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. 2013;8(1):e55626.
doi: 10.1371/journal.pone.0055626. Epub 2013 Jan 31.

Gamna-Gandy bodies of the spleen detected with susceptibility weighted imaging: maybe a new potential non-invasive marker of esophageal varices

Jiuquan Zhang  1 , Ran Tao, Zhonglan You, Yongming Dai, Yi Fan, Jinguo Cui, Qing Mao, Jian Wang
Affiliations

Gamna-Gandy bodies of the spleen detected with susceptibility weighted imaging: maybe a new potential non-invasive marker of esophageal varices

Jiuquan Zhang et al. PLoS One. 2013.

Abstract

Background/objectives: Portal hypertension (PH) is a clinical sequelae of liver cirrhosis, and bleeding from esophageal varices (EV) is a serious complication of PH with significant morbidity and mortality. The aims of this study were to assess the ability of 2D multislice breath-hold susceptibility weighted imaging (SWI) to detect Gamna-Gandy bodies (GGBs) in the spleens of patients with PH and to evaluate the potential role of GGB number as a non-invasive marker of PH and EV.

Materials and methods: T1-, T2- and T2(*)-weighted imaging and SWI were performed on 135 patients with PH and on 37 control individuals. Platelet counts were collected from all PH patients. Two radiologists analyzed all magnetic resonance imaging (MRI) data, and measured the portal vein diameter, splenic index (SI), and platelet count/spleen diameter ratio. The numbers of patients with GGBs in the spleen were determined, and the numbers of GGB were counted in the four MRI sequences in GGB-positive patients. The portal vein diameter, SI, platelet count, and platelet count/spleen diameter ratio of control individuals were compared with those of GGB-negative and GGB-positive patients on SWI images. The correlations among GGB numbers, the portal vein diameter, the SI, the platelet count, and the platelet count/spleen diameter ratio were analyzed.

Results: The GGB detection rate and the detected GGB number by using SWI were significantly greater than those by using T1-, T2-, and T2*-weighted images. The number of GGBs in the SWI images correlated positively with the portal vein diameter and SI and correlated negatively with the platelet count and platelet count/spleen diameter ratio.

Conclusion: SWI provided more accurate information of GGBs in patients with PH. The number of GGB may be a non-invasive predictor of improving the selection for endoscopic screening of PH patients at risk of EV.

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Conflict of interest statement

Competing Interests: Yongming Dai is employed by a commercial company “MR Collaboration NE Asia, Siemens Healthcare.” There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Measurements of portal vein diameter, SI, and platelet count/spleen diameter ratio.
Measurement of portal vein diameter 3–4 slices above the junction of the superior mesenteric and splenic veins on transverse T2-weighted fat-suppressed images (a). Measurement of splenic craniocaudal (b), anteroposterior (c), and transverse (d) distance on coronal and axial T2-weighted images.
Figure 2
Figure 2. SWI detected significantly more patients with GGBs than did T1-, T2-, and T2*-weighted images.
TIWI (a), T2WI (b), T2*WI (c), and SWI (d) images of a 36-year-old male patient with post-hepatitis cirrhosis. No GGBs were visible on T1WI(a) or T2WI (b); a few were visible on T2*WI (c) (arrows); and more were visible on SWI (d) (arrows).
Figure 3
Figure 3. SWI detected more GGBs than did T1-, T2-, and T2*-weighted imaging.
TIWI (a), T2WI (b), T2*WI (c), and SWI (d) images of a 45-year-old male patient with post-hepatitis cirrhosis, showing typical GGBs. Many GGBs smaller than 3 mm in diameter that were visualized on SWI and T2*WI were not visible on TIWI and T2WI. The diameters of the same GGBs were 5.7, 4.2, 8.8, and 9.2 mm on the TIWI, T2WI, T2*WI, and SWI images, respectively (arrow).
Figure 4
Figure 4. GGB numbers on T1WI, T2WI, T2*WI, and SWI images per patient.
Number of GGBs per patient detected on a single representative slice of T1WI, T2WI, T2*WI, and SWI images.
Figure 5
Figure 5. Correlation of GGB numbers with portal vein diameter, SI, platelet count/spleen diameter ratio, and platelet count.
The GGB numbers counted on SWI images were significantly correlated with the portal vein diameter (a), SI (b), platelet count (PC) (c), and platelet count/spleen diameter ratio (d).
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