First Automated Software
Quantitative Liver Function

Small Liver Volumes: Cause and Significance

John Hoefs, M.D
Depts of Medicine, Divs of GI & Hepatology, University of California Irvine, Irvine, California
Hepatology, Liver Specialty Center, Irvine, CA, United States
AASLD, The Liver Meeting, 2019.


Small liver size is thought to indicate cirrhosis. Liver length may not be ideal for detecting a small liver and more precise techniques using liver volume are available. Hepatiq includes a precise measure of functional liver volumes (fLV) that correlates with volumes by anatomic measurements (Liver Transplantation 19: 292-304). However, fLV is more convenient and can be measured serially over time (Liver Transplantation 19: 292-304).
Small liver volumes will correlate with cirrhosis and normal individuals will be uncommon.
A 3015 Liver-spleen scan database has been collected serially since 2010. fLV has been measured on all these scans. We consider normal fLV to be 7-12 cc/lb IBW (IBW = ideal body wt). We evaluated the cause of liver disease in 31 patients with fLV = or <5 cc/lb IBW. Three with incomplete data were not included in some of the analysis which then included 28 patients.
Hepatiq automatic measurement of fLV by the indicator dilution method as previously described (Hepat;55:1019). Functional spleen volume (fSV; N < 2.5 cc/lb IBW) and perfused hepatic mass (PHM: N 100-110) were also measured.
The distribution of fLV in 3015 scans in our database is shown in figure A. 446 scans (14.8%) had an fLV below our lower limit of normal (figure A) and 31 patients had 43 scans (1.4 %) with fLV values =/< 5 cc/lb IBW (the vertical line on figure A). To the left of the line in this figure are the patients for this study. In this study, 4 patients had acute severe liver disease (2 with multiple scans are shown in figure b). The first fLV value in these patients is the lowest and then enters the normal range over time. Both patients were jaundiced and subsequently recovered. The largest group of patients are those with end-stage chronic liver
disease (CLD) complicated by HCC (9 patients) followed by cirrhosis without HCC (7), CLD with a flare (3) and CLD without cirrhosis (3). 2 patients appeared to be normal and 3 patients were incompletely categorized. Excluding the incompletely categorized patients, 23/28 had severe acute disease or cirrhosis. Surprisingly, 5/28 had pre-cirrhotic CLD or normal (with normal PHM and fSV). In those with CLD, the cause was HBV 8, HCV 6, ACAH 3, PBC 1, NASH 1, CC 3, ALD 1 and unknown 5. Overall, 9/28 (32.1 %) patients with CLD had an HCC and most patients developed a small fLV during treatment probably as a result of loss of uninvolved tissue along with HCC. 7/28 patients have died, 8 unknown and 13 are alive.
1. fLV =/<5 cc/lb IBW is associated with end-stage CLD +/- HCC and has a poor prognosis.
2. Severe acute LD can produce a very small liver followed by rapid regrowth.
3. A very small liver does not always indicate far advanced CLD..

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