалии. Вестник рентгенологии и радиологии. 2020;100(6):347-54 [Gromov AI, Alliua EL, Kul'berg NS. Approaches to Determining the Liver Volume and the Fact of Hepatomegalia. Journal of Radiology and Nuclear Medicine. 2020;100(6):347-54 (in Russian)]. doi: 10.20862/0042-4676-2019-100-6-347-354
  32. de Padua V Alves V, Dillman JR, Somasundaram E, et al. Computed tomography-based measurements of normative liver and spleen volumes in children. Pediatr Radiol. 2023;53(3):378-86. doi: 10.1007/s00247-022-05551-z
  33. Prassopoulos P, Daskalogiannaki M, Raissaki M, et al. Determination of normal splenic volume on computed tomography in relation to age, gender and body habitus. Eur Radiol. 1997;7(2):246-8. doi: 10.1007/s003300050145
  34. Морозов С.В., Труфанова Ю.М., Павлова Т.В., и др. Применение эластографии для определения выраженности фиброза печени: результаты регистрационного исследования в России. Экспериментальная и клиническая гастроэнтерология. 2008;(2):40-8 [Morozov SV, Trufanova IuM, Pavlova TV, et al. Primenenie elastografii dlia opredeleniia vyrazhennosti fibroza pecheni: rezul'taty registratsionnogo issledovaniia v Rossii. Eksperimental'naia i klinicheskaia gastroenterologiia. 2008;(2):40-8 (in Russian)].
  35. Giuffrè M, Fouraki S, Comar M, et al. The Importance of Transaminases Flare in Liver Elastography: Characterization of the Probability of Liver Fibrosis Overestimation by Hepatitis C Virus-Induced Cytolysis. Microorganisms. 2020;8(3):348. doi: 10.3390/microorganisms8030348

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Dynamics of liver volume changes in children with isolated autoimmune hepatitis, %.

Download (109KB)
Indexing metadata
3. Fig. 2. Dynamics of liver volume changes in children with autoimmune hepatitis and cholangitis.

Download (111KB)
Indexing metadata
4. Fig. 3. Dynamics of liver fibrosis based on non-invasive liver elastography in children with autoimmune hepatitis, %.

Download (117KB)
Indexing metadata
5. Fig. 4. Dynamics of liver fibrosis based on non-invasive liver elastography in children with autoimmune hepatitis and cholangitis, %.

Download (113KB)
Indexing metadata

Copyright (c) 2025 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 74329 от 19.11.2018 г.